WIXLIB

Nurse ChampionsNurse Champion Program:Nursing Excellence in ActionAt MedStar Southern MarylandHospital Center, there are more than60 nurses who regularly receive extra,specialized training, help train othernurses in their respective units, andlead the charge in adapting to newhospital policies and procedures.These nurses are known as nursechampions, and belong to one of fivechampions programs, including: Contemporary PrimaryNurse Champions Fall Nurse Champions Geriatric Resource NurseChampions - Nurses ImprovingHealthcare for Health SystemElders (NICHE) Program Pain Nurse Champions Skin and WoundNurse ChampionsEach program is led by a combinationof nursing professional development(NPD) specialists, nursing practiceinnovation (NPI) specialists, andnursing directors. The nursinginformatics (NI) team supports theprograms by providing MedConnectsupport with reports about useof interdisciplinary plans of care(IPOC) and improvements in nursingdocumentation and decision supportidentified by the nurse champions.These five programs have beengradually phased in, but therehas been an increased focus tostrengthen all five of them in the pastyear. Currently, nurse championsPictured left to right: Lolita Perkins, CNA, and Tara McLane, BSN, RN, Assistant NursingDirector 3 Westare present on every nursing unit,including the post-anesthesiacare unit (PACU) and emergencydepartment.Perhaps the largest benefit we’vereceived from these nurse championsis that they are providing peer topeer education and clinical expertiseto their colleagues. Nurse championsare motivated for positive outcomesfor patients and are engaged inmonthly educational activitiesoutside of their typical duties.The Contemporary Primary NurseChampion program denotes a modelof care that identifies one primarynurse for each patient and supportsrelationship-based care through oneon-one interactions between nursesand patients. NICHE is a nationalnursing education and consultationprogram designed to improvegeriatric care. The three remainingchampion programs are focusedon preventing and managing falls,wounds, and pain.Champion programs areinterdisciplinary in their approach;champions collaborate withphysicians, physical therapists,pharmacists, social workers, andothers across MedStar SouthernMaryland. Certified nursing assistantsare also engaged in educationaland improvement activities in thefalls, skin/wound, and geriatric nursechampion programs.MedStar Southern Maryland Hospital Center 7

Pictured left to right: Lactation team members, Marian Stokel, RN, and Cathy Gibson, BSN, RN, lactation services coordinator,Sparkle Lopez, MHEP, BSN, RN and Interim Director, Women & Newborns Center, Brenda Freborg, MSN, RN8 FY2019-2020 Annual Nursing Report

Women & NewbornFinal Phase of Baby-Friendly DesignationBaby Friendly Designation assuresour patients and families that we arealigned with best practices related tobreastfeeding. Giving birth at a babyfriendly hospital has the benefit ofenhanced breastfeeding support byknowledgeable staff. The Women &Newborns Center has entered the 4thand final phase of our 4-year journeyto achieve Baby-Friendly Designationat MedStar Southern MarylandHospital Center. We have completedthe first three phases.beginning of September 2020. Weare anticipating a call to confirmspecific dates.The overall goal is to keep mother andbaby together as much as possible,so the postpartum team is currentlyworking on several initiatives to keepmother and baby together evenwhen the baby may need increasedcare such as photo-therapy, vital signmonitoring and antibiotic therapy.This aligns with best practice andincreased patient satisfaction.DiscoveryThe discovery phase consisted ofa formal assessment of the currentpractices and development of ourBaby-Friendly Task Force. A qualityimprovement plan was developed.DevelopmentDuring this phase we developedand aligned our policies, prenatal/postpartum teaching plans, stafftraining plan and data collectionplan. All of this was submitted andapproved by Baby-Friendly.DisseminationThe next step was to ensure that all staffhas completed the training as well ascompletion and posting of all pertinentpolicies. Verification of policies,education and three months of datacollection was sent to Baby-Friendly forapproval. We were required to reach80% to pass this phase.DesignationThe quality improvement plan isfully implemented at this point.We have completed our readinessinterview and our onsite assessmentis tentatively scheduled for thePictured left to right: Breastfeeding support group member andSparkle Lopez, MHEP, BSN, RNMedStar Southern Maryland Hospital Center 9

Bringing NewEfficiency Standards toCath Lab OperationsThe cardiac cath lab at MedStar Southern Maryland Hospital Centerreceived high praise from Cleveland Clinic for two projects aimed atimproving cath lab efficiency. Physician champion and Chairman ofCardiology, William Suddath, MD, along with Director of CardiologyServices, Ora Reaves, MBA, BSN, RN, led their team to improvementsin cath lab room turnover times and first-case on time starts. Theseprojects are well-suited to clinical and continuous improvement aseach has defined time points. With defined time points, it becomeseasy to recognize outliers, or identify what factors impede on-timecase starts and room turnover times. Once the factors were known,Dr. Suddath and Ora were able to implement an improvement plan.Working as a team, the cath lab has decreased the room turnover timeby more than 50%, and tripled the number of on-time case starts.Pictured left to right: Eshetu Eshete,Director, Cardiology Services, Ora Reaves,MBA, BSN, RN, Valerie Morgan, PamelaHarris, Patricia Baker, MS, RN, TawannaDevine-Scott, Norman Scott, and IyobosaBazuaye.With this demonstrated success, the cath lab team is undertakingmore quality improvement projects in the future which will consistof decreasing hospital transport time from rural areas using stateof Maryland air transport for suspected ST elevation myocardialinfarction patients.(Cleveland Clinic’s Heart & Vascular Institute, Consult QD, Jan. 30,2020).Pictured: Cath lab used for diagnostictesting and cardiac intervention.OurNurses.OurHeroes.Pictured from the critical care unit, back row, left to right: Anita Jones, RN, Ana Velasquez, RN,Gloria Johnston, BSN, RN, Suselem Lopez, RN, Chelsea Guillory, RN. Front row, left to right:,Mary Rackey, BSN, RN and Shannon Nighman, RN.10 FY2019-2020 Annual Nursing Report

“There are severaldevices on eachunit so that nursingleaders, nurses,and nursing techscan use them.”Cody Legler,Vice President andChief Nursing OfficerPictured: Erin Wright, BSN, RN, using the Zebra TC51 devicePictured on the criticalcare unit, left to right:Genese Lamare, MD,Mary Rackey, BSN, RN,Renee Sicheri, MSN, RN,Nichole Franklin, RN, andIrene Wosu-Asuru, BSN, RNUpgrade to TC51Devices ImprovesCommunicationand SafetyAs of March, 2020, TC51 devices (short for TC51HC touch computers, also known as “zebras”) arenow present on each nursing unit, along with a fewother locations around the hospital such as thecardiology department. They currently function asa three-in-one device for nurses to make calls, sendsecure messages and receive alerts. Using TC51s,nurses and nursing technicians can now direct callsspecifically to another clinician, versus dialing amore generic Spectralink number. “There are severaldevices on each unit so that nursing leaders, nurses,and nursing techs can use them,” said Cody Legler,Vice President and Chief Nursing Officer. “Eachnurse has a unique login, so devices can be passedon to another nurse when the shift changes. Thesenew devices replace the phones our nurses used tocarry around and they give clinicians easier access toeach other.”TC51s are more portable and offer moresophisticated messaging and alerts systems thanthe previous technology. This new system optimizesthe safety component in caring for patients. Nursesare no longer solely relying on being able to seeand hear the call bell light in patient rooms, thenew devices function as an alert system whenevera patient hits their call button. The future state ofTC51 devices across all MedStar Health locationswill include added capabilities such as scanningbarcodes to ensure accuracy for medicationadministration, specimen collections, and properpatient identification. The devices will also integratewith MedStar Health’s systemwide Electronic HealthRecord (EHR) system. As time goes on, it is hopefulthat there will be even more palpable effects ofusing TC51s. “They could help improve patientsatisfaction scores and lead to better outcomes suchas preventing falls and better pain control for ourpatients,” said Legler.Pictured from the 3rd floor nursing unit, left to right:Marie Tsodzou, MSN, RN, Linda Thomas, CNA, andKimberly Brown-Gross, BSN, RN, nursing director.MedStar Southern Maryland Hospital Center 11

Pictured: Nurse extern and nursing student, Valecia Cave.12 FY2019-2020 Annual Nursing Report

Nursing Professional DevelopmentNurse Extern ProgramPreparing nursing students to enterthe workforce is a primary goal ofmany nursing programs. However,many students never have theopportunity to work in a hospitalor a clinical environment beforegraduation. Nurse extern programsprovide that valuable experienceby allowing students to work at ahospital during school. They alsoprovide several benefits to thepartnering hospital.To support nursing professionaldevelopment and training, MedStarSouthern Maryland Hospital Centerlaunched its nurse extern programin June 2020. Similar programs areavailable at all other hospitals in theMedStar Health system. During theprogram, nurse externs work a fulltime schedule at MedStar SouthernMaryland for approximately sixweeks in the summer. The studentsperform basic technical duties,including medication administrationand patient assessment, under thedirect supervision of a registerednurse. Nurse externs are encouragedto retain their employmentthroughout their academic schoolyear, and upon graduating fromnursing school, the nurse externhas the opportunity to join MedStarSouthern Maryland full time.Teamwork is especially importantfor nurse extern candidates. Havinga strong desire to engage withan interdisciplinary team, whilemaintaining a focus on education,is also vital. To be considered, nurseextern applicants must completean application and an admissionsinterview. They must meet thejob description requirements andhave already completed certaincoursework. Additionally, applicantsmay request to work in specific areasof the hospital, based on availability.The critical care unit and Women& Newborns Center tend to be themost popular areas requested bystudents.Pictured: Nurse extern and nursing student, Valecia Cave.MedStar Southern Maryland Hospital Center 13

MedicalDivision of Nursing:Medical Service Line UpdateMany renovation projects haverecently taken place at MedStarSouthern Maryland Hospital Center.The first of several included 1 Eastand 1 West moving to the 3rdfloor. This was necessary for theemergency department renovationproject. With the move to the 3rdfloor, designated observation bedswere identified. The designation ofobservation beds allows for finitefocus on treatment and dischargein a timely manner for our patients.These changes were embracedby our associates. In addition tophysical changes, the 3rd floor is theidentified chronic ventilator unit. Thenursing associates have receivedtraining and are skilled in chronicventilator management.Under the guidance of MedStarHealth’s system nursing team, severalinitiatives and programs have beendeveloped and implemented toenhance the quality of care providedto our patients.Across the Division of Nursing, theimplementation of the nurse driventelemetry protocol was developed.This protocol incorporates the safediscontinuation of the telemetry forpatients that do not meet the criteria.This protocol has made it possible forour patients that do require cardiacmonitoring to have the deviceavailable and the use expedited.14 FY2019-2020 Annual Nursing ReportPictured: Cheryl Jones, serving as a redeployed nursing runner during COVID-19.Furthermore, this has helpedexpedite the admission process forour patients.In addition to the telemetry protocol,the full capacity protocol wasdeveloped to expedite admissions fromthe emergency department. This patientcentered goal is focused on enhancingthe patient admission experience.MedStar Southern Maryland listenedto associates and included an initiativeto support the bedside clinicians. Anursing runner position was created.This position is a support associatewho completes errands and othertasks that previously took cliniciansaway from the bedside.The Division of Nursing is proudof these accomplishments and iscommitted to further enhancementsto continue to provide excellent careto our patients.

Pictured: Stacey Whiting, RN, assisting a patient with a cardiac ventilator.Pictured left and right: 1 East and 1 West moved to the 3rd floor to accommodate the new emergency department renovation project.MedStar Southern Maryland Hospital Center 15

PerioperativeTeamwork inPerioperative ServicesPerioperative services has beensuccessful in cross training all postanesthesia care unit (PACU) andendoscopy nurses to our preoperativeholding area, allowing staff resourcesto be managed effectively in allareas of care for our patients. Thecentral sterile processing (CSP)department has been integral ininternalizing the sterile processingneeds for both off site Medstar Healthambulatory centers and internalambulatory offices. This collaborationhas improved patient care acrossthe system. Currently 80% of ourCSP team is recognized for nationalcertification.Perioperative services kicked off2019 with its first SPIRIT AwardStaff Recognition Awards Program.Perioperative SPIRIT Award 2019recipient Jimmy Green, endoscopytechnician, was presented with aFCOTS 2018-2019MSMHC2018201988.3%84.9%Perioperative Services TOT 2018 - 2019MSMHC2018201934.5 minutes36.0 minutescertificate, and an engraved manteltrophy denoting his accomplishment.Several associates who receivedrecognition were honored withcertificates and engraved plaques.The awards were determined bydemonstrating the SPIRIT Valuesand exemplary work performance.Nominations were submitted bycolleagues, other departments,surgeons and anesthesia personnel.MedStar Southern Maryland HospitalCenter perioperative servicesdepartment has also consistently ledthe Medstar Health System for bothfirst-case on time starts (FCOTS) andturnover time (TOT).Pictured left: Director, Deborah Walker, MHA, BSN, RN presenting endoscopy technician, Jimmy Green with the 2019 perioperative SPIRIT Award.Pictured right, left to right: Sterile processing department associates, Gwen Carter, assistant director, Joanne Dixon, George Hampton, Lai Leung,and Godslove Dankwah.16 FY2019-2020 Annual Nursing Report

Intensive Care UnitGrowing Intensive CareTreatment OptionsContinuous renal replacementtherapy (CRRT) is used for criticallyill hemodynamically unstablepatients experiencing acute kidneyinjury. After much collaborationwith nephrology, dialysis,pharmacy, critical care, nursingprofessional development, andnursing informatics, CRRT serviceswere offered at MedStar SouthernMaryland Hospital Center beginningDecember 2019. Providing thisservice to the community enablespatients to receive the highestquality of care and remain close tohome and family, improving overallpatient satisfaction and experience.Since the inception of these services,the critical care unit has not had totransfer patients to other facilities forthis treatment. The critical care unithas now provided CRRT services toover one dozen patients, includingCOVID-19 patients. CRRT providesa slow continuous 24 hour per daytreatment for critically ill patients.CRRT filters the patient’s bloodthrough a special filter that removestoxins and excess fluid, returning theclean blood to the patient.Pictured: Marian Fet, BSN, RN, setting up the continuous renal replacement therapy (CRRT) machine.MedStar Southern Maryland Hospital Center 17

EmergencyMedStar Southern MarylandHospital Center’s Emergency DepartmentMedStar Southern Maryland HospitalCenter’s emergency department(ED) leadership team and associateshave worked diligently over the lasttwo years to elevate and improvepatient care delivery and the patientexperience. With multiple newprojects and the ever-changingenvironment that is medicine, theED staff has excelled at meeting theneeds of the community.In 2018 MedStar Southern Maryland’sED expanded its emergencypreparedness capabilities inbecoming a designated SpecialPathogens Assessment Center for thestate of Maryland. The design andbuild of specialized treatment space,coupled with the education andtraining of staff, ensure we can providecomprehensive care to any level ofspecial pathogen that may present toour hospital.The development of the providerin triage process in 2019 providesa rapid evaluation of patientspresenting to the ED before beingplaced in a care space. The triagenursing team’s expansion to match theprovider in triage availability ensuresPictured left to right: Chiledum Ahaghotu, MD, MBA, MHL, FACS, Kevin Reed, MD,Kristin Quade, MSN, RN, Susan Eckert, MSN, RN, and Stephen Evans, MD at thegroundbreaking ceremony for the new emergency department and front entrancerenovation project.that the treatment process is startedexpeditiously, improving patientoutcomes, and patient satisfaction.In August 2019, the ED expansionproject officially broke ground asthe ED split into two separate carespaces. While the EMS entranceremained the same, patients arrivingby personal vehicle now enter throughthe renovated inpatient unit for care.While the departments functionindependently, the team focuses oncollaborative care and treatment.In February 2020 the ED upgradedits capability with the use of thetelehealth platform for all patientspresenting with stroke symptomsduring hours when there is not aneurologist within the hospital.This platform allows for the virtualevaluation of all potential strokepatients by a neurologist who thencollaborates with the ED attending indetermining best treatment optionsfor the patient.Pictured left: New temporary front and emergency entrance. Pictured right: Rendering of the new front entrance and emergency renovation project.18 FY2019-2020 Annual Nursing Report

DirectoryNurse Leadership DirectoryCody D. Legler,DNP, APRN, NP-BC, RN-BC, NEA-BC, CNLVice President and Chief Nursing n Quade, MSN, RNNursing Director, Emergency en Elliott, MHA, BSN, RNSr. Nursing Director, Nursing icole Quincy-Smith, MSN, RN, NEA-BCNursing Director, 2 East/2 n Mack,DNP, MBA, APRN, RN-BC, CCNS,ACNPC, ACNP-BCSr. Nursing Director, Nursing Excellence& Resource Management301-877-5572karen.M.Mack@medstar.netOra Reaves, MBA, BSN, RNDirector of Cardiology Services301-877-4591Ora.Reaves@medstar.netElena Arellano, MSN, RNDirector of Centralized Float Pool & Agency301-877-4537Elena.Arellano@medstar.netRenee Sicheri, MSN, RNNursing Director, Critical Care301-877-4270Renee.Sicheri@medstar.netKimberly Brown-Gross, BSN, RNNursing Director, 3 East/3 borah A Walker, MHA, BSN, RNDirector, Perioperative e Johnson, MSN, RNNursing Director, 2 South301-877-4455Anne.Johnson@medstar.netMedStar Southern Maryland Hospital Center 19

MedStar Southern MarylandHospital Center7503 Surratts Road, Clinton, MD 20735301 868-8000 MedStarSouthernMaryland.org

contemporary, innovative and progressive programs and initiatives that support our highest quality and safety journey at Medstar Health and our Best Place to Work philosophy. The unexpected COVID-19 Pandemic came upon us in the beginning of calendar year 2020, and without hesitation the MedStar Southern Maryland nursing team leaped into