Medicine and Health Sciences Commons^™

Sterile Tubing Changes To Prevent Clabsis In The Nicu, Rachel Janson, Megan Meyer

Nursing Posters

Purpose Statement:

NICU patients have a decreased risk of CLABSI infections when two-person sterile central line changes are implemented into central line maintenance bundles compared to bundles that only use one-person clean line change techniques.

Background:

Neonates admitted to the neonatal care intensive care unit (NICU) often require the placement of central lines for the administration of medications, fluids, parental nutrition, and hemodynamic monitoring. Despite their many advantages, central lines can lead to serious infections, known as cental line associated bloodstream infections (CLABSI). These infections are not related to an infection from another site and develop within forty-eight hours of …

Sch Icu Expanding Pics Throughout Centracare, Jessica A. Tindal

Nursing Posters

Purpose:

Sharing information about Post Intensive Care Syndrome (PICS) to all in CentraCare. PICS symptoms do not appear until weeks to months after a critical care illness so patients at home may not know what to do with their symptoms.

Future Plans:

• May 2023 - introducing CICU to the PICS process during their Nurse Practice meeting.
• May 2023 - updating the Hospital Medicine Section CNS
• Fall 2023 - meeting with the Ambulatory Work Cabinet group to see if our system of notification is working
• What opportunities do we have with teaching Progressive RNs about PICS and our Diaries?
• How can …

Accelerated Onboarding For Unlicensed Personnel When Preceptors Are Limited, Britney Winkelman

Nursing Posters

Problem:

The timeframe between hiring unlicensed personnel (UP) to beginning the role within the organization began to increase due to limited orientation resources, rising staff shortages, and insufficient number of preceptors.

Purpose:

Accelerate the onboarding of UPs to decrease the workload for preceptors and reduce staff shortages, while generating competence and reducing costs for the organization.

From Silos To Collaborative Working Relationships With Ems And Ed, Angela Moscho

Nursing Posters

Opportunity:

To establish a strong, collaborative relationship between St. Cloud Hospital Stroke Center, St. Cloud Hospital Emergency Department and Emergency Medical Services.

Background:

Two separate health care systems with one goal in mind: best stroke care for a community member experiencing stroke-like symptoms.

Current Practice in 2017:

• Code stroke activation with LTKW (last time known well) up to 6 hours.
• Inconsistent pre-notifications and pre-activations by EMS and ED.
• St. Cloud Hospital and Mayo Clinic Ambulance with siloed/individualized protocols for their respective health systems.

Clinical Nurse Specialists: A Rare Breed, Teresa Jahn, Evalyn Michira, Elizabeth Plante

Nursing Posters

What is a CNS?:

• A clinical nurse specialist (CNS) is an advanced practice registered nurse (APRN) with graduate level education in nursing.
• CNSs are prepared to provided leadership, consultation, and clinical expertise for patients and their families, nurses, and systems.
• Have the autonomy to diagnose and treat based on advanced clinical assessment like other APRNs (Nurse practitioners, certified nurse midwives, certified registered nurse anesthetists).
• CNS work in all areas of healthcare like clinics, emergency departments, hospital units, entire healthcare systems, or even as independent practitioners/contractors.

Dynamic Bronchoscopy For Excessive Dynamic Airway Collapse, Jennier Salaski, Krista Ophoven

Nursing Posters

Definition:

Excessive Dynamic Airway Collapse (EDAC) is a respiratory condition characterized by >50%luminal narrowing on expiration.

Heated High Flow Oxygen Therapy Management Of Respiratory, Swallowing/Dysphagia And Nutrition Needs, Jenelle Overgaard

Nursing Posters

Problem

• Patients diagnosed with COVID-19 pose challenges for oxygenation. Often requiring heated high flow oxygen therapy (HHFOT) for days to weeks, with literflow commonly over 40 L/min with maximum of 60 L/min.
• There is minimal research on aspiration risk at higher literflow, therefore practice included decreasing liter flow to 20 L/min for oral intake was standard.
• During oral intake, with literflow decreased to 20 L/min, patients' oxygen saturations would quickly trend down.
• Alarms indicating low saturation would create anxiety, cause patients to eat faster potentially increasing risk for aspiration.

Solution

• For adult inpatients meeting criteria, increase maximum literflow allowed during …

Icu Cauti Incidence Reduction, Michelle Gamble

Nursing Posters

Situation:

Catheter-Associated Urinary Tract Infection (CAUTI) rates in the adult Intensive Care Unit (ICU) increased from nine infections in FY21 to 18 in FY22.

Backgroud:

CAUTIs are the most reported healthcare acquired infection. It is important for healthcare providers to understand the complications and effects of CAUTIs. CAUTIs contribute to extended length of stay, increased healthcare costs, and patient morbidity and mortality.

Most CAUTIs are directly related to inadequate urinary catheter care. Evidence based practice demonstrates a decrease in CAUTIs related to the use of Theraworx^® Protect wipes twice daily (BID) and as needed (PRN) for patients with a …

Promotion Of National Certification In Telemetry, Janelle Maciej

Nursing Posters

Situation:

Goal to bring awareness to telemetry nurses, the specialty certifications they are eligible for, and criteria for eligibility. Currently, six telemetry nurses hold a nationally recognized certification.

Action Plan:

• March 19, 2023 was Certified Nurses Day and was the kickoff for the start of encouragement for telemetry nurses to be certified.
• Each telemetry nurse was delivered a card and lifesaver candy inviting them to consider a nationally recognized certification.
• A certification informational packet promoting CV-BC and PCCN certification was placed at each desk and referenced during huddle for one week.
• Certification preparation books are available upon request.

Pupillometry, Elizabeth Plante, Casey Schmidt

Nursing Posters

Background:

• Measuring pupillary light reflex is a standard part of neurological assessment.
• Changes in pupil reactivity may indicate unfavorable outcomes, such as increased intracranial pressure and brain herniation.
• Physiologic and pharmacologic agents may affect pupil reactivity.
• In some instances, pupillary light reflex is the only piece of neurologic assessment readily testable.

What I Need: Self Care At The Unit Level, Jessica A. Tindal

Nursing Posters

Purpose:

Self-care is individualized and best done when awarded on a small scale.

Goals:

For all employees of the ICU to:

• Feel valued outside of work
• Be recognized for taking care of themselves
• Participate in positive discussions
• Be rewarded for work life balance
• Be reminded of self-care
• Not feel alone with their thoughts
• Pause and reflect
• Help others, spouses, kids, etc.

Future plans include:

• Seasonal questions of things to see, places to explore
• Recipe sharing
• Hobby experts
• Focusing on staffs' interests

Recognition Of Nonconclusive Seizures In Patients After Cardiac Arrest Using, Teresa Jahn, Elizabeth Plante

Nursing Posters

Background:

Evidence - Prevalence of nonconvulsive status epilepticus or other epileptiform activity in patients who are comatose after a cardiac arrest is between 12-22%. Consistent with the literature, at this facility approximately 12% were found to have non convulsive seizures. Prolonged epileptiform discharges may cause secondary brain injury and increased mortality. In 2020, the American Heart Association recommended EEG monitoring should be promptly performed and interpreted for the diagnosis of seizures in all comatose patients following cardiac arrest.

Local Problem - Comatose patients admitted to critical care after cardiac arrest who require targeted temperature management (TTM) have continuous EEG monitoring …

Safe Intra-Hospital Transport Of Adult Patients On Non-Critical Care Units, Teresa Jahn, Janelle Maciej, Greta Titus

Nursing Posters

Plan:

Between 2021 and 2022, two non-critical adult patients returning from the imaging department after an invasive procedure developed increased oxygen needs, which ended in death for on patient and a transfer to critical care for the other.

No formal guidelines exist for the intra-hospital transport by unlicensed personnel may be absent. An intra-hospital transport checklist was developed for non-critical care patients leaving the unit for procedures in the imaging department.

Do:

• A "RN Pre-Invasive Procedure Transport Safety Checklist" was created by a telemetry RN (MSN student, Greta Titus) and CNS, Teresa Jahn
• The checklist was designed to answer questions …

Transitions To Normal Saline Only For Cvads, Megan Lehn, Ann Backes

Nursing Posters

Purpose Statement:

The purpose of this project is to implement a practice change throughout the system to remove heparin flushes for Central Venous Access Devices (CVADS) pending a successful pilot on Medical Oncology.

Synthesis of Evidence:

• Shama et al (2019) conducted a systematic review and meta-analysis including 886 participants that revealed no clear differences in CVC patency between heparin and NS.
• Klein et al (2018) conducted a pilot study on a 30-patient bone marrow transplant unit, each patient had a new CVC and were divided into two groups. Among 698 catheter-associated events overall incidence of central line issues were similar …

It's Time To Break Old Habits: Admitting Stemis To The Telemetry Unit, Teresa Jahn, Tanya Glenz

Nursing Posters

Beginning December 2020 uncomplicated ST-Elevated MI patients will be admitted directly to Telemetry following intervention instead of CICU.

June 2020: Review and develop evidence- based exclusion criteria for admission to Telemetry

June 2020: Create a process for communication between the nursing supervisor, cath lab, Telemetry Unit and CICU for patient placement

Fall 2020: Meeting with Telemetry and CICU charge nurse, nursing supervisor and cath lab RN to discuss communication process

Dec 2020: Begin tracking STEMI patients

• Unit admitted to (Telemetry or CICU/ICU)
• Requiring transfer to CICU/ICU from Telemetry

A Multidisciplinary Approach To Reduce Complications From Blind Small Bore Feeding Tube (Sbft) Insertion, Teresa Jahn, Jennifer Burris, Peggy Lange, Elizabeth Plante, Mithun Suresh Md

Nursing Posters

Between 2019 and 2021, six lung perforations related to blind placement of SBFTs.

A multidisciplinary team reviewed current methods of placing SBFTs and the feasibility of each:

• Fluoroscopy
• 2 Step X-Ray
• Capnography
• Electromagnetic visualization

Capnography was selected as a safe and cost-effective way to attempt to identify insertion location in real time.

• Four team members were selected and trained to insert SBFT using capnography
• Each placement attempt and outcome of placement was tracked
• Outcomes were identified as successful or unsuccessful
• Any adverse events were to be tracked

Open All Hours!: Bariatric Surgery Patients Love Csc, Naomi Schneider, Mallory Mondloch

Nursing Posters

During the fall and winter of 2020, St. Cloud Hospital saw a dramatic increase in the number of COVID-19 patients. Additionally, elective surgeries in Minnesota were on hold during the early months of the pandemic, and later in 2020 there was a significant backlog of these patients, waiting for their procedure. To serve patients and their families, St. Cloud Hospital teams planned for a way to safely and professionally offer surgical care needs to Central Minnesota.

Early Detection Of Sepsis, Holly Kockler, Evalyn Michira

Nursing Posters

The aim for this project was to improve early identification and intervention for sepsis to lower mortality rates and increase sepsis order set usage.

Key Drivers:

• Sepsis mortality rate is higher than compare groups
• Sepsis Order Set utilization is low
• Sepsis core measure performance is below benchmark

Centracare Launch Of Covid Antiviral Therapy, Jessica Miller, Todd Lemke Pharmd, Dennis Heinen Rph

Nursing Posters

• Efficiently monitor the limited available stock of oral antiviral COVID therapies during surge states
• Prescribe safely and appropriately
• Dispense to patients close to home.

Icu Liberation: Early Mobility And Exercise, Leann Volkers, Holly Kockler, Kristi Patterson

Nursing Posters

The aim of this project was to streamline and standardize the delivery of the follow up Important Message from Medicare (IMM) for IP admissions across CC and Carris-RWF in compliance with regulatory standards of care.

Key drivers identified:

• Site specific variation
• Underutilization of Epic functionality
• Use of data to understand performance

Promoting Patient Outcomes: Clabsi Prevention, Woon Paek

Nursing Posters

What is a CLABSI?

“A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line” (CDC, 2021)

Best practices for preventing CLABSIs:

• Perform hand hygiene
• Don proper PPE
• Sterile/aseptic technique during insertion
• Prioritize for cares related to central line first
• Daily assessment for need of central line
• Daily chlorhexidine gluconate bathing
• Remove catheters that are unnecessary
• "Scrub the hub" BEFORE EVERY access
• Change dressings every 7 days or as needed
• Assessment of site/dressing condition
• Change purple Ultrasite caps with dressings
• Tubing changes per CentraCare policy
• Discard …

Innovative Use Of Ehr To Support Admission Screening For Emerging Pathogens, Patricia Dumonceaux Msn, Rn, Cic, Phn, Carolyn Harlander-Zimny, Elizabeth Kiffmeyer, Ellen Simonson, Tamara Welle

Nursing Posters

• CentraCare hospitals were the first in Minnesota to identify a patient with Candida auris (C. auris), an emerging pathogen.
• 2018 Centers for Disease Control and Prevention (CDC) and state health department recommended adoption of enhanced admission screening process to allow for early identification of patients at risk of being colonized with C. auris/Carbapenem-Resistant Organisms (CROs).
• C. auris, a fungus, and CROs, comprised of organisms from the Enterobacteriaceae family resistant to carbapenems, are emerging multidrug resistant pathogens. Emphasis on identification and early isolation of at-risk patients decreases risk of transmission.

Improving The Management Of Tardive Dyskinesia On An Inpatient Mental Health Unit, Jennifer Krebsbach

Nursing Posters

Implement a practice change on the adult mental health unit to improve the accuracy and increase the rate of completion of the abnormal involuntary movement scale (AIMS) for tardive dyskinesia (TD).

Perioperative Glucose Monitoring Protocol, Nicole Helgeson

Nursing Posters

Currently, there is no established glucose management protocol for our surgical patients. Poor outcomes related to hyperglycemia may include increased morbidity/mortality, surgical site infection (SSI), sepsis, renal, and cardiac concerns. The purpose of this protocol is to improve the care and outcomes for surgical patients through a consistent standardization of glucose management.

Purewick External Female Catheter, Elizabeth Kiffmeyer, Mallory Mondloch

Nursing Posters

Catheter-Associated Urinary Tract Infection (CAUTI) rates increased in FY21 compared to FY20, and many units continue to not meet their National Database of Nursing Quality Indicators (NDNQI) target goal even through FY22.

A group of CentraCare stakeholders gathered, including bedside nursing staff, urology techs and nursing leadership, to discuss barriers and areas for opportunity. Representatives from BARD®, our urinary catheter supply company, were invited to conduct an analysis on our urinary catheter/ CAUTI reduction practices. Findings from the analysis included an opportunity to implement an external female catheter.

Icu Liberation: Early Mobility And Exercise, Vanessa Fuller, Andrea Nyquist

Nursing Posters

ICU Liberation:

The Society of Critical Care Medicine’s (SCCM) Intensive Care Unit (ICU) Liberation Bundle was created to reduce the harmful effects of events that occur in the ICU setting. Early mobility and exercise is part “E” of the ICU Liberation Bundle; goals are to reduce ICU and hospital length of stay (LOS), prevent readmissions, reduce discharges to long term care facilities, reduce delirium and coma days, and reduce likelihood of hospital mortality (SCCM, 2021)

Preoperative Weight Loss For Patients Undergoing Lumbar Spine Surgery Utilizing Motivational Interviewing To Decrease Postoperative Complications: A Quality Improvement Project, Amanda Welle

Nursing Posters

Do patients who are obese, based on BMI>30 and are offered lumbar spine surgery, who undergo preoperative MI via telehealth to lose weight, compared to those who don’t undergo MI have decreased postoperative complications at 30 days postoperatively?

Conclusions/Implications:

• Results from this QI project suggest a higher BMI class is associated with postoperative complications-wound infection.
• However, given the small sample size no conclusions could be drawn
• This QI project should be replicated on a larger scale
• The process for recruitment and intervention is established. The Neurosurgical providers are supportive of the continued study.

Very Important Discharge Appointment (Vida), Jennifer Burris, Holly Kockler, Gail Olson, Kristi Patterson, Natasha Pflueger, Jennifer Salzer, Leann Volkers

Nursing Posters

To improve patient flow, access, and decrease strain on resources by enhancing the current process of Discharge and Loop Back Huddle by identifying two patients for early discharge the next day.

Current Practices:

• Discharge huddle and Loopback (Discuss care progression for all pts)
• Discharge planning using the IDEAL Model (Patient and Family Engagement with Discharge)
• Electronic Discharge Readiness Tools (Exp Discharge Date, Discharge milestones, etc.)

Next piece of the puzzle:

• VIDA: a framework to identify 2 patients to be discharged before 11 am – so the bulk of our discharges do not occur between Noon and 4:00 pm.
• Decreasing the …

Neurointerventional Post-Procedure Assessment And Documentation Compliance, Chandra Brower

Nursing Posters

Per stroke best practice guidelines, pulse and groin checks need to be completed post-neurointerventional procedure per orders. Our plan is to improve assessment and documentation of post-procedure pulse and groin checks by improving the flow of the Electronic Medical Record (EMR). By enhancing clinical documentation and improving the documentation process, nursing practice can be supported, and best patient care delivered.

Implementation And Standardization Of Evidence Based Practice For Reprocessing Of Flexible Endoscopes, Patricia Dumonceaux, Jenna Rooda, Dena Walz

Nursing Posters

To improve patient safety and quality of care by implementing a standardized process for high level disinfection (HLD) of flexible endoscopes