Medicine and Health Sciences Commons^™

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.