Medicine and Health Sciences Commons^™

Nurse Mentorship And Retention, Alicia St Michel

Nurse Residency

Background: Every year hospitals experience staff turnover. Implementation of a mentorship program apart from someone who is a preceptor, could help with staff retention and staff satisfaction.

The Therapeutic Use Of Intraoperative Music To Reduce Postoperative Pain In Patients Receiving General Anesthesia, Caroline Ford

Nurse Residency

Background: The recovery from surgery can be very painful for some patients and require opioid management and longer hospital stays for unmanaged pain. Music has been a non-analgesic way of helping patients with chronic pain and recent studies have shown that music intraoperatively can greatly improve the patients' pain after surgery requiring general anesthesia.

Environmentally Friendly Disposal Of Pharmaceuticals In The Hospital Setting, Kate Sobanik

Nurse Residency

Background: The Environmental Protection Agency and Department of Drug Enforcement have regulations on the safe handling of narcotics as well as guidelines for environmental sustainability with the disposal of all pharmaceuticals. Federal, state and local regulations can vary but hospitals are required to dispose of pharmaceuticals in specific ways to prevent injury to the environment and living organisms.

The Challenge: No Harm Index Relay Race, Hannah Taylor, Kate Campbell

Nursing

The Challenge: No Harm Index Relay Race is an evidence-based learning program developed to provide a group of learners the opportunity to solve a series of skill-related puzzles and complete tasks related to the National Database of Nursing Quality Indicators

Sustaining Care Team Engagement Using A Hierarchy Of Needs Framework, Katherine Skroski, Sam Canonico, Hailey Frager, Mary Beeaker, Natalia Johnson, Rebecca A. Brookes

Operational Transformation

Cardiology Intensive Care & Cardiovascular Interventional (CICU & R9 West) teams provide superb care to critically ill cardiac patients at Maine Medical Center. Covid Pandemic revealed the importance of physical and mental health wellbeing, as well as care team engagement in order to continue to provide outstanding care to patients. CICU/R9 West Leadership looked for ways to improve team engagement and ensure that care team members’ needs are met and sustained.

Robotic Vs. Laparoscopic Bariatric Surgery, Chloe Aiken, Abigail Reera

Nurse Residency

Background: As OR nurses, we have seen an increase in the number of robot-assisted bariatric surgeries instead of being performed laparoscopically. In the United States, the first surgical robotic telepresence system became available in 1987. From there, IntuitiveSurgical, Inc. reworked that system to create numerous prototypes leading to the DaVinci series that we utilize at SMHC.

Implementation Of Frequent Skin Assessments, Tiffany Gagnon

Nurse Residency

Background:

The current skin assessment policy at the Behavioral Health Unit at Southern Maine Health Care requires more frequent skin checks for patients who are immobile in a mental health department.

The Agency for Healthcare Research and Quality (AHRQ) reports “hospital-acquired pressure injury rates continue to rise across the United States” (Pittman et al., 2022).

Initiating Chlorhexidine Wipes For Infection Prevention In The Icu, Samantha Carey

Nurse Residency

Background

• Central line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable (Reynolds, 2021).

• Chlorhexidine gluconate (CHG) is an antiseptic that can be used for skin cleaning and has been shown to be effective against a wide range of organisms, including some antimicrobial-resistant organisms.

• The primary objective of this study was to assess the incidents of CLABSI’s when CHG wipes were implemented compared to traditional bathing soap and water for patients with a central line in …

Smoking Cessation Post-Discharge For Medical Surgical Patients, Jessica Francis, Julie Lavery

Nurse Residency

Introduction: Does the combination of behavioral counseling coupled with medication (vs medication alone) result in greater smoking cessation for our patients after discharge?

How Important Are Regular Breaks For Bedside Nursing Staff?, Gabriel Wohl

Nurse Residency

Background: A career in nursing can be a challenging one and a rewarding one. Nurses work directly with patients in need, in a way that their efforts have an immediate and tangible impact. Due to the nature of the work itself, nursing is also a physically, mentally, and emotionally demanding career that often leads to exhaustion, burnout, and in many cases, a departure from the profession altogether. It is well known that nurses work long hours and often receive little to no breaks. Is this lack of proper breaks a chief accessory to the overall dissatisfaction and burnout that nurses …

The Registered Nurse, Fall Prevention, And Mobilization Alarms, Anna Williams

Nurse Residency

Background:

Current Maine Health policy requires response to a mobilization alarm within 5 minutes by a RN, CNA or other clinician. Fall risk assessments are required upon arrival and admission, at the beginning of each shift, transfer between units, changes in patient condition and after a fall.

Current practice involves the TIPS tool.

Reducing Postpartum Hemorrhage Rates At Maine Medical Center, Meaghan Smith, Colette Dumais, Tracey E. Mcmillan, Carrie Comeau, Mandy Wallace, Jenelle Boulanger, Jodi-Lynne Vaughn, Kelly Ouellette, Natalia Johnson, Suneela Nayak, Rebecca Brookes

Operational Transformation

In the United States, approximately 700 women die each year from pregnancy related deaths and the most frequent cause of preventable maternal mortality is obstetric hemorrhage. The postpartum hemorrhage (PPH) rate at Maine Medical Center (MMC) is three times the national average. At our facility we care for the most complex patients in the State and we must decrease our rate to accurately reflect our expertise, knowledge and skills.

Is Sepsis Hiding In Plain Sight? Implementation Of An Interprofessional (Ip) Sepsis Simulation To Detect Early Sepsis, Sarah Chang, Amanda Bennett, Anne Dean, Meaghan Anderson, Micheline Chipman

Costas T. Lambrew Research Retreat 2023

Early detection of hospital-acquired sepsis can be challenging. With highly effective IP teams and efficient healthcare systems, sepsis treated quickly can influence morbidity and mortality. This project is aimed at training IP teams in early recognition of sepsis using simulation. Nurses and providers rarely have opportunities to learn together. Simulation followed by an IP debrief is an excellent tool to collaborate for safe patient care.

Code Blue: Back To Basics, Melissa N. Allen Msn, Rn, Hannah Taylor Msn, Rnc-Mnn, Jennifer Smith Bsn, Rn

Southern Maine Health Care

Introduction: High-quality cardiopulmonary resuscitation (CPR) improves a patient’s chance of survival. High-quality CPR started immediately after cardiac arrest combined with early defibrillation can double or triple the chances of survival.

In 2021 Joint Commission (JC) provided new and revised in-hospital resuscitation standards due to suboptimal patient outcomes related to poor resuscitation performance.

Team Engagement & Obstetrics Transformation Committee, Colette Dumais, Faye Weir, Lynn Willey, Kristen Heanssler, Brittany Babb, Suneela Nayak, Natalia Johnson, Rebecca Brookes, Obstetrics Transformation Committee,Maine Medical Center

Operational Transformation

Gallup defines employee engagement as the involvement and enthusiasm of employees in their work and workplace. Employee engagement helps to measure and manage employees' perspectives on the crucial elements of workplace culture. Based on over 50 years of employee engagement research, engagement employees produce better outcomes (better patient care) than other employees. Based on the unit survey, team members, with the support of local leaders, formed the Transformation Committee. This Committee was developed as a shared governance, team led model to address process improvement needs and create a culture of active engagement in problem solving.

A Qualitative Analysis Of Postgraduate Training Programs For Family Nurse Practitioners, John R. Massey

Journal of Maine Medical Center

Introduction: Family nurse practitioners (FNPs) are registered nurses who are trained at the master’s level and manage the care of patients in the primary care setting. FNP postgraduate training programs further prepare them and ease their transition from education to practice. Although these programs are emerging and relatively new, they are becoming more common as graduates and employers seek further preparation to practice in the primary care setting.

Methods: Interview questions were developed using guidelines from the Consolidated Framework for Implementation Research. Participants were selected using convenience sampling. Fourteen semi-structured interviews with key informants were conducted between July 2021 and …

Spiritual/Religious Orientation And Moral Distress In Pulmonary Care Nurses: An Exploration Of Ethical Norms, Moral Agency And Moral Resilience, Kristiina Hyrkas, Myrna Koonce

Costas T. Lambrew Research Retreat 2021

Introduction

• Nurses who provide care which they perceive as increasing suffering often experience moral distress (MD).

• Response to MD is a key factor in nurse wellbeing and retention, and is widely studied in nurses.

• Less research exists on foundations of moral belief and practice among nurses.

Resilience Of Regional Hospital Nursing Staff Working During The Covid-19 Pandemic Measured By The Connor-Davidson Resilience Scale, Jill Petzel Baer

Costas T. Lambrew Research Retreat 2021

Low resilience is widespread in nursing staff during the COVID-19 pandemic

Perceptions Of Self-Efficacy And Experiences Of Mindfulness On Pain And Anxiety In Patients Undergoing A Colorectal Surgery: A Prospective Mixed Methods Study, Rebecca Brown, Julie Fitzgibbons, Rachel Farrington

Costas T. Lambrew Research Retreat 2021

Introduction

• Pain and anxiety have a physiological response on the body.

• Increased heart rate, respiratory rate and blood pressure can lead to complications, and thus longer hospitalization along with decreased patient satisfaction.

Resilience Of Regional Hospital Nursing Staff Working During The Covid-19 Pandemic Measured By The Connor-Davidson Resilience Scale., Jill Petzel

Maine Medical Center

As the COVID-19 pandemic stretches on, the importance of resilience is increasing as it protects against PTSD while aiding an individual in selecting healthy coping strategies. In a study of 657 healthcare workers in New York City in April 2020, more than half of healthcare workers screened positive for acute stress (PTSD symptoms), almost half screened positive for depression, and one third screened positive for anxiety; many also reported symptoms of insomnia (Schecter et al., 2020).

Resilience is important in nursing because it ensures a viable, healthy workforce for the future. Resilience has been described as the ability to ‘bounce …

Preventing Falls-Interventions In Geriatric Psychiatry Patients: An Overview Of Current Literature, Samantha Beckwith

Maine Medical Center

PREVENTING FALLS-INTERVENTIONS IN GERIATRIC PSYCHIATRY PATIENTS: AN OVERVIEW OF CURRENT LITERATURE

Samantha Beckwith, BSN, RN, PMH-BC, P6

Background: The Inpatient Psychiatry unit at Maine Medical Center (P6) is a 21-bed unit specializing in geriatric and medical psychiatry. The majority of patients have a primary diagnosis of Dementia with Behavioral Disturbance. The unit features 12 double occupancy rooms and one single occupancy room, as well as a large activity room. Patients participate in a therapeutic milieu in which they are encouraged to interact with other patients in common areas and ambulate around the unit. The average number of patients is 19.6 …

Evaluation Of Pharmacist- Or Nurse-Driven Long-Acting Insulin Titration Protocol In Adult Primary Care Patients With Type 2 Diabetes, Ruth Manzi, Corinn Martineau, Carmine Laporta, Mary Muca, Samantha Marrier, Donald Medd, Jennifer Aronson

Journal of Maine Medical Center

INTRODUCTION

Studies have supported protocolized insulin titration to optimize insulin therapy. We implemented a long acting insulin titration (LAIT) protocol in a primary care setting to aid patients achieve optimal control of their diabetes. The purpose of the study was to evaluate the performance of the LAIT protocol.

METHODS

This retrospective analysis included patients ≥18 years with type 2 diabetes (T2D) and a hemoglobin A1c (A1C) >8% who were managed as outpatients at clinics within our health care system. We collected demographic and clinical data before and after a patient’s enrollment in the LAIT protocol. Our primary outcome measure was …

The Center For Nursing Research And Quality Outcomes, Jennifer Laflamme, Kristiina Hyrkas

Annual Reports

10 Year Anniversary Book of Research, Magnet Conference and Quality Improvement Project Abstracts, 2010-2020: Cover and Table of Contents. Index published separately.

The Center For Nursing Research And Quality Outcomes, Jennifer Laflamme, Kristiina Hyrkas

Annual Reports

10 Year Anniversary Book of Research, Magnet Conference and Quality Improvement Project Abstracts, 2010-2020: Index. Cover and Table of Contents published separately.

Improving Patient Experience And Education By Leveraging Technology, Cathy Palleschi, Wendy Osgood, Mark Parker, Cecilia Inman, Alicia Russell, Eileen Shanahan, Erin Pappal

Operational Transformation

It is estimated that 65% of the population are visual learners. With that in mind, a team of cardiac nurses in a large academic tertiary hospital developed a quality improvement project to hopefully improve patient engagement as well the patients’ perception that the nurses explained things in a manner that they could understand.

Baseline patient survey scores for the question, “Nurses Explained Things In A Way That I Understand”, were under the 75^thpercentile for a period of 9 months. A root cause analysis was conducted and it demonstrated numerous reasons for this score.

Several countermeasures were instituted to …

Development Of Mechanical Ventilator Educational Brochure For Patients/Families, Cathy Palleschi, Wendy Osgood, Mark Parker

Operational Transformation

Patients on mechanical ventilation often have no memory of events while being ventilated. In addition, families during this time, are often overwhelmed and unable to retain information provided to them by caregivers.

In attempt to address these issues, a team of care providers in an tertiary academic hospital established a goal to create a mechanical educational brochure with the goal to reduce associated anxiety and improve overall understanding of information provided.

As part of a clinical transformation project, a root cause analysis was conducted and a number of countermeasures were initiated. Some of these included a survey to capture feedback …

Improving Patient Flow By Increasing Early Discharges On A Mother & Baby Unit, Faye Weir, Joy Moody, Kathleen Cyr, Cathy Palleschi, Stephen Tyzik, Joseph East, Heidi Morin, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

Discharging patients early in the day has many advantages amongst which is increased bed availability. However, the experience in a large academic tertiary medical center demonstrated that most discharges occurred early to mid afternoon. A care team on a mother /baby unit established a quality improvement project to increase the number of discharges by 11AM and streamline key discharge planning activities.

A root cause analysis identified multiple barriers to attaining he established goals. To address these barriers, a multi prong approach was instituted to include a discharge education KPI for all unit staff.

Data collection post countermeasure implementation demonstrated some …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Improving The Workflow And Partnership Between Registration And Clinical Staff In An Outpatient Urgent Care Center, Melissa Fairfield, Bailey Eells, Faye Collins, Joyce Cornish, Stephen Tyzik, Joy Moody, Wendy Osgood, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

An outpatient urgent care unit was experiencing challenges in balancing the need to register patients and delivering care in the timeliest manner as possible. Upon examination, it was found that delays were being experienced in patient triage and discharge that resulted in low patient satisfaction scores.

A team of providers was established to review all process steps and a quality improvement project was created to attain a goal of 100% of the time discharge would not be delayed due to incomplete registration.

Baseline metrics demonstrated current numbers of delayed discharges, median time from door to triage as well as door …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …