Visit any unit at Brigham and Women’s Hospital (BWH) and you will see nurses’ vital work in action. Not as visible, but no less important, are the many initiatives that Brigham nurses participate in and lead, which help drive innovation and improvements that result in enhanced patient care as well as expanded educational opportunities for staff. Following are three examples of initiatives that were presented by nurses at February’s Nurse-in-Charge (NIC) Council meeting.
Vascular Nursing Committee
In 2014, then-Mayor Thomas Menino and then-Governor Deval Patrick recognized Vascular Nursing as a specialty by declaring the second week in June as the first ever Vascular Nurses Week for the Commonwealth of Massachusetts and City of Boston. With the support of BWH Shapiro 8 Cardiovascular Unit Nurse Director, Alice O’Brien, MS, RN, and the Chief of the Division of Vascular and Endovascular Surgery Michael Belkin, MD, four BWH nurses and one nursing student from Shapiro 8: Karen Hanrahan, BSN, RN, Denise Marie Fay, BSN, RN, Fernanda Trevisone, BSN, RN-BC (since retired) and then-student Anabelen Contreras, BSN, RN, CVRN-BC, developed an impromptu educational event to celebrate the week.
Following the success of this event, these nurses established the first Vascular Nursing Committee to promote advancement of nursing education and practice in the treatment of vascular medicine and surgery patients at BWH. “Our number one champion has been our nurse director, Alice O’Brien, MS, RN,” added Denise. “She encouraged us to establish the vascular committee and provides time for us to work on these projects.” The committee now includes Kathleen Mullane, ADN, RN.
Four years and four proclamations later, the annual celebration of Vascular Nursing Week has evolved at BWH into a yearly educational event with multiple interactive displays. Interdisciplinary collaboration has been key, said Karen, citing the support of Drs. Michael Belkin, C. Keith Ozaki, Matthew Menard, Louis Nguyen, and Edwin Graveraux along with the assistance of all the vascular surgeons, physician assistants and cardiovascular medicine MDs. Inter-nursing collaboration has expanded with the nursing staff in the OR, Cath Lab and ICU along with regional nursing colleagues from area hospitals.
The five nurses are now working to establish New England’s first chapter of the Society for Vascular Nursing (SVN). Ana, a recently elected member to the SVN Board of Directors, is also on the planning committee for the upcoming SVN and Society of Vascular Surgery (SVS) conference in Boston. As part of the closing talks at this upcoming conference, Karen and Ana will present key takeaways from the inaugural Compassion in Action conference they attended last year as SVN representatives, in collaboration with SVS Executive Director Ken Slaw, PhD.
Karen, Ana and the other vascular committee members also plan to present an abstract that was accepted by the conference review committee. No strangers to presenting, the team has shared their work before at conferences in Orlando, FL; Las Vegas, NV; and Nashville, TN; where their research poster took first place.
The nurses hope the New England-Boston Chapter of SVN (NEBSVN) will be operational by the time the SVN and SVS hold their convention in June. They envision the chapter, which will be based out of Boston, hosting two to three educational conferences a year with day-long CU sessions, Ana said.
Karen said the benefits of their work includes increased camaraderie and excitement about their nursing practice, adding, “Because of this initiative, we are more of a cohesive group in terms of patient care and outcomes, and that benefits everyone.”
The CCU Blog
The Cardiac Intensive Care Unit (CCU) at BWH also benefits from greater staff collaboration fostered by a nurse-driven initiative. Five years ago, after attending the conference of the American Association of Critical-Care Nurses’ National Teaching Institute (NTI), Melanie “Mel” Nedder, MSN, RN, CCRN-CMC, CVRN-BC, and several other nurses from the CCU Nurse Practice Council, wanted to share the information they’d learned during the conference with their unit staff, but how?
Mel said, “Sometimes on the unit, you are so busy, you don’t even get a chance to chat let alone share information from a conference.” Mel and her coworkers approached then-Nurse Director, Karen Reilly, DNP, RN, MBA, now associate chief nurse of Cardiovascular Thoracic and Surgical Acute and Critical Care Nursing Services, and proposed they start a blog to share educational opportunities gleaned from conferences like the NTI, peer-to-peer. They used a simple, free blogging website and CCU Ed-ventures was born.
Fifteen months after starting the blog, they surveyed unit staff to find out if the blog was a useful educational tool. Eighty-six percent of the 67 percent responding to the survey felt the blog was an effective learning tool while 60 percent said their practice had changed or would change based on information they learned through the blog.
Buoyed by this success, Mel, with Karen and four colleagues: Sharon Levine, MSN, RN, CVRN-BC; Caroline Galligan, BSN, RN; Kathleen Ryan Avery, RN, MSN, CCRN; and Elizabeth Eagan-Bengston, MS, RN, wrote a paper about the blog, which was published in Critical Care Nurse in Feb. 2017.
Other BWH units have inquired how they might start their own blogs. Said Mel, “The information shared in CCU Ed-ventures provides an opportunity to look at things we do every day through a different lens, which helps drive innovation that results in improved patient care.”
Shapiro 9/10 QuadraMed
In August 2017, nurses in Medical Cardiology at BWH launched an initiative to improve the reliability of their patient acuity classifications using QuadraMed. By documenting key patient indicators in QuadraMed, patients are classified based on acuity, or their level of assessed care. This information helps drive the allocation of nursing staff. Patient acuity trends also help inform budgeting, strategic planning and how to quantify the impact of nursing care on patient outcomes. “When QuadraMed is integrated into Epic,” said Beth Harmon, BSN, RN, nurse in charge, Shapiro 10W, “the system will be generating patient acuity for us based on the documentation of key indicators, so our documentation has to be top-notch.”
With the support of Program Director of Acuity and Workload Measurement Sharon Donnelly, BSN, RN, and other unit-based Nursing Practice Council colleagues, Beth, along with Lauren Mahoney, BSN, RN, nurse in charge, Shapiro 10E, and 9E and 9/10 Nurse Educator Jackie Massaro, MSN, RN, ACNS-BC, surveyed staff to learn which key indicators were the most challenging for nurses to document. They found that nearly every indicator generated questions, so, “We developed a slideshow and rolled out 45-minute classes with pre- and post-tests,” said Beth. “We also launched a Blue Star initiative to improve compliance,” added Lauren. A blue star on the daily assignment sheet signifies which RN has responsibility for ensuring that every patient is classified within each 24-hour period.
Shapiro 9/10’s commitment to change has paid off with an improved patient type agreement rate of 83 percent. Beth and Lauren expect that rate will only increase as they complete rolling the class out to every nurse on the unit by the end of March.
Lauren said other units have expressed interest in adopting their work, including the Critical Care Unit. “We couldn’t have done this without the support of our unit based Nursing Practice Council, our Interim Nurse Director Elizabeth Eagan-Bengston, MS, RN, Nurse Educator Jackie Massaro and all the RNs who covered each other’s time while colleagues attended class,” said Beth. “It takes a village. With everyone’s efforts, we’re reaching our goal of improved reliability.”