From left: Shapiro 9/10 Medical Cardiology Nurse Practice Council members Brittany Crawford, Amy Taylor, Katie Skusevich, Lauren Mahoney, Andrea Brea, Aimee Cohan, Jess Andrews and Kim McGovern

When Amy Davenport, BSN, RN, and Kimberly McGovern, BSN, RN, PCCN, identified an increase in CAUTI cases on Shapiro 9W/10EW adult non-intensive care units, they worked with both their Unit-Based Practice Council (UBPC) and the CAUTI Prevention Task Force to understand the cause and address it.

The UBPC clinical nurse members, together with Debra Pelletier, MSN, RN, nursing director, Amy Bulger, MPH, RN, CPHG, nursing program director and CAUTI Prevention Task Force co-chair, and Infection Preventionist Robert Tucker, MPH, CIC, completed chart audits to determine that these CAUTI cases were due to catheter maintenance rather than insertion practices.

The team developed a CAUTI Prevention Checklist, approved by both the UBPC and the CAUTI Prevention Task Force, focused on evidence-based maintenance interventions, including:

• • placing the drainage bag below the bladder

• • ensuring the drainage bag is off the floor

• • securing catheter tubing properly with the green clip and ensuring that there are no kinks or loops in the tubing

• • performing Foley care daily and as needed and documenting it in the flowsheet every shift

• • discussing continued catheter placement and use of alternatives daily or more frequently

UBPC members also provided education on the importance of proper indwelling urinary catheter maintenance and removal using the nurse-driven protocol.

After these interventions, the Shapiro 9W/10EW CAUTI rate per 1,000 catheter device days decreased from 5.0 in Feb. 2019 to 0 in May–Dec. 2019.

Why It’s Magnet: Magnet requires an example of clinical nurses improving patient safety as part of the Exemplary Professional Practice component (EP16) of the Magnet model. This is one of many examples throughout the Brigham demonstrating how nurses work together to improve patient safety. It’s who we are.

Additional members of the UBPC and CAUTI Prevention Task Force who participated in these efforts include: Elizabeth Harmon, BSN, RN; Lauren Mahoney, BSN, RN; Jacqueline Dow, MSN, RN; Amy Taylor, BSN, RN; Andrea Brea, BSN, RN

From left: IV team members Maribeth Coolbrith, Lorna Holmes, Barbara Sosnicki and Sasha DuBois

The Intravenous Therapy (IV) team comprises nurses who specialize in the placement and management of peripheral IV (PIV) catheters and other vascular access devices, as well as vein preservation.

In 2019, the team reviewed the PIV catheter replacement policy, which stated that all steel needles and short IV catheters should remain in place no more than 4 days.

After discussing the associated unpleasant patient experience and reviewing frequent PIV routine re-sites, the team found that a high number of IVs were changed per policy instead of based on patient symptoms.

The IV nurses conducted a literature review and identified evidence-based practices, including recommendations to replace PIVs only when clinically indicated, according to the Journal of Infusion Nursing: Infusion Standards of Practice.

In checking with other hospitals, the team found that most no longer followed a time-based practice for routine PIV change.

Based on their research and expertise, the team members updated the policy (IVT _01) to reflect that PIV catheter replacement occurs when clinically indicated, including but not limited to, infiltration, erythema, phlebitis and pain.

The policy changes were approved by the Standards, Policies and Procedures Committee and the Nurse Executive Board.

Why It’s Magnet: Magnet requires one example of clinical nurses’ use of evidence-based practice to revise an existing practice within the organization as part of the New Knowledge, Innovations and Improvements (NK3b) component of the Magnet model. It’s who we are.

Nurses who participated in these efforts included: Sharon Kohler, MS, RN, CRNI; Barbara Sosnicki, BSN, RN, CRNI; Lorna Holmes, BSN, RN, CRNI; Maribeth Coolbrith, BSN, RN, VA-BC; and Sasha DuBois, MSN, RN, NEA-BC, nursing director.

What Makes Us Magnet? Share Your Thoughts!

• Visit the Magnet Kudoboard to post your thoughts, examples and messages about what makes the Brigham a Magnet organization.

• A few things to keep in mind:

• • Comments are moderated, so your comment will not appear immediately.

• • You’ll be asked for your email address and if you would like to give permission for your post (including your name) to appear on our social media channels.

• • You can share images and gifs, but please ensure that patient privacy is respected in any messages or photos that you post.

Alex Machajewski, Lisa Hulme and Katie Bradley

Many orthopaedic surgery patients receive a single-shot peripheral nerve block (sPNB) — a one-time local anesthetic injection — to reduce post-operative pain. As the anesthetic wears off, approximately 30 percent of patients experience rebound pain.

To reduce rebound pain, the Braunwald Tower 12BC unit-based practice council, led by co-chairs Katie Bradley, BSN, RN, and Lisa Hulme, MSN, RN, worked with MaryKate Hegarty, MSN, RN, former nursing director, Michael Weaver, chief of Orthopaedic Trauma, Jose Zeballos, MD, chief of the Post Operative Pain Service (POPS) and Inna Zinger, DNP, MSN, ANP-BC, of the POPS.

They developed a multi-faceted plan, which included:

• Creating a smart phrase in EPIC to capture a patient’s pain level upon admission and every six hours until an sPNB wears off.
• Assessing the sPNB more frequently and paging the POPS if a patient’s pain increases
• Conducting a literature review for evidence-based practices
• Collaborating with the Orthopaedic Service and POPS to implement bedside interprofessional rounds in the evenings
• Working with the interprofessional team to develop a customizable order set to ensure patients were premedicated prior to their sPNB wearing off
• Educating nurses on the unit about the changes, with support from Melissa Moniz, MSN, RN, professional development manager

The evidence-based changes nurses and team members made in alignment with the professional practice model helped to decrease pain for patients who received a sPNB.

Specifically, following the implementation of evening interprofessional rounds, the percentage of these patients with an average functional pain score under 4 improved to 80 percent in August 2021.

Why it’s Magnet: Magnet designation requires two examples of an improved outcome associated with an evidence-based change made by clinical nurses in alignment with the Professional Practice Model as part of the Exemplary Professional Practice component (EP1EOa) of the Magnet model. This is one of many examples of nurses practicing in alignment with the components of the PPM: collaboration, compassion, knowledge and excellence in support of relationship-based care.. It’s who we are.

Additional members of the unit-based practice council who participated in these efforts include: Lisa Gillis, MSN, RN, Paula Criscuolo, BSN, RN, Julie Archibald, MSN, RN, Allison Daley, MSN, RN, Lian Atturio, BSN, RN, and Alex Machajewski, MSN, RN, CNL, current nursing director.

At left: Marguerite Ganthier, Gilmara Alves and Marines Matos, patient care associates and observers; At right: Rosemond Polynice, patient care associate and observer, with Lauren Wilkinson, BSN, RN.

When CLABSI rates in intensive care units increased at the end of 2018, the CLABSI Prevention Task Force, co-chaired by Maria Bentain-Melanson, DNP, RN, nursing director of Shapiro 6 and 7, developed a plan to eliminate these infections, including:

• Identifying inconsistent use of the central line insertion checklist as an area for improvement and conducting a best-practice literature review.
• Developing a process to ensure a dedicated, trained observer (a patient care associate) was available for every central line insertion to ensure checklist compliance.
• Creating a checklist tool for observers to complete and for the task force to review to determine additional opportunities for improvement.

Bentain-Melanson worked with Allison Webster, DNP, RN, nursing director of the Float Pool, and Professional Development Managers Carol Daddio Pierce, MSN, RN, CCRN, and Karen Morth, MSN, RN, CCRN-CSC, to develop and implement observer training sessions in the Neil and Elise Wallace STRATUS Center for Medical Simulation.

As a result of these efforts, the CLABSI rate per 1,000 central line days in the ICUs decreased from 1.66 (October – December 2018) to 0.82 (July – September 2019); and from 1.42 (October – December 2019) to 0.93 (January – March 2020).

Why it’s Magnet: Magnet designation requires one example of an improved patient outcome associated with a nurse director’s membership in an organization-level decision-making group as part of the Transformational Leadership component (TL5EO). It’s who we are.

At left: Sara Pitman (center) with patients Delphine (left) and Celestin (right) in Rwanda during this month’s mission; at right, Kevin McWha and Susan Gabriel on a past mission.

Over the past 15 years, a group of Brigham nurses and other staff have volunteered with Team Heart, a nonprofit organization working to build a sustainable program to address the burden of cardiac disease for those with advanced rheumatic heart disease in Rwanda.

Brigham nurses who have volunteered include: Susan Gabriel, BSN, RN, CCRN, Lisa Kelley, BSN, RN, and Barbara Williams, BSN, RN, of Shapiro 6 West; Kristin Bartucca, RN, PCCN, and Cynthia Scherer, BSN, RN, of Shapiro 7; Sara Stankiewicz Pitman, BSN, RN, of the MICU; Leslie Grignaffini, BSN, RN, CCRN, CMAN, LNC, of the Patient Access Center;  Kevin McWha, BSN, RN, of the PACU; Katie Morrison, BSN, RN, of the Operating Room; Denise Mackey, MSN, RN ,of the Pain Clinic in Foxboro; Marie Caulfield, MSN, RN, of Shapiro 9/10; and others.

These nurses have traveled to Rwanda to care for patients and provide education and support to staff over the years, with Pitman participating in the 2022 mission this month.

The nurses and team members raise their own travel funds and additional funding to support patients’ post-operative care and medications.

The Brigham has supported these efforts by providing supplies for trips to Rwanda, accommodating staff schedules and recognizing the efforts of nurse volunteers in hospital communications.

Why it’s Magnet: The Structural Empowerment component of Magnet requires an example of the organization’s support of nurses who volunteer in a local or global population health outreach initiative (SE10b). It’s who we are.

Jennifer Riley

While pasteurized donor human milk (PDHM) has well-known benefits for infants in the newborn ICU setting, Jennifer Riley, MSN, RN, IBCLC, sought to understand its impact on healthy infants as an alternative to formula.

She developed a research proposal, received a $2,500 Karsh Enrichment Grant and collaborated with the Pediatric Newborn Medicine Department.

After data collection and analysis, the team found:

• No difference in breastfeeding outcomes between parents who chose PDHM and those who chose infant formula for medical supplementation.
• Differences in maternal education, body mass index and breastfeeding intent between feeding groups.
• That mothers in both groups demonstrated comparable levels of breastfeeding self-efficacy and lower breastfeeding self-efficacy scores at one month postpartum.

In April 2021, the study was published in Breastfeeding Medicine.

Other staff who participated included: Mandy Belfort, MD, MPH; Sarbattama Sen, MD; Kaitlin Drouin, MA, MS; and Sara Cherkerzian, SM, ScD

Why It’s Magnet: Magnet designation requires an example of how clinical nurses disseminated the organization’s completed nursing research study to external audiences as part of the New Knowledge, Improvements and Innovations component (NK2b) of the Magnet model. This is one of many examples demonstrating how nurses are contributing to the body of evidence surrounding patient care and nursing practice.

It’s who we are.

New infusion pumps line a hallway in the Shapiro Center in 2019

The Brigham was the first hospital within Mass General Brigham to transition to the Baxter Spectrum IQ pump in 2019 as part of a systemwide initiative to integrate the electronic health record with a large volume smart infusion pump.

This required interprofessional teams across the Brigham to replace approximately 3,800 large-volume infusion pumps on the main campus and off sites with the Baxter model.

Anne Bane, MSN, RN, BC, nursing director, Informatics and Medication Safety, co-led the conversion with Biomedical Engineering and Pharmacy leaders. The interprofessional team also included IS, Anesthesiology, Central Transport and Materials Management.

In preparation, Bane engaged clinical nurses from the divisional committees to complete the nursing validation of the pharmacy’s drug library.

During the May 2019 go-live of the Baxter pumps, nurse super users and professional development managers provided continuous support to clinical nurses using the pumps.

When programming an infusion on the pump, nurses are now directed to the Baxter drug library, a safety feature which has improved compliance. The library has enhanced patient safety with dosing guardrails, including hard and soft limits, for about 1,100 intravenous medications.

In recognition of these efforts, the Baxter Pump Implementation Team received a Partners in Excellence Award (now called the Pillar of Excellence Award) for optimizing collaboration in 2020.

Why it’s Magnet: Magnet designation requires one example of the organization’s recognition of an interprofessional group inclusive of nursing for their contributions in influencing the clinical care of patients as part of the Structural Empowerment component (SE13). This is one example demonstrating the collaboration of interprofessional teams and meaningful recognition. It’s who we are.

Kim Ladouceur, RN, nurse in charge for Braunwald Tower 11ABD, demonstrates the bedside organizer.

An out-of-reach call button or a misplaced TV remote or personal belonging may increase some patients’ risk of falling if they attempt to get out of bed on their own to access these items.

In 2019, this was top-of-mind for Maureen Tapper, MSN, RN, PCCN, a nurse in-charge (now nursing director), and Sarah Thompson, MSN, RN, CCNS, CWON, a Wound, Ostomy and Continence nurse, who was the professional development manager on Thoracic Intermediate and Surgical Care at the time.

Working with the Brigham Digital Innovation Hub, Tapper and Thompson identified a cost-effective product that attaches to the patient’s bed and secures items like cell phones, TV remotes and the call button.

They received funding from Estrellita Karsh, longtime friend and donor of the Department of Nursing, for a pilot.

Tapper and Thompson provided education about the bedside organizer and surveyed clinical nurses, PCAs and patients during the pilot.

One patient shared: “In the past, I was always dropping the phone, TV remote, and other items on the floor. They were cluttering my bedside table or under the sheets somewhere. With the organizer, everything was in reach and in one place. This made calling the nurse in the middle of the night so much easier. Thank you, Thoracic nurses, for developing the bedside organizer.”

Based on survey results, Tapper and Thompson worked with the vendor to tailor the bedside organizer, which was later approved by the New Products Approval Committee.

Because of its impact on safety, quality of care and patient experience, the organizer is now given to every Thoracic patient upon admission. Tapper and Thompson are also exploring opportunities to implement the product more broadly.

Why it’s Magnet

Magnet designation requires an example of an innovation involving nursing as part of the New Knowledge, Improvements and Innovations (NK5) component of the Magnet model. This is one of many examples throughout the Brigham demonstrating how nursing-led innovations improve the care and experience of patients and loved ones.

It’s who we are.

During Patient Care Associate (PCA), Medical Assistant (MA) and Emergency Services Assistant (ESA) Week , staff gathered in the Bornstein Family Amphitheater on June 16 for a celebration of compassionate care.

Maddy Pearson, DNP, RN, NEA-BC, senior vice president, Patient Care Services, and chief nursing officer, presented TULIP Award certificates and pins to three PCAs—Michaela Fox, Martine Lauture and Farah Marcel—in recognition of their tremendous contributions.

TULIP stands for Touching Unique Lives In Practice and celebrates PCAs, MAs and ESAs for going above and beyond to provide outstanding, compassionate care. Fox, Lauture and Marcel were nominated by colleagues for getting to know their patients, understanding what was important to them and improving their experience.

Michaela Fox
Connors Center 8 North, Surgical Oncology–Gynecology

Michaela Fox

“Michaela, who recently graduated from nursing school, floated to 12BC, an orthopedic unit. Michaela’s care and compassion shined brightest while helping me care for one of my patients who was very frustrated that she had to rely on others to perform basic activities of daily living. Michaela helped her shower, wash her hair, eat breakfast and aided in other activities. When I asked Michaela if everything was okay, she told me the reason it took longer than usual was because she wanted to afford the patient the opportunity to participate in each activity. The next time I went into the patient’s room, she was sitting up in her chair, smiling. She was able to find some of her own strength because Michaela took the time and patience to help her do that. The patient reported that it was the best day she had so far in the hospital. Sensing the patient’s anxiety and frustration with her own situation, Michaela took the extra time to give the patient what she needed to feel more confident in herself.”

Farah Marcel
Braunwald Tower 15, Surgical Intermediate Care

Farah Marcel

“I had a patient who was admitted and was clearly afraid. Farah went out of her way to make her feel safe. Farah spoke to the patient in a soft manner and took the time to make her feel more comfortable. Farah made sure the patient had food and drink choices because the patient could remember her likes or dislikes. I would welcome Farah to take care of any of my family members after witnessing her tremendously caring ways.”

Martine Lauture
Braunwald Tower 10A, Cardiovascular Interventional Care

Martine Lauture

“Martine floated to our floor to sit with a patient who was confused. . Martine was exceptional in her role as a sitter; she was attentive, compassionate and extremely patient. Martine engaged with her all day, talking about her life, family and hobbies. The patient had been barely eating in the days prior, but Martine took the time to get to know the patient and ordered her several meals throughout the day, all of which she loved and ate. Martine truly went above and beyond for this patient, holding her hand when she was upset and giving her the TLC she needed. I could not have done my job without Martine. I am so appreciative of the exceptional care she provided to this patient.”