2011 Nursing Annual Report - FINAL.pub - South Shore Hospital

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2011 Annual Nursing ReportTABLE OF CONTENTSA Message from Our Chief Nursing Officer 32011 Magnet Model 4Global Issues in Nursing & Healthcare 5Structural Empowerment 6‐7Exemplary Professional Practice 8‐31New Knowledge 32‐39Innovations 40‐43Improvements 44‐61Transformational Leadership 62‐69Empirical Outcomes 70‐74Empirical Outcomes, Innovation, New Knowledge and ImprovementsYÜÉÅ g{xÉÜç àÉ cÜtvà|vx2

A Message from Our Chief Nursing OfficerDear Colleagues,Last year, using the framework of the organization's strategic plan and the Institute of Medicine’s 2010 report onThe Future of Nursing to focus their efforts, over 1,200 registered nurses worked tirelessly to help make SouthShore Hospital the best place to work and to receive care in the region. The empirical results are impressive, withsubstantial and sustained gains in clinical outcomes. Additionally, we were challenged to reduce silos betweencare providers and we set to work cooperatively across the continuum of care to return the patient/family to thecenter of the care processes.As research continues to demonstrate that a more educationally prepared nursing workforce is associated withbetter patient outcomes, the nursing profession has been challenged to achieve higher levels of educationthrough a system that promotes seamless academic progression. Initially we established an academic practicepartnership with Simmons College to increase the proportion of our nurses prepared at the bachelor’s level. Thepartnership quickly evolved to create opportunities for students and faculty of the college to conduct research atthe hospital. As our nurses became more proficient in research, their expertise contributed to our journey towardsMagnet re‐designation. This academic partnership was expanded in 2008 to include an interdisciplinary master’sin healthcare administration with the express purpose of promoting transformational leadership excellence. Thepartnership continues to evolve and has been instrumental in building internal leadership capacity from the bedsideto the boardroom. It has also assisted with the adoption of evidence based care pathways that improve outcomessuch as fewer hospital acquired infections, falls, pressure ulcers and improved wound healing rates. In2011, a third BSN cohort began classes on‐site at SSH and an inaugural MSN cohort began classes in early 2012.In 2011, we learned how to listen to each other, our patients, and their families better, and we began our Leanjourney. Colleagues also continued to build upon the foundational aspect of a professional nursing practice environmentby attending hundreds of educational classes and acquiring new skills and certifications. 2011 was also anoteworthy year in that key and innovative new delivery models were designed and tested, which will be essentialto our organization's success under the new reimbursement models. Despite these impressive gains, much workremains to be done. However, I am energized by the fact that the same multi‐disciplinary team — advised by ourwonderful patient and family advocates that accomplished this past year's success — will be tackling these newchallenges. It is a truism that past actions are often the best predictor of future behavior. Inthat case, we are in excellent shape. Onward!With deep respect and appreciation,Timothy Quigley, RN, MBA, NEA‐BC, Vice President of Nursing/CNO, South Shore Hospital3

2011 Magnet Model4

Global Issues in Nursing & HealthcareAs the American health care delivery system has entered a new era that includes stricter utilizationguidelines, lower reimbursement rates, and a greater emphasis on quality of care, the challenges ofcaring for an increasingly older patient population, ever‐changing insurance requirements, and theeffort needed to satisfy today’s technology savvy patients, all require health care organizations tofocus on performance improvement initiatives — including investing in technology — to improvethe quality of patient care.In 2010‐2011, several colleagues participated in a fieldwork study project in order to assess the extentof interoperability in the South Shore Hospital (SSH) provider networks and to develop a replicablemetric for assessing progress over time. At issue is a more efficient, safe, and improvedhealth delivery system. SSH strives to be a community leader in making this elevated level of connectivitypossible. The ultimate goals of South Shore Hospital are to: promote higher quality, morecost‐efficient and patient focused care, promote patient safety, improve the population and communityhealth, and demonstrate cost savings through interoperability. This “Study of Utilizationand Significance of Interoperability in the Care of Heart Failure Patient” presented metrics and produceda starting point from which to work.Community interoperability between South Shore Hospital and nearby providers is essential toimprove the health of the people in the surrounding area. Improvements in safety and increasedquality of care are dependent on gaining full access to patient data from all providers of care acrossthe continuum. Access to real time information would allow providers to make real time treatmentdecisions knowing the recent and current clinical picture of the patient. For example, administeringa diuretic sooner in the care path may lead to shorter length of stay and improved outcome for theheart failure patient. Expansion of connectivity with greater access to key medical criteria is criticalto maximize the potential benefit of interoperability.South Shore Hospital has made substantial investments in electronic health record (EHR) technology,but full access to patient data can only be achieved through the electronic sharing of patientspecificinformation with providers across the continuum of care. This sharing would lead to a moreefficient, safe, and improved health delivery system which can only be accomplished through realtimedata sharing. Members of the fieldwork team concluded that the creation of a central electronicrepository to capture clinically relevant data with reporting capabilities to assist clinicians inimproving timely interventions would lead to the achievement of health metric goals.5

Structural EmpowermentShared Governance at South Shore HospitalIn 1990, South Shore Hospital was among the first hospitals in the nation to create a shared governancemodel of nursing practice. Today, the organizational strategy is to evolve and support evidenced‐basedchanges in nursing practice that result in optimal patient outcomes. Patients and families are at the centerof our care processes and their optimal health drives practice change at the bedside.Nurses provide care as part of an integrated team of medical and clinical colleagues. Effective and efficientdecision‐making requires a coordinated and organized approach to this important and complexwork. Shared Governance provides the needed structure for nurses throughout South Shore Hospital tocollaborate about professional practice issues and contribute a distinctive perspective to interdisciplinarycare.Clinical nurses from various departments across the entire organization research evidence‐based practice.They develop their professional practice through peer review, case presentation and certification,review key quality metrics, and apply technology to support process improvement initiatives. The endresult of all these efforts results in improved patient care and better patient outcomes.Why Get Involved?Shared Governance is a proven concept that leads to empowerment of nurses and ultimately to professionalautonomy. When organizations establish this type of professional practice environment, evidenceshows improved patient outcomes.Shared Governance offers the means to influence the quality of care you and others provide.Serving as a council member or council chairperson is a recognized leadership role within SouthShore Hospital and in other organizations.Actively participating in Shared Governance is an opportunity to develop career‐building skills inpractice, research, quality, education, and leadership.Rather than being one who reacts to change initiated by others, the door is open for you to becomea partner in the change process.The ability to lead and influence others is a necessary step in clinical advancement and in your ownprofessional development.6

Structural EmpowermentSouth Shore Hospital’s Shared Governance model was redesigned in 2010 to better align with the newAmerican Nurses Credentialing Center’s Magnet model, and the new goals of the councils were aligned withthe strategic nursing plan.The Research and Practice Councils were combined to create an Evidence‐Based Practice Council. TheClinical Nurse Specialist and Nurse Manager Councils were combined to create the Nursing LeadershipCouncil and the Quality Council joined with the Nurse Informatics Committee. The councils each chose anursing strategic goal to advance throughout the year.In January 2011, the Shared Governance Councils and Nursing Executive Committee held its 7 th AnnualShared Governance Summit, with over 120 nurses in attendance. In the following months, Chief NursingOfficer Timothy Quigley, RN, MBA, NEA‐BC, presented “A Look into the Future of Nursing at South ShoreHospital” to interested nurses who had not attended the Summit.7

Exemplary Professional PracticePictured above: Elona Bufi, RN, BSN, Emerson 3 (left), and Catherine Cleary, MS, RN, CDE, Diabetes NurseSpecialist and Inpatient Diabetes Educator.Our nurses exemplify professional practice every day! Whether they are teaching each other new skills orteaching their patients how to take medication after they return home .. mentoring a new colleague .. presentingan evidence‐based poster at a professional conference .. or serving on the board of their professionalorganization .. nurses at South Shore Hospital are committed to their practice and to making SSH thebest place to work and receive care. Read on for more information about our fabulous nurses!8

Exemplary Professional PracticeNurses Create a Professional Empowering Educational ResourceIn early 2011, Nursing Peer Review was developed by the Shared Governance Professional DevelopmentCouncil’s Nursing Peer Review Task Force. The process is intended to be a learning experience for the nursebeing reviewed, as well as the peer providing the review. Peer Review will be used to improve outcomes,shape nursing units, and help nurses grow as professionals. The elements of focus for Peer Review includefour areas of practice: leadership, quality, professional development and service. Peer review pilots tookplace in Case Management, the Home Care Division, PACU, Emerson 4, and the Intensive Care Units.Social Services Sponsors Lunch & Learn Highlighting Nuances of Suicide Risk AssessmentIn September 2011, more than two dozen multidisciplinary staff members participated in an educational“Lunch & Learn” presentation entitled Understanding Suicide Risk Assessment in the Hospital Setting, presentedby Tom Hickey, Psy.D., CEO and Managing Director of Pembroke Hospital. The primary message wasthat while it is impossible to predict who will successfully commit suicide, health care providers can perform athorough, evidence‐based risk assessment in order to determine which patients appear to be at a higher risk.Nurses Teach Others the Reiki ExperienceIn conjunction with the Pain Advisory Council, Level 1, 2, and 3 Reiki classes have been offered to staff for thelast several years. Reiki is a form of energy healing that promotes comfort and a feeling of overall well being.These classes have been co‐facilitated by Mary Ellen Kelleher, RN, Maternity, and Jean Beneduci, RN, EmergencyDepartment. Jean has been a Reiki Master for more than two years and is a staff nurse in the EmergencyDepartment and a member of the Complementary Medicine Team at SSH. The Complimentary MedicineTeam offers Reiki and massage to patients. This service has been used primarily by patients on Emerson3, but is available to all patients in any other area by request or referral.Birthing Unit Nurses Create a Unit‐Based Shared Governance CouncilThe Birthing Unit elected a Shared Governance unit‐based council that is linked to our divisional and hospital‐wide councils to optimize alignment and to provide continuity. This council is responsible for unit growth,standards of care, and communicating information to the entire team. One of the first tasks of this councilwas to develop and recommend staffing guidelines that adhere to hospital policy and could be adoptedthroughout the division. The recommendation was well received by the divisional director and a six monthpilot was put in place. After the pilot passed its six month target it was adopted by the division, supportingequality and an improved sense of teamwork across the division. In addition, a Nursing Obstetrics unit‐basedclinical practice committee was established to review, change, and improve practice in FY11.Obstetrics Nurses Pioneer Peer Interview ProcessThe Nursing Obstetrics department has a staff‐led multidisciplinary (RN, NA, UC) peer interview committeethat interviews prospective candidates. Last year, they hired and trained 5 outside candidates, assisted withcross training 5 staff between Birthing Unit/MSC/MIU and 6 in house transfers into MIU.9

Exemplary Professional PracticeCLINICAL LADDER AT SOUTH SHORE HOPSITALSouth Shore Hospital’s Nursing Division continues to promote its Clinical Ladder program, which recognizesexceptional nurses for the great work they do each and every day – for our patients as well as forthe advancement of their chosen profession of nursing. Evidence of being a role model for other nursesand demonstration of clinical excellence in one’s daily practice must be reflected in the portfolio thateach nurse submits for consideration into the Clinical Ladder program. The following nurses were designatedduring 2011:January 2011Dottie Megnia, RN, BSN, CNOR,ONC,Operating Room, RN3, Clinical Ladder Year 5April 2011Joyce Maloney, RN,BSN, RNC, NICU/Special Care,Nursery, RN 3, Clinical Ladder Year 3May 2011Alicia Del‐Prete, RN, BSN, ONC, Pratt 4 South,RN3, Clinical Ladder Year 2October 2011Christine Staples, RN, BSN, Home Care Division,RN3, Clinical Ladder Year 2December 2011Jennifer St. Gelais, RN, BSN, Neonatal IntensiveCare Unit, RN3, Clinical Ladder Year 1Irma Sivieri, RN, BSN, CRNI, VA‐BC, IntravenousTherapy , RN3, Clinical Ladder Year 3Pictured at left: Joyce Maloney,RN,BSN, RNC, NICU/SpecialCare, Nursery, RN 3, ClinicalLadder Year 3.Pictured at right: Alicia Del‐Prete, RN, BSN, ONC, Pratt 4South, RN3, Clinical LadderYear 2.10

Exemplary Professional PracticePictured above left: Dottie Megnia, RN, BSN,CNOR,ONC, Operating Room, RN3, ClinicalLadder Year 5.Pictured above right: Irma Sivieri, RN, BSN,CRNI, VA‐BC, Intravenous Therapy , RN3,Clinical Ladder Year 3Pictured at right: Christine Staples, RN, BSN,Home Care Division, RN3, Clinical LadderYear 211

Exemplary Professional Practice2011 Nurses Week Award RecipientsLeadership AwardStephane Campbell, RN, BS, Medical/Surgical NurseManagerLisa D. Murphy, RN, BSN, Surgical AdministrationNurse ManagerSue Tobin Mentor AwardKathleen Cronin, RN, Operating RoomJanice Ferioli, RN, CRNI, Infusion Therapy Team,Home Care DivisionPeer AwardKerri Cushing, RN, MSN, CPNP‐PC, CPNP‐AC,PediatricsKristi Holden, RN, BSN, Emergency RoomCommunity AwardMary Roth, RN, Home Care PractitionerHome Care Division’s Oncology TeamLisa D. Murphy, RN, BSN, Surgical Admin Nurse Manager,thanks all her supporters as she accepts the Nursing LeadershipAward at the 2011 Nurses Week Dinner.Pictured above: Kerri Cushing, RN, MSN, CPNP‐PC, CPNP‐AC, Pediatrics, accepts the 2011Nurses Week Peer Award from presenter SarahUrtz, RN, BSN.12

Exemplary Professional Practice2011 Nurses Week Award RecipientsPictured at left: Stephane Campbell,RN, BS, Medical/Surgical Nurse Manager,accepts the Nursing LeadershipAward at the 2011 Nurses Week Dinner.Pictured at right, theHome Care DivisionOncology Team(from left to right):Erin Foth, RN, CaseManager, PamCaron, RN, DeniseEames, RN, and DustinFitch, RN, BSN,OCN.Not pictured: DianeCiesluk, RN, BSN.13

Exemplary Professional PracticeNovember 4, 2011“I would like to share a story with you about one of South Shore’s Emergency Room nurses. I was a firstyear student at Quincy College doing my medical‐surgical rotation at South Shore Hospital when I wasfloated down to the ED and asked to shadow Kellie (Ugarte) Simpson for the day. It was fairly busy fromthe start and only got busier. Throughout the morning Kellie, in her very cheerful manner, explained howshe goes about her day. I watched her admit new patients, soothe patients who had been there for awhile, answer family members’ questions and get reports from ambulance drivers. Kellie did this with awarm, cheerful, professional manner — I was so impressed with her from the start! But as the day wenton, it got busier and busier. Kellie asked me to admit patients, do vital signs and answer any questions Icould, as she went about the more serious business of administering medications, giving updates to thedoctors and handling the critical care patients.The ED got busier and busier, but throughout the day Kellie still managed to answer all of my questions,explain the procedures and protocols that she was attending to, show me her documentation and computerresponsibilities, and show me around the department. She did all of this in a cheerful and professionalmanner. When it was time for my shift to end, I told my clinical professor, Kay Higdon, “I have tostay, there are 5 trucks waiting to unload. I can’t leave, Kellie needs me here!” She realized I meant what Isaid and allowed me to stay on. There are a few times in life when someone has such a profound effecton you that you shape your future based on what you just learned from that person. Kellie had such aneffect on me!I went home after my day with her and looked up all of the area hospital web‐sites until I found a positionas a nursing assistant in the ED that was available. I was hired immediately and I still work there. Recently,as a second year nursing student, I floated down to the Pediatric Emergency room and much to my luckand surprise Kellie had also been floated there for the day. I was so excited to have the opportunity tospend the day alongside her again! She once again shared all of her expertise and knowledge about emergencymedicine, she answered all of my questions and she did all of this in a warm and professional manner.I admire her for her excellent nursing skills and knowledge, her warm and caring patient care skillsand her wonderful demeanor on the job. Kellie is someone who I look up to and aspire to be like when Ibegin my nursing career. I am truly grateful for all that she has taught me in the two days I have spentwith her in the ED.”Sincerely,Leigh McLaughlin, Nursing Student14

Exemplary Professional PracticePictured above: Kellie (Ugarte) Simpson, RN, Emergency Department, whose skills and patient careabilities made a recognized impact on a nursing student she was precepting in 2011.15

Exemplary Professional PracticeJann Ahern, RN, BSN, Executive Director of theHome Care Division, was elected to the MassachusettsHome Care Alliance Board of Directorsfor a two year term. The Home Care Alliance is anonprofit association of more than 180 homecare providers across Massachusetts that haspromoted home care as an integral part of thehealth care delivery system for over 40 years.Their mission is to "unite people and organizationsto advance community health through careand service in the home".Donna Amado, RN, BSN, CNOR, PerioperativeNurse Educator, is chair of the AORN MassachusettsChapter I Continuing Education Committee.Paula Beaulieu RN, BSN, MM, Director of EmergencyServices, was selected to be a member ofthe Emergency Nurses Association’s nationalcommittee on Emergency Department crowding.This committee is charged with:Implementing recommendations and correspondingaction plans relative to ED crowdingMonitoring emergency department crowdingstandard setting activities of federalagencies and other standard making bodiesProviding articles for ENA Connection and/orJournal of Emergency Nursing AdvocacycolumnReviewing legislation and regulations addressingemergency department crowdingand recommend public policy positions andstrategiesRick Breen, RN, received the Patient Family CenteredCare Nurse of the Year awardAlex Brinkert, RN, Home Care Division's VNADiabetes Team, is officially a Certified DiabetesEducator and now recognized by the NationalCertification Board of Diabetes Educators.Elaine Campbell, RN, BSN, CPAN, PACU Nurse,and Lisa D. Murphy, RN, BSN, PACU NurseManager, presented a poster at the AmericanSociety of Perianesthesia Nursing organization’snational conference in April 2011 titled "UsingTechnology to Enhance Patient and Family CenteredCare."Allison Conlon, RN, MSN, ACM, SupervisorCase Management, participated in a South ShoreHospital Research study titled “Nurses Perceptionsin Achieving Early Hospital Discharges”, andpresented the findings at the Cleveland Clinic inMay 2011.Cindy DeLuca, RN, BSN, CIC, Infection ControlManager, was chosen to present a challenging TBcase to members at the National TB Nurse CoalitionAnnual Meeting , Tuesday June 14, 2011. Thetheme of this year's meeting was "Facing Challenges,Discovering Solutions."16

Exemplary Professional PracticeSusan Duty, RN, MSN, APRN‐BC, ScD, NurseResearch Scientist, presented at the University ofMaryland at Baltimore, on the topic of “ImprovingHeart Failure Outcomes Research Study Collaborative”,and at South Shore Hospital, on the “IHOExperience: Keeping Track of Time Spent Teaching.”Susan Duty, RN, MSN, APRN‐BC, ScD, NurseResearch Scientist, also attended the followingconferences: Harvard School of Public Health:Preparedness Education and Research LearningCenter Meeting, March 2011; Human SubjectsResearch Protection, sponsored by Dana Farberand the Office of Human Subjects Protection,June 2011; and the Myeloma Conference, sponsoredby Dana Farber and Multiple Myeloma ResearchFoundation, September 2011. Universityof Maryland at Baltimore, Improving Heart FailureOutcomes Research Study Collaborative, October2011; and the Sigma Theta Tau Biennial Conventionwhere she served as a voting delegate for theTheta‐at‐Large Chapter.Karen Gammon, RN, Recovery Room, presenteda Lunch & Learn educational session on sportsconcussions.Mary Ann Garrin, RN, BS, Clinical Nurse Specialist,along with three other colleagues fromWomen and Infants Hospital in Rhode Island, publishedan article entitled Therapeutic Hypothermiafor Neonatal Hypoxia‐Ischemic Encephalopathy inthe April 2011 Nurse Currents, an Abbott Laboratories,Inc. publication.Elizabeth Gillen, MPA, RN‐BC, Manager of ClinicalInformatics, presented a poster "Front LineNurses: Keys to a Successful Medication CPOE Implementation”at the 21st Annual Summer Institutein Nursing Informatics (SINI), at the Universityof Maryland School of Nursing in July 2011.Elizabeth Gillen, MPA, RN‐BC, Manager ClinicalInformatics, received her ANCC board certificationin Nursing Informatics in June. In addition,her abstract, entitled "Front Line Nurses: Keys to aSuccessful Medication CPOE Implementation", wasaccepted for poster presentation at the 21st AnnualSummer Institute in Nursing Informatics(SINI), at the University of Maryland School ofNursing in July.Catherine Gilson, RN, MHA, RNC, nurse manager,is an active participant in the Post PartumSupport Network to provide resource availabilityregarding Post Partum Depression to mothersand families on the South Shore.Kathleen Harran, RN, CAPA, from Day Surgery/780Main Street is now a Certified AmbulatoryPeri Anesthesia nurse.Sandra Krall, RN, BSN, BC, Emerson 4, graduatedfrom Fitchburg State University with a master’sdegree in Forensic Nursing.17

Exemplary Professional PracticeJohan Langley, RN, CNOR, 2 Pond Park AmbulatorySurgery, is now CNOR certified.In October, Charlene Long, RN, BSN, ACM, andpatient representative, Richard Elliot, were invitedto speak to the STAAR statewide collaborative ,about their experience working together to fostercommunication across the continuum.Kelly Mattar, RN, CMSRN, MHA, Clinical NurseSpecialist, submitted a poster to the Academy ofMedical Surgical Nurses conference in Boston titledTo Flush or Not to Flush: Measuring the Efficacyof Heparin Flush in Central Venous Access Devices.Marilyn McAlpine, RN,BSN, received the EmergencyDepartment’s Nurse of the Year award.Julie McIntyre, RN, MS, CNOR, Director of PerioperativeServices, is now CNOR certified.Susan Medici RN, MSM, Director, Case Management,was selected to present the collaborativework of the STAAR cross continuum task force atthe Annual STAAR summit in February of 2011.Theresa Mondo, RN, BSN, Recovery Room, wasawarded a certificate of recognition for civilianmerit from the New Jersey State Policemen's BenevolentAssociationin June 2011,for providing immediateresuscitationfor a choking victimat a restaurant inNew Jersey.Pictured at left:Deborah Moore,RN, BSN, MHA,and DeborahDoyle, RN, BSN,MHA, ONC,CNOR, attend aSimmons CollegeMHA presentationprogram.18

Exemplary Professional PracticeJulie Paul, CNM, DNP, Nurse Midwife, presentedat the Frontier School of Midwifery and FamilyNursing, a project titled “In an obstetrical triageunit, does the adoption of a dedicated nurse‐ midwifetriage model compared to private provider model,result in improved patient satisfaction with the triageexperience” in May 2011.Sharon Perkins, RN, MSN, CRRN, Clinical NurseSpecialist, Emerson 4 and Hemodialysis, presenteda poster at the National Association of ClinicalNurse Specialists Convention, attended by KellyFitzpatrick, RN, MS, BC, CMSRN and Kelly Mattar,RN, MHA, CMSRN.Timothy Quigley, RN, MBA, NEA‐BC, Chief NursingOfficer has been re‐elected to the Board of theMetro‐Boston EMS Council for the years 2011‐2013. This is his third term. Tim has also been selectedas a member of the Board of the Organizationof Nurse Leaders (ONL), and serves as theSoutheastern Region representative on the MembershipCommittee.Connie Rogers, RN, BSN, CMSRN, BC, Center 4,successfully passed her Gerontology RN Certification.She now has dual certifications in Med‐Surgand Gerontology.Irma Sivieri, RN, BSN, CRNI, VA‐BC, IV Therapy,was recently elected as Vice President for the Massachusettschapter of National Assoc of HispanicNurses.Kathleen Shubitowski, RN, MSN, CEN, EmergencyDepartment Clinical Nurse Specialist, developedand coordinated a faculty model “Grow YourOwn” program for non‐ED trained registerednurses. The model organized orientation schedulesincluding “mentoring” days with ED clinical experts,organized in‐service days with experts fromclinical areas, and provided simulations to familiarizestaff with equipment and case scenarios. Kathyalso submitted a poster which was accepted for the5th International Conference on Patient‐ and Family‐Centered Care, 2012.Gerda Sullivan, RN, BS, CAPA, 2 Pond Park AmbulatorySurgery, is now CAPA certified.Lori Taylor, NP, Surgical Intensive Care Unit,passed her advance practice licensing exam.Debra Trongone, RN, CNOR, Operating Room, isnow CNOR certified.Angi Walsh, RN, MA, CNOR, Perioperative ClinicalNurse Educator, and Donna Amado, RN, BSN,CNOR, Perioperative Nurse Educator, presented aposter at the 58 th Association of periOperative RegisteredNurses (AORN) Congress in Philadelphia,title “A Culture of Excellence Model: Promoting thePatient & Family”, in collaboration with PerioperativeDepartment colleagues: Judith Orsie, RN,BSN, Patricia Heenan, RN, BSN, CPAN, ReneeBornheim, RN, BSN, Jean Mollica‐Smith, RN,CNOR, Linda Dares, RN, Judith Wright, RN,BSN, and Jacquelyn Dinsmore, RN, BC.19

Exemplary Professional PracticeAngi Walsh, RN, MA, CNOR, Perioperative ClinicalNurse Educator, presented the following atthe spring AORN Workshop in Boston:“Professional Partners: the Weight Loss SurgeryPatient Journey”. Angi is also a member of theNational AORN Education Committee, and presentedat a Schwartz Rounds held last year titled“When the Patient is a Family Member”.Faye Weir, RNC, MSN, Director of Parent ChildServices, and Dr. Tracy Tomlinson, Maternal FetalMedicine, have been named as members to theMassachusetts Perinatal Quality Collaborative.The Collaborative has been established to focuson the quality and safety of obstetric care providedin Massachusetts. The collaborative is currentlyworking on quality measures of eliminationof elective deliveries prior to 39 weeks gestation,the rising rates of cesarean deliveries and care ofthe premature infant.Clinical Nurse Specialists Kelly Fitzpatrick, RN,MS, BC, CMSRN, Kelly Mattar, RN, MHA,CMSRN, and Sharon Perkins, RN, MSN, CRRN,presented posters at the Academy of Medical‐Surgical Nurses (AMSN) National Convention inBoston, MA.The following nurses became Medical‐Surgicalcertified last year: Debra Ayers, RN, CMSRN,Center 4; Dawn Forristal, RN, BSN, CMSRN,Center 4; Ann Gardner, RN, CMSRN, Pratt 3;Melissa McAlpine, RN, CMSRN, Pratt 3; GenaO'Hara, RN, CMSRN, Pratt 3; MaryAnn Reilly,RN, BSN, BC, Center 4; and Denise Sherwood,RN, BSN, CMSRN, Center 4.The following Emergency Department nursescompleted the state’s rigorous SANE (Sexual AssaultNurse Examiner) course: Julie Anstead, RN,Debra Bloor‐Smith, RN, Kristi Holden, RN, DominiqueLounge, RN, Francine O’Connell, RN,BC, Jennifer Powell, RN, and Christina Wood,RN. SANEs are specially trained and certified inperforming forensic medical‐legal exams and providemedical care to survivors without interruption,maintaining the chain of evidence from theexam.The following Pratt 4 South nurses received orthopaedicnursing certifications from the NationalAssociation of Orthopaedic Nurses: Kara Devlin,RN, ONC, Beth Dickson, RN, BS, ONC, PatriciaHasenfus, RN, ONC, Tracey Lang, RN, BSN,ONC, Erin Puliafico, RN, ONC, and GabrielQuinones, RN, ONC.The following Float Pool nurses are certifiedmedical surgical registered nurses: Kelly Nagi,RN, BSN, CMSRN, Donna Doherty, RN,CMSRN, and Takeysha Duarte, RN, BSN,CMSRN.Emerson 3 nurses Anna Phillips, RN, BSN, OCN,and Carolyn Marshman, RN, BSN, OCN, passedthe exam to become an Oncology Certified Nurse.The Maternal Infant Unit/Birthing Unit hosted aMASS AWHONN conference related to the establishmentand use of the Massive Transfusion protocol.30 Participants came from around the state.20

Exemplary Professional PracticeThe Massachusetts Emergency Department SBIRTprogram Advocates of the Year were presented to:Kathryn Googins, RN, BSN, Nate Van Heuveln,RN, Dr. John Walsh, and Mark Coyle, PAC. TheMassachusetts ED SBIRT program brings Screening,Brief Intervention and Referral to Treatment(SBIRT) to seven emergency departments (EDs) inMassachusetts.Fifty‐four Perianesthesia Nurses attended thefirst annual Skills Day for their specialty.Members of the Perioperative Services department,led by Yvonne Kesner, RN, BSN, CNOR,created an educational pediatric video which isavailable on the SSH portal.The South Shore Visiting Nurses Association(SSVNA) hosted a series of community educationevents in 2011, including the following: Diabetes:Facts and Fiction; Women and Heart Health(spring and fall); The Role of the Hospitalist; TotalJoint Replacement (spring and fall); Total JointReplacement Advancements; Food for Life; andAge Related Eye Diseases.In addition, colleagues at the Home Care Divisionparticipated in 20 Health and Wellness and communityfairs; 9 community cable access shows and5 radio shows promoting health and wellness inthe community.The Maternity Unit received the 2010 BreastfeedingAchievement Award from the MassachusettsDepartment of Public Health, which recognizesinstitutions with established programs and opportunitiesfor staff to learn how to support breastfeeding.Such opportunities demonstrate an institution’sdedication to providing recent, evidencebasedinformation to ensure that families receivethe best breastfeeding care.The following case managers received their AcuteCase Management Certification (ACCM) in 2011:Ann Cashman, RN, BSN, Donna Gately, RN, BSN,Catherine Lehman, RN, and Betty Olsson, RN.The Case Management Department continuesto have 100% of all eligible case managerscertified!Pictured at left: (front row, from left to right)Laura Donovan, RN, BSN, CCRN, CardiacCare Unit, Gail Gallagher, RN, CCRN, SurgicalIntensive Care Unit, and Debra Connelly,RN, BS, CCRN, Home Care Division; (backrow) Elizabeth Bedenbaugh, RN, BSN,CCRN, Surgical Intensive Care Unit, andJeanne Marston, RN, MSN, CCNS, CCRN,Critical Care Clinical Nurse Specialist, attendthe 2011 ICU Certification Dinner.21

Exemplary Professional Practice — Certified NursesROBERT C ABBADESSA, RN, BSN, EMT‐PEMERGENCY ROOMKATHLEEN A ABRUZESE, CLIN RESOURCE RN, AD, CNOR, CRNFA, ONC OPERATING ROOMTRACI A ADAMS, RN, AD, CRNIINTRAVENOUS THERAPYCHRISTINE ADDISON, RN, BSN, IN PT OBBIRTHING UNITANN ALLAIRE, RN, AD, MSPRATT 3 SOUTHCHRISTINE T ALLEN, CASE MAN, , CCMCASE MANAGEMENTGAIL ALTIERI, RN, BSN, IN PT OBBIRTHING UNITDONNA AMADO, RN, BSN, CNOROPERATING ROOMJULIE ANSTEAD, RN, BSN, SANEEMERGENCY ROOMCARLA ARONSTEIN, RN, AD, CNNNURSING HEMODIALYSISQUAY BAKER, RN, DIP, CNORDAY SURGERY‐780 MAINKATHLEEN M BANCROFT, RN, AD, CNORDAY SURGERY‐780 MAINAUDREY BARRITT, RN, BSN, MAT/NEWBORNNURSING OBSTETRICSHELEN E BARTOLONI, RN, AD, CCRNCCUMARY ELIZABETH BEDENBAUGH, RN , BSN, CCRNSICULINDA N BEGLEY, RN, BSN, CPANRECOVERY ROOMPATRICIA BELL, RN, DIP, IN PT OBBIRTHING UNITJANET D BIGELOW, RN, AD, IN PT OB, CCEBIRTHING UNITPATRICE A BINARI, RN , AD, CMSRN EMERSON 4KATE M BIRTWELL, CASE MAN, BSN, ACM, CLNCCASE MANAGEMENTHILARY E BLACK, LAC CONSULTRN, BSN, IBCLCWOMEN & FAMILY HLTHWENDY A BLANCHARD CASSESE, RN, DIP, BREAST HEALTH NAVIGATOR BREAST CARE CTRDEB BLOOR‐SMITH,RN , SANEEMERGENCY ROOMDEBRA A BOSTROM, RN, BSN, MS CENTER 4ANN M BOUDREAU, RN, AD, CMSRN EMERSON 4MARGARET BREEN, WOM/FAM ‐ RN, BSN, CCEWOMEN & FAMILY HLTHALEXANDRA BRINKERT, RN , BSN, CDE 2011DIABETESEDWINA E BRINKLEY, RN, DIP, CNORDAY SURGERY‐780 MAINDIANNE C BRYAN, RN, BSN, Clinical ResearchEMERGENCY ROOMDONNA S BUCKLEY, RN, DIP, MATCHILDNURSING OBSTETRICSMARIE Burns, RN, BSN, CLNCCHEST PAIN UNITBETH S BUSSARD, RN, AD, PEDINURSING PEDIATRICSELLEN BYRD, RN, MSN, CCRNNICU/SPECIAL CARE NURSERYJANE M CAHILL, RN, DIP, CNORDAY SURGERY‐780 MAINSUSAN M CAHILL, RN, MSN, CCRNCCUELAINE M CAMPBELL, RN, BSN, CPANRECOVERY ROOMELIZABETH L CAREY, RN, AD, CCRNNICU/SPECIAL CARE NURSERYCINDY R CARLONI, LAC CONSULT RN, DIP, IBCLCWOMEN & FAMILY HLTHLAURA C CARROLL, RN, AD, CCENURSING OBSTETRICSCATHLEEN S CAVANAUGH, RN, BSN, CMSRNNURSING FLOATS22

Exemplary Professional Practice — Certified NursesDONNA CHAPMAN, RN, MSN, ANPEMERGENCY ROOMJUDITH A CHASE, RN, AD, CNOROPERATING ROOMLAURA E CHRISTENSEN, RN, AD, CSTOPERATING ROOMCATHERINE CLEARY, RN, MS, CDEDIABETESJODY A CLERGY, RN, MSN, ANPCARDIOVASCULAR CTRTHERESA M COAKLEY, RN, AD, IN PT OBBIRTHING UNITMARY‐BETH COLE, RN, DIP, CMSRN CENTER 4LEE I COLEMAN, RN, BSN, CMSRN EMERSON 4JULIE B COLLAS, RN, BSN, NEOINTENSIVE CARENICU/SPECIAL CARE NURSERYBARBARA E COLLINS, RN , BSN, WOCNWOUND CAREJENNIFER A COLLINS, RN, BSN, IN PT OBNICU/SPECIAL CARE NURSERYALLISON CONLON, RN, MSN, ACMCASE MANAGEMENTDEBRA A CONNELLY, RN, AD, CCRNCCULORRAINE CONNOLLY, RN, BSN, CCRNRAPID RESPONSE TEAMPATRICIA CONWAY, RN, BSN, OCN EMERSON 3DIANE M COONEY, RN, BSN, MAT/CHILDOB PRE‐NATAL TESTINGMARYANN CORKUM, RN, MSM, CAN PRATT 3MARGARET E COTE, CASE MAN, AD, ACMCASE MANAGEMENTMARY COURTNEY, RN, BSN, IBCLC, BEREAVEMENT CBCNICU/SPECIAL CARE NURSERYNANCY CRANE, RN, BSN, CCRNMICUCAROL L CRITTENDEN, RN, BSN, IN PT OBBIRTHING UNITJUDI CULLANINE, RN, MSN, CCRNNURSING PEDIATRICSKERRI L CUSHING, RN, MSN, CPNP‐PC, CPNP‐ACNURSING PEDIATRICSKELLIE A DALEY, RN, BSN, ONCNURSING FLOATSELDA DALY, RN, AD, BEREAVEMENT CBC, CBENURSING OBSTETRICSGAYLE DAVIDSON, RN, BSN, CDE, CRRNDISEASE MANAGEMENTRUBEN G DE LOS TRINOS, RN, BSN, CRNI, GERO, MSINTRAVENOUS THERAPYKEVIN DELOREY, RN, BSN, CARDIOVASCULAR PRATT 5ALICIA DELPRETE, RN, BSN, ONCPRATT 4 SOUTHKELLY A DELUCA, RN, BSN, IN PT OBBIRTHING UNITPAM DEMOUCELL, RN, MEd, CRRNCLIN PROFJEANNE DEMPSEY, RN, AD, CNOROPERATING ROOMSTEPHANIE E DEVIK, RN, BSN, CCRNMICUKARA L DEVLIN, RN, AD, ONCPRATT 4 SOUTHBETH M DICKSON, RN, AD, ONC 2011PRATT 4 SOUTHJACQUELYN L DINSMORE, RN, AD, PAINPAIN CLINICPAULA DION, CASE MAN, DIP, ACMCASE MANAGEMENTMARYJANE DOHERTY, RN, BSN, CPANRECOVERY ROOMMAUREEN H DONNELLY, COORD, DIP, CNNNURSING HEMODIALYSISVIRGINIA DONNELLY, CLIN RESOURCE RN, BSN, CNOROPERATING ROOM23

Exemplary Professional Practice — Certified NursesCAROL A DONOGHUE, RN, AD, CNORDAY SURGERY‐780 MAINLAURA DONOVAN, RN, BSN, CCRNCCUERIN M DOWD, RN, BSN, ONCPRATT 4 SOUTHDEBORAH E DOYLE, RN, BSN, CNOR, ONCOPERATING ROOMCOLLEEN M DRUMMOND, RN, BSN, TOBACCO TREATMENT SPECIALIST DAY SURGERY‐780 MAINTAKEYSHA DUARTE, RN, AD BSN, CMSRNNURSING FLOATSJILL C DUNBAR, RN, AD, CMSRN EMERSON 4REBECCA D DUNK, RN, AD, CNMPERINATOLOGY SVSPATRICIA L DURANT, RN, BSN, CPAN, PAINPAIN CLINICSUSAN DUTY, RN, Sc. D, MSN, ANP‐BCCLIN PROFESSIONAL DEVKATRINA DWYER, RN, BSN, MHAHCDMAURA C EASTMAN, RN, AD, LOW RISK NN NSGNURSING OBSTETRICSLIZ ENNIS, RN, BSN, CPHQVNALISA ENWRIGHT, RN, BSN, IN PT OBBIRTHING UNITJUDITH A ERIKSON, RN, DIP, PAINPAIN CLINICLAURIE S ESAU, RN , BSN, CGRNCCUJENNIFER ETHIER, RN, BSN, VA‐BCINTRAVENOUS THERAPYJANICE FERIOLI, COORDI, AD, CRNIHOME INFUSION THERPYCINDY FIOCCHI, RN, BSN, CAN CENTER 4DUSTIN FITCH, RN, BSN, OCNHCDKELLY FITZPATRICK, RN, MS, BC, CMSRNMED SURG ADMALISON J FOLEY, RN, AD, CAPADAY SURGERYELIZABETH FRASER, RN, BSN, ACMCASE MANAGEMENTPAMELA FREDERICKS, RN, BSN, CDEVNAELIZABETH A GALLAGHER, RN , BSN, OCNHOME INFUSION THERPYGAIL E GALLAGHER, RN, DIP, CCRNSICUANN J GARDNER, RN, AD, CMSRNPRATT 3 SOUTHGINA M GARGANO, RN, AD, WCCNEMERGENCY ROOMKAREN A GAUDREAU, RN , DIP, MS,GERO CENTER 4LYNNE A GERENIA, RN, AD, RRT EMERSON 4JANICE M GILMORE, RN , BSN, CRRN TEAM 3CATHERINE GILSON, RN, BS, MHA, IN PT OBNURSING OBSTETRICSANDREA B GLENNON, RN, AD, GEROPRATT 3 SOUTHMELISSA GODLEWSKI, RN, MSN, ANPINTRAVENOUS THERAPYMICHELE C GOLDEN, CASE MAN, AD, ACMCASE MANAGEMENTLINDA J GOMES, RN, AD, IN PT OBBIRTHING UNITPATRICIA GORMAN, RN, MM, CICQUALITY MANAGEMENTKAREN J GOSLIN, RN, DIP, CMSRN EMERSON 4KIMBERLY A GRACE, RN, BSN, CARDIOVASCULARCHEST PAIN UNITJENIFER GREEN, RN, AD, BA, CENEMERGENCY ROOM24

Exemplary Professional Practice — Certified NursesDONNA GUILBEAULT, RN, BSN, MAT/NEWBORNNursing ObsTETRICSKAREN HAKALA, CASE MAN, , ACMCASE MANAGEMENTSUZANNE B HALE, CASE MAN, AD, ACM, CCMCASE MANAGEMENTJOSEPH A HALLISSEY, RN, AD, EMT‐POPERATING ROOMANN C HALLOIN, NP, MSN, CFNP, COHN‐S, CMEMPLOYEE HEALTHNANCY J HAMILTON, RN, AD, MSEMERGENCY ROOMKATHLEEN HANNON, CASE MAN, BSN, ACM, CRRNCASE MANAGEMENTKATHLEEN M HARRAN, RN, AD, CAPADAY SURGERY‐780 MAINKERRI HARRINGTON, RN, BSN, VA‐BCINTRAVENOUS THERAPYMARY K HARRINGTON, CASE MAN, BSN, ACMCASE MANAGEMENTPATRICIA E HASENFUS, RN, DIP, ONC 2011PRATT 4 SOUTHDEAN HASPELA, RN, MSN, CNS, ONCPRATT 4 SOUTHPATRICIA J HEENAN, RN, BSN, CPANRECOVERY ROOMDENNIS HINES, RN, MSN, CFNPEMPLOYEE HEALTHNANCY P HOFF, RN, BSN, CARDIOVASCULARCHEST PAIN UNITMICHELLE T HOFFMAN, RN, BSN, IN PT OBBIRTHING UNITMELISSA HOGAN, RN, , CMSRNPRATT 3 SOUTHKRISTI M HOLDEN, RN, BSN, SANEEMERGENCY ROOMJEANNE W HOLWAY, CASE MAN, DIP, ACMCASE MANAGEMENTJANET HOOKER, RN, , CPENEMERGENCY ROOMSALLY HOWARD, RN, DIP, CNOROPERATING ROOMEILEEN M HUIE‐STEVENSON, RN, , CWOCNWOUND CARENANCY J HUMPHREY, RN, AD, CLCNURSING OBSTETRICSWAYNE HYLAN, RN, BSN, CNOROPERATING ROOMM BETH JACOBS, RN, BSN, CNOROPERATING ROOMPAMELA JOHNSON, RN, DIP, NEOINTENSIVE CARE NSGNICU/SPECIAL CARE NURSERYKAREN M KEENAN, RN, BSN, CPENEMERGENCY ROOMHOPE L KELLMAN, LAC CONSULT RN, BSN, IBCLCWOMEN & FAMILY HLTHKELLY MATTAR, RN, BSN, MHA, CMSRNMED SURG ADMMICHELLE H KELLY, RN, BSN, IBCLCNURSING OBSTETRICSYVONNE M KESNER, RN, BSN, CNOROPERATING ROOMKIMBERLY A KEVILLE, RN, AD, CNOROPERATING ROOMEUNHYE KIM, RN, DIP, CRNI, MSINTRAVENOUS THERAPYANDREA J KINDAMO, RN, AD, ONCPRATT 4 SOUTHCHERYL A KING, RN, AD, CMSRN EMERSON 4DIANE KING, NP, MSN, ANPEMPLOYEE HEALTHSANDRA L KRALL, RN , BSN, MS EMERSON 4JAIME D KULLAK, RN, MSN, WHNPBIRTHING UNITPATRICIA A LACKEY, CASE MAN, DIP, ACMCASE MANAGEMENTHEATHER LAKATOS, LAC CONSULT RN, BSN, IBCLCWOMEN & FAMILY HLTH25

Exemplary Professional Practice — Certified NursesNANNETTE M LANDRY, RN, MSN, CNMNURSING OBSTETRICSTRACEY LANG, RN, AD, ONC 2011PRATT 4 SOUTHSHANNON H LAUBENSTEIN, RN , BSN, MSCASE MANAGEMENTERIN K LEHANE, RN, AD, MAT/NEWBORNNURSING OBSTETRICSDIANE E LOGAN, RN, BSN, MSEMERGENCY ROOMCHARLENE LONG, RN, BS, ACMCASE MANAGEMENTMAUREEN J LONG, RN, AD, MS, GERO CENTER 4SYLVIA LORAN, RN, AD, GERO PRATT 5DIANE F LOTTI, RN, DIP, CNOROPERATING ROOMDOMINIQUE LOUNGE, RN, AND, SANEEMERGENCY ROOMDONNA MACNEIL, RN, BSN, CEN, CCRN, CTM, EMT‐PEMERGENCY ROOMJOAN MAGUIRE, RN, BSN, CNOR,ONCOPERATING ROOMCHRISTINE C MAHON, RN, BSN, NEOINTENSIVE CARE NSGNICU/SPECIAL CARE NURSERYVALERIE A MALINOWSKI, RN, BSN, CARDIOCHEST PAIN UNITJOYCE A MALONEY, RN, BSN, NEOINTENSIVE CARE NSGAD NICU/SPECIAL CARE NURSERYKIMBERLY MANZONE, RN, MSN, ANPEMERGENCY ROOMGENIPHER M MARASIGAN, RN , BSN, CMSRN EMERSON 4PATRICIA M MARINELLI, RN, MSN, ANPCCUSUSAN MARKHAM, RN, , CPENEMERGENCY ROOMJESSICA MARTIN, CASE MAN, BSN, LNCCCASE MANAGEMENTALICE MASIELLO, RN, MSN, CNPD‐BCCLIN PROFLISA MASIELLO, RN, BSN, CCRNSICUANN MARIE MATERNA, RN, AD, MSDAY SURGERY‐780 MAINKELLY MATTAR, RN, BSN, CMSRNPRATT 4 SOUTHJOYCE B MATTERN, RN, BSN, CARDIOVASCULAR PRATT 5MARILYN MCALPINE, RN, BSN, CENEMERGENCY ROOMMAUREEN MCALPINE, RN, BSN, CAPARECOVERY ROOMCASEY B MCAULEY, RN, DIP, ONCPRATT 4 SOUTHKATHERINE MCCAFFERTY, RN, AD, MAT/CHILDNURSING OBSTETRICSGINA MCCOLLEM, RN , , WOCNWOUND CAREMARY B MCGOWAN, RN, AD, CNOROPERATING ROOMJULIE MCINTYRE, RN, MSN, CNOROPERATING ROOMJANET A MCKAY, RN , , CRRN TEAM 4STACY J MCLELLAN, RN, AD, IN PT OBBIRTHING UNITSUSAN MEDICI, RN, MM, ACMCASE MANAGEMENTDOROTHY M MEGNIA, RN, BSN, CNOR,ONCOPERATING ROOMLINDA MEHEGAN, RN, DIP, CNOROPERATING ROOMSUSAN MEIGHAN, , BSN, CENEMERGENCY ROOMKERA R MERRILL, RN, BSN, ONCPRATT 4 SOUTHMARY A MILLER, RN, AD, CMSRN EMERSON 426

Exemplary Professional Practice — Certified NursesJEAN MOLLICA SMITH, RN, DIP, CNORDAY SURGERY‐780 MAINNOREEN MULKERRINS, RN, AD, CPNNICU/SPECIAL CARE NURSERYLISA MURPHY, RN, BSN, NE‐BCRECOVERY ROOMCAROL A MURPHY, RN, AD, IBCLCNICU/SPECIAL CARE NURSERYBARBARA MYLETT, RN , DIP, CPENEMERGENCY ROOMDONNA M NAEGER, RN, BSN, NEOINTENSIVE CARE NSGADNICU/SPECIAL CARE NURSERYCHRISTINE M NEAGLE, RN, AD, MAT/CHILDNURSING OBSTETRICSCATHERINE NELSON, RN, MSN, CPHQQUALITY MANAGEMENTJUDY NICOTERA, RN, , CPENEMERGENCY ROOMDOROTHY NILAND, CASE MAN, BSN, ACMCASE MANAGEMENTKELLY NORCOTT, RN, BS, CLNCCSICUCONSTANCE M NORVE, RN, AD, CMSRN EMERSON 4DEBORAH L OAKES, RN, DIP, CWCNDISEASE MANAGEMENTFRANCINE E O'CONNELL, RN, BSN, MSEMERGENCY ROOMGENA M O'HARA, RN, AD, CMSRNPRATT 3 SOUTHKATHLEEN M O'KANE, RN, DIP, CCRNSICUPATRICIA M O'REILLY, RN, BSN, CNORDAY SURGERY‐780 MAINJACQUELINE A OWENS, CASE MAN, BSN, ACMCASE MANAGEMENTMARIA E PARISI, RN, BSN, TOBACCO TREATMENT SPECIALIST SMOKING CESSATIONDENY JANE PASCUA, RN, BSN, MSPRATT 3 SOUTHPAMELA J PATTERSON, RN, BSN, IN PT OBBIRTHING UNITEMMANUELA PAUL, RN , BSN, MS TEAM 2SHARON PERKINS, RN, MSN, CRRN‐A EMERSON 4SANDRA J PICHE, RN, BSN, IN PT OBBIRTHING UNITSHARON J PISTORINO, RN, BSN, CNOROPERATING ROOMNAOMI POLLARA, RN, DIP, CMSRN EMERSON 4SUSAN POND, RN, MPH, CPHQQUALITY MANAGEMENTHEATHER L POWDERLY, RN, BSN , IN PT OBBIRTHING UNITJENNIFER POWELL, RN, , SANEEMERGENCY ROOMPAULINE I POWERS, RN, DIP, MS EMERSON 4ERIN PULIAFICO, RN, AD, ONC 2011PRATT 4 SOUTHTIMOTHY QUIGLEY, RN, BSN, NEA‐BCADMINSUZANNE T QUIGLEY, CASE MAN, AD, ACMCASE MANAGEMENTGABRIEL QUINONES, RN, AD, ONCPRATT 4 SOUTHAVITAL L RECH, RN, BSN, CCRNCCUMARYANN REILLY, RN, BSN, MS, BC CENTER 4LISA RENGUCCI, RN, MS, IBCLCNURSING OBSTETRICSNANCY M RICE, RN, DIP, MS EMERSON 4HOLLACE D ROCHA, RN, AD, ONCPRATT 4 SOUTHJOAN O ROCHE, CASE MAN, DIP, ACMCASE MANAGEMENT27

Exemplary Professional Practice — Certified NursesPATRICIA RODGERS, RN, DIP, IN PT OBBIRTHING UNITCONSTANCE ROGERS, RN, BSN, CMSRN CENTER 4KAREN A ROSHER, RN, BSN, CCRNNICU/SPECIAL CARE NURSERYJUDITH A ROY, WOM/FAM‐ RN, BSN, CCE, CBE, INFANT MASSAGE, SCH NURSE WOMEN & FAMILY HLTHJACQUELINE RYAN, RN, BSN, ONCDAY SURGERY‐780 MAINWANDA SALVATORE, RN, BSN, ONCDAY SURGERY‐780 MAINCAROLYN SANGER, RN, BSN, OCNMED SURG ADMCAROL A SANSONE, RN, DIP, PAINPAIN CLINICDENISE SAVAGE, RN, AD, IN PT OBBIRTHING UNITANNMARIE T SCARLATA, RN, BSN, CARDIOCHEST PAIN UNITSUSANN SEAFUSE, RN, AD, MSPRATT 3 SOUTHMARIA SESTINA, WOM/FAM‐ RN, BSN, CCEWOMEN & FAMILY HLTHPAULA M SHAUGHNESSY, RN , DIP, CHPNHOSPICE TEAMDEBRA L SHAW, RN, AD, CNORDAY SURGERY‐780 MAINHOLLYANN SHEA, RN, AD, MAT/NEWBORN NSGNURSING OBSTETRICSKATHLEEN SHUBITOWSKI, RN, MSN, CENED ADMROSEMARY SIMMONS, RN, , CCMNURSING HEMODIALYSISPAMELA P SIMPSON, RN, BSN, IN PT OBBIRTHING UNITIRMA O SIVIERI, RN, BSN, CRNIINTRAVENOUS THERAPYDONNA SKINNER, RN, AD, CNNNURSING HEMODIALYSISJANET M SKOV, RN, BSN, IN PT OBBIRTHING UNITKIM SMITH MERLUZZO, RN, AD, IN PT OBBIRTHING UNITFRANCES A SMITH, RN, AD, NEOINTENSIVE CARE NSGNICU/SPECIAL CARE NURSERYLAUREN A SMITH, RN, AD, MSPRATT 3 SOUTHMARCIA G SMITH, RN, AD, NEOINTENSIVE CARE NSGADNICU/SPECIAL CARE NURSERYMARY T SMITH, RN, DIP, CCRNNICU/SPECIAL CARE NURSERYLINDA L SORRENTINO, LACCONSULT RN, DIP, IBCLCWOMEN & FAMILY HLTHPATRICIA K SQUIRES, WOM/FAM ‐ RN, DIP, CCEWOMEN & FAMILY HLTHTAMI L ST ANDRE, RN, DIP, CRNIINTRAVENOUS THERAPYELIZABETH R STAUNTON, RN, AD, IN PT OBBIRTHING UNITDIANE K STELZER, RN, BSN, MAT/CHILDOB PRE‐NATAL TESTINGGARY STEPHEN, RN, MM, CNOROPERATING ROOMDEBRA A SULLO, RN, BSN, CCRNDAY SURGERY‐780 MAINPATRICIA M SUSLO, CASE MAN, BSN, CCMCASE MANAGEMENTJENNIFER TAYLOR, RN, BSN, CPNNURSING PEDIATRICSDONA TEHRANIAN‐BURNS, RN, DIP, IN PT OBBIRTHING UNITJENNIFER COCCIO THOMPSON, RN, MSN, CPHQ, CPNPNICU/SPECIAL CARE NURSERYJANET L THOMPSON, NP, MSN, ANPCARDIOVASCULAR CTRLISA TIBBETTS, RN, MS, PNPNURSING PEDIATRICSBARBARA TILDEN, RN‐BC, MSNCLINICAL PROFESSIONAL DEVEL28

Exemplary Professional Practice — Certified NursesVIRGINIA TREMBLAY, RN, CPHQVNAMAURA TRIEBER, RN, AD, IN PT OBBIRTHING UNITKAREN E TUDINO, CASE MAN, BSN, ACMCASE MANAGEMENTCHRISTINE UNANDER, RN, MS, IN PT OBBIRTHING UNITCHRISTINE UNANDER, RN, MSN, IN PT OBPCD ADMVINCENT P URBAITIS, CLIN RESOURCE RN, AD, CNOROPERATING ROOMJANE VANDERLIN, RN, CAPARECOVERY ROOMANNE E VENDITTI, RN, BSN, IN PT OBBIRTHING UNITSARAH VOSSOUGHI, RN, BSN, CENEMERGENCY ROOMJEANNE M WALKER, RN, DIP, CAPADAY SURGERY‐780 MAINANGELA WALSH, RN, BSN, MA, CNOROPERATING ROOMTARA WALSH, RN, CPHQVNADENISE A WEBER, RN, BSN, IN PT OBBIRTHING UNITKERRY WEISS, RN, BSN, CNORDAY SURGERY‐780 MAINLAUREN P WELLS, RN, BSN, CMSRNPRATT 3 SOUTHELLEN P WENNERS, RN, BSN, CMSRNPRATT 3 SOUTHJAN E WHITE, RN, MSN, CETNCLIN WOUND CTR‐HBOTTAMETHEA C WILLIS, RN , BSN, CMSRN CENTER 4LAUREN G WOOD, RN, BSN, CMSRNPRATT 3 SOUTHLAURIE A ZANI, RN, AD, IBCLCNICU/SPECIAL CARE NURSERYThe Power of Knowledge!96 Nurses Hold30015020Master’s Degrees ..43 in Nursing!Nurses AreCertified inTheir Specialty(42%)NursesAttendedConferencesin 2011NursesAwardedClinical LadderStatus SinceInception29

Exemplary Professional PracticeSouth Shore Hospital’s Visiting Nurse AssociationCelebrates 100 Years of Exemplary ServiceThe South Shore VNA celebrated 100 years of service to the community with a variety of events this pastyear. In April, 2011 South Shore VNA hosted a reception at Thayer Academy in Braintree and in August,2011, colleagues from the Home Care Division, along with their family members, attended a Brockton Roxbaseball game.Pictured above: Joe Dwyer and wife Tina Dwyer, RN, BSN, MBA, Community Outreach Manager,and Lisse McLellan, RN, BSN, Health Information Systems Coordinator, and husband Craig, enjoydinner before a Brockton Rox baseball game.30

Exemplary Professional PracticePictured at left: Maura Vitello,RN, BSN, Hospice Liaison,and Brenda Karkos, RN, MSN/MBA, Director, Hospice of theSouth Shore, enjoy a nightout at a Brockton Rox baseballgame to celebrate the100th anniversary of theSouth Shore Visiting NurseAssociation.Pictured at right: Soo Li,RN, Home Care Practitioner,and her husband DavidWong take a moment topause for the camera atone of the celebratoryevents commemoratingthe 100th anniversary ofthe South Shore VisitingNurse Association.31

New KnowledgeSouth Shore Hospital Cohorts Graduate from Simmons CollegeNursing Colleagues Take Advantage of Opportunity to Earn DegreesOn Friday, May 20, 2011, two South Shore Hospitalcohorts participated in Simmons College’s 106thcommencement exercises in Boston, including21 nurses receiving bachelor’s ofscience degrees in nursing, and 6 nursingcolleagues receiving master’s degrees inhealth administration.South Shore Hospital launched its first onsite“RN to BSN” Program in affiliation with SimmonsCollege in 2007. In August of 2010, the firstcohort of 21 students successfully completed theprogram. A second cohort of 15 nurses completedtheir studies in December 2011, and a third cohortbegan in September 2011.Consistent with the Institute of Medicine’s reporttitled The Future of Nursing: Leading Change, AdvancingHealth, studies have shown that patientscared for by nurses with BSN degrees haveoptimal outcomes.In addition, an on‐site master’s degreeprogram in healthcare administration(MHA) was offered at South Shore Hospital,also through Simmons College. Thisgroup of 16 professionals, including six nurses, beganclasses in May of 2008. A second MHA cohortbegan classes in September of 2010. In January2012, the first cohort of nurses in our new on‐sitemaster of science in nursing (MSN) program beganclasses.Congratulations to all of our graduates!Pictured above, from left to right: Christine Sands, RN, MHA, BSN, Cheri Dauphinee, RN, MHA, BSN, Deborah Doyle,RN, MHA, BSN, ONC, CNOR and Deborah Moore, MHA, RN, BSN.32

New KnowledgePictured above, from left to right: (front row) Anna Marie Phillips, Beth M. Marshall, Robin Ann Sherrick, Christina NoraRichardson, Judith Oldham Holmes, Beth Anne Cusack, Kelly M. Wharton. Back row: Dawn Marie Forristall, ConstanceRenee Rogers, Heather Reilly, Nancy L. Ahearn, Beverly Jean Coronis, Janice Hagman, Christine Marie Neagle, MaryElizabeth Bedenbaugh, Tamethea Charisse Willis, Denise Marie Sherwood, Marcia Fonseca Dalton, Donna M. Doherty,Donna Chase, Director of Clinical Professional Development, Karen A. Rosher, Kellie Ann Daley, and Patricia E.Hensley.Simmons College Bachelor of Science in Nursing Program GraduatesNancy L. Ahearn, magna cum laudeMary Elizabeth Bedenbaugh, magna cum laudeBeverly Jean Coronis, magna cum laudeBeth Anne Cusack, magna cum laudeKellie Ann DaleyMarcia Fonseca Dalton, summa cum laudeDonna M. Doherty, cum laudeDawn Marie Forristall, summa cum laudePatricia E. Hensley, magna cum laudeJudith Oldham HolmesKimberly Anne LuceBeth M. Marshall, cum laudeChristine Marie Neagle, summa cum laudeAnna Marie Phillips, cum laudeChristina Nora Richardson, cum laudeConstance Renee Rogers, magna cum laudeKaren A. Rosher, summa cum laudeRobin Ann Sherrick, summa cum laudeDenise Marie Sherwood, summa cum laudeKelly M. Wharton, cum laudeTamethea Charisse Willis33

New KnowledgeSimmons College Master of Health Administration GraduatesMelissa Ann Arcadipane, B.S.Ann Marie Bohmiller, B.S. *Rosanne E. Clancy, B.S.N.Cheri Lynn Dauphinee, B.S.N. *Deborah Elizabeth Walsh Doyle, B.S.N.Amy Lyn Duarte, B.A.Jeanne Marie Fallon Rines, B.S.Karen A. Harhen, B.A. *Jacqueline Louise Kilrain, B.S. *Tessa Lara Chenaille Lucey, B.S.Kelly Mattar, B.S.N. *Deborah M. Moore, B.S.N.Jesslyn Jean Lenox Murphy, B.S.Christine Castagna Murray, B.A. *Jacquelyn Marie Polito, B.A. *Christine A. Sands, B.S.N. ** Upsilon Phi Delta Honor Society Member / 3.8 GPA or higherPictured above, left to right: Deborah Doyle, RN, MHA, BSN, ONC, CNOR, Deborah Moore, MHA, RN, BSN, KellyMattar, RN, MHA, BSN, CMSRN, Cheri Dauphinee, RN, MHA, BSN, Rosanne Clancy, RN, MHA, BSN, and ChristineSands, RN, MHA, BSN.34

New KnowledgeThe following nurses graduated from various collegesand universities with their degrees this past year:David Begley, RN, SICU, graduated with his BSNfrom Curry College, Kathleen Melvin, RN, BS receiveda MSN with specialization in Nursing Informaticsfrom Walden University, and Eunjee Stewart,RN, BSN, MICU, graduated with a BSN from UMass/Boston.The following nursing assistants graduated fromnursing programs in 2011: Nicole Doucet, JaimeDeree, and Amanda Harten, all from Center 4, CurryCollege; Elizabeth Hayden, Center 4, St. AnselmCollege; Ashley Nihiley, Emerson 4, UMass/Lowell;and Lisa Cullity, ICU, Labouré College.In May, more than 500 nurses attended one of 29interactive Core Measures educational classes thatwere held to familiarize nurses with the latest informationregarding these important metrics. After attending,nurses could identify Core Measure patientsand state how identification of these measures benefitsour patients and impacts SSH. More informationon these improved outcomes appears later in thisreport.Learning modules and policy attestations that wererolled out this past year included: Asthma Care Enhancements,Blood Glucose Meter Recertification,Catheter Associated‐UTI Prevention, Code Help,Core Measures, Data Destruction, Death CertificateProcess, DNR, Flu Vaccine, Fractional MileageAmounts on Ambulance Claims, Insulin for Practitioners,Moderate Sedation, Nursing Peer Review Process,Skin Education, and Updates on Family PresenceDuring Resuscitation.Schwartz Rounds were held monthly and providedthe opportunity for our patient care colleagues todiscuss thoughts and feelings they experienced duringdifficult situations encountered on the job. Thefollowing Schwartz Rounds were held last year: KeepingPace with the Walking Man, Providing Comfort toOne of Our Own, Bariatric Care: An All Team/All DayApproach, Working Together for a Good Outcome,When a Colleague is a Patient, Recognizing Culturaland Linguistic Barriers, and The Great Masquerader:TB in the Reproductive Age Patient.The Nursing Division offered “Lunch & Learn” presentations,including subjects presented by the DiversityCommittee, on the following: Health Literacy,Legacy of Dr. Martin Luther King, All Men are CreatedUN‐equal, The LGBT Aging Project, Care of the HinduPatient & Families, Care of the Buddhist Patient &Families, Care of the Patient & Family of Hispanic Heritage,A Class Divided, and Dealing with ChallengingWounds. ICU Education Session Lunch & Learnsincluded: Intra‐aortic Balloon Pump Review &Changes, New England Organ Bank Referral Update,Common Causes of Electrolyte Imbalance Found inICU, Early Goal Directed Therapy & Sepsis, and FloTrac. The Home Care Division’s Practice Councilsponsored an in‐service training in April, titled “LongTerm Planning, Advocating For Your Elder Clients",presented by Ronald Kearns, RN, Esquire, and in November,"Health Care Literacy" was presented by Dr.Daniel Oates.The Meditech 5.6 design team consisting of frontline staff nurses from each division providedMeditech upgrade training in late summer and earlyfall, prior to the massive and successful MeditechInformation System upgrade on October 18th.35

New KnowledgeAn evidence‐based practice poster presentation was held during Nurses Week in 2011. Fifteen of our SimmonsCollege RN‐to‐BSN students presented their EBP posters to dozens of nurses and other colleagueswho attended. Participants were able to describe the steps involved in searching the literature for relevantarticles, and determine whether the evidence presented supports a practice change.Poster Topic:Pasteurized Donor Human Milk (PDHM) and Necrotizing Enterocolitis,Feeding Intolerance, Late Onset Sepsis and Enhanced GrowthPresenters:Christine Neagle, RNCLaurie Zani, RN, IBCLCThe Presence of a Palliative Care Team Promoting CrucialConversationsBrenda Bellofatto, RNMichele Golden , RN, ACMCarolyn Marshman, RNWhat are the Most Effective Methods of Engaging Patients and Familiesin Discharge Education Regarding Management of Heart Failure (HF)?Noreen Clarke, RNJudith Fasci, RNShannon Willinger, RNWill a Clinical Decision Support System Increase Nurses Time at theBedside and Increase Press Ganey Scores at SSH?Debra Ayers, RNStacy Bartlett, RNWill a Multimodality Therapeutic Activities Protocol in an Acute CareGeriatric Setting Reduce the Incidences of Delirium in Elderly Patients?Karen Gaudreau, RN, CMSRNTamethea Willis, RN, CMSRNWill Increasing Labor Support Techniques Have an Effect on theCesarean Birth Rate in Low Risk Primigravidas?Janet Bigelow, RNCLinda Gomes, RNCStacy McLellan, RNC36

New KnowledgePictured Above: Pam De‐Moucell, RN, M.Ed., CRRNNurse Educator, ClinicalProfessional Development,and Stacy (Bartlett) Kennedy,RN, BSN, Center 4.At left: Christine Neagle,RNC, Obstetrics, and ChristinaLeung, RN, BirthingUnit, attend an Evidence‐Based Practice Poster Presentationduring NursesWeek 2011 .37

New KnowledgeNew Graduate Residency Program Prepares Nurses of the FutureFor the fourth consecutive year, South Shore Hospital offered a residency program for new graduate nurses.As the workforce of aging nurses continues to grow nationwide, many institutions are not able to offer positionsto new, inexperienced nurses. At South Shore Hospital, we are proactively preparing for the future bytraining new graduate nurses to replace the large number of experienced nurses who will begin to retire overthe next decade. This human resource strategy will ensure that the accumulated wisdom is transferred to ournext generation of nurses, who will be ready to provide the same high‐quality care that our patients and theirfamilies have come to expect at South Shore Hospital.Eight new graduate nurses began an intense twelve‐week residency in July 2011, which included experientiallearning and simulated training during the two major phases of the program. The program focused on theAmerican Organization of Nurse Executives’ defined “Nurse of the Future” core competencies, including patientcentered care, professionalism, informatics and technology, evidence‐based practice, leadership, system‐basedpractice, safety, communication, teamwork and collaboration, and quality improvement.The following new nurses successfully completed the residency program in September 2011: BrittanyBlazuk, RN, BS, E3; Kathleen Mahoney‐Simpkins, RN, P3; Ashley Nehiley, RN, E4; Eric von Reigers, RN,P5; Lisa Samargedlis, RN, P4S; Colleen Smith, RN, E4; Jaime Wallen, RN, C4; Amanda Wentworth, RN,P3. We are pleased to report the retention rate of our new graduate nurses — 32 participants since 2008 — is94 percent.Front row, from left:Kate Mahoney‐Simpkins, Pratt 3,Colleen Smith, Emerson4, LisaSamargedlis, Pratt4N. Back row, fromleft: Brittany Blazuk,Emerson 3, Eric vonRiegers, Pratt 5N,Jaime Wallen, Center4, Ashley Nehiley,Emerson 4, andAmanda Wentworth,Pratt 3.38

New KnowledgeHelen Bartoloni, RN, CCNS, Critical Care Unit, JudithCannon, RN, BSN, CCRN, Critical Care Unit, MeaghanDonovan, RN, BSN, Surgical Intensive Care Unit, GailGallagher, RN, CCRN, Surgical Intensive Care Unit, andJeanne Marston, RN, MSN, CCRN, Med‐Surg ClinicalNurse Specialist, attended the American Associationof Critical‐Care Nurses National Teaching Institute.Paula Beaulieu RN, BSN, MM , Director of EmergencyServices attended the 2011 ENA Annual Conference inTampa, FL, and the 10 th Annual Patient Flow OptimizationConference in Chicago, IL.David Begley, RN, BSN, Surgical Intensive Care Unit,Carolyn Tose, RN, BSN, Surgical Intensive Care Unit,and Jeanne Marston, RN, MSN, CCRN, Med‐Surg ClinicalNurse Specialist, attended the Harvard TraumaSymposium.Karen Donahue, RN, BSN, CMSRN, Wound Care Center,attended the Academy of Medical‐Surgical Nurses(AMSN) National Convention in Boston, MA.Darren Elsmore, RN, ONC, Operating Room, attendedthe Synthes AO Conference in April 2011Emerson 3 nurses Erin Carey, RN, BSN, BS, CarolynInglis, RN, BSN, and Kelly Wharton, RN, BSN, attendedthe Palliative Care Conference in June.Emerson 3 nurses Patricia Conway, RN, BSN, OCN,and Anna Phillips, RN, BSN, OCN attended the OncologyNursing Society Conference in April 2011.Emerson 4 nurses Patrice Binari, RN, CMSRN, MaryMiller, RN, CMSRN, Connie Norve, RN, CMSRN, andRachel Repoza, RN, CMSRN, all passed the Academyof Medical Surgical Nurses Medical/Surgical certificationexam.Kelly Fitzpatrick, RN, MS, BC, CMSRN, Medical/Surgical Clinical Nurse Specialist, attended the End ofLife Nursing Education Consortium (ELNEC) Training inSan Diego,CA; National Academy of Clinical Nurse Specialists(NACNS) National Convention in Baltimore,MD; and Academy of Medical‐Surgical Nurses (AMSN)National Convention in Boston, MA.Beth Jacobs, RN, BSN, CNOR, Operating Room, attendedthe Pediatric Trauma Conference in May 2011and the Laser Safety Officer Training in July 2011.Kimberly Keville, RN, CNOR, Operating Room, attendedthe “Managing Brain Injury at the Beside”Conference in February 2011.Patricia Madden, RN, Chest Pain Unit attended theCongestive Heart Failure Conference in Boston .Valerie Malinowski, RN, BSN, BC, from the Chest PainUnit, attended the Congestive Heart Failure Conferencein Seattle, WA this past year.Anna Meyer RN, MSN, Emergency Department NurseManager, successfully completed the Organization ofNurse Leaders of Massachusetts and Rhode Island(ONL) leadership course.Connie Rogers, RN, BSN, BC, CMSRN, Center 4, attendedthe Academy of Medical‐Surgical Nurses(AMSN) 2011 Conference and the 2011 Magnet Conference.Lauren Van Luling, RN, BSN, Operating Room, attendedthe Resolve Through Sharing (RTS) BereavementConference in May 2011.Tamethea Willis, RN, BSN, CMSRN, Center 4, attendedthe Academy of Medical‐Surgical Nurses (AMSN) 2011Conference.39

InnovationsRiding the Wave of the FutureTexting Available Shift Information Increases Productivity and Colleague SatisfactionIn an effort to be more efficient with time spentcalling our colleagues to cover shift vacancies, inpatientunits at South Shore Hospital are utilizing anew process that streamlines the way coverage isobtained when a shift becomes available. The goalof this innovative approach is to eliminate at least80% of the phone calls currently made to colleagues(with regards to staffing issues) by using atext messaging option on individuals’ cell phones.Historically, each unit’s operations supervisor ormanager would make up to 25 phone calls in orderto fill a staffing need. This new process allows him/her to contact all available colleagues with just onemessage, which shows up as a text message oneach person’s phone at the same time.The first person who replies that he/she is availablereceives the shift (unless it is overtime). Preferencesfor shifts are rotated if more than one person responds.This new process saves time and has improvedcolleague satisfaction. Many have verbalizedthat they would prefer to receive a text messagerather than a phone call, because it is less intrusivein their lives.The team working on this pilot program utilized the“Five Why’s” of Lean Healthcare when decidingwhether or not this solution would be a better alternativeto the existing process. Based on results ofthe analysis, a decision was made to pilot this processin the critical care units.The names of all colleagues in the unit were listedon either a text message list or voice message list(based on their preferred way to be contacted).When a unit had a shift vacancy, those team memberson the text message list received a standardtext message with the shift details from the operationsmanager or nurse manager.This mode of communication was optional – it wasoffered to streamline the process of calling staffwith important announcements and staffing needs.Those team members listed on the voice messagesystem received a call from the operations supervisoror nurse manager with the shift details. Allmembers who received a text or voicemail wereasked to call back if they were able to pick up theshift.The operations supervisor then called all membersof the team who responded that they were available,and either booked them for that shift orthanked them for their willingness to help. This wasdone as soon as possible depending on the numberof people who replied. (Note: Straight time wasalways considered before overtime.)Anecdotal data from operations supervisors involvedin the pilot program during 2011 (conductedin the critical care units) indicate that significantlyless time was spent filling an empty shift using thetexting notification method than using the traditionalmethod. Enthusiasm from colleagues wasoverwhelming. In fact, colleagues would like to expandthis to include other types of notifications.The pilot was so successful in the critical care unitsthat it was launched in other areas of the hospital inJanuary 2012.40

InnovationsTransforming Care for South Shore Medicare PatientsIn 2011, South Shore Hospital(SSH) and the South Shore VisitingNurse Association (SSVNA),the region’s largest provider ofhome health services, collaboratedwith two local organizationsto streamline healthcare forMedicare patients and help reduceunnecessary hospital readmissions.The South Shore Community CareConnections initiative represents agroundbreaking collaborationamong community health careproviders and service agenciesthat will fundamentally transformthe model of care for Medicarepatients in Southeastern Massachusetts.South Shore Hospital, along withSouth Shore Elder Services(SSES), the primary area agencyon aging which coordinates resourcesand programs for elderpatients on the South Shore, andHarbor Medical Associates, oneof the region’s largest primaryand specialty physician practicesserving residents across the Hospital’sprimary service area, submitteda grant proposal to Medicareand Medicaid Services (CMS)to request funding for CommunityBased Care Transition Programs.The South Shore Community CareConnections proposal sought toaccomplish the goals of the programthrough the implementationof three fundamentalchanges in the current caremodel: Advanced in‐hospital risk assessmentlinked directly withtiered post‐discharge services. The creation and expansion ofnew roles within the individualpartner organizations that areexplicitly designed to coordinatecare across setting transitionswith the clear, commonobjective of avoiding rehospitalization. Establishment of a commoninformation technology infrastructurethat enables sharedidentification of at‐risk patientsand sharing of relevantdata to coordinate care acrosssettings.While the grant proposal was notsuccessful, this project broughttogether a team of communityhealthcare providers and serviceagencies across the South Shoreregion of Massachusetts thatrepresents the spectrum of caresettings experienced by the vastmajority of Medicare patientsstruggling with conditions thatcan often lead to readmission.The South Shore Community CareConnections initiative providedthe opportunity to collaboratewith our community partners,generate forward‐thinking ideas,and change how we – as an organization– look at our care deliverysystem. Several contemporaryideas are already being incorporatedinto practice within theexisting funding capacity of theseorganizations.41

InnovationsUtilizing the Hospital Incident Command Structure (HICS) Huddle:An Information Systems Outage Communication and Planning StructureAs we use technology more often in our practice, itis essential to optimize the systems that support it.In an effort to enhance communication of InformationSystem (IS) outages and solicit input from multipledisciplines for decision‐making, SSH beganusing the Hospital Incident Command Structure(HICS) in 2011, modified for IS issues.A “HICS Huddle” team was created to define thisnew process and included focus groups from Nursing,Administration, Informatics, and InformationSystems, who provided input and brainstormed todefine the huddle. A pilot was developed whichincluded the following steps (based on HICS reportingstructure). As soon as a significant problemwith Information Systems, such as an outage orslowdown, occurs:1. A predefined conference call phone number isbroadcast to the HICS Huddle team, which includesthe IS Director (on call), VP, AdministrativeClinical Coordinator (ACC), Nursing Director(on call), Administrator (on call), Clinical Director(on call), IS Applications Director, and ClinicalInformatics Director.2. Technology troubleshooting occurs immediatelyand the initial report of the problem is sharedwith the group.3. Input is actively solicited from supervisors andadministrators closest to the clinical end‐userwho can give a better definition of the problemthan can be obtained simply from reviewing thetechnology troubleshooting.4. The decision to revert to downtime proceduresis now made together and a communication andaction plan are agreed upon. A decision on whento reconvene is also made.5. Broadcast communication messages are sent toevery charge RN via the beeper system, as wellas to every PC in the hospital warning of theproblem and what to do. A follow up message issent when the problem has been resolved.In addition, a HICS database was established todocument the steps taken, the decisions made, andthe processes used, which is useful for post‐incidentreview of what worked and what needs to be revised.While IS administrator peer groups outside SSHutilize this structure for external emergency responses,no one else is using it for IS operations.Anecdotal results show that the new process is agreat improvement over the old one — frustration isconsiderably less, key decision‐makers feel moreempowered by the process, and decisions are morefully informed and planned — and more robust —because of the input.Using a nationally known structure already in placefor emergencies led to a smooth adoption for nonemergent(as well as emergent) situations in theInformation Systems department. With more involvementfrom Nursing and other administrators,the plans for handling IS outages are better informedand communicated. Overall the new processallows for quicker and better communication,shared decision‐making, and reduced frustration.42

InnovationsHome Care Division Participates in New Medical Home PilotIn 2011, the Home Care Divisioncollaborated with communitypartners on innovative ways toimprove care outcomes for ourshared patients. On August 8,2011 we began a 90 day MedicalHome Pilot with South ShoreMedical Center. The goal of thepilot was to decrease emergencyroom visits, hospitalizations, andcosts for a select group of highrisk, medically complex patients,and to help them remain ashealthy as possible in their homeenvironments.Two VNA nurses, CherylSilipigno, RN, Home Care Practitioner,and Eileen Cleary, RN,VNA Team Leader, were selectedto be care coaches during the trialand together managed 17 TuftsMedicare Preferred patients forSouth Shore Medical Center. Thecare coaches made home visits,provided telephonic management,and coordinated care for thesepatients twenty‐four hours a day,seven days a week.The care coaches also assistedpatients with tasks as simple asarranging rides to appointments,as well as more complex taskssuch as medication reconciliationin order to provide a single sourceof truth for all providers.The care coaches worked collaborativelywith South Shore MedicalCenter, skilled nursing facilities,other VNAs, Elder Services, hospitals,and a multitude of other communityproviders to ensure thatthe patients received the best,most cost‐effective care to assistthem in remaining as healthy aspossible in their homes.The trial was a huge success andnext steps include continuing thismodel in an Accountable CareOrganization structure in FY12 for3,700 managed medical patientsof South Shore Medical Center.Pictured at left: Cheryl Silipigno,RN, and Eileen Cleary, RN, whowere selected to be care coachesduring a new medical home pilotprogram.43

ImprovementsSouth Shore Hospital’s Nursing Division is committedto providing quality care to our patients. Someof the many nurse‐sensitive quality indicators inwhich we strive for excellence include: patient fallrates, ventilator associated pneumonia (VAP) rates,and catheter acquired urinary tract infection rates.These are only a few of the 165 quality elementsthat are being collected by the organization (andthe number is growing!)Tracking Our Fall RatesAnalysis of our falls data revealed the majority ofthe falls are related to toileting. While overall fallsincreased last year, the rate of falls with injuries istrending down. Initiatives such as our new hourlyrounding practice have helped us monitor the qualityof care our patients receive, ensure the safety ofour patients and anticipate their toileting needs.See additional information under Empirical Outcomes.VAP Prevention ChampionsSince the number of patients with Ventilator AssociatedPneumonia (VAP) increased slightly in 2011(7 cases) from 2010 (6 cases), a multi‐disciplinaryteam was developed last year to increase collaborativeefforts to address this problem. In response, wehave increased Respiratory Department monitoring;created education for ancillary departments,such as Diagnostic Imaging, to ensure correct repositioningof patients; made improvements in oralcare; added additional cuff pressure monitoring byRespiratory staff prior to transport; used increasedcare when storing blades used during intubation;completed weekly compliance audits; and utilized"VAP Prevention Champions" to better identifyand correct potential issues.New Ventilators for Preemie PatientsThe new 2011 NRP Guidelines reflect a change instandard of care related to ventilation of the newborn.As a state designated Level 3 Obstetrical Serviceand NICU, it is imperative that we are at theforefront of our field. To that end, we have purchasesix NeoPuffs. These are used for infants at orbelow a gestational age of 32 weeks for the deliveryof blow by O2, CPAP or positive pressure ventilationby bag mask or ETT.Cross‐Training in Parent/Child DivisionThe Birthing Unit, Birthing Unit Triage, and MaternalSpecial Care Unit have begun cross‐trainingtheir colleagues in order to increase individualnurse capabilities and ultimately, their value to theorganization. Cross‐training not only improves theindividual nurse’s skills, but provides a strategiccost effective way to utilize existing staff withouthiring additional staff. They have also begun toreduce unit costs by involving colleagues in brainstormingof new ideas to conserve resources andmoney. One example of how this creativity hashelped save money is the reduced usage of electronicfetal monitoring belts by 50%, which equatesto $28,000 annually.44

ImprovementsPediatric Emergency Department Expands Hours of OperationOur Pediatric Emergency Department expanded its hours of operation from 12 hours a day, to 24 hours aday, 7 days a week, beginning July 18, 2011, in order to better meet the needs of pediatric patients in ourregion. We (and the patients and families we serve) are thrilled, and daily volumes increased 20% beforemarketing initiatives commenced.Pictured at left:Cindy Cooney, RN,BSN, Michelle Sarrat‐Tougas,RN,Judy Nicotera, RN,BSN, CPEN, andMarisa Brett‐Fleegler, MD, worktogether as a teamin South ShoreHospital’s PediatricEmergency Department,nowopen 24 hours aday, 7 days a week.45

ImprovementsNew Ambulance Helps Early DischargesIn FY11, South Shore Hospital purchased an additionalambulance, equipped with Basic Life Supportequipment, to help facilitate early discharges. Thenew ambulance helped increase our capability totransfer patients to other facilities, including specialtyhospitals, skilled nursing homes, rehab facilities,and in some cases home. This is important asfully 20% of our patients are discharged to postacutecare facilities.Patient Family Advisory CommitteeAssists with Obstetrics RenovationsIn FY11, South Shore Hospital’s obstetrics programimproved its “Likelihood to Recommend” patientsatisfaction score (as measured by Press Ganey)from 93.2 (72 nd percentile) for fiscal year 2010 to94.0 (82 nd percentile). In response to patient feedback,the Maternity department is completing asignificant upgrade to their unit. The $1.2 millionproject began in July and was completed in December2011. Planning for the project involved membersof the Patient Family Advisory Committee,current and past patients, nursing colleagues, andleadership. In preparation for the renovations, two“mock up” patient rooms were designed andopened for feedback before final details were determined.Patient satisfaction scores related torooms have already demonstrated great improvementsince the project began.Perioperative Services Works ToImprove Work FlowThe Perioperative Services department made considerablechanges within the department in orderto improve work flow, optimize staff and equipment,and improve the overall patient experience.These changes include the following: Created the "8" bed plan in Post AnesthesiaCare Unit (PACU), expanding capacity to 8 patients,24 hours a day, 7 days a week Added 4 monitored bays to pre‐operative area Re‐designed pre‐surgery evaluation andmoved to an all phone interview process forpatients Moved pre‐surgery evaluation to 797 MainStreet, a larger space, and added on‐site chartroom and lab/EKG for patient convenience Purchased all new endoscopy high definitionequipment, as well as DaVinci Robot to performgynecologic, thoracic and urology cases The New Pain Center has moved to the Centerfor Orthopedic, Spine and Sports Medicineand now has a waiting room, 2 treatmentrooms and 4 consult rooms Realigned managerial oversight within PerioperativeServices Created a dedicated flow facilitator for thePACU46

ImprovementsCritical Care Staff Uses Japanese Methodology to Streamline ProcessesIn an effort to save time, streamline processes, and control waste, several members of the critical careunits have utilized an innovative approach to reorganize the supply closet located in the CCU. Known as“5S”, this increasingly popular organization methodology includes a cyclical process to help achieve efficiencyand maintain order within the workplace. The term “5S” is derived from the five Japanese (andEnglish) words that describe each step of the cycle: (1) sort (2) straighten (3) shine (4) standardize and (5)sustain. It is part of the Lean improvement process which reduces waste by leveraging the knowledge offront line colleagues. Reducing waste and variability in our processes will increase quality and add valueto the provider – and receiver – of care.Pictured above: Margaret Prioli, RN, BS, CCU, stands outside the Critical Care Unit’s newly streamlinedand more efficient supply closet.47

ImprovementsImproving Patient Flow With Use of“Bridging Orders”In 2010, a new emergency code procedure called“Code Help” was mandated by the MassachusettsDepartment of Public Health for all Massachusettshospitals in an effort to ensure successful restorationof ED outflow and capacity within a definedtime frame.At SSH, we developed a process that will help expeditethe patient flow out of the ED into the inpatientarena which provides the patient an additional levelof safety and protection. “Bridging orders” are writtenwhen inpatient beds are available and Hospitalistshave a queue of patients in the ED waiting foradmission orders. Bridge orders will become thenormal way for all medical ED patients to move outof the ED in FY12.Patients who are deemed eligible for bridging ordersmust be clinically stable, non‐ICU patients who arebeing admitted to the hospital under care by thehospitalist group. Other patient flow initiatives duringthe year include the following: Daily 6:30 am patient flow conference call withphysician/nursing collaboration and administrativeleadership Cardiology rounding and development of telemetryprotocol guidelines ED physician and hospitalist collaboration onbridging and Code Help orders, which allowpatients to be sent upstairs to complete theirorders by hospitalists on the accepting floors. “2 X 10” (two patients out by 10 am) and predicteddischarges identified each evening anddocumented on the patient tracker Ancillary departments such as Rehab, Lab, DiagnosticImaging, EMS/ Ambulance Servicesand Environmental Services reworking staffingand work load to accommodate earlier dischargetimes Reassessment of the patient flow alerts, 24/7criteria, and action plans for all departmentsinvolved in patient care Information System tools and databases formetrics documentation Case Management Morrisey Tool provides specificdata on barriers to discharge Patient and Family Care Scripting beginning inthe ED through the patient’s arrival to the floorNDNQI Pain Study ParticipationSouth Shore Hospital was invited to participate inthe NDNQI study, Dissemination and Implementationof Evidence‐Based Methods to Measure and ImprovePain Outcomes, a study funded by the Robert WoodJohnson Foundation’s Interdisciplinary NursingQuality Research Initiative. The goal of this project isto measure and improve pain care processes andoutcomes in a sample of 100 hospitals across theUnited States. This is the first time that NDNQI isgathering data directly from patients about theirexperience with nursing care.48

ImprovementsMEDITECH 5.6 UpgradeThe Clinical Informatics Team, led by Kathleen Melvin, RN, MS,worked with the IS and Pharmacy teams in this major undertaking.This process involved direct caregivers from all clinicalareas providing input, resulting in a major re‐write of manycomponents of the documentation systems, streamlining theworkflow in many areas. The work that was accomplished bythe many team members demonstrates their complete dedicationto the patients, families and peers that we serve.Their teamwork demonstrated great synergy in the collaborationbetween the clinical and information system colleagues asthey worked to ensure that the end‐product would meet theneeds of the many users. The core team – with the support of100 super‐users – was vital to the successful implementationby providing support throughout the clinical areas. Over 500changes were made in the week after go‐live, during which thesuper‐users provided 24/7 support.Pictured above: Kathleen Melvin, RN, MS,who led the Clinical Informatics Team duringlast year’s Meditech 5.6 Upgrade.Pictured below: Jill Ribbe, RN, SICU, andAlicia DelPrete, RN, BSN, ONC, P4S, preparefor our information system upgrade.49

ImprovementsNew Initiative Launched to HelpDischarge Patients By NoonMembers of Nursing and Case Management Departments,along with our physician colleagues,worked together to launch a new initiative to helpdischarge more patients by noon. This initiative hasnot only helped with patient flow, it has helped toshift and reduce a great deal of the work structurethat was directed toward the late evening and nightshift, where resources are significantly decreased. Inaddition, it has assisted in making additional bedsavailable earlier, which helps off‐load the ED/PACU,as well as other inpatient transfers, earlier and moreefficiently. On average, we discharge 16 to 17 patientsper day before noon, seven days a week. Ourgoal is to get 50% of all discharges out by noon andwe are currently at 60% of our target.Skin & Wound Resource Group (SWRG)Reinforces Good Clinical PracticeThe Skin and Wound Resource Group continued toconduct its quarterly pressure ulcer audits. Over thepast five years, the result of the audits have shown adramatic reduction in the prevalence rate – from 12percent in 2006, to less than 3 percent today, whichwe are proud to say is half of the national average.These audits reinforce the importance of good clinicalpractice, as well as proper documentation – bothof which are critical as we enter the new world ofhealth care “pay for performance” regulations andrisk losing reimbursement for pressure ulcers thatoccurred while a patient was hospitalized.Help Home Program Helps FacilitatePatient’s Transition HomeIn June 2011, South Shore Hospital launched a pilotprogram to help patients get home quickly andsafely. The Help Home Program (HHP) runs from 9am to 2 pm, and has a clearly defined selectionprocess around the patients who can participate inthe program. Patients preselected by Case Management,in collaboration with Nursing and physicians,are transported to the "Discharge Lounge", locatedin the newly renovated and comfortable lobby ofthe EDTU. Once there, the patient is able to waituntil his or her family arrives and is then escorted tothe car by our helpful valets and attendants. If apatient’s ride is unavailable, transportation home isprovided by South Shore Hospital at no cost, andoccurs via a comfortable van staffed by SSH EMTsor paramedics. While patients are waiting in thelounge for an expected 1‐2 hour time frame, a dedicatedliaison is available to help with all nonmedicalrelated concerns (such as ambulation to thebathroom, food, etc.) Since the inception of thisprogram in June, we have received an impressiveamount of positive patient feedback. Use of thecourtesy van, which drove 84 patients home in themonth of August, is growing as more departmentsbecome aware of this service. Since the beginningof the program, the discharge waiting area has seena 21% patient utilization rate and continues tothrive.50

ImprovementsPictured above: Fran Lonergan, RN, Emerson 3, takes a break from daily activities to flash a smile forthe camera and show off a new, patient‐designed white board.51

ImprovementsHome Care Division Recognized for TheirWork to Reduce Hospitalization RateIn the fall of 2011, the Home Care Division’s publiclyreported outcomes were published for the time periodof July 1, 2010 through June 30, 2011. Overall,we met all state and national rates, and exceededstate and national rates in all but one category. Theoutcome that is really exciting is our acute care hospitalizationrate. This represents the risk adjustedpercentage of patients who are hospitalized whileon service. The lower the percentage, the better.Our rate for this reporting period was 19%! The averagerate across Massachusetts is 28% and nationally,27%. This represents terrific work by all membersof our organization, out in the field and in theoffice, and we should be extremely proud. Eventhough the outcomes are only based on OASIS fromthe VNA, the availability of great sister programs (inboth Home and Health Resources and Hospice) isvery instrumental in keeping our patients safely athome.New Employee Badges Provide StaffAdded SecurityAfter concerns were brought up through the SharedGovernance Practice Council that staff memberswere uncomfortable about having their last namesvisible on their ID badges, South Shore Hospitalidentification badges have been re‐issued to all inpatientunit staff members with only individual'sfirst names listed on them.New Hourly Rounding Pilot Aims toImprove Patient Care and SafetyIn May 2011, three units in the Medical/SurgicalCritical Care Division — Pratt 3, Center 4, and Pratt 5— started an hourly rounding pilot program. Prior tothe launch, an hourly rounding task force — consistingof front‐line nursing staff, nursing assistants,unit secretaries, managers and clinical nurse specialists— had met for four months. They collected data,and prepared and refined processes to ensure oursuccess in this pilot roll‐out. In order to evaluate thesuccess of this pilot, the team reviewed the totalnumber of patient call lights activated during eacheight‐hour shift, as well as the utilization of pedometersto track the distance walked by staff.One specific unit at SSH independently tried hourlyrounding for an eight hour day shift and noted only4 call lights the entire time—drastically less thanwhen hourly rounding is not conducted. Hourlyrounding is a powerful tactic that is proven to produceamazing results, including: improved clinicaloutcomes, decreased fall risk, reduced call lights,increased patient satisfaction, improved colleaguesatisfaction and reduction in the amount of unnecessarywalking.52

ImprovementsMaternity Streamlines WorkflowConscious of decreasing non‐value added actions,cabinets at each nurse’s station were organizedwith the most often used supplies to decrease theamount of time and distance staff had to travel toretrieve items. One Unit Coordinators spent timeevaluating the admission packet in order to decreaseduplication and remove inaccurate information.Now colleagues are ordering clean and neatcopies of information from the Print Shop for patients.This decreases the amount of time theyspend at the copy machine as well as the amountof printer paper usage.Birthing Unit Patients and FamiliesNow Involved in Discharge ProcessIn response to Press Ganey patient satisfactionresults, as well as the Coremotive project to improvepatient flow and decrease boarding in theBirthing Unit, the Maternity & Infant Unit is activelyworking to improve the discharge process.Discharge is now part of the white board educationand improved procedures have streamlined “day ofdischarge” activities. Patients and families are educatedon what to expect and anticipate on the dayof discharge. An improved favorites list of medicationsfor Med Reconciliation, and a decrease in thenumber of signatures required at discharge havecontributed to a more timely discharge process.Colleagues are actively engaged in the process andprogress is measured on a daily basis by monitoringhow many patients have discharged to homeby 11:00 am, 12 noon, and 1:00 pm. Progressgraphs are updated weekly.Optimizing Patient Flow in Birthing UnitLast year, we engaged the help of a consultinggroup, Coremotive, to assist South Shore Hospitalin optimizing patient flow though the Birthing Center,and to reduce the Caesarean section rate asappropriate. Through the effective use of methodologiessuch as Lean and Six Sigma, SSH will realizeimproved processes affecting Birthing Centeroperations, greater patient safety and satisfaction,greater staff satisfaction and sustainable cost savings.The main objectives of this initiative include:improved patient throughput (flow), improvedstaff productivity, improved procedure scheduling,and improved mechanisms to reduce C‐sectionrate. Preliminary results demonstrated a decreasedfrequency of boarding patients in the Birthing Unitafter delivery, a decreased length of stay for caesareandeliveries, a higher percentage of on‐timestarts for our 8 a.m. scheduled caesarean deliveriesand a decrease in our C‐section rate. In addition, afocus on nursing communication around preparationfor discharge and the discharge process resultedin increased patient satisfaction scores. Sixmonth results have shown a sustained 10% reductionof the C‐section rate, from a baseline of 42%down to 38%.53

ImprovementsSTABLE Program Comes to SSHUnder the leadership of Lisa Rengucci, RNC, MS,IBCLC, Clinical Nurse Specialist for the Mother &Infant Unit, we were able to bring the STABLE programto SSH. This internationally recognized programis designed for nurses, doctors, respiratorytherapist and EMT’s to recognize and stabilize atrisknewborns until they have reached the appropriatelevel of care. To date, 30 of our colleagues aswell as several of our community partners havebeen STABLE certified at SSH. In December wewill offer the STABLE cardiac program. Both programswill be offered twice a year going forward.Updated DNR Policy to IncludeLimited Code MeasuresIn 2011, South Shore Hospital updated its policyregarding “Do Not Resuscitate” (DNR) Orders andadded a new “DNR and Limited Code Procedure”for all areas except for the Neonatal Intensive CareUnit (NICU). While many people know what “DNR”means, it is mistakenly used for a variety of otherorders as well. Color‐coded bracelets now providevisual confirmation of a patient’s code status.Every eight hours, the nurse must verify that thecorrect band and clip are still in place by verifyingthem against the most recent physician order, andthen document this in the nursing interventions.This initiative was led by a multidisciplinary teamheavily populated by nurses, and builds on the patient‐centeredwork to support families at the bedsideduring a code.Maternal Special Care Unit OpensIn March of 2011, the Maternal Special Care Unitwas opened on the second floor of the Emilsonbuilding, contiguous with other obstetrical servicesfor optimal quality, clinical coverage, and patientflow. This unit is designed to support high risk antenatalpatients of any gestational age and highrisk post partum patients. The unit is equippedwith 10 monitored beds for both fetal monitoringand cardiorespiratory monitoring and is staffedwith trained high risk antenatal registered nursesable to provide the necessary care.Each registered nurse is required to be certified inthe Neonatal Resuscitation Program, which providesemergent care to newborns, and AdvancedCardiac Life Support for adults. Our daily censushas continued to rise over the last few months (anaverage of 6 patients per day in the past 6 months)as the awareness grows that this critical service isnow available to the community and patients donot need to be transferred to other facilities forcare.Colleagues continue to enhance this service byscheduling events and celebrations for their longtermpatients. During Hurricane Irene, for example,the nurses hosted a “Hurricane Party” withcake, decorations and music. This provided a welcomediversion for the patients, who often stay 2to 12 weeks.54

ImprovementsEvidence Based IV Practice ChangeImplemented to Decrease RiskIn 2010, South Shore Hospital went heparin flushfree as evidence now supports saline to be as effectiveas heparin, while decreasing patient risk. Heparinis an anticoagulant used to prevent a patient’sblood from clotting. It is commonly used in lowdoses in an effort to prevent thrombosis and maintainpatency of centrally placed catheters. Since2006, heparin has been a high profile drug in themedia and in health care. The drug was the cause ofat least 62 deaths in 2008 and has sickened hundredsdue to an active pharmaceutical ingredient.(www.fda.gov/Drugs/DrugSafety/.../UCM112597)After removing heparin from the flush protocol, thehospital saw occlusion rates decrease or stay thesame. Continued efforts to reinforce this new protocolremained in place in 2011, as we strive to keepour patients healthy and safe.cavity. These newer alternatives to more traditionaltechniques help improve the quality of care for ourpatients.Pediatric Unit Receives GrantIn November of 2010, the Pediatric Unit wasawarded a $25,000 grant from the Ronald McDonaldFoundation, which provided support for refurbishingthe inpatient pediatric lounge. The roomwas updated with sleeping sofas for parents, newtoys, a big screen TV and computer for families, andupdated décor.IV Nurses Utilize New and Safer Waysto Access Patients’ VeinsIV nurses have recognized that rapid vascular accessis needed for the administration of medications andfluid, and can make the difference between life anddeath in critical or unstable patients. Our IV nursesare using alternative ways to get access, such asintraosseous (IO) access and insertion of PICC linesin the internal jugular vein guided by ultrasound.Intraosseous access is defined as the placement of avascular device with a tip located within the bonematrix and is used to introduce fluids or medicationsinto the systemic circulation via the marrowIrma Sivieri, RN, BSN, CRNI, VA‐BC, IntravenousTherapy, demonstrates use of ultrasound invenipuncture.55

ImprovementsMulti‐Year Effort Continues: Safe PracticeInitiative Needs Evaluation (SPINE)In 2011, members of the Med/Surg Division wereissued gait belts so every nurse and nursing assistantwould have individual equipment for theirexclusive use. Training was provided for them duringSkills Day by the SSH Rehab Department. Inaddition, two more ceiling lifts, four more mobiledevices and widespread roller boards were purchasedto make patient lifting easier and safer.Injury rates associated with lifting c0ntinue to be aconcern. Our goal is to reduce them by 50% overthe next three years with the help of the SPINEinitiative.New Center for Orthopedic, Spine andSports Medicine OpensOn September 23rd, 2011, the Ambulatory SurgicalProgram previously located at 780 MainStreet, closed and all orthopedics volume theremoved into the new Center for Orthopedic, Spineand Sports Medicine facility located at 2 PondPark, Hingham. The new facility opened in October2011 with 6 operating rooms, 18 pre‐ and postoperativebays, and a treatment room. Anothertreatment room is in the process of being built inthe Messina Building, on the 3 rd floor just outsideof the Main OR. This new treatment room addressesa clinical infrastructure gap that has beenidentified by our surgeons, and will be staffed byOR nurses.Off‐site Childbirth Education OfferedIn November of 2010, SSH partnered with ISISParenting to provide childbirth education classes,and early parenting education to our patients andtheir families. Classes are taught at the ISIS site inHanover and in June of 2011, ISIS added classes atAtlantic Women’s Health in Plymouth, MA. IsisParenting's educational programs support expectingand new parents from pre‐conception to achild's third year of life, with a strong focus onpregnancy wellness, childbirth preparation, newbornand infant care and safety, breastfeeding,sleep support, new parent adjustment and childdevelopment offerings. SSH continues to provideextensive hospital‐based educational programsincluding our breastfeeding support group, preandpost‐natal exercise programs, and support forthose experiencing miscarriage, pregnancy loss, orpostpartum depression.Lactation Consults on the RiseThe Women’s and Family Health Lactation Departmentincreased their consults by more than 70visits in 2011 as a result of directed Late PretermInfant education presented at the unit competencyday.56

ImprovementsNew Pediatric Intravenous PumpsThe Pediatric Department identified a need to havespecial Intravenous Pumps for our pediatric patientswhich would provide an extra level of safety.The existing SMART pumps which were in use didnot provide the level of control necessary for thepediatric patient. After a multidisciplinary review,Carefusion Alaris pumps were purchased at a totalcost of $250,000. A team from Nursing, Pharmacy,Information Systems and leadership was establishedfor selection, programming and implementation,in both the Inpatient Pediatric Unit and thePediatric Emergency Department. The pumpshave been in use since August and have addressedthe concerns around pediatric intravenous medicationadministration. Feedback from front‐line colleaguesand users has been uniformly positive.Pediatric Hourly Rounding ImprovesLikelihood to Recommend ScoresOur inpatient Pediatrics Department has improvedpatient satisfaction through a collaborative approachwith physicians and staff. In June, the pediatricunit implemented hourly rounding, which hasbeen tailored to the specific needs of the pediatricpatient. Staff reviewed patient satisfaction questionsto determine what specifically could be addressedduring hourly rounding. Colleagues implementedhourly rounding using the acronym“PEDIO” to direct their rounding assessments andinterventions on P – Pain, E – Education, D – Dietaryneeds, I – IV assessment, and O – OtherPictured above: Kathy Burke, RN, Pediatrics, is allsmiles while she updates patient information on arolling computer.(including caring moments). In addition, nurses andphysicians round together each morning and afternoon,which has improved satisfaction related tophysicians and patient’s inclusion in plan of care.Since implementing changes, the overall“Likelihood to Recommend” scores have improvedfrom the 32 nd percentile in the second quarter tothe 93 rd percentile in the third quarter of 2011.57

ImprovementsCatheter Associated UTI’s (CAUTI’s) Taskforce Creates Care GuidelinesAn interdisciplinary taskforce consisting of colleaguesfrom Nursing, Quality, Information Systemsand Infection Control continued its work on reducingthe incidence of catheter associated urinarytract infections (CAUTI’s) — the most common typeof hospital‐acquired infection — by providing guidelinesand education around best practices for usingcatheters properly. Evidence clearly demonstratesthat CAUTI’s are related to the duration of time adevice is left in place.SSH specific data on urinary tract infections weregathered and benchmarked with past data and withhigher performing facilities. (For more information,see graph under Empirical Outcomes section.) Areview of the literature identified specific interventionsthat were not currently in practice or were notconsistently being used .This multidisciplinary task force was appointed toreview all current processes, conduct a gap analysis,and make recommendations for change. A comprehensiveCAUTI reduction program was designed,which included the development of a Clinical CareGuideline based on CDC CAUTI Prevention Guidelines(see below) and a robust educational program.1. Use of bladder scanners to prevent unnecessarycatheterization2. Daily assessment for removal of catheter3. Proper hand hygiene4. Maintaining a closed system, avoiding contaminatingdrainage spigot, and maintainingunobstructed urine flow to drainage bag5. Consistent use of a catheter securement device6. Visual reminders in the form of a red stop signaffixed to each urinary catheter drainage bagand a similar magnetized sign for white boards7. Inclusion of patients and families to empowerthem to ask each day when the catheter canbe removed8. Discussion of patients with catheters eachmorning during huddle to ensure timely removal9. Changes were made to the Electronic MedicalRecord in order to capture insertion time/date/name of person inserting; to prompt assessmentevery 8 hours; to continuously assesscontinued need for the catheter; to verify thatthe securement device is intact; to verify theneed for the catheter still exists; and to recordcatheter care is performed10. Requiring daily renewal orders in the computerizedphysician order entry system11. Development of a nurse driven urinary catheterremoval protocol and algorithmEducational programs were held by Infectious Diseasephysicians, who targeted hospitalists, and includedinformation on ways to reduce the need forbladder catheters primarily, and if a catheter isdeemed essential, a mandate to remove the catheterat the earliest opportunity.58

ImprovementsParent Child Division Assesses Fall RisksNational Patient Safety Goal # 9 focuses on reducingthe risk of patient harm resulting from falls.The Parent Child division recognized that the assessmenttool for the medical/surgical patient didnot apply to either the pediatric or the obstetricalpatient. As a result, the Clinical Nurse Specialistsfor these areas helped the staff review availableassessment tools which are specific to these typesof patients. Changes to the Fall Risk Assessmenttools are in process to assure that assessments arepertinent to the specialized populations served andthat Nursing is able to continue to assure for optimaland individualized safety in reducing falls.Bedside Medication Validation (BMV)Implemented in the NICUIn February 2011, the Neonatal Intensive Care Unitimplemented Bedside Medication Verification(BMV). While this was the last area for BMV implementationat SSH, the needs of the neonate wereextremely complex and required a collaborativeeffort between physicians, Nursing, Pharmacy,Clinical Informatics and IT to assure continuedquality care for this fragile population of patients.The BMV project has taken 18 months and $2 millionin resources, but along with ComputerizedProvider Order Entry (CPOE), it provides nursesand patients with the very best evidence‐basedtechnology and tools to reduce medication errors.For more information, see page 73, under EmpiricalOutcomes.Maternity Department OffersEmergency Response TrainingThe Maternity Department offers unit‐based, staffledEmergency Response Training education. EldaDaly, RN, CBE, and Ann Kenison, RN, BS, scheduleand teach classes, and monitor expiration dates forstaff. Discussions during the session focus on potentialobstetric emergencies.Heart Failure Pathway Developed toAssist Challenging PatientsIn 2011, South Shore Hospital’s Department ofNursing, in conjunction with the Department ofCardiology, developed a heart failure pathway tomeet the needs of this challenging group of heartfailure patients. The pathway looks across the continuumfrom medications to spiritual support andeverything in between, including ED to dischargetransition. It fosters nurse/physician communication,thereby elevating nursing practice and providingenhanced patient care. It challenges nurses tosee the “big picture” from things as fundamental astaking weights and other intake and output measures,to titrating medications, in order to achievedesired goals and meet core measures. The programhas been piloted and the plan is to “go‐live”hospital‐wide in early 2012.59

ImprovementsEMERGENCY PREPAREDNESS DRILLS AT SSHDuring 2011, colleagues had the opportunity to participatein a series of hospital incident commandtraining series on evacuation. South Shore Hospital’sIncident Command (HICS) training series thisyear included four sessions for leaders and staff tolearn and practice activities in the emergency operationscenter during a disaster. Sessions were heldfor the command staff, operations, planning, logistics,and finance sections, with the focus on facilitydisasters that would impact operations and potentiallyforce us to evacuate.In addition to HICS training, SSH colleagues participatedin several emergency preparedness drills in2011 including:CODE PINK / INFANT OR CHILD ABDUCTIONcourse of the exercise. As the building was lockeddown and witnesses provided information to Securitypersonnel, they were able to quickly apprehendthe suspect in the parking garage.REGIONAL EMERGENCY PREPAREDNESS DRILLLast June, 30 South Shore Hospital leaders participatedin a two‐hour regional emergency preparednessfunctional exercise in conjunction with the HarvardSchool for Public Health’s Center for PublicHealth Preparedness. This functional exercise allowedthe 14 hospitals within the MassachusettsPreparedness Region 4AB to practice activities relatedto cross‐agency coordination and activation ofa memorandum of understanding (MOU) during aregional public health emergency scenario.In March, SSH conducted a “Code Pink”, or infant/child abduction exercise, with the Weymouth PoliceDepartment to test our emergency preparednessplan and security procedures that are in place forthis type of event. During "Code Pink" all departmentsmonitor stairwells, entrances and elevators,and the Security and Public Safety Department“locks down” all entrances and parking lot exits.Areas of improvement to the plan and procedurewere identified.The scenario involved a female patient carrying an“infant” in a carrier, who was being held in the hallwayof the Emergency Department, and an unidentifiedperson who abducted the child during theCODE YELLOW & CODE EXTERNAL DISASTERIn September, South Shore Hospital participated ina town‐wide emergency preparedness exercisealong with several community partners, includingthe Weymouth fire, police, emergency management,and public works departments, as well asFallon Ambulance. The simulated scenario involveda chlorine tank that ruptured at the local watertreatment facility, exposing employees and a groupof visitors to a dangerous chemical. The purpose ofthis exercise was to evaluate the town‐wide responseto a hazardous material event and masscasualty incident, with each town entity having itsown objectives and agenda in the exercise.60

ImprovementsPictured above: Nursing assistant Elvida Cantave (left of “patient”) and Susan Meighan, RN, BSN, ClinicalCoordinator, Emergency Department (right of “patient”) participate in a town‐wide emergency preparednessdrill in 2011.61

Transformational LeadershipAt South Shore Hospital, our nurse leaders strive to motivate colleagues and engage them to find meaningand value in their work, as well as make contributions to our organization. In 2011, Chief Nursing Officer,Timothy Quigley, RN, MBA, NEA‐BC, communicated our vision to nurse colleagues through openforums which focused on the future of Nursing at SSH. In addition to providing valuable information tocolleagues, these forums helped promote intellectual stimulation by engaging colleagues to work together,and by asking for — and valuing — their feedback. This two‐way process was not only valuable ineliciting ideas and suggestions from nurses, but in providing them with the tools they will need to performtheir jobs in the future.The role that our front line colleagues play in the transformational leadership process at SSH in critical.Specifically, nurses were taught about the urgent need to improve core measure performance and patientexperience scores, and designed processes to do exactly that. Nurses are now held accountable tomeasurable outcomes of their practice. When you map out these scores from those aforementioned areas,they spiked upwards in 2011 due to these focused efforts. Nurses also attended numerous open forumswith the CNO and sought out literally hundreds of external and internal learning opportunities tohelp understand the changing health care environment and to thrive within it. In addition to the SimmonsMHA program, the groundwork was laid for a new MSN program that began in January 2012. Finally, SSHinvested significant funds and resources in 2011 in order to further develop twelve nurse leaders throughthe use of executive coaching.In 2011, South Shore Hospital continued to develop all existing leaders — as well as prepare new leaders —for future challenges that we expect to encounter in the delivery of health care throughout the next fewyears. Colleagues in leadership positions were invited to attend quarterly off‐site meetings that focusedon topics relevant to our organization such as Active Listening, Social Engineering and Continuous Improvement.In addition, our Leadership Development Series, offered to all leaders in 2011, focused on thefollowing topics: A Culture of Safety: Accountability versus Blame, Understanding and Building Trust inthe Workplace, Quality Tools for Health Care Leaders, and Financial Accountability for Health Care Leaders.The organization also provided education and/or training sessions on topics such as: Absence Management,Behavioral Interviewing Skills, Conflict Resolution, Corrective Action and How to Conduct an Investigation,Difficult Conversions, Fair Labor Standards Act, How to Write a Job Description, Introduction tothe Culture of Service Excellence, The Joint Commission, Leadership Development for New Leaders, PerformanceManagement, The Power of Behavioral and Peer Interviewing, Setting Goals, and Sexual Harassmentin the Workplace.62

Transformational LeadershipThe Art of Active Listening: Do You Hear What I Hear?Communicating with colleagues isone of the most important thingswe do as members of South ShoreHospital. It doesn’t matterwhether that colleague is a frontlineclinician, physician, communitypartner, or a member of ourexecutive team – how we interactwith each other drives our abilityto execute our strategic plan andultimately meet the needs of thecommunity we serve. Communicationis made up of many interrelatedcomponents; one of themost important of these is activelistening. Once developed, the artof listening becomes the foundationfrom which we build programsand teams together.Over the last several years, ourleadership meetings and quarterlycolleague forums introduced theguiding principles of Patient andFamily Centered Care. These principlescan and should be applied tocolleagues as well. Each day wespend three fourths of the hoursthat we are awake reading, writing,speaking and listening, andout of that time, 40‐50% is (orshould be) spent listening. However,unlike reading, writing andspeaking, which have a wide arrayof formal and informal educationalprocesses during the course of ourlifetime, only two weeks of formaltraining is dedicated to the art oflistening.Truly listening to someone meanstranscending your own story – bygetting out of your frame of reference,value system, history andjudging tendencies – and embeddingyourself into the frame ofreference or viewpoint of anotherperson. Only when empatheticlistening occurs do we hear thingsfrom the perspective of the personwho is speaking.Active listening does not end withthe conversation. Once you hearthe voices of your colleagues, thenext step in the process is providingfeedback, which can come in avariety of ways and should occurdaily. When ideas, suggestions orfeedback are received, a responseis necessary. It does not matter ifthe idea, suggestion or feedbackwill be acted upon. The key is toprovide the response and explainwhy it was accepted or declined,and acknowledge that we valueinput from all colleagues.How Can We Do Better? Really listen to the voices ofour colleagues (be an activelistener) Provide feedback when suggestions,concerns or ideas areshared (whether ideas areaccepted or declined) Ask colleagues for their inputfirst, not last (inclusion in decisionmaking) Look for mutually beneficialsolutions to problems or issuesas they ariseWhen we actively listen to thevoices of all our colleagues, webecome transformational leadersand agents for change. As leaders,we need to challenge ourselves toprovide the structure for change tooccur.63

Transformational LeadershipThe following section displays indices of leadership and professional practice environment as measured byfront line nurses using the National Database of Nursing Quality Indicators (NDNQI). We measure theseannually and in 2011, we exceeded the national benchmark in 14 of 18 categories for non‐teaching hospitals.Nurse Autonomy (Measured by NDNQI)Mean Score585654525048464456.1254.82 54.5452.5549.6649.2647.0045.362004 2005 2006 2007 2008 2009 2010 2011PleaseNote:A score of40 or better= GOOD.A score of60 or better= VERYGOODDecision Making (Measured by NDNQI)Mean Score53514947454341393751.5048.8748.5046.9544.8844.2041.8738.272004 2005 2006 2007 2008 2009 2010 2011PleaseNote:A score of40 or better= GOOD.A score of60 or better= VERYGOOD64

Transformational LeadershipProfessional Status (Measured by NDNQI)Mean Score716967656361595769.4967.34 68.1963.0163.8960.8959.8657.612004 2005 2006 2007 2008 2009 2010 2011PleaseNote:A score of40 or better= GOOD.A score of60 or better= VERYGOODJob Enjoyment at SSH (Measured by NDNQI)615959.61PleaseNote:Mean Score575553514949.9152.2755.2053.1955.6956.5455.312004 2005 2006 2007 2008 2009 2010 2011A score of40 or better= GOOD.A score of60 or better= VERYGOOD65

Transformational LeadershipAdapted Nursing Work Index Scales (Measured by NDNQI)Mean Score6459544944PleaseNote:A score of40 or better= GOOD.2004 2005 2006 2007 2008 2009 2010 2011Nursing AdministrationNursing ManagementA score of60 or better= VERYGOODProfessional DevelopmentNurse Manager is Good Leader (Measured by NDNQI)Mean Score63626160595858.0261.2559.4658.4760.7562.5462.8361.85PleaseNote:A score of40 or better= GOOD.A score of60 or better= VERYGOOD2004 2005 2006 2007 2008 2009 2010 201166

Transformational LeadershipCareer Development Opportunities (Measured by NDNQI)Mean Score696459544967.8162.23 62.09 62.6860.9158.1854.8349.872004 2005 2006 2007 2008 2009 2010 2011PleaseNote:A score of40 or better= GOOD.A score of60 or better= VERYGOODSatisfied With Job (Measured by NDNQI)686667.81PleaseNote:Mean Score646260585664.4262.69 62.6061.70 61.8162.0056.882004 2005 2006 2007 2008 2009 2010 2011A score of40 or better= GOOD.A score of60 or better= VERYGOOD67

Transformational LeadershipWould Recommend SSH to Friend As Place of Employment(Measured by Culture Audit)4.84.754.74.64.63Mean Score4.54.44.34.534.354.534.24.14.152006 2007 2008 2009 2010 2011Scale: 1=strongly disagree, 2=disagree, 3=tend to disagree, 4=tend to agree, 5=agree, 6=strongly agreePictured at left:Case Manager PatriciaSuslo, RN, spends afew minutes at her PCbefore seeing patients.68

Transformational LeadershipPictured above (left to right): Case Management Leadership — Alison Conlon, RN, MSN, ACM, Supervisor,Susan Medici, RN, MM, ACM, Director, Susan Fitzgerald, RN, BSN, ACM, Manager, and Charlene Long,RN, BSN, ACM, Supervisor, work together to help our patients return home as quickly as possible.69

Empirical OutcomesThe following section of empirical outcomes demonstrates the rapidly evolving and converging fields ofnursing science, performance improvement, and nursing informatics. We are proud to present these outcomesand continue to strive to exceed national benchmarks and use 100 percent sampling in evidencebasedsystems. We have begun to transition into a Lean environment and are guided by a philosophy ofzero defects, designed by the professional nursing colleagues at the front line of care delivery.4Combined Medical/Surgical & Critical Care Fallsand Falls with Injuries By Month3.5Falls per 1,000 Patient Days32.521.510.50Q108Q208Q308Q408Q109Q209Q309Q409Q110Q210Q310Q410Q111Q211Q311Q411Overall MS‐CC FallsLinear (Overall MS‐CC Falls)Overall MS‐CC Falls with injuriesLinear (Overall MS‐CC Falls with injuries)Since benchmarking with NDNQI in 2008, many falls initiatives have resulted in a steady decline of patientfalls, keeping us well below the national benchmark for non‐teaching hospitals. Falls with injuries havemodestly declined during this time, with almost half of the quarterly rates below the NDNQI benchmark.70

Empirical OutcomesCAUTIs per 1,000 Patient Days Number of Foley Days25002000150010005004.003.503.002.502.001.501.000.500.0002286 2348 19223.062.982011 Foley Catheter Days2.602174 21832.300.921758 1860 17942.840.543.341613 1638 2109Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecFoley Cath DaysLinear (Foley Cath Days)Despite a steady reduction in foley catheter days in 2011, and an initial promising decline in CAUTI ratesbelow the mean NDNQI benchmark for non‐teaching hospitals, the decline was not sustained.2011 Catheter Associated Urinary Tract Infections1.241.832.37Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec17112.9271

Empirical OutcomesVentilator Associated Pneumonias By MonthVAPs per 1,000 Vent DaysAlthough we haveused NDNQI benchmarksto promotepractice changesand have adoptedan evidence‐basedVAP bundle of care,we have not experienceda consistentdecline in VAPrates.2011 Hospital Acquired Pressure Ulcers By YearPercent HAPUWe have had a very successfulpressure ulcer reduction programsince our initial benchmarkingwith NDNQI in 2006,with sustainable results wellbelow the mean NDNQIbenchmark for non‐teachinghospitals. In the past 4 years,our prevalence has been belowthe benchmark for all but 2quarters for Med/Surg and 3quarters for ICU.72

Empirical OutcomesTotal # of Reported Medication Errors270260250240230220210265EMAR and BMVImplemented235CPOEImplemented213200FY 2009 FY 2010 FY 2011In October 2009, South Shore Hospital went live with a new electronic medication administration record(EMAR) as well as a bedside medication verification system (BMV). In October of the following year,computerized physician order entry (CPOE) was rolled out to providers. During this time, our reportedmedication errors decreased by 20% from 265 in FY 2009 to 213 in FY 2011.Pictured at left: PACU nurses ElaineCampbell, RN, BSN, CPAN, PatriciaHeenan, RN, BSN, CPAN, and CynthiaGrasso, RN, administer meds using thebedside medication verification system.73

Empirical OutcomesPress Ganey Patient Satisfaction Score for Likelihood of RecommendingMeanScore100PercentileRank999089.795.68980797078th77.76960595057th494039302920191014th90Inpatient Outpatient Emergency DeptMeanPercentile Rank‐1Inpatient Pain “Top Box” Scores / Percentile Ranks% of Responses'Always'90%90thPercentileRank9980%8970%60%50%40%70%45th61%78%65%796959493930%2920%15th1910%6th90%Q1 Q2 Q3 Q4Top Box (Pain Always Controlled)Percentile Rank‐174

Our Nurses Make a Difference Every Day!Pictured above: (sitting) Jessica Viola, MD, Internal Medicine Hospitalist; (standing, from left to right) JillDunbar, RN, Jennella Coutts, Discharge Specialist, Dorothy Niland, RN, MPH, ACM, Case Manager,Charlene Long, RN, BSN, ACM, Supervisor Case Management.75

55 Fogg Road, South Weymouth, MA 02190‐245576