2010 Nursing ANNUAL v4d - PinnacleHealth

Standardization of DialysisUnit Equipment andProcesses Saves $240,000Over the past two years, PennyFrownfelter, Director of Nursing, has ledthe merger of the Dialysis Units at theHarrisburg Campus and CommunityCampus to form one cohesive unit. Inspite of the challenges of two separatelocations and a variety of differencesbetween processes and policies, the finaloutcome of a combined department hasresulted in better care for our patients,increased staff satisfaction, and a costsavings of $240,000. The followingchanges were initiated with great success:• Creation of a nurse manager positionto oversee both Dialysis Units. Thisposition was filled by KathleenGarcia, RN.• Staff worked collaboratively todetermine which supplies andequipment would be stocked in eachunit.• A Pyxis machine and MAK softwarewere installed for more efficient, safemedication administration.• The nursing unit budgets werecombined to one cost center topromote more effective staffingpatterns.• A day shift charge nurse position wascreated to facilitate patientassignments and flow.• One on-call nurse was designated tocover both units to improve responseto fluctuations in work load.• All staff members rotated throughboth units to improve consistency ofpatient care.• A Dialysis nurse represents the uniton the Practice Council. This inputresulted in a pre-printed order set toenhance care processes.• A dedicated Dialysis Intranet siteprovides nurses with easy access toimportant dialysis policies, hours ofoperation, and resources fordialyzable medications.Emergency DepartmentThroughput DramaticallyImprovedSheri Matter, CNO, has beeninstrumental in championing the EDthroughput project to improve patientflow, financial outcomes, patientsatisfaction, and quality outcomes. Sherimet with Emergency Departmentmanagers and staff to identify ways toimprove the throughput process atCommunity General. Six Sigmamethodology was utilized to eliminateerror and reduce variation in processes.In March 2008, an interdisciplinary SixSigma team was formed to examine thisproblem and multiple strategies wereimplemented to address the major issues.With the success of the CGH Throughputinitiative, a Six Sigma project for EDThroughput at Harrisburg Hospital wasinitiated resulting in improvements inED length of stay and patients leavingwithout treatment (LWOT). At bothcampuses the LWOT rate has decreasedby 50%. The creation of the PatientLogistics Center and implementationof the TeleTracking System has also hadsystem-wide impacts. It has centralizedprocesses for patient placement and haseliminated the need for direct admitpatients to be sent to the EmergencyDepartment. The system has also improvedcommunication between multipledepartments such as Housekeeping,Physical Therapy, Speech Therapy,Outcomes Management and Rehab.Emergency DepartmentThroughput ImprovementStrategies1. Increasing bed capacity bymaking the EAU a virtual unit.2. Adjusting staffing patternsto meet patient volume.3. Re-designing the triageprocess.4. Non-urgent patients are placedin a results waiting area in achair in order to wait for finaldisposition orders after theyare triaged.5. The Emergency DepartmentClinical Assistants’ scheduleswere adjusted to better meetthe patient volume demand.6. A core group of designatedCharge Nurses was established.7. Standardized preliminaryadmission orders weredeveloped.8. Telemetry bed capacity wasincreased.9. Additional point-of-care lab testswere made available in the ED.9