Page 4 • RN Idaho May, June, July 2018 Advocacy in Action Every Mother Has the Freedom to Feed Her Baby Adrean Cavener, BS, Lobbyist email@example.com After a lot of hard work from advocates from across the state, H.B. 448 became law this legislative session. This bill gives protection to breastfeeding mothers from the indecent exposure statute. H.B. 448 worked its way from the House to the Senate without a single “nay” vote, and the Governor signed it into law shortly after. It was truly incredible to see mothers with their sweet children in committee rooms during hearings to lend their support for the bill. (Many legislators even commented that it was an unfair advantage…) So, after years of work on the issue and countless hours from volunteers and supporters since 2003, mothers across the state can finally rest easy that they can now nurse in public without the threat of legal action. A special thanks to Representative Paul Amador for his leadership in moving this bill forward to a successful signing! We would also like to thank ANA Idaho for their support of this important bill for Idahoans. For specific language and session activity, you can find H.B. 448 at https://legislature.idaho.gov/sessioninfo/2018/ legislation/. Also, do not hesitate to contact your local legislator and thank him/her for their support of this monumental legislation. Representative Amador with his son Peter. Many mothers, families, community members, lactation consultants and nurses came in support of the bill. Photo credit: Senator PattiAnne Lodge Representative Paul Amador (R) testifying in the Senate Committee Hearing on H.B. 448 while holding his 6 month old son, Peter. Nurses for Idaho! continued from page 1 Senator Maryanne Jordan and Representative Sue Chew to the full body of the Senate and the House. The Day at the Capitol not only engaged legislators to learn about nursing, but also provided an opportunity for nurses to learn the workings of the legislature and the difficult process for a bill to become a law. Thank you to everyone who participated, especially those who braved the heavy snow so early to help set-up! To learn more and get involved making a difference for nursing in our state, consider joining the Legislative Affairs Committee with ANA-Idaho! Contact Anna Rostock at firstname.lastname@example.org or Michael McGrane at email@example.com. We look forward to hearing from you! Bundled Payments for Care Improvement (BPCI) Initiative: The role of nurse navigators and how they fit in with the initiative Nurses come from around the state to participate in “Nurses for Idaho!” Nurses Day at the Capitol 2018 Teresa L. Coiner, RN, BSN, MHS Nurse Navigator, Saint Alphonsus-Nampa Teresa.firstname.lastname@example.org All nurses are navigators. When we first step into a patient room, we literally become their navigator. Managing a patient’s course of care right from the very beginning is a positive step that directly impacts his clinical outcome. The Bundled Payments for Care Improvement (BPCI) initiative was implemented at both Saint Alphonsus Boise and Nampa locations in 2015. This initiative is a patient-centered strategy: the navigator facilitates efficient health care access by using their nursing skills to manage a patient’s course of care (Centers for Medicare & Medicaid Services, 2018). As navigators in a hospital setting, we meet with patients to set collaborative goals of care with the patient and their family/support system. The ultimate goal is nearly always to get patients back home after hospitalization, however, occasionally the next best site of care may be a skilled nursing facility or their condition may require setting up home health services. In general, as nurse navigators, we provide the following services: a) education to guide patients through the disease process, b) education on treatment options and understanding the recovery process, c) access to community resources and medical equipment, d) medication review, e) access to psychological and clinical support, f) coordination with primary care providers and other specialists, and g) home visits. As BPCI nurse navigators, we make important contributions to improve the quality of life, quality of care, and efficiency of resource use for our medically complex patients. The following is a case study that demonstrates the importance of the BPCI nurse navigator role. 82 year-old Mrs. Smith was admitted to the hospital for congestive heart failure (CHF) and pneumonia. During her stay, she was assigned a nurse navigator due to her medical complexity and because she lives alone, has limited family support and doesn’t drive. At the time of discharge, Mrs. Smith was given orders for a home health agency to provide physical therapy, nursing care, and a bath aide. The assigned nurse navigator called Mrs. Smith post discharge and discovered that home health had not yet been initiated, prompting the navigator to provide a home visit that afternoon. Mrs. Smith was pleased not only that she had met the nurse navigator during her hospital stay but that her complex needs were being met and she was not “falling through the cracks” of the system. At the home visit, the navigator discovered multiple medication discrepancies, one being that the patient was taking over 1000 mg of aspirin a day. Additional observations revealed that the CHF patient had a “bag full” of medications, lots of chips and nuts within reach, and the patient did not have a scale to weigh herself daily. The Navigator called the patient’s PCP (primary care provider) and had medications clarified, set up an office visit, and then arranged transportation through the Saint Alphonsus Express van. At the time of the scheduled PCP appointment, the navigator attended the appointment with the patient. In addition, the navigator provided the patient with a scale so she could weigh herself daily and then taught Mrs. Smith to use a daily log called the Zones to Manage Heart Failure-Green-Yellow- Red; which is a daily log for tracking weight, heart rate, blood pressure and shows what “zone” they are in for the day. After weekly calls and several home visits, the navigator was not only able to keep the patient from being readmitted to the hospital, but also helped her to better manage her congestive heart failure. The impact of the Bundled Payments for Care Improvement Initiative Nurse Navigator role is an exciting and critical one for maximizing the health of patients as they navigate the complexities of our health care system. Reference: Centers for Medicare & Medicaid Services. (2018). Bundled Payments for Care Improvement Initiative (BPCI) Fact Sheet Retreived: https://www.cms.gov/Newsroom/ MediaReleaseDatabase/Fact-sheets/2015-Fact-sheetsitems/2015-08-13-2.html Left to right: Anna Rostock, Barbara Hocking, Brie Sandow, and Kim Popa Participants visit the House and Senate floor
May, June, July 2018 RN Idaho • Page 5 Nurse Led Implementation of a Family Bonding Time Julie M. Finney BSN, RNC, Mother/Baby Unit, St. Luke’s Meridian Medical Center Jane Grassley PhD, RN, IBCLC, School of Nursing, Boise State University email@example.com The day starts at 7:00 AM on our 13-bed Mother/baby unit, with bedside report to the oncoming shift. The new parents may have been up all night feeding their baby and now it’s morning and they have a revolving door of interruptions. They may see up to 13 different people from the medical providers to the photographer, as well as family and visitors during the day. These interruptions do not include the couplets’ nurse or certified nursing assistant (CNA) making hourly rounds, assessments, and administering medications. This is a significant problem (Adatia, Law, & Haggerty, 2014). One study found that new mothers experienced an average of 53 interruptions on postpartum day one (Morrison & Ludington-Hoe, 2012). To address this problem, St. Luke’s Meridian Medical Center implemented a Family Bonding Time (FBT). Our goals were to allow parents to have a specific time during the afternoon to spend with their baby without interruptions and to improve exclusive breastfeeding rates. This article describes the process of meeting these goals which involved changing the culture of the unit and inviting the staff to be part of the process (Skelton-Green, Simpson, & Scott, 2007). The team-based educator recruited four nurses, two from day shift and two from night shift for the implementation team. The Women’s Services Administrator funded each member a total of 4 hours for this work. The next step involved planning our implementation strategy. First, we defined allowable activities during FBT, such as patients ordering lunch or calling for pain medications, breastfeeding help, or other concerns. Unacceptable activities included unnecessary noise and non-urgent tasks or procedures for mother or baby. We then strategized how to communicate this culture change. The Marketing Department helped us reach a wider audience about FBT within our system and community through the health system e-newsletter and blog. They formatted a flyer and banner that explained FBT to families and visitors in our waiting area. Team members delivered flyers to provider clinics and childbirth educators to share with families. Laminated door signs were posted outside mothers’ rooms for those participating in FBT. Next, we created a plan to inform our unit staff and other departments about FBT and the anticipated “go live” date. We presented FBT at a unit meeting with an explanation of the concept and allowed time for questions. For the other departments, each member of the team met, phoned or emailed the director or supervisor of their assigned departments within the hospital. Departments agreed to complete their specific daily tasks in the mornings, prior to the 2:00 PM start time of FBT. This included pediatric and obstetrical providers, photo staff, car seat technicians, and hearing screeners. Environmental Services (EVS) had concerns that their cleaning, garbage pickup and linen delivery conflicted with FBT hours. We met to discuss the benefits of FBT and worked out a plan to change garbage pickup and linen delivery times. EVS agreed to not clean rooms during FBT unless the need was critical. After 2 months of planning, we implemented FBT, which was facilitated by having a planning team member available each Great Careers Start at at Lourdes. Registered Nurse Emergency Department Inpatient Rehab ICU For additional opportunities please visit our website. Lourdes Employment Office Lourdes Employment Office 520 N. 4th Ave. 520 N. 4th Ave. Pasco, WA 99302-2568 Pasco, WA 99302-2568 PH (509)546-2283 PH (509) 546-2283 FAX (509) 546-2296 FAX (509) 546-2296 yourlourdes.com Equal Opportunity Employer Equal Opportunity Employer day shift to remind staff to speak to their families about FBT and schedule patient care before or after FBT. Planning team members supported staff from other departments in making alternative arrangements for unit’s work. Our implementation of FBT was successful with positive outcomes. Mothers and families have commented that they appreciate the time without visitors. Exclusive breastfeeding rates increased from 67% to 87%. Environmental services, pharmacy, and dietary services successfully changed their routes and times of delivery. The unit staff use FBT to catch up on charting, read email, complete education modules, or take a lunch break. Staff are also able to focus on new admits or discharges while their other mothers are participating in FBT. Even with a successful implementation of this nurse driven improvement, reminders may be needed, including to ancillary department personnel. Noise at the nurses’ Please call Human Resources for questions or more information at 541-575-4192 Explore or Apply Online: station continues to be a challenge. Sustaining FBT involves ongoing education, including orientation for new unit and hospital staff, and reminders to all staff of its importance. Providing FBT for our families is vital to help provide a private time to bond with their infants. Nurses must commit to improving the environment within hospitals to promote family bonding and patient and family centered care. References Morrison, B., & Ludington-Hoe, S. (2012). Interruptions to breastfeeding dyads in an LDRP unit. The American Journal of Maternal Child Nursing, 37(1), 36-41. Adatia, S., Law. S., & Haggerty, J. (2014). Room for improvement: noise on a maternity ward. BMC Health Services Research, 14(604). doi: 10.1186/s12913-014-0604-3 Skelton-Green, J., Simpson, B., & Scott, J. (2007). An integrated approach to change leadership. Nursing Leadership, 20(3). WORK-LIFE BLEND Come see for yourself. You BELONG here!! Expand Your Career Blue Mountain Hospital District, a Critical Access Hospital which serves the Grant County region. Located in beautiful eastern Oregon. We have an incredibly dedicated and dynamic team based environment. Currently Seeking • Experienced RN (Associate or BSN) – ER, OB, OR, Med Surg (Full-time, Part-time and Casual positions available) • RN, LPN/LVN and CNA (Intermediate Care Center/Nursing Home) • Physical Therapist (Outpatient/Home Health) • Director of Nursing Services (Intermediate Care Center/Nursing Home) • Quality and Performance Improvement Director (Healthcare) • Clinic Director (Family Practice Rural Health Clinic) Best Benefits • Benefits include Retirement Plan with Employer Match • Generous PTO • Advancement Opportunities • Nursing Shift Differential • A lifestyle of enjoying the outdoors in a quiet, remote & rural community. “Quality Healthcare Close to Home” EOE/AA We support a tobacco free and drug free workplace. www.bluemountainhospital.org Seattle Portland Salem Eugene Bend Location John Day, Oregon Spokane John Day Boise
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