2019 ANNUAL REPORT

WakeMed Nursing

Dear Nursing Colleagues,

It’s hard to believe that four years have passed since we earned Magnet® recognition, but here we are—ready to soon greet our Magnet apPRAISErs for our re-designation visit!

So much has changed in our professional practice, much of it reflecting initiatives that are being tackled on the national stage. In just the past year, we partnered with Emergency Department physicians to identify alternatives to opioids, we have re-imagined and launched innovative care for observation patients, and we have used best evidence to change the way we prioritize care of expectant mothers in our OB EDs. We are introducing patients to new technology at the bedside, and we continue to disseminate our new, key strategies in care at state and national conferences.

You, the WakeMed clinical nurses, are at the heart of everything we do. It is your expertise at the bedside, and your vigilance and voice, that inform us when practice needs to be changed.

We thank you for your patient and family advocacy. We thank you for your involvement in Clinical Nurse Council and unit-based initiatives to improve patient outcomes. And, most importantly, we thank you for being WakeMed nurses.

So proud to be, like you, a WakeMed nurse,

Cindy Boily, MSN, RN, NEA-BCSenior Vice President & Chief Nursing OfficerWakeMed Health & Hospitals

David Manyura, RNPast ChairClinical Nurse Council

One of the highlights of my day is having the opportunity to witness first-hand the work that our exceptional nurses do on behalf our patients and their families. As someone whose parents were nurses and had the good fortune (wisdom) to marry a nurse, I am deeply aware of the important, challenging and rewarding work you do. As a leader at WakeMed, I have seen time and again that you are committed to providing the highest quality care in the safest environment possible – all with your trademark compassion that no other organization can claim.

This year, our Board of Directors also had the chance to see and experience the outstanding work that you all are doing through a special video presentation highlighting nursing accomplishments from the last 12 months. It was a special opportunity for our Board members to see the people and passion behind WakeMed Nursing and hear about the incredible work you do each day.

I am humbled by the dedication, passion and love that WakeMed nurses share with each patient and family member that needs our help. The work you do inspires us all to be kinder, more compassionate and caring people.

On behalf of the WakeMed Board of Directors, our executive team and our WakeMed family, thank you for advancing the WakeMed mission in our community.

Donald R. GintzigPresident & CEOWakeMed Health & Hospitals

THE PATIENT EXPERIENCE

One-on-one Time with PatientsNurse managers and clinical leaders at WakeMed’s hospitals perform daily rounds on patients to help ensure their comfort, safety and engagement in their care. Daily interactions with our patients also help nurse leaders validate that the care clinical nurses deliver meets standards of practice as well as patient expectations. Patients and families also share lots of positive comments about clinical staff during Nurse Leader Rounds, giving nurse leaders lots of opportunities to celebrate and recognize their teams!

Nurse Leader-Patient Rounds in FY19

53,000+

INTERPROFESSIONAL COLLABORATION

Expediting Best-Practice Care for Clinical EvaluationA new, patient-centered model and interprofessional team approach expedite care for observation patients in our 1A Clinical Evaluation Area (CEA). How are they making the most of their model?• Unit utilized for observation patients• First-of-its-kind status/communication board created that prioritizes

patients for discharge• Patients stay in the unit for Cardiology and Cardiovascular testing procedures• Structured, interprofessional team huddles• 24/7 Case Management

1A Clinical Evaluation Area ImprovementsPRE-IMPLEMENTATION

OCT. 18 - FEB. 19POST-IMPLEMENTATION

MAR. 18 - SEP. 19

CEA LOS 57.6 hours 34.24 hours

# of Patients 239 344

QUALITY OUTCOMES

Continuous Education Improves Quality of CareWakeMed nurses are excellent educators! Their outstanding falls with injury and pressure injury scores prove it.

The Wound Ostomy Continence team developed an innovative education program that can be viewed on a cell phone. Medical-Surgical, Rehab and Critical Care nurses also received pressure injury prevention education.

Re-educating clinical nurses about AvaSys® Telesitter® observation technology utilization, new bed in-services and a Falls Prevention Fundamentals class held three times a year are just a few of the nursing efforts that are decreasing falls with injury at WakeMed hospitals.

Thanks in large part to our innovations in education, our National Database of Nursing Quality Indicators® (NDNQI®) scores at WakeMed Raleigh Campus have consistently been better than the national mean since we began NDNQI participation in 2014.

RALEIGH TOTAL FALLS WITH INJURY 2014-2019

RALEIGH HOSPITAL-ACQUIRED PRESSURE INJURY 2+ OR > 2014-2019

CARY TOTAL FALLS WITH INJURY 2014-2019

Patient-centric Comfort MeasuresWakeMed’s nurse-led, multimodal pain management program is yielding impressive results. Led by a clinical nurse specialist (CNS), the program involves pharmacologic and extensively researched non-pharmacologic pain control strategies. Clinical nurses are big supporters of Nursing’s work to decrease opioid pain control and they are stepping up to receive training on alternative therapies (Reiki therapy, aromatherapy, healing touch). A multidisciplinary team also created new protocols for the use of acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) instead of opioids when possible.

Use of non-opioid therapies at WakeMed is proving to reduce overall opioid use and over-sedation risk, improve patient safety—and patients report that they are comfortable!

Supporting At-Risk Community MembersAnother facet of the project is to support patients facing opioid overdose. WakeMed Emergency Departments can now distribute NARCAN® Nasal Spray to appropriate patients.

The NARCAN distribution project as well as professional training for staff to provide alternative therapies were made possible with the support of the WakeMed Foundation.

MULTIMODAL APPROACH TO REDUCE PAIN & OPIOID USE

Providing Effective Alternatives to OpioidsFY18

20% IV Opioid Use72% Acetaminophen31% NSAIDS Use

FY19

Opioid Use - Sustained 20%+3%Acetaminophen - Sustained 72%+8%NSAIDS Use - Sustained 31%+20%

SUCCESS THROUGH STANDARDIZATION

Evidence-Based Responsiveness in the OB EDsNurses in WakeMed’s three Obstetrics Emergency Departments (OB EDs) are outperforming patient prioritization standards set by the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN). Our nurses use the AWHONN Maternal Fetal Triage Index (MFTI) to prioritize a woman’s urgency for provider evaluation. On average, they complete the MFTI 4 minutes faster than AWHONN’s recommended 10-minute timeframe. Our OB ED nurses worked with Information Services on an innovative, color-coded visual cue—Lean methodology—in Epic and use a number scale to prioritize patients to facilitate their new process.

AWHONN 10 mins.

WakeMed6 mins.

Average MFTO Completion

TECHNOLOGY TO ENHANCE RELATIONSHIPS

Bedside iPadsIt’s amazing how technology can enhance nurse-patient communication. Bedside iPads, now available in many patient rooms, put lab results, current medication information and even photos of the care team at a patient’s fingertips. The iPads are also equipped with the InDemand app—a favorite feature with nurses. The availability of this interpretation service on the Bedside tablets means they can converse with patients in real-time with ease.

InDemandUsage in1 Year

55%

NATIONAL LEADER:

ERAS for Cardiac SurgeryWakeMed Raleigh Campus is the nation’s first Center of Excellence for Enhanced Recovery after Surgery (ERAS) for Cardiac Surgery, thanks to the interprofessional work of nurses, physicians, pharmacists and other clinicians. Team members hosted the first and second national ERAS for Cardiac Surgery training conferences and earned a top performance rating from the Society of Thoracic Surgeons (STS).

While the WakeMed team of ERAS for Cardiac Surgery pioneers continues to receive accolades, it is our patients who are receiving the most benefit from this proven protocol.

PRE ERAS2016

POST ERAS2019

Post OP LOS 7 days 5 days

GI Complications 6.3% 3.7%

Total ICU hours 43 29

WakeMed Nursing Professional Development

RNs with National Certifications

42.49%

BSN-or-higher Degrees

73.18%

WakeMed Awards & Accolades 2019American College of Cardiology• Raleigh Campus received the NCDR Chest Pain – MI Registry Platinum Performance Achievement Award.• Raleigh Campus and Cary Hospital were re-certified as Chest Pain Centers.

American Heart Association/American Stroke AssociationRaleigh Campus• Stroke: Gold Plus and Target: Elite Honor Role• Heart Failure: Gold Plus and Target

Cary Hospital• Stroke: Gold Plus and Target: Elite Honor Role• Heart Failure: Silver Plus and Target: Honor Role

Emergency Nurses Association Hall of Fame• Elizabeth Stone, RN, Children’s ED, was 1 of 8 in the country inducted.

Home Health CompareWakeMed Home Health earned top performance rating.

National Committee on Quality AssuranceEight WakeMed Primary Care locations re-designated as Patient-Centered Medical Homes.

PRC Recognition (Patient Experience)• Top Performer – Department: Mobile Critical Care Services• 5-Star Awards – Departments: Brier Creek Healthplex-Emergency Department, Cary Hospital-Outpatient Lab, Cary Hospital-Outpatient MRI, Cary Hospital-Outpatient Specialty Rehab, North Hospital-Outpatient Surgery, North Hospital-Medical/Surgical, North Hospital-Women’s Pavilion & Birthplace, North Hospital-Outpatient Lab, Raleigh Campus-6A CVIC, Raleigh Campus-Cardiac Rehabilitation, Pediatric Cardiology-Apex, Pediatric Endocrinology-Apex, Pediatric Outpatient Minor Procedures, Pediatric Weight Management-Apex, ENT-Head & Neck Surgery-Apex, Heart & Vascular-Apex, Heart & Vascular-Cardiovascular & Thoracic Surgery, Heart & Vascular-Cary, Heart & Vascular-Complex Arrhythmia, Heart & Vascular-Heart Center, Heart & Vascular-Advanced Heart Failure, OB-GYN-Brier Creek, Primary Care-Holly Springs, Primary Care-Downtown Raleigh, Urgent Care-Cary, Urology-Raleigh Medical Park

The Joint CommissionCary Hospital received re-certification as an Advanced Primary Stroke Center.

The Society for Enhanced Recovery After Cardiac SurgeryRaleigh Campus named first-ever ERAS Cardiac Center of Excellence.

Society of Thoracic SurgeonsRaleigh Campus received top performance rating and #1 composite quality score for isolated CABG in the state.

Triangle Business Journal• Healthiest Employers• Health Care Hero: Jessica Dixon, RN, Infection Prevention

Triangle Chapter of the Association of Fundraising ProfessionalsCongratulations to Brenda Gibson, past chair, WakeMed Board of Directors, long-time WakeMed advocate and outstanding supporter of WakeMed nurses for receiving the Excellence in Philanthropy Award.

NURSING RESEARCH, PEER-REVIEWED PUBLICATIONS & PRESENTATIONS - 2019

STUDY DESIGN PI STATUS

Clinical Characteristics of Intranasal Dexmedetomidine for Sedation in Children Undergoing Nonpainful Procedures

Descriptive M. Davis, BSN, RN, CPN(Site PI)

Closed

Health Care Providers’ Attitudes and Beliefs of Family-centered Care Practices in the NICU

Survey D. Vittner, PhD, RN, CHPE Closed

Effect of A Multifaceted Implementation Program on Compliance of Daily Chlorohexidine Bathing in Critical Care and Bone Marrow Units

Multisite stepped-wedge, cluster randomized trial

P. Woltz, PhD, RN(Site PI)

Open

An Exploration of Music Therapy Among Patients with Serious Medical Illness

Qualitative C. Taylor, BSN, RN Review

Efficacy of Intervention Components on Sleep in the Inpatient Rehabilitation Setting: A Factorial Experiment

Parallel-group randomized 2X2 factorial trial

P. Woltz, PhD, RN Design

PublicationsKlaess, C., Urton, M., Whitehead, P., Rosier, P., Burnie, J., & Mickel, M. (2019). Pain management pillars for the clinical nurse specialist: summary of NACNS opioid pain management task force. Clinical Nurse Specialist, 33(3), 136-145.

Vittner, D., Butler, S., Smith, K., Makris, N., Brownell, E., Samra, H., & McGrath, J. (2019). Parent engagement correlates with parent and preterm infant oxytocin release during skin-to-skin contact. Advances in Neonatal Care, 19(1), 73-79.

Cline, L., (In print). The impact of the electronic health record: the correlation to patient-centered care in nursing. Nursing 2019.

Oral PresentationsLindahl, A., Shelton, R., & Kramer, J. (2018, October). Overcoming barriers that will keep you from building an app people actually use. Epic App Orchard 2018 Conference, Verona, WI.

Carter-Scott, P., Hammond, N., & Sickle, C. (2018, November). MyChart Bedside and genba walks. North Carolina Council of Nursing Informatics, Raleigh, NC.

Fennell, R., & Grant, B. (2018, November) Nurses’ comfort level discussing sexual health care with patients. American Public Health Association, San Diego, CA.

Bird, P. (2019, January). One health system’s approach to ED/hospital diversion. North Carolina Providers Council, Greensboro, NC.

Carter-Scott, P., & Sickle, C. (2019, January). Bedside implementation and optimization. EPIC - XGM 2019 Conference, Verona, WI.

Carter-Scott P, & Sickle, C. (2019, January). Keeping Bedside at the bedside. EPIC - XGM 2019 Conference, Verona, WI.

Hammond, N., & Carter-Scott, P. (2019, January). Closing gaps between IT and end users: utilizing clinical informatics and genba. EPIC - XGM 2019 Conference, Verona, WI.

Research

Reif, S., & Sickle, C. (2019, January). Got milk? Keeping it simple…right milk, right baby, keeping Bedside at bedside. EPIC - XGM 2019 Conference, Verona, WI.

Knight, D., Smith, C., & McKay, C. (2019, January) Preventing CAUTI/CLABSI rounding for outcomes. AHRQ/NCHA: AHRQ Virtual Learning Group.

Klaess, C. (2019, January). Non-opioid modalities for pain management. Raleigh Lions Club, Raleigh, NC.

Woltz, P., & Knight, D. (2019, February). Transforming adequate staffing with a voluntary system-wide nursing reallocation program. Sigma Theta Tau International Conference: Creating Healthy Work Environments, New Orleans, LA.

Urton, M. (2019, March). Examination of a population-based fall incidence in a rehabilitation setting. National Association of Clinical Nurse Specialists Annual Conference, Orlando, FL.

Urton, M. (2019, March). Eye on the prize: a remote video monitoring (RVM) fall reduction initiative. National Association of Clinical Nurse Specialists Annual Conference, Orlando, FL.

Williams, F. (2019, March). Mentorship and nurse residency programs. Eastern Regional Educators Conference, Greenville, NC.

Best, S., & O’Hara, R. (2019, March). Helping patients overcome obstacles to self-management. Diabetes Management and Foot Care Conference, Greensboro, NC.

Elliott, J., & Reguin-Hartman, K. (2019, March). HAIPI rounds: hospital-acquired infection prevention initiative. National Association of Clinical Nurse Specialists Annual Conference, Orlando, FL.

Kubic, M. (2019, March). Igniting change in tracheostomy patient care: a CNS-led interdisciplinary tracheostomy team. National Association of Clinical Nurse Specialists Annual Conference, Orlando, FL.

Klaess, C. (2019, March). Non-opioid modalities for pain management. Apex Rotary Club, Apex, NC.

Klaess, C. (2019, March). Pain management: not just about opioids. SHINE Conference, Raleigh, NC.

Bogamil, L. (2019, April). Care of the amputee patient in acute inpatient rehab. Greater NC Chapter of Association of Rehabilitation Nurses, Wilmington, NC.

Bogamil, L. (2019, April). Aromatherapy. Greater NC Chapter of Association of Rehabilitation Nurses, Wilmington, NC.

Stephenson, H. (2019, April). Do’s and don’ts: transitioning an organization to a new competency model. American Nurses in Professional Development Annual Convention, Phoenix, AZ.

Klaess, C. (2019, April). Understanding biases – improving awareness and delivery of care for patients with OUD. Academy of Medical-Surgical Nurses Chapter Meeting, Raleigh, NC.

Reep, K. (2019, May). Using twitter for professional development. North Carolina Nursing Association Clinical Nurse Specialist Webinar.

Burgess, J. (2019, August). Facing a life-altering illness: Joy’s way. United Ostomy Association of America 2019 Conference, Philadelphia, PA.

Klaess, C. (2019, September). Pain Management in Trauma: Options for your tool box. WakeMed-AHEC Trauma Conference, Raleigh, NC.

Elliot, J., & Reep, K. (2019, September). Supporting the patient through critical illness. WakeMed-AHEC Critical Care Conference, Raleigh, NC.

Elliot, J., Conklin, A., Miliano, V., Johnson, T., Haupt, E., & Werner, E. (2019, September). Sepsis care best practices. Southern Atlantic Healthcare Alliance, Cary, NC.

George, S., Maloy, C., & Sandel, K. (2019, September). Emergence delirium: a quality improvement project to decrease the incidence of emergence delirium in PACU. North Carolina Association of Peri-anesthesia Nurses State Conference, Greenville, SC.

Wheaton, S., & Perdue, K. (2019, October). Clinical nurses are Happy2Help with an innovative voluntary on-call replacement program. AACC National Magnet Conference, Orlando, FL.

Poster PresentationsBurgess, J. (2018, October). Ostomy patient bill of rights. National Association of Home Health and Hospice Care, Grapevine, TX.

Cesare, J. (2018, October). After discharge: are substance exposed infants at higher risk for child abuse and/or neglect? National Association of Neonatal Nurses, Anaheim, CA.

Gough, N. (October, 2018). Bridging communication gaps using a visual/read through huddle board. National Association of Neonatal Nurses, Anaheim, CA.

Craft, D., Ayscue, C., Knight, D., Wheaton, S., & Woltz, P. (2019, March). Nurses are happy to help (H2H) with a voluntary on-call replacement program. North Carolina Organization for Nurse Leaders Conference, Greensboro, NC.

Hassing, S., & Guzman, K. (2019, March). Going with the flow: how a collaborative throughput initiative can improve ED quality metrics, patient hand-offs, and staff satisfaction. North Carolina Organization for Nurse Leaders Conference, Greensboro, NC.

Rawls, E., Jones, R., Anderson, W., Krizay, M., Gaskins-McClaine, B., & Williams, F. (2019, March). The village concept in cardiac rehabilitation: improving patient participation and referral. American College of Cardiology Conference, New Orleans, LA.

Vittner, D., & Novak, J. (2019, March). Parent engagement in the NICU. New England Association of Neonatal Nurses Annual Conference, Mystic, CT.

James, E., Milano, V., & Howard, C. (2019, April). Automating EHR-based reports to understand patient transfers from the emergency department to facilities outside of a health care system. American Nursing Informatics Association National Conference, Las Vegas, NV.

McIntyre, S., Hicks, N., Hamilton, P., & Udekwu, O. (2019, April). The team that huddles together saves lives. Trauma Center Association of America Conference, Las Vegas, NV.

Reep, K., & Woltz, P. (2019, April). An evidence-based review of the safety of concomitant use of oxygen and petroleum jelly. Duke CNS Extravaganza, Durham, NC.

Ross, M., Sandhu, R., Perez, C., Klaess, C., Wilson, B., Wienold, J., & Campbell, L. (2019, April). Implementation of multimodal pain management to reduce opioid usage. 2019 North Carolina Association of Women’s Health, Obstetric and Neonatal Nurses Section Conference, Goldsboro, NC.

Hayes, P., Lewis, A., & Mayour, R. (2019, September). Movin’ on up: a collaboration between medical-surgical areas and intensive care units to improve transfer times and patient flow. The Academy of Medical-Surgical Nurses, Chicago, IL.

Lockridge-Brown, J. (2019, August). Understanding continuous insulin infusion. American Association of Diabetes Educators Annual Conference, Houston, TX.

Brown, L. (2019, September). Using clinical informatics to streamline nursing workflows. North Carolina Nurses Association Annual Convention, Winston-Salem, NC.

FY 2019 STATISTICAL HIGHLIGHTS

Licensed Beds 941

Discharges 55,917

Emergency Department Visits 295,132

Inpatient & Outpatient Surgeries 38,525

Total RNs 3,674

Nursing Turnover Rate (National: 14.85%)

11.00%

RN Average Years of Service 7.53

Nurse Fellow Retention RateAfter 1 Year

91%

Nursing Executive Shared Decision-making Leaders