2017/2018 nursing report nurses driving change · ecmo program 4 family birth center breathes...

Nurses Driving Change

Through Evidence-Based Practice & Innovation

2 0 1 7 / 2 0 1 8 N U R S I N G R E P O R T

Contents 2 Leading the Way for

Change Through Compassion and Collaboration

3 Our Multidisciplinary Approach for an ECMO Program

4 Family Birth Center Breathes “New Air” into Pain Management

5 The SWAT Nurse’s Many Hats

6 Alameda Model in the Psychiatric Stabilization Unit Makes a Positive Impact for Patients

7 Billings Clinic’s Nurse Residency Awarded Accreditation with Distinction

7 Nurse Residency Program Has Significant Impact on Retention of Nurses

8 Nurse Residency Champions of Evidence-Based Practice

9 Nurses as Authors

12 Depression Outcomes from a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination

13 Wound Ostomy Nurse Navigator

14 Watchful Eye for Safety with AvaSys Patient Surveillance

15 Nursing Strategic Map, 2018-2021

16 Peppermint Essential Oil to Control Nausea in Hospitalized Patients

17 BSN Certification Rates

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Nurses Driving ChangeThrough Evidence-Based Practice & Innovation

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Dear Staff, Colleagues and Friends,Our vision to be a national leader in quality, safety, service and value has posed many wonderful opportunities for us. With this vision in mind, Billings Clinic and the Nursing Division have taken on several new challenges and have accomplished much over the past year. As a Magnet facility since 2006, we strive to constantly move forward with evidence-based improvements and achieve high quality outcomes for our patient population.

You will read about new clinical initiatives that have been forged by nurses at Billings Clinic, all evidence-based and innovative in the approach to provide our patients with the highest level of quality care.

Billings Clinic nurses are encouraged to bring information back from conference attendance, regional association meetings and from journals that will enhance and improve the process and outcomes for our staff and patients. In this annual report, I am proud to present stories of nurses introducing new technology in Critical Care and Labor, Delivery, Recovery and Post-Partum. The addition of an evidence-based patient surveillance system was researched and installed to improve outcomes for falls prevention. The Nurse Residency leadership team successfully navigated the accreditation process that resulted in PTAP Accreditation with Distinction.

I am incredibly proud of working along side Billings Clinic direct-care teams and leadership as it seems that every day our staff drive a new and improved process to continually provide advancing care to our patients.

My passion for nursing began as a Certified Nurse’s Aide and soon progressed to a Licensed Practical Nurse. After a short time, I was able to obtain my RN BSN. After many years of serving as a Clinical Coordinator and a Nurse Manager in outpatient and inpatient areas, I went back to obtain my Master of Science in Nursing. I then went on to serve as the Medical Surgical Nursing Director prior to becoming the Chief Nursing Officer at Billings Clinic. I can fully appreciate the drive our nurses have to further their education and professional careers through continuing education and process improvement initiatives.

I will never forget the incredible work by clinical staff who serve our patients and their families every day. Each day our team makes a difference in many lives, helping them to face new challenges and fears. Nursing continues to be challenging everyday as regulations change that impact financial, human resource and material needs. Our staff at Billings Clinic are problem solvers and love a great challenge. We are truly better when we work together, and stories in this annual report are strong evidence.

Through staying engaged in evidence-based practice, Billings Clinic nurses stay on the leading edge of innovation which allows them to control nursing practice at Billings Clinic by staying informed. I cannot thank this team enough. We have much to be proud of.

Thank you to all the who contributed to this annual report.

Laurie L. Smith, MSN, RN, NEA-BC CNO, Billings Clinic

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Leading the Way for Change Through Compassion and CollaborationAs Billings Clinic employees, we are committed to provide the best service experience and outstanding quality care our patients need and deserve. Across the continuum of care, from a clinic appointment to a hospital stay, our nurses are integral to providing complete, safe, and evidence-based care for our patients.

Nurses are at the core of the collaborative and interdisciplinary team’s approach to the patients plan of care. Nurses solve problems, and they challenge us to define, change and improve methods for the way we provide patient care. Our nurses serve as a catalyst for change demonstrated through decreased infection rates, serving as preceptors to student nurses, ensuring the safety of our medication practices, engaging in research for nursing best practices, all which results in benefits to the community and region we call home.

On behalf of our organization, I want to extend my heartfelt appreciation for the dedication and care our nurses bring to our organization. Through their diligence for providing the highest level of care regardless of complexity or simplicity of the encounter, our nurses take pride in raising the bar required for exceeding our patients’ expectations and meeting the requirements of a designated Magnet organization. To be the best takes humility, tenacity of purpose, courage, and a willingness

to measure the impact on those we serve. Thank you for exceeding patient expectations every day and for always putting the patient first.

Robert K. Merchant, MD, FCCP Interim Co-CEO, Billings Clinic


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Our Multidisciplinary Approach for an ECMO Program A well-trained multidisciplinary team is needed to safely care for ECMO patients. Clearly defined roles and collaboration allowed us to initiate and maintain an ECMO program with desirable outcomes. We can provide local and regional support for patients in a large referral area.

Extracorporeal Membrane Oxygenation (ECMO) is a therapy that utilizes a machine’s artificial lung to add oxygen to a patient’s blood and pumps it through their body like the heart. This process takes place outside of the body. This also allows the ECMO team to lower the settings of the ventilator, allowing the lungs to rest and heal.

The ECMO program was brought to Billings Clinic with the help of Pam Zinnecker, MSN, RN, CCRN-k, and Dr. Alexander Kraev. The Billings Clinic Foundation helped to purchase the ECMO System and the nine months of training for Pam and eight other ICU nurses. Our ECMO program coordinator, Pam Zinnecker, is the integral link to establishing and maintaining the ECMO program.

ECMO specialists are ICU RNs who receive training and remain competent via quarterly education/competency sessions and working with the program coordinator when caring for the ECMO patient.

In addition to educating the primary team, ancillary team members, including but not limited to respiratory therapists, pharmacists, laboratory, dietary, physical and occupational therapy are educated to their role regarding ECMO and care of the patient on ECMO.

Staffing the ECMO patient is 1:1 or 1:2 depending on the overall acuity of the patient. An ECMO specialist is always part of the staffing matrix, following the orders and guidelines for patient management to optimize ECMO therapy including anticoagulation, sweep, FIOs and volume administration. Non-specialist ICU nurses caring for the patient on ECMO have received education and complete annual competencies.

Perfusionists round daily to monitor the circuits and are available as a bedside resource.

Our facility can support one patient on ECMO at a time, and we average one patient per month. Due to limited resources, including nursing and equipment, patients may require transfer to a larger facility after being placed on ECMO at Billings Clinic.

We attribute our successes to the multidisciplinary team. In 2017, we placed eight patients on Veno-Arterial (VA) ECMO, three patients on Veno-Venous (VV) ECMO and two patients on Veno-Arterial-Venous (VAV) ECMO. In 2018, we placed six patients on VA ECMO and four patients on VV ECMO. Statistically, VA ECMO patients have a lower survival rate than VV ECMO patients, and our success mirrors those statistics. We have celebrated 10 success stories related to ECMO and patients who are able to come off ECMO and proceed to discharge. We have guided five patient families through the decision to move toward comfort care rather than transfer to another facility. Overall, we have improved our ability to choose patients for ECMO.

We were invited to present our ECMO story at the 2018 ELSO (Extracorporeal Life Support Organization) Conference. Pam Zinnecker, MSN, RN, CCRN-K, Amber Hellekson, BSN, RN, CCRN, and Mary Goldammer, BSN, RN, CCRN, presented how we were able to implement ECMO in a smaller facility using a multidisciplinary approach.

ECMO pump regulation and monitoring devices

ECMO presentation at International ELSO Conference (L-R): Amber Hellekson, RN, Specialist; Sherry Harper, Perfusionist; Pam Zinnecker, RN, Program Coordinator; Mary Goldammer, RN, Specialist

ECMO team celebrates with patient after discharge

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Family Birth Center Breathes “New Air” into Pain ManagementChildbirth Clinician Educator Jessica Halgren BSN, RN, LCCE, led this organization on a journey to provide a new pain management option for women in labor and giving birth. While Attending the Rocky Mountain Childbirth Conference, she heard about the resurgence and promising use of Nitrous Oxide in laboring women. Both the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the American College of Nurse – Midwives (ACNM) have released statements supporting the use of Nitrous Oxide.

“Nitrous Oxide should be a vital component in the provision of quality maternity care, and the bedside labor nurse is the ideal candidate to initiate N2O use.” – AWHONN Practice Brief 2018

Nitrous Oxide has seen a resurgence over the last several years as an option for women who may be looking for an alternative to epidural anesthesia. A common pain management tool in the 1980s, nitrous oxide has seen a “rebirth.”

The program at Billings Clinic Family Birth Center gained momentum after Halgren returned from the annual Rocky Mountain Childbirth Education Conference sharing her newly gained enthusiasm for this self-administered option for women. The LDRP RN set up, educated, continues to monitor and document all aspects of this nurse driven protocol.

Program approvals, policy creation and educational requirements were accomplished in 12 months. Capital expenditure for the equipment was approved, and Halgren conducted all educational sessions and competency validation for the LDRP RN’s didactic content, hands-on demonstration and a written competency exam.

The option of nitrous as a self-administered pain management tool puts the control in the hands of the laboring woman. She determines when to place it on her nose/mouth and how deeply to inhale the 50/50 nitrous/O2 blend. As the photo depicts, she is able to physically do something to impact the pain of her labor; self-administration of medication has repeatedly demonstrated that lesser volumes are consumed when the patient manages the process.

Ms. Halgren had her fourth child in July 2019 and utilized the Self-Administered Nitrous Oxide option. Her birth experience as noted by her is below:

“I had been teaching students in Billings Clinic childbirth classes about the use and benefits of Nitrous Oxide as pain management in labor. When I found out I was expecting our fourth child, I was excited that I would now have this option available to me as well.

As I was being admitted for labor, I let my nurse know that I wanted to try the Nitrous Oxide… just to see what it was like. The contractions grew stronger and closer together. I was experiencing the “shakes,” and I felt tense. At that point, I requested to try the Nitrous Oxide. When a contraction would begin, I took a couple deep breaths of the Nitrous Oxide. Over the peak of the contraction, the dissociative effect really worked for me! I could still feel the pain, but it seemed far away from me. My body was able

to relax, and I definitely felt more in control.

Between that relaxation, the ability to move into productive labor positions (enhanced with wireless monitoring), continuous support from my husband, and utilizing other coping techniques (like vocalization), my labor was able to progress, and before I knew it, I was 8.5 cm! I was offered an epidural at that point, but I really felt confident that I could do it with the Nitrous Oxide. I was able to spontaneously push in response to a “strong urge,” one that I had taught about but never felt before (due to the numbing effects of epidurals I had used with my other deliveries). After my

daughter’s safe arrival, my ability to move was uninhibited, which was a bonus.

While I recognize that this option does not work the same for all patients or every delivery, I’m glad that it is available as an option for women in labor at Billings Clinic. Birth is a significant experience. If we, as health care providers, can help facilitate a positive experience for women and their families, that is significant as well. For me, it was unforgettable and empowering. Now, as a mother of four, a reminder that I can do hard things is very helpful! I am grateful my husband and I had the option to experience the birth of our daughter in this way.” – Jessica Halgren, BSN, RN, LCCE


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The SWAT Nurse’s Many HatsOver the past few years, the Main Operating Room (MOR) and Peri-anesthesia Care Unit (PACU) have experienced higher volumes of patients needing care after-hours. These higher volumes of occurrences necessitated a creative plan for staffing to meet the regulatory standards of care in the PACU. American Society of Peri-anesthesia Nurses (ASPAN) standards state, “Two registered nurses, one of whom is an RN competent in Phase I post-anesthesia nursing, are in the same room/unit where the patient is receiving Phase I level of care. The same staffing requirements apply when patients are in the Peri-anesthesia Care Unit (PACU) after-hours as during regular business hours” (October 2017). The MOR nurses were utilized to fulfill the second nurse requirement but were logging shifts of greater than 15 hours at times to meet this standard for PACU.

Clinical nurses collaborated with nursing leadership from the PACU and Nursing Resources on a solution for meeting a variety of demands within the organization. Rising inpatient staffing challenges as well as the after-hours flex in volumes for PACU were taxing on Nursing Resources to provide enough coverage to fill the needs. Billings Clinic approved additional personnel support for Nursing Resources to provide the second nurse requirement to meet ASPAN Phase I recovery standards as well as quick and immediate support to the inpatient nursing units during off-hours performing a variety of tasks to meet the demands of changing patient needs and conditions. It was affectionately named the SWAT RN, for the nurse’s ability to come into a situation and stabilize, whether in PACU or on the floors.

The SWAT RN began coverage in August 2018, and staff input has been instrumental in the successful adoption of this role. In addition to the coverage for PACU, the SWAT RNs have provided support to the inpatient units when admissions have neared capacity for staff and have been a resource for the insertion of IVs when the Vascular Access Team is unavailable. They help alleviate stress for staff of units where numerous admissions have come rapidly, as an extra set of hands, to balance workload and admission tasks, while also assisting patients with the delivery of time sensitive care.

“When I was still on the floor, SWAT RNs were incredibly helpful! Whether it was starting an IV, passing meds or breaking a 1:1, they were always willing to help and saved us from drowning several times. I believe that role has been incredibly beneficial.” – Lindsey Gustafson, BSN, RN, CMS-RN

“The SWAT role has done nothing but great things for night shift. They are so responsive to our needs. As a charge RN, I am always requesting their assistance. They have also helped me countless times when I am in staffing. Whether it be with attaining IV access in difficult IV patients, passing medications when nurses are swamped or helping with tasks that aren’t commonly performed on IPM, they are a good resource. I think they have helped improve staff morale also. Just knowing they are available when we are drowning is a good feeling. At times, resources at night can be slim. I have been a night shift nurse for almost 10 years. This role is one of the best things Billings Clinic has done to help the night shift staff. Thank you SWAT team! – Emily Mitchell, RN, IPM

SWAT RN was affectionately named for

the nurse’s ability to come into a situation and

stabilize, whether in PACU or on the floors.

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Alameda Model in the Psychiatric Stabilization Unit Makes a Positive Impact for PatientsIn 2016, Billings Clinic began a lean six sigma process to address a number of issues being experienced by patients with psychiatric chief complaints in our Emergency Department. Length of stay in the ED for this group of patients was approaching nine hours. Our admission rate for this patient group was 57% or higher because our psychiatrists had two choices: admit or discharge, and it was safer to admit. Our 30-day readmission rate was 19% and had been for years. We knew that patients were not having a positive experience in the Emergency Department due to the nature of their illness. Finally, we knew we needed to find a solution that focused on the patient experience.

A design was found that had evidence supporting better patient outcomes that was championed by Dr. Scott Zeller who said “Patient boarding for long hours in emergency departments is a nationwide health care issue. Federal and state efforts to solve it have revolved around increasing numbers of inpatient psychiatric beds. The Alameda Model focuses on immediate treatment at the outpatient level of care, with a goal of avoiding hospitalization altogether. It bypasses medical emergency rooms completely in two-thirds of cases, further reducing issues of regional ER overcrowding. These are national health care reform goals.” Based on finding the ideal design for Billings Clinic, a multidisciplinary yellow belt team was formed which included nurses, social workers, mental health workers, facilities staff, and was headed by a lean six sigma black belt. The team worked on unit design objectives based on data from current state and consultations with Dr. Zeller and his team in California, and with the help of direct caregivers in the department of psychiatry, a unit size and design were agreed upon. There were key design components agreed to by the team: reduce admissions, decrease re-admissions, improve patient experience, improve wait time, meet demand of increased growth, improve patient access, and reduce the number of psych patients in the ED and improve throughput.

All this information was included into the process of getting a unit designed that allowed psychiatry to become the primary place that psychiatric emergency patients were seen and treated. The unit was completed and ready for occupancy in April of 2018, and patients began flowing from the Emergency Department to the unit we called the Psychiatric Stabilization Unit (PSU). Immediately, our lengths of stay in the Emergency Department began to decline. Patient experience began to improve, and nearly all of the design goals began to be met. The unit is designed without individual rooms, which allows patients the opportunity for social interaction with other patients and immediate access to staff. The unit has meals delivered three times a day, and food is placed in easily accessible refrigerators that allow the patients access to food and drink when they want it and are not reliant on the nursing staff to meet those basic needs. The unit is designed as an observation unit with an expected length of

stay under 24 hours to allow for development of treatment plans and connection with community services.

Our results have been extraordinary. Since opening, we have seen nearly 5,000 patients and have had less than 10 instances of seclusion or restraint. We have seen our admission rate on the psychiatric inpatient unit drop by one-third and our 30-day readmission rate drop by one-third. The average LOS for our patients in the ED has dropped to 3.7 hours. Hours on capacity has dropped to under 20% from a high of 89%. We are able to provide a patient experience that provides social interaction, daylight, time for treatment plan development, and most importantly, the right care at the right time.


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Billings Clinic’s Nurse Residency Awarded Accreditation with DistinctionIn April 2018, the Billings Clinic Nurse Residency Program was awarded Accreditation with Distinction as a practice transition program, the highest recognition awarded by the American Nurses Credentialing Center’s Accreditation Program. The Nurse Residency Program is a year-long program and is designed to provide each new graduate nurse with the skills and knowledge necessary to deliver competent, safe and effective patient-centered care. Quality outcome measures achieved by residents in transition to practice programs and new graduate nurse retention overwhelmingly demonstrate the benefit of having a nurse residency. Accreditation with distinction recognizes that the Nurse Residency Program at Billings Clinic is meeting national standards for nursing excellence and quality. The accreditation designation will help to recruit and retain high-caliber nurses and further validates that the education and experiences provided by our Nurse Residency Program will enhance the nurse as he/she advances on their professional path towards proficiency and expertise.

Nurse Residency Program Has Significant Impact on Retention of NursesSince the Nurse Residency Program’s inaugural year in 2016, 205 new graduate nurses have launched their professional nursing careers at Billings Clinic. The Nurse Residency Program uses a robust, evidence-based curriculum to provide each new graduate nurse with the tools and skills they need to build competence and confidence to become an integral member of the health care team. New graduate nurse retention and turnover rates are measured by transition to practice programs across the country and continue to support the need and benefit of structured programs to help new nurses acquire the knowledge and skills to deliver safe and quality care.

Since 2016, data trends in new graduate nurse retention rates at Billings Clinic demonstrate an increase in retention rates that are exceeding the national average. Results from a 10-year longitudinal study of new graduate nurses called the RN Work Project found that 17.5% leave their first nursing job within the first year (Kovner, Brewer, Fatehi & Jun, 2014). First-year nurse retention at Billings Clinic for 2018 approximated 90%.

Improvement in new graduate nurse retention has helped the Billings Clinic financial bottom line. Cost savings of over half a million dollars over three years has been appreciated through lower nurse turnover and replacement costs.

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Nurse Resident Title of EBP Poster

Beth Besel NPO After Midnight: Is it Best Practice for Patient Safety?

Carlee Bunkers Implementation of a Polyurethane Intravenous Catheter to Reduce Risks of Phlebitis

Heather Carrier Sharps Injuries in the Operating RoomDavid Cifaldi Perioperative Pain Management in

Trauma PatientsGrace Collins Biofilm Formation on Foley CathetersBecky Crabtree Day/Night Shifts: Recommendation to

Flip-Flop Between?Deborah Cranford Screening Used for Mental Health PatientsRachelle Darragh Can Immersive Virtual Reality Be Effective for

Pain Reduction?Sarah Dietz Hazardous Drugs: Protect YourselfLaura Duppong Effective Pain Assessments Increasing Safety

and SatisfactionJenna Ferris Color-coded Food Trays for the Diabetic PatientErinn Fjetland For the Love of God, Let Me Sleep!Joel H. Folkers Enclosure System Providing Fall Prevention &

Patient SafetyKendra Fournier Aromatherapy in the Psychiatric SettingAmethyst Jade Ganson Cobalt Toxicity in Total Hip Arthroplasty PatientsMadeleine Hammond Diabetic Nurse Educator: Treat the Root of

the ProblemAsha Heggen Vital Sign Monitoring on the Night ShiftLauren Hendrix Crisis Stabilization Units for Psych EmergenciesAdam Hertig Correcting End-of/Start-of-Shift Transfer

ComplicationsLauren Jones Improving Patient Outcomes Through Bedside

Neurological ChecksKelsey Jovick Caring For Patients Undergoing Alcohol

WithdrawalHeather Kelly Periarticular Joint Infiltration

Nurse Resident Title of EBP Poster

Jasey Leavitt Compliance with Intermittent Pneumatic Compression Devices

Felicity Linger Clotting Management in TraumasDayna Madtson Fall Risk Assessment in the Emergency

DepartmentMikaela Mostad Bringing Home the BacteriaJulia Nelson Showering with Peritoneal Dialysis CathetersKatie Nessan Nitrous Oxide in KidsAshley Parnell Diagnosing InfluenzaSaije Pollard Reaching Optimal Health Through

PEMF TherapyYvonne Ransom Central Line Associated Bloodstream

InfectionStormy Richards Turmeric Supplements for Post-Operative

Pain ControlMarina Rokke Preventing Pressure Injuries Through a

Turning and Positioning SystemTaylor Rose Aromatherapy Use with DementiaJeremy Salazar Misuse of the Emergency DepartmentShay Shelhammer Analgesia for Cesarean Section PatientsCortney Smith Liquid Plasma in Trauma SituationsJamie P. Stahl Quiet Time on a Neurosurgical FloorKaren A. Stucky Pain Assessment Tools: NRS vs CAPAKathryn Taillie Certified Nurse Midwives (CNMs) in the

Family Birth CenterLacie Thomas Patient Education and EmmiRyan Tierney B/P Monitoring After Lymph Node RemovalCourtney Unruh Missed Orders in the Emergency DepartmentPaige Wagner Combating Nurse Burnout with VolunteersJodi Waller Nurse Staffing Matrices: Do I Have Too Many

Patients to Provide Safe Care?Brittany Wetstein Implementation of Pediatric Home OxygenDanelle Wooley Pain Management in the Emergency Setting

Nurse residents practice ostomy care in the Simulation and Experiential Learning Lab

Cohort 7A graduated February 2019!

Nurse Residency Champions of Evidence-Based PracticeNurse residents are at the forefront of scholarly inquiry at Billings Clinic through their participation in research and development of an evidence-based project during their first year of residency. This experiential approach to generating and sharing new knowledge has helped our nurse residents to solve clinical problems and inform best practice changes at Billings Clinic which have contributed to enhanced patient outcomes. Residents not only apply the skills they learn during this process but grow in their professional role as lifelong learners and patient advocates who champion scientific inquiry to integrate best available evidence into practice at the bedside.

At the conclusion of year one of the program, nurse residents present their EBP projects symposium-style to hospital leaders and educators at their graduation ceremony. Members of the Nursing Research Council (NRC) and the Collaborative Science & Innovation team at Billings Clinic collaborate with the nurse residents to refine and advance their project ideas and help disseminate their work.

Examples of nurse residency evidence-based projects that have resulted in practice changes at Billings Clinic include implementation of an Optifoam Island dressing with embedded antimicrobial silver ions to minimize dressing related skin damage, reduce pain, and foster earlier patient mobilization in total joint patients; and research on microbial biofilm which helped further define nursing practice and policy to minimize catheter-associated UTIs.


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Nurses as AuthorsAuthor(s) Type of Title Publication/Meeting Date of Publication/ Publication Presentation

Jeannine Brant, PhD; Debbie Wujcik; Carrie Stricker; William Dudley

Diane Thomas Hurd, PMHNP-BC

Diane Hurd, PMHNP; Mariela Herrera, MD; Jeannine Brant, PhD; Nicholas Coombs, MS; Eric Arzubi, MD

Jeannine M. Brant, PhD

Ya-Huei Li, PhD; Elizabeth Mullette, RN, MSN; Jeannine M. Brant, PhD, APRN, AOCN, FAAN

Susan S. Tavernie, PhD; Jia-Wen Guo, PhD; Jacqueline Eaton, PhD; Jeannine M. Brant, PhD; Patricia Berry, PhD; Susan L. Beck, PhD

Diane Thomas Hurd, PMHNP-BC


Brant, J. M.; Stringer, L.; Peterson, L.; Herbert, S.; Coombs, N.


Brant, J. M.; Stringer, L. H.

Ya-Huei Li, PhD; Jeannine Brant, PhD

Sarah Tracy, BSN, RN, OCN; Leah Scaramuzzo, MSN, RN-BC, AOCN; Jeannine M. Brant, PhD, APRN, AOCN, FAAN

Poster Presentation

Poster Presentation

Journal

Podium Presentation

Journal

Journal

Podium Presentation

Poster Presentation

Journal

Podium Presentation

Book Chapter

Poster Presentation

Poster Presentation

Shared Decision-making Preferences and Pain Characterization in Patients with Cancer

The Need for Speed – Triple Chronotherapy, A Rapid Adjunctive Intervention in the Acute Treatment of Depression and Suicidality in the Adolescent Population

Prospective, Open Trial of Adjunctive Triple Chronotherapy for the Acute Treatment of Depression in Adolescent Inpatients

From Abstract to Poster: Presenting Your Work with Clarity and Impact

The Stepped-Wedge Trial Design: Paving the Way for Cancer Care Delivery Research

Context Matters for Nurses Leading Pain Improvement in U.S. Hospitals

The Need for Speed – Triple Chronotherapy, A Rapid Adjunctive Intervention in the Acute Treatment of Depression and Suicidality in the Adolescent Population

Barriers and Solutions to Conducting Patient Reported Outcomes (PRO) Research in Patients with Pain

Predictors of Oversedation in Hospitalized Patients

Integration of Patient-Reported Outcomes: Research and Practice

Cancer Pain

A Predictive Model to Identify Opioid-induced Respiratory Depression among Hospitalized Patients

The Grab-and-Go Resiliency Kit

American Society of Clinical Oncology (ASCO) 2018 Palliative and Supportive Care in Oncology Symposium; San Diego CA

2018 Neuroscience Education Institute (NEI) Congress

Journal of Child and Adolescent Psychopharmacology

Journal of the Advanced Practitioner in Oncology (JADPRO) Live 2018 Conference; Hollywood, Florida

Journal of the Advanced Practitioner in Oncology

Pain Management Nursing

American Psychiatric Nurses Association 32nd Annual Conference; Columbus, Ohio

2018 American Society of Clinical Oncology (ASCO) Quality Care Symposium; Phoenix, AZ

American Journal of Health System Pharmacists

Rochester, NY NCORP

Cancer Nursing: Principles and Practice

International Society for Pharmacoeconomics and Outcomes Research 23rd Annual International Meeting, Baltimore MD

ONS 43rd Annual Congress, Washington, DC

November 16, 2018

November 9, 2018

November 2, 2018; Published Online: 2 Nov 2018 https://doi.org/10.1089/cap.2018.0063

November 1, 2018

Volume 9; No. 7, November/December 2018, Pages 722-727

Volume 19, Issue 5, October 2018, Pages 474-486

October 24-27, 2018

September 28-29, 2018

September 15, 2018; 75(18):1378-1385

August 2018

July 10, 2018

May 23, 2018

May 20, 2018

Continued on page 10

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Author(s) Type of Title Publication/Meeting Date of Publication/ Publication Presentation

Leah A. Scaramuzzo, MSN, RN-BC, AOCN; Amy Walton, BSN, RN, OCN; Jeannine M. Brant, PhD, APRN, AOCN, FAAN

Shannon Crable RN, OCN; Leah A. Scaramuzzo, MSN, RN-BC, AOCN; Jeannine M. Brant, PhD, APRN, AOCN, FAAN

Tauna Jeffery, RN; Jeannine Brant, PhD

Brianna D. Biggins, BSN, RN, OCN; Leah A. Scaramuzzo, MSN, RN-BC, AOCN; Jeannine M. Brant, PhD, APRN, AOCN, FAAN

Jeannine Brant, PhD

Betty Mullette, MSN; Jan Smith

Ciemins, E. L.; Coon, P. J.; Coombs, N. C.; Holloway, B.; Mullette, E. J.; Dudley, W. N.

Ciemins, E. L.; Arora, A.; Coombs, N.C.; Holloway, B.; Mullette, E. J.; Garland, R.; Walsh Bishop-Green, S.; Penso, J.; Coon, P. J.

Cheryl Miller, RN, BC, MSN

Pam Zinnecker, MSNEd, BAN, RN, CCRN-K

Tafelmeyer, J.; Wicks, R.; Brant, J.; Smith, L.

Brant, J. M.; Mayer, D. K.

Poster Presentation

Poster Presentation

Poster Presentation

Poster Presentation

Podium Presentation

Podium Presentation

Journal

Journal

Podium Presentation

Poster Presentation

Journal

Journal

Zero CLABSI: It Takes a Village to Make It Happen

Stem Cell Infusion Guidelines and Practices

Cancer Care Delivery Research: The Importance of Oncology Nursing Engagement

Oncology Nurse Informaticist: Driving Evidence-Based Practice Through Documentation

Opioids: They’re Not Always the Answer

The Alzheimer’s/Dementia State Plan… Not Just a Book on a Shelf!

An Intent-to-Treat Analysis of a Simultaneous Multi-Site Telehealth Diabetes Prevention Program

Improving Blood Pressure Control Using Smart Technology

Making the Impossible Possible

PTSD Journal Project

Incorporating Nurse Input and Evidence into a Newly Designed Unit to Improve Patient and Nursing Outcomes

Precision Medicine: Accelerating the Science to Revolutionize Cancer Care






Montana Gerontology Society 36th Annual Conference – Pathways: Aging in the 21st Century, Bozeman, MT

British Medical Journal, Open Diabetes Research & Care

Telemedicine and e-Health

International Meeting on Simulation in Healthcare (IMSH 2018) Los Angeles, CA

Society of Critical Care Medicine. Critical Care Quality Summit

Tafelmeyer, J., Wicks, R., Brant, J., & Smith, L. (2017). Incorporating Nurse Input and Evidence into a Newly Designed Unit to Improve Patient and Nursing Outcomes. J Nurs Adm, 47(12), 603-609. doi:10.1097/NNA.0000000000000554

Clin J Oncol Nurs

May 20, 2018

May 19, 2018

May 18, 2018

May 18, 2018

May 18, 2018

April 27, 2018

April 21, 2018

March 1, 2018

January 13-17, 2018

December 2017

December 1, 2017

December 1, 2017

Nurses as Authors


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Author(s) Type of Title Publication/Meeting Date of Publication/ Publication Presentation


Cheryl Miller, RN, BC, MSN

Brant, J. M.; Mohr, C.; Coombs, N. C.; Finn, S.; Wilmarth, E.

Brant, J. M., Newton, S., Maurer, M. A.

Rodriguez, N. M.; Brant, J. M.; Pendharkar, D.; Arreola-Ornelas, H.; Bhadelia, A.; de Lima Lopes, G., Jr.; Knaul, F. M.

Podium Presentation

Podium Presentation

Journal

Journal

Book Chapter

The Growing Landscape of Palliative Care

A Relational Coordination Theory Informed Nurse Residency Program

Nurses’ Knowledge and Attitudes about Pain: Personal and Professional Characteristics and Patient Reported Pain Satisfaction

Pain Management in the Middle East: Building Capacity with Global Partners

Thinking Differently in Global Health in Oncology Using a Diagonal Approach: Harnessing Similarities, Improving Education, and Empowering an Alternative Oncology Workforce

SWOG, Chicago, IL

3rd International Systems and Complexity in Health Conference at George Washington Conference, Auburn, VA Campus

Pain Management Nursing

Oncol Nurs Forum

ASCO Educational Book

November 1, 2017

October 27-28, 2017

August 1, 2017

July 1, 2017

July 2017

Core Curriculum Authors

Depression Outcomes from a Fully Integrated Obstetric Mental Health Clinic: A 10-Year ExaminationIn 2007, an Advanced Practice Registered Nurse (APRN) at Billings Clinic, Diane Goedde, MSN, APRN, RNC, collaborated with Diane Arkave, MSW, LCSW, and Astri Zidack, EdD, LCPC, to develop an integrated Obstetric Mental Health Clinic (OBMHC) to manage psychiatric disorders in the perinatal population. This year (2019) marks the clinic’s 12th consecutive year of service. Ms. Goedde attended a national mental health meeting where she discussed her model during a networking session. Others encouraged her to examine outcomes and disseminate findings of the model so that others could benefit from the work done. The team approached the Nurse Scientist Jeannine M. Brant, PhD, APRN, AOCN, FAAN, and together, the team conducted a retrospective database study. Co-investigators included two additional co-investigators from the Collaborative Science and Innovation Department (CSI) who joined the team: Betty Mullette, RN, MSN, Research Nurse and Ya Huei Li, PhD, Statistician.

The purpose of this study was to examine depression outcomes in women receiving psychiatric services from a psychiatric nurse practitioner between 2007 and 2017 at a fully integrated OBMHC and to explore patient and health care team perceptions of OBMHC experiences.

The study received full board approval by the IRB of Billings on March 20, 2017.

Summary of FindingsThe sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit. Patients taking three or more psychiatric medications attended more OBMHC visits. Trend analysis indicated women with the highest levels of depression had the best response to the intervention. Qualitative patient interviews reveled high satisfaction with the clinic; three qualitative themes emerged: Safe Place, Mental/Emotional Stability, and Integrated Personalized Approach. All obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care.

Clinical Nurse Dissemination to External AudienceFollowing study conclusion, Diane Goedde, MSN, APRN, RNC, Diane Arkave, MSW, LCSW, and Astri Zidack, EdD, LCPC, along with the research team scheduled writing sessions to prepare a manuscript for publication. The team discussed potential journals for dissemination, and Ms. Goedde chose the Journal of the American Psychiatric Nurses Association (JAPNA), recognizing that this journal’s audience would benefit most from the study findings. Sections of the manuscript were divided among team members who worked collaboratively to complete the manuscript. It was submitted in March 2019. The team received a decision letter on May 15, 2019 which encouraged the team to revise the manuscript. The team again met to discuss revisions and made revisions together as a team during writing sessions. The team resubmitted the manuscript and received a request from the JAPNA editorial team to make additional revisions. The team again met and made requested revisions and resubmitted the manuscript on September 9, 2019.

The clinical nurse investigators noted three significant contributions of their work:

• The study adds to the body of literature on OB Mental Health Clinics (OBMHC) and treatment of perinatal psychiatric disorders (PNPD) in pregnancy

• Clinical nurses at Billings Clinic had the opportunity to participate in research and then disseminate findings in a peer-reviewed journal

• The research study illustrates a successful model that can be replicated to manage perinatal depression and benefit the obstetric team

The purpose of this study was to examine depression outcomes in women receiving psychiatric services from a psychiatric nurse practitioner between 2007 and 2017 at a fully integrated OBMHC and to explore patient and

health care team perceptions of OBMHC experiences.

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Wound Ostomy Nurse NavigatorJanice McFarland, RN, manager of General Surgery, along with a physician cohort, recognized the need for enhanced care, treatment, education and “normalization” of the processes involved for patients undergoing new surgical ostomy placement. They began by looking at volumes of new colostomy patients, wound and ostomy nurse turnover rates and availability or lack of appropriate resources. The team felt there was inadequate patient teaching, inconsistent care and no after-treatment support. Anecdotal information also pointed to the fact that several post-colectomy patients presented to the Emergency Department (ED) due to lack of appropriate resources, access to supplies and/or training.

The team discovered that they were doing approximately 270 colon cases per year, which was a volume that they felt more than validated the need to provide additional care for these patients. The goal was to provide exceptional care for these patients across the continuum.

Ms. McFarland presented a proposal to hire a combined Ostomy and Enhanced Recovery After Surgery (ERAS) nurse to fill this gap. Although the initial pro forma did not look like this position would pay for itself, our Chief Nursing Officer (CNO) felt the enhanced care more than justified the financial outlay and advocated to get the position approved. We then began a vigorous nation-wide recruitment effort and interviewed several well-qualified nurses. We hired Michael Sealy BSN, RN, to fulfill the valuable role designed for enhancing patient care and outcomes.

His initial job expectations were to provide counseling prior to ostomy placement regarding the life-changes that would affect the patient, provide education regarding ostomy products, how to obtain them and how to troubleshoot issues. His goal was to be a consistent resource and offer continuity of care for these patients beginning in the outpatient phase, meeting with them as inpatients and being involved in post-op visits. As Mr. Sealy has continued to develop the role, he has been able to optimize the total care for the ostomy patient by being present at the surgeon visit when the initial discussion occurs, be present at the bedside in the pre-operative arena prior to surgery and marks the surgical site with the surgeon and the patient for optimal ostomy placement, provides support for the patient, family and staff in their post-operative inpatient encounter to reinforce the initial teaching and proper ostomy care, ensures the patients have the correct supplies for discharge and provides resources to them for how to get supplies once they are home. He has provided his office and personal cell phone number to patients so he can provide answers to questions as they arise. In addition, Mr. Sealy has become a resource to the emergency department when ostomy patients present due to issues related to their device.

Through the interprofessional collaborative approach to the ostomy patients’ care and coordination, Ms. McFarland provided Mr. Sealy with the opportunity to enhance the lives of patients across the spectrum of health care services.

Michael Sealy, BSN, RN, providing education on ostomy device selection with patient

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Watchful Eye for Safety with AvaSys Patient SurveillancePatient safety is at the forefront of every decision at Billings Clinic. The patient fall reduction program has been taxed with increasing needs for resources that do not overburden the staff. An intense review of processes and equipment left few options for providing continuous 1:1 support for patients to prevent falls. An interdisciplinary falls prevention team, known as RUF (Reducing Unit Falls), comprised of both direct and indirect caregivers, including RNs, CNAs, Physical and Occupational Therapist, and nursing leadership reviews inpatient falls monthly and determined a need for an “out of the box” approach to patient safety.

After extensive research into continuous video monitoring options, the AvaSure Patient Surveillance platform (AvaSys) was purchased and implemented in all inpatient nursing units in March 2018. As part of the implementation plan and to ensure broad education and real time support to clinical areas where AvaSys would be used, a multidisciplinary team of Clinical Champions were identified. The Clinical Champions were all provided hands-on training with the equipment, monitoring guidelines, device set up and troubleshooting, and communication expectations of staff to the video monitor clerks.

AvaSys telesitters provide 24/7/365 continuous visual and audio monitoring for patients identified as appropriate for this technology solution. Patients are monitored with a mobile non-recording camera that provides immediate supervision and surveillance for optimal patient safety. The implementation has improved the caregiver experience by improving workflow and empowering care teams, as well as reducing 1:1 sitter cost utilized for patients at risk for falling while under our care.

AvaSys telesitters provide patient and family-centered care that is seamless, safe, and provides comfort. For the organization, Billings Clinic has enhanced how care is provided to help patients achieve better outcomes. Falls have declined by 52.6% on IPM alone.

Taylor Muessig, telesitter

Portable AvaSys System aides in falls reduction


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Nursing Strategic Map, 2018-2021

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Peppermint Essential Oil to Control Nausea in Hospitalized PatientsFour clinical nurses from the cardiovascular unit – Cassandra Jensen, RN, BSN, Amanda Jones, RN, BSN, Carla Mohr, RN, BSN, and Nicole Mohr, RN, BSN – recognized that nausea and vomiting was not always controlled by standard drug therapy. Carla Mohr stated, “Patients would still have nausea after I gave them something, and we wouldn’t have any other option!” The team had heard a lot about aromatherapy and its potential impact on nausea and desired to incorporate peppermint aromatherapy into the antiemetic regimen for hospitalized patients. A literature review revealed that few studies have carefully examined this issue. Most studies were small, and the Nursing Research Council (NRC) at Billings Clinic felt that more research needed to be done in this area. Therefore, the NRC encouraged the team to design a research study that would allow patients to use peppermint aromatherapy as an option to help control nausea. The clinical nurses also engaged three additional co-investigators from the Collaborative Science and Innovation Department: Betty Mullette, RN, MSN, research nurse, Ya Huei Li, PhD, statistician, and Jeannine M. Brant, PhD, APRN, AOCN, FAAN, nurse scientist.

Patients who were receiving care in the cardiovascular or medical surgical areas of the hospital were invited to participate in the study if they experienced nausea during hospitalization. When nausea set in, patients could choose either peppermint essential oil aromatherapy only or an antiemetic medication with aromatherapy. Clinical nurses then asked the patient about their level of nausea right at the start of the nausea episode and 30 minutes after receiving the aromatherapy or combination of antiemetic and aromatherapy. Patients who used only the aromatherapy had a 3.5-drop in their nausea score, and interestingly, those who used both the antiemetic and aromatherapy had a 1.8-point drop. Only 37% of patients had used aromatherapy prior to the study, indicating patients were open to trying this option; 60% of patients used aromatherapy only for their nausea episode, meaning that they did not require a drug to treat their nausea.

The clinical nurse investigators noted three significant contributions of their work:

• The study adds to the body of literature on aromatherapy use in hospitalized patients

• Clinical nurses at Billings Clinic had opportunity to participate in research

• The research study led to a change in nursing practice, and patients now have the option to try and manage their nausea with essential peppermint oil aromatherapy


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