nursing annual report 2013

health | hope | healing

2013 NURSING ANNUAL REPORT

2 | NURSING ANNUAL REPORT

Compiled byJacqulyn Robison, BSN, RN, GRN ContactJacqulyn Robison, BSN, RN, GRNP 308.630.1450E [email protected] 4021 Avenue BScottsbluff, NE 69361 rwhs.org

REGIONAL WEST HE ALTH SERVICES | 3

ContentsMessage From The CEO ............................................................................4Message From The CNO ...........................................................................6Shared Governance/Magnet Update .......................................................8Snapshots From 2013 Breakfast With Shirley ........................................92013 Nurses Day Award Winners ..........................................................10RN Magnet Awards ................................................................................. 112013 Star Awards Presented to Nurses ............................................... 132013 Patient Safety Annual Report ...................................................... 15Behavioral Health Unit ............................................................................17Acute Rehabilitation Unit........................................................................ 18Medical Surgical Services ...................................................................... 19Birth and Infant Care Center and Pediatrics ..........................................21Wound Clinic, Float Pool, House Supervisors, Restorative Care, and Dialysis .............................................................. 23 Endoscopy Unit ........................................................................................24Perioperative Services ...........................................................................25 Outpatient Surgery (OPS) ....................................................................... 26Perianesthesia Care (PACU) ...................................................................27Operating Room (OR) ............................................................................. 29Scottsbluff Surgery Center (SBSC) ........................................................31Critical Care and Emergency ...................................................................32Air Link Transfer Center .......................................................................... 35Home Care .............................................................................................. 36Imaging Services .....................................................................................37Cath Lab.................................................................................................. 38Cardiac And Pulmonary Rehabilitation .................................................. 39Case Management ................................................................................. 40Community Health ...................................................................................42Pharmacy Medication Reconciliation Nurses ...................................... 44Quality Resource .................................................................................... 45Risk Management ................................................................................ 46Trauma Services ......................................................................................47Wound Care/Ostomy Report ................................................................ 48Shared Governance Report ................................................................... 50Certified Nurses ...................................................................................... 54


The Institute for Healthcare Improvement has defined a “Triple Aim” initiative to serve as a beacon for improvement efforts. The Triple Aim is:

• Improving the patient experience of care, including safety, quality, and satisfaction;

• Improving the health of populations; and

• Reducing the per capita cost of health care.

Our efforts at Regional West over the past several years have been quite consistent with the Triple Aim, and we must remain true to these objectives in order to prosper in the future. Our focus on patient safety is the most important element of this goal—we must never passively accept that patients might be harmed as a result of an encounter with our system. We have made progress on our goal of reaching a Serious Safety Event Rate of zero by the end of 2014, having gone 113 days since

our last serious safety event at the time this is being written, but constant attention to patient safety is required for us to achieve the ultimate safety goal: that patients are never harmed in our institution. I am very appreciative of the efforts you all are making in this important initiative, and know that you will not relax your focus on safety.

Population Health Management (PHM) is the second of the Triple Aim goals. This goal, as its title suggests, is directed at finding and carrying out activities that will result in an overall improvement in the health of the population. This is more difficult for hospital systems to address, because the goal of most health systems is to increase activity while the goal of PHM is to

MESSAGE FROM THE CEO Todd Sorensen, MD, MS President and CEO | Regional West Health Services

To my patient care colleagues:The health care system in the United States continues its rapid transformation, though to what exactly is not yet clear. We know the focus must change towards a much more patient-centered system in which the patient’s needs are considered above other considerations.


improve the population’s health and thus decrease the need for hospital and other services.

We are working hard with eight other systems around the state as members of the Regional Provider Network (RPN) to find ways to acquire the capabilities to do PHM. These requirements include such things as data and information systems, case management protocols, and clinical pathways, all of which represent substantial challenges for systems our size to do alone. We are excited about the possibilities represented by RPN, both because it will enable these capabilities and because doing good PHM will prove to be tremendously valuable to the people of the region.

And of course we are all aware of the need to reduce cost as we are developing all these other capabilities. This represents perhaps the biggest challenge we face, that is, building new capability in the face of falling volumes and payments for what we do. This is a challenge being faced by virtually every system in the country, so there are lots of really smart people working on it, but never the less it remains a major challenge.

As always in times of rapid change, the future is at once frightening and enticing. Given the opportunity and sufficient reason, American initiative has proven time and again to have remarkable ability to invent new ways of doing things. I am confident that we will find the

same remarkable inventiveness with respect to the present challenges we in health care face. And I am equally confident that we have the best team we could have to help us move forward.

Thanks for all you do!

Todd


MESSAGE FROM THE CNOShirley Knodel, RN, MS Chief Nursing Officer | Vice President Patient Care

While we have been taught as health care workers that first we are to do no harm, our mission goes beyond that. It takes us from malfeasance, meaning to do no harm, to beneficence, meaning a commitment to promoting the client’s well being. To do that we have to live our value statement, “We ask-always–What is in the best interest of the patient?”

How are we doing this? By shining an intense focus on safety, quality, and the patient experience carried out in an efficient manner.

In 2013, we focused heavily on safety training for all staff and providers, making safety a core value and developing safety coaches on each unit for each shift. We have become more proficient at analysis of near misses, incident reports, and serious safety events. We have gained proficiency in apparent cause analysis, root cause analysis, and common cause analysis. Our serious safety event has shown a downward trend since 2010 when we began our journey to make safety a core value but we are not accepting that. Our goal is to reach zero events.

We have an active Board Quality Committee, which contains community members who serve on our board of directors. They participate in a review of our quality reports every month and ask questions as well as make suggestions. Through education, collaboration, and transparency, we are driving more focus on best practice clinical guidelines, clear consistent policy and procedures, ongoing education, and accountability. In 2012 we also added nursing peer review as a process that has matured through 2013. It has been an excellent learning tool to drive best practice and improve quality.

The core quality measures are showing improvement in all categories. The quality dashboard at the time of this writing shows 39 of 47 measures with a percent positive to be above 90 percent. Twenty of those measures also saw an increase in the percent positive from 2012 to 2013, with many

OUR MISSION

Regional West Health Services seeks to serve all the people of its communities as a steward of their health and health care.

OUR VISION

Our vision is that patients, physicians, and staff are valued and are the receivers and givers of health care that is safe, efficient, and of the highest quality both now and in the ever-changing future.

VALUE STATEMENT

We ask-always-What is in the best interest of the patient?


of them achieving 100 percent positive.

We have focused on improving the patient experience as well. A year ago we had only one inpatient satisfaction metric at or above 90 as the percentile rank in comparison to other hospitals in our database. Our latest month’s inpatient scores show that we have six metrics at or above the percentile rank of 90. They are courtesy and respect of nurses, clear communication by nurses, communication of possible side effects of medications, quality of food service, explanations of new medicines, and talking to patients about help after discharge.

We are imbedding the use of AIDET, rounding with a purpose, hand off communication, collaboration across care teams, and transparency with patient satisfaction results. Staying steady with our course of education, collaboration, and

transparency will need vigilance to continue improvement. Our goal is to be at or above the 90th percentile rank for patient satisfaction overall.

Our Shared Governance Committees and Unit Practice Councils have accomplished much in 2013. Shared Governance has restructured to roll quality and safety together, added a Nurse Finance Council, and a Night Shift Council. The Nurse Finance Council has been focusing on cutting costs through efficiency by creatively looking at processes that can be streamlined and eliminating waste. The Night Shift Council is working on issues that are unique to that shift. It is important to engage night shift staff to bring consistency and reduce variation in order to improve patient care. Employee engagement is essential to success in improving the patient experience. The Shared Governance Council, along with nursing leadership, made

the decision in 2013 to pursue Pathway to Excellence.

We were rewarded for our hard work in 2013 by being reaccredited by The Joint Commission as well as The American College of Surgeons reaccrediting us in our Level II trauma designation. These recognitions are proof of the hard work and dedication of staff and providers working together to provide outstanding care to our patients. Our ongoing accreditations in CAMTS for Air Link, Cancer Service’s outstanding achievement award from the American College of Surgeons for the fourth time in a row, CARF accreditation for Acute Rehab Unit, and the Bariatric Center of Excellence designation all are additional examples of providing outstanding care and putting the best interests of the patient first.


SHARED GOVERNANCE/ MAGNET UPDATE Jacqulyn Robison, BSN, RN, GRN Survey Preparedness and Magnet Coordinator

April 2014 marked the beginning of my Magnet Coordinator position at

Regional West Medical Center. Up until this time, Jordan Colwell did a wonderful job at facilitating the different Shared Governance meetings and pursuing Magnet status. He also did extensive research on transitioning from the pursuit of Magnet Accreditation to Pathways to Excellence—both of which are obtained through the ANCC. Jordan has transitioned into a new role with Regional West Health Services and I would like to applaud him for all the hard work he has done here at Regional West as Magnet Coordinator.

My background originates from the Omaha community where I worked for 13 years at a hospital that was in the process of working on their Pathways to Excellence Certification for the last year of my tenure with

them. I was privileged to serve with many nurses who worked diligently on this new process. As I get to know the culture here at Regional West, my goal is to get to know each nursing staff

member personally and see what they hope to achieve in their professional career. Pathways institutes 12 steps to help gain accreditation. With everyone’s help, I believe this endorsement is very attainable.

Regional West has some truly talented leaders, Shared Governance Council members, and bedside nurses who are

all driven and motivated. The bitter truth is that patient satisfaction scores are a part of our daily trend and sometimes we get overwhelmed by hearing this statement day after day.

Pathways is meant to keep the nursing structure energized, excited, and equipped to be ready and work those long 12 hour days, even when there seems to be no end in sight. My goal is to help everyone get the recognition they deserve as well as help everyone learn how to shift in this world of ever evolving health care.

Here’s to a new path in which we will all be traveling together. Here’s to helping each other stay focused along the way. Finally, here’s to making our efforts as a team so that none of us are left behind on this Pathways journey.

Respectfully,

Jackie


SNAPSHOTS FROM 2013 BREAKFAST WITH SHIRLEYShirley Knodel, RN, MS


Friend of Nursing Award

Peg McFarland | Perioperative Technology and Support Coordinator

“Peg McFarland is a deserving nomination for the Friend of Nursing

Award. Peg is the Office/Tech Support Coordinator in the Operating Room. Peg deserves this award because she does so much behind the scenes

work that she never gets recognized for. Peg not only does scheduling for the OR, posts patient charges, makes numerous reports for various people, keeps track of all the employee’s time cards, but she also has been given the huge task of helping our HSM upgrade. HSM is the system that is used in OR for charting and charges.”

Outstanding LPN

Sonya Gilliand, LPN | Perioperative Department

“One of Sonya’s great qualities is her attention to safety as a core value.

Sonya has always provided care according to Regional West Medical Center’s elements for safety behavior. Sonya models the behavior

patient first every time, working together, and improving every day. The patient is the most important whenever Sonya dons her blue scrubs. She is attentive to the special needs of the patient that occur in the Operating Room and strives for the best outcomes with all patients.”

2013 NURSES DAY AWARD WINNERS


Empirical Outcomes

Ruth McGee, BSN, RN | 3rd Floor

“Ruth encourages her patients by being a good listener, is observant of

possible needs, and strives to fulfill them no matter what they are. Involves doctors, nurses, aides, and other departments necessary to fulfill the needs of the patient.”

Exemplary Professional Practice

Chris Micheels, RN | Perioperative Department

“Some of the descriptive qualities of her character include: good-natured,

prudent, good judgment, talented teacher and mentor, gentle, patience, compassionate, a wealth of knowledge, valuable resource and just plain brilliant!”

Transformational Leadership

Lori Reifschneider, RNC-AWHC | Nurse Manager, Regional West Physicians Clinic

“Lori is very compassionate and supportive of her nursing staff. She has

been right there beside us, helping several of us during tragic personal occurrences. She was understanding in providing time away from our

jobs and then when we returned, she provided staffing support that allowed us to get back into our working roles. But more important, she also gave us wonderful emotional support and encouragement, above and beyond anything required by her position. Lori truly cares for each of her staff.”

RN MAGNET AWARDS


New Knowledge, Innovations, and Improvement

Mary Lockwood, RN | Perioperative Department

“Mary Lockwood should receive the RN Magnet Award. Mary is an RN in

the Operating Room who is also the supervisor of the preoperative assistants in the instrument room. Since taking on this difficult role, Mary has

had to learn about the OR instrumentation, as well as proper cleaning and sterilization. Mary is in charge of making sure that all instruments and trays used in the surgery cases are properly decontaminated, washed, and then sterilized based on not only the AORN standards (operating room standards), but Joint Commission standards and AAMI standards (Association for the Advancement of Medical Instruments).”

Structural Empowerment

Lenna Booth, BSN, RN | Interventional Radiology

“I feel Lenna is very deserving of this award for many reasons. First of all,

as a senior staff member in a very small department, a lot of the decision making on a day to day basis falls to her, as well as the delegation of the paperwork

and work load. She spends many hours during their quiet times working on reviewing and updating the policies and procedures that govern that department.”

Outstanding Preceptor of Nursing Students

Travis Hargreaves, BSN, RN, CCRN | CICU/PICU

“I would like to recommend Travis for the Preceptor award nomination.

Travis is an excellent example of how a preceptor should guide his nursing students.”


2013 STAR AWARDS PRESENTED TO NURSESLenna Booth, BSN, RN | Interventional Radiology

If you are looking for an excellent and compassionate nurse,

Lenna can be the role model, according to her patients that she has taken care of.

“During a recent stay at Regional West, I received a stress test in the Respiratory Therapy Department. My nurse, Lenna Booth, was absolutely wonderful. She went into great detail to explain the procedure. She then explained the possible uncomfortable side effects. Unfortunately, some do happen. But Lenna was so precious and compassionate. She held my hand and through my IV she reversed the meds and took the pain away. I can’t say enough about her wonderful care for me. She is truly a Shooting Star.”

“Lenna gave me quality understanding and amazing patience all through the heart testing. Always caring, her touch and sweet smile that shone from her heart to mine. Bless you Lenna for your outstanding care for me.”

“Lenna has also taken the time with patients undergoing radiology procedures who have claustrophobia or anxiety. These types of tests can be scary and nerve-racking. She took the time to listen to a patient who was severely distressed and put that patient at ease while showing patience and compassion. Thank Lenna for being a role model. You have earned your STAR award with grace.”

Lauretta Lopez, RN | Preadmit Testing

Congratulations to Lauretta for being awarded STAR of the

Year for 2013.

To truly understand why Lauretta (also known as Laurie) is deserving of the

STAR of the Year award for 2013, one must read the letter that was written to our CNO here at Regional West. This will paint the picture of how Laurie is another excellent role model in nursing for her compassion, awareness, and courage.

“Dear Ms. Shirley Knodel, RN, I am writing to commend Laurie Lopez, RN for the highly professional and courageous actions she took to try and save the life of a cardiac arrest patient while vacationing in Puerto Vallarta. On Friday, May 3, 2013, my wife and I were on vacation and staying at a resort in Puerto Vallarta. At around noon we sat near the main pool area and soon thereafter began a conversation with two men who were sitting next to us. Without warning, one of the men slumped down in his chair and his eyes rolled backward. Being an EMT, I immediately began an examination of him (patient), opened an airway and found he was not breathing and there was no heartbeat present. The man’s partner told me the patient had double bypass heart surgery in 2010, was a diabetic, and he had taken his medication earlier that day.

We cleared the chairs away, and laid down some towels on the ground in preparation for beginning CPR. I was joined by Jose, who is the resort’s activities director, and he helped me bring the patient


to the ground. Jose did two rescue breaths and we again checked for vital signs and found none. We then began performing CPR. We were immediately thereafter joined by Laurie Lopez, who identified herself as a nurse. RN Lopez also did an examination of the patient and she then joined us in performing CPR. She and I took turns doing compressions while Jose continued to give mouth to mouth resuscitation.

Lopez had the highest level of medical training present and she took charge of the situation. I was very impressed with her oversight of the situation and the professional manner by which she gave us direction and carried out patient care. After approximately 40 minutes of performing CPR, a doctor arrived on scene. Apparently, the hotels contract with a local doctor to respond when a guest becomes ill.

The doctor did not have any equipment with her. She helped maintain the patient’s airway while we continued to perform CPR. Another guest at the hotel brought her portable oxygen machine and a nasal cannula

to us and we placed that on the patient. Ten minutes later the ambulance crew arrived. The defibrillator model they had is one we used over 10 years ago. They shocked the patient a couple of times with negative results. The medic crew struggled with establishing an IV and administering the medications. You could see the frustration in the facial expressions of the doctor and she directed RN Lopez to assist with the administration of medications, which she performed without delay and in a highly skilled manner. The patient was strapped to a backboard and then carried to an elevator where we stood him up for the elevator ride to the upper parking area where the ambulance was located, all the while still performing compressions and ventilating with a bag-valve mask.

We later learned that the patient did not survive the cardiac arrest. I returned to the pool area and met with RN Lopez and we gave each other a supportive hug. As often as we respond to these kinds of medical emergencies, there is always a tug at your heart when there is

an unfortunate outcome and it is just not always possible to put it out of your mind and return to vacation mode. I want to commend RN Lopez for joining us in performing CPR, which was exhausting given the length of time involved, coupled with the heat and humidity that existed. Her professional, take charge manner was reassuring to all that we had a highly skilled and experienced nurse on-scene and that the patient was going to receive the very best in what we could do to save his life. Please extend to RN Lopez my most sincere thanks and appreciation for all that she did that day. She was courageous.”

Thank you again, Laurie, for your excellent nursing skills. You have modeled the wonderful skills as a nurse that we know all of our staff carries as well. We appreciate you here at Regional West.


2013 marks four years since the start of our patient safety initiative. We ended

the year with a Serious Safety Event Rate (SSER) of 0.55, which is just over a 77 percent reduction in serious safety events since we started this journey in 2009. Our goal for 2013 was 0.25. It was disappointing not to reach that goal and serves as a reminder to maintain diligence in using the safety behavior tools that will help decrease error and therefore, decrease harm to patients.

2013 highlights• Safety coaches completed

a successful year. These dedicated front line workers continue to work with their managers and directors to build and reinforce accountability of the safety behavior tools; coach and cross monitor co-workers; and provide support and education to staff.

Dylan Cardiff, Safety Coordinator, and Christa

Pelster, Environmental Services, help lead this program.

• 2013 year end Common Cause Analysis data:

Compliance 23.1%

Critical Thinking 23.1%

Attention to Detail 12.5%

Knowledge and Skill 11.3%

Process 9.4%

Communications 7.5%

Culture/Mission 6.3%

Non-Intuitive Environment 1.9%

Planning and Coordination 1.9%

Policy and Procedure 1.9%

Resource Allocation 0.6%

Work Stress 0.6%

Culture remains high at 84.3 percent in the System Failure Modes by category. Critical Thinking and Compliance, at 30.8 percent and 23.7 percent respectively, are the top two

Individual Failure Modes by category.

• Safety Behavior Training continues on the first day of New Hire Orientation. We have a dedicated team of people who deliver this information. Trainers are as follows:

• Sean McCracken—Cardiopulmonary

• Sylvia Dolberg—Assistant Director, Imaging Services

• Karna Kleager—Manager, Outpatient Surgery (OPS) and Post Anesthesia Care Unit (PACU)

• Dylan Cardiff—Safety Coordinator

• Linda Fowler—Clinical Coordinator, ICU/PCU

• Michelle Powell—Staff RN, Outpatient Surgery

• Lenna Booth—Staff RN, Interventional Radiology

• Leader Safety Behavior Training is provided quarterly for new leaders. It is also open to current leaders as

2013 PATIENT SAFETY ANNUAL REPORTSusan Backer, MSN, APRN-CNS, ACNS-BC Clinical Nurse Specialist/Patient Safety Officer

[continued to page 16]


a refresher and to anyone who wants to further develop their leadership skills. Julie Schaff, Education Department Director, coordinates this training.

• Nursing Peer Review Committee (NPRC) started in June 2013. This committee was developed by the Shared Governance Quality and Safety Council. The purpose of the NPRC is to ensure quality performance of direct nursing care at Regional West Medical Center by assessing the performance of nursing practice and utilizing the results of such assessments to improve care.

Committee goals are to• Improve the quality of care

provided by individual nurses

• Monitor nurses’ practice performance

• Identify opportunities for performance improvement

• Identify system process issues

• Monitor significant trends by analyzing aggregate data

• Ensure that the process for peer review is clearly defined, fair, defensible, timely, and useful

• Enhance the practice of nursing and promote nursing as a profession

The committee is made up of direct care RNs from the core nursing units. Members are:

• Toni Straub—ICU/PCU

• Ginny Blackburn—Perioperative Services

• Jennifer Hooton—Acute Rehab Unit

• Danielle Dorshorst—Perinatal Unit

• Lisa Descharme—Ortho/Neuro Unit (2E)

• Rachel Hutchinson—Adult Post Surgical Unit (2W)

• Susan DeBlieck—Medical/Oncology Unit (3E)

• Lorrie Joplin—Emergency Department

• Kelly Fiesterman—Medical/Oncology Unit (left mid-year for a different position)

• Will Branham—Emergency Department (left organization)

It is a joy to work with this engaged and dedicated group of front line nursing staff.

We ended the year with a hospital survey on Patient Safety Culture. We changed survey tools this year from Pascal Metrics Culture

Survey to AHRQ (Agency for Healthcare Research and Quality) Hospital Survey on Patient Safety Culture. The Pascal survey was last administered in December 2011 through VHA Mountain States. Since this chapter has since dissolved we investigated other survey options. We decided on the AHRQ Hospital Survey on Patient Safety Culture and feel that it best reflects the work we are doing in the Safety Culture Initiative. The survey closed in early January 2014 and data is currently being analyzed.

Everyone is working hard to keep safety at the forefront. That’s not easy to do in this ever changing and uncertain health care climate. We know one thing is certain—keeping our patients safe must be a Core Value. Patient safety affects all other aspects that are important in health care, such as finances, quality, and satisfaction. If we can’t keep our patients safe, nothing else really matters.

“We are what we repeatedly do. Excellence, therefore, is not an act but a habit.”

—Aristotle

[continued from page 14]


“Acceptance of the unacceptable is the greatest source of grace in this world.”

—Eckhart Tolle

When I read this quote, I can’t help but think that nurses who work in the behavioral health field must be gifted with an inordinate amount of grace. Working with mentally ill patients day in and day out takes a special kind of person. Psychiatric nurses “go where angels fear to tread,” caring for patients who are deeply depressed, floridly psychotic, or addicted to substances is very challenging in and of itself.

However, the true strength of the psychiatric nurse is acceptance of the unacceptable. Being able to sit with a patient who is experiencing intense emotional pain, to listen and truly hear what they are saying and to accept their level of despair without false encouragement requires a keen awareness of your own attitudes and feelings.

We are fortunate to have nurses on the Behavioral Health Unit

who have the passion to work with these complex patients and who understand the mind body connection in overall health and well-being.

The Behavioral Health Unit faced many challenges during 2013. Largely due to better outpatient management and more effective psychotropic medications, we saw a 15 percent decline in inpatient census. Along with shrinking revenue sources and ever growing requirements from regulating agencies, it has been an ongoing challenge to balance need with available resources.

In spite of the challenges we had many things to celebrate!

We made it through three surveys in 2013; Joint Commission, CMS, and Region I without any major deficiencies.

With safety always at the forefront, we finished 2013 with no serious safety events on the unit.

We are very proud to say that the overall patient fall rate decreased significantly from 16 unassisted falls in 2012 to just two in 2013.

All staff completed the Hendrich II falls education in August 2013 and we are optimistic that we will continue to meet or exceed our target of five falls per 1,000 patient days.

Patient satisfaction continues to be area of primary focus. In 2013, staff received training in AIDET as a primary communication tool for all interactions with patients, families, and other customers. Throughout the year we honed our communication skills and we hope to see steady improvement in our patient satisfaction scores as a result.

2014 will once again be a year of transitions as we adjust to downsizing the unit from 18 to 12 beds and reducing staff by a total of six positions. Forging ahead in the uncertain health care world will require grace and a fair share of tenacity but we are up for the challenge.

BEHAVIORAL HEALTH UNITMary Armstrong, RNDirector, Behavioral Health Unit


Although the Acute Rehab Unit (ARU) did not see growth in our 2013

average daily census, we had many positive things happening on the unit throughout the year. When looking at our patient population, we grew in the area of patient referrals, and the number that came from an external facility grew by 5.5 percent. We were able to return 76 percent of our patients to their home setting, and only eight percent of our patients returned to an acute care setting. That is almost three percent lower than the national average.

Patient satisfaction continued to be a focus area for ARU during 2013. In order to help with employee engagement, we had the ARU staff actually take the survey as if they were a patient on the unit, and then took a look at how we would score ourselves. From there we decided what areas we would like to focus on. We maintain a consistent practice of leadership rounding on patients, and provide timely follow-up with staff on any concerns/issues, as well as timely recognition

and praise given to staff who are praised by patients during rounding.

Part of the Performance Improvement activity on ARU includes the scoring of the Functional Independence Measurement (FIM) of each patient. The FIM instrument is a seven level scale that measures a patient’s level of independence. In 2013, we were able to purchase an On-Demand web-cast subscription that provides easy access for nursing and therapy to provide continuous training for FIM scoring. This is very important education, as this scoring is part of what drives quality/reimbursement on ARU. The staff received continuing education credit upon completion of these modules.

Also in the area of Performance Improvement on ARU, Unit Manager Pam Cover worked on education for discharge medications as a quality indicator. She has put an assessment into place to determine which patients may be at high risk for re-admission secondary to

medication administration once they have been discharged. The hope is to improve patient safety, see a decrease in re-admission rates, and increase patient satisfaction rates in the area of explanations regarding new medications.

During the year, the ARU Patient Advisory Council was active and supportive in many ways on the unit, in the hospital, and in the community. They sent letters to the hospital administration speaking to issues of accessibility for parking and restrooms. Changes were made within the hospital to address these issues. They have also sent letters to the City of Scottsbluff with similar requests and those efforts are ongoing. We are proud of them for making a difference!

ACUTE REHABILITATION UNIT

Tami Bokelman, MSW Program Director

Pam Cover, RN, CRRN Nurse Manager


T he Medical Surgical Services Department includes the Orthopaedic/Neurologic

Surgical Unit, the Adult Post-Surgical Unit (including care of the bariatric surgery patients), the Medical/Oncology Unit, and Vascular Access Team. Staffed with teams of licensed, professional nurses and nursing support personnel, we strive to provide high quality, safe, compassionate nursing in collaboration with other disciplines. Our department strives to keep the patient at the center of all of our considerations.

The front line nursing staff are the true experts at patient care. Therefore, dynamic Unit Practice Councils (UPC) are an essential part of unit improvement and performance. The UPC chairs were Kara Plett (Medical/Oncology), Shy Engel (Ortho/Neuro), and Sam Kizzire (Adult Post-Surgical). This year, each Unit Practice Council created charters to better realize their mission and purpose within the nursing governance system. The Unit Practice Councils meet monthly. Through their council, Medical/Oncology participated in the Festival of Hope, a nonprofit

organization helping cancer patients who live in western Nebraska and eastern Wyoming. The Ortho/Neuro Council addressed the process of dismissal education and has initiated a project to help nursing save steps and allow entering the room with hands free to enhance good hand hygiene. The Adult Post-Surgical Council initiated a project to answer call lights more quickly.

Also involved in Nursing Shared Governance from our department during 2013 were Paul Adams (Chair, Nurse Finance), Diana Baratta (Administrative Advisor, Prof Practice), Mary Barraza (Co-chair, Nurse/Pharmacy), Mike Bokelman (Nurse Finance), Lena Miramontes (Professional Practice), Rebecca Montanez (Care and Practice), Amanda Norman (Care and Practice), Liz Ossian (Quality and Safety), Nicki Rotert (Night Shift Council), Tara Shallenberger (Secretary, Professional Practice), and Vianey Zitterkopf (Professional Practice).

RNs who have maintained their specialty certifications include: Megan Anderson (Oncology),

Lisa Fabricius (MedSurg), Tara Shallenberger (MedSurg), Christy Walters (MedSurg), and Mona Urwin (Bariatric).

It is always great to have someone join our team in a nursing support role, then advance to RN. We congratulate Amanda Norman, formerly CNA on Ortho/Neuro, who achieved her RN degree in May 2013.

We would like to recognize Joyce Sinner, LPN, who achieved the President’s Award for contributing over 1,000 hours as a community volunteer.

Leading the teams of our three nursing care units are the Clinical Resource Nurses (CRN), experienced nurses who offer support to the nursing staff, coordinate nursing care, and are instrumental in communications both on and off the units. Our Clinical Resource Nurses during 2013 were Andrea Arellano, Shelley Dupuy, Shereen English, Lisa Fabricius, Rachel Hutchinson, Nikki Rotert, Melanie Schanaman, Jennifer Schmer, Tammie Setter, Tara Shallenberger,

MEDICAL SURGICAL SERVICESDiana-Jean Baratta, MSN, MA, RN Director, Medical Surgical Services



Tammie Setter, Lenae Snyder, Crystal Sterkel, Ruth Vasquez, Sheree Verbeck, and Christy Walters. The three nursing units are seen as sister units, with the CRNs collaborating across units for staffing and other patient needs. This collaboration has noticeably increased over the last year as the CRNs engaged in two Leadership/Teambuilding retreats including teambuilding exercises, a fun yet meaningful game facilitated by Randy Meininger, and the YMCA facilitated ropes course. Activities required cooperation and critical thinking resulting in carry-over to daily operations.

Two new Clinical Coordinators, Melissa Snyder and Stacey Powell, were hired to help with the continuous educational needs of the department nursing staff. Simulation as a learning methodology was introduced. Melissa and Stacey used simulation training to teach recognition of the signs and symptoms of sepsis, when to call the Rapid Response Team, and how to conduct a Code Blue. Both clinical coordinators were instrumental in conducting the department’s Education Days to ensure competency. In addition, they have been very involved in the residency program for new graduates and in working with the Education Department to define unit competency expectations.

Diana-Jean Baratta, Director; Chris Buhr, Manager Medical/Oncology; Rebecca Montanez, Manager Ortho/Neuro and Adult Post-Surgical have made efforts to round regularly on the units, visiting with both patients and unit employees, which is important in developing sensitivity to operations. Staff members have commented that they enjoy having leadership present.

Mandatory staff meetings were established to ensure all nursing staff receive the information and education necessary for their role. We are grateful to the many people who took time to speak to the groups during 2013. These included Austin Engel (charting from a risk management perspective); Shirley Knodel, Sarah Shannon, and Connie Rupp (uniform research project); members of the Quality Department (documentation to meet CORE measures); Paul Hofmeister and Kathy Gibbons (HIPPA compliance); Susan Backer, Michelle Powel, and Liz Ossian (nursing peer review); and Dylan Cardiff (fire extinguisher training).

Nursing hand-off shift-to-shift occurs at the bedside and was introduced in 2012. We realized that, while bedside report improves safe patient hand-over, the team had become more fragmented, knowing nothing

about patients other than their own assignment. Since we want the staff to be responsive to call lights with anyone available expected to answer any light, and all responsible for patient safety, certain critical information needed to be disseminated to the entire team. Therefore, a before shift team huddle was established, the off-going charge reporting to the entire on-coming team about fall risk, code status, and other crucial organizational information.

Concerned about patient satisfaction, infection prevention, and privacy, the department piloted a private room project. There are seven very small double rooms on Medical/Oncology and nine additional double rooms on the Post-Surgical Unit. Ortho/Neuro has all private rooms and only fills up about half the time. Working together, we try to avoid rooming two patients together until we cannot. The project has been mostly successful, with patients sharing a room only at times of very high census or when their diagnosis makes it more appropriate to keep them within the specialty area. Both patients and nurses have expressed their appreciation of our efforts.



T he delivery of high quality, safe, and efficient care that keeps the patient at

the center of our concerns will continue to be our focus as we move forward in 2014.

Birth and Infant Care Center Staff • We welcomed some new faces

in 2013; Vanessa Rhembrandt, RN, and Jessica Kortmeyer, RN.

Awards • In 2013 there were two

nominees for the 2013 Regional West Medical Center’s Precepting Nurse’s Award; Michelle Dillon and Jessica Brumbaugh.

• Connie Rupp was nominated for Outstanding 2013 RN Magnet Award, Transformational Leader.

• Sara Kraft-Leavitt won the award for the “Best Nurse” in the Star Herald Newspaper.

Education• Postpartum hemorrhage

• Hospira Smart A+ IV Pump education

• Safe Sleep education

• ER11 training

• NORS education

• “How To’s and What If’s of Breastfeeding”

• CCHD screenings program

• AIDET training and documentation

Equipment/Supplies• New Hospira Smart A+ IV

Pumps

• New sleep sacks for babies

• Electronic hands-free hand sanitizer dispensers

Breastfeeding We have continued to implement Skin to Skin after birth. As research proves, our breastfeeding latch scores have improved as well as our breastfeeding duration because of this practice change. This also has been a patient satisfier. Our mothers report this has been such a wonderful experience they wish they could have done this with their other babies. Breastfeeding is on the rise because of the known benefits and health care reform. Nationwide the breastfeeding rate is 77

percent. Here at Regional West, we are happy to report that our breastfeeding initiation rate average is 85 percent.

Neonatal Intensive Care Unit (NICU) Staff• We welcomed a new face in

2013; Carly Temple, RN.

Education • Hospira Smart A+ IV Pump

education

• Safe Sleep education

• ER11 training

• NORS education

• How To’s and What If’s of Breastfeeding”

• CCHD screenings program


Equipment• New sleep sacks for babies

• Hospira Smart A+ IV Pump education

BIRTH AND INFANT CARE CENTER AND PEDIATRICS Connie Rupp, BSN, RN Director, Birth and Infant Care Center and Pediatrics



Pediatrics Staff • We welcomed a new face in 2013;

Kristin Mitzel, RN.

Equipment/Monitoring• A new NaviCare Nurse-Call

System was installed on the Pediatric floor.

• New Hospira Smart A+ IV Pumps were installed.

Education• Pediatric Case Review-Meningitis

• New Smart A+ IV Pumps

• ER11 training

• NORS education

• Pediatric case review-Pertussis

• Pediatric case review-Sepsis


• ER12 training

• UPRIGHT fall prevention education

Awards In 2013 there were four nominees for the 2013 Regional West Medical Center’s Precepting Nurse’s Award; Nina Grubbs, Catharine Houstoun, Jennifer Komarek, and Julie Meier.

All Areas

Patient Satisfaction • We are continuing to

work on improving patient satisfaction. In 2013, each staff member wrote an example of how they were able to improve patient satisfaction or make a difference for a patient. This was our way of proving competence of the understanding of what patient satisfaction means. These were used weekly in our Friday Updates for staff to read. We also worked on AIDET and have been monitoring for usage and success.

Safety Improvements• Use of Smart IV pumps

• Implementation of breast milk double check by two people

• Continuous education and reinforcement of the use of Safety Tools. Use of Safety Story at every meeting. Encouragement of reporting good catches.

Joint Commission Survey• Successful 2013 survey!

• Performance Improvement white boards

• Implemented magnetic white boards in BICC and Peds to display monthly and quarterly progress in Performance Improvement.



Wound Clinic A Wound Symposium was held in October 2013. Thank you to Dr. Walsh, the Education Department, and the Wound Clinic staff for your involvement in making the symposium a great success.

Float Pool The Clinical Rescue Team staff floated to the following areas in 2013: 2E, 2W, 3rd, 4th, ICU/PCU, Postpartum, Peds, Outpatient

Surgery, Interventional Radiology, Cardiac Rehab, Scottsbluff Surgery Center, and the Emergency Department.

DialysisMonthly Quality Assurance and Facility Management meetings have been established between DaVita and Regional West Medical Center. A new process for sending water culture reports to the Infection Control Committee has been established.

DaVita started providing Peritoneal Dialysis Services at Regional West Medical Center.

Language Access The Language Access Coordinator position was approved and has since been filled. More to come on this.

WOUND CLINIC, FLOAT POOL, HOUSE SUPERVISORS, RESTORATIVE CARE, AND DIALYSIS Sarah Shannon, BSN, RN | Director, Wound Clinic, Float Pool, House Supervisors, Restorative Care, and Dialysis


T he Endoscopy nurses provide the majority of their nursing care to patients at

the Scottsbluff Surgery Center-Endoscopy Unit. However they also provide support to Regional West Medical Center inpatients who need an Endoscopic procedure. Thus, they also strive to be knowledgeable of the hospital nursing protocols by being involved with PCS’s nursing activities such as their PI intervention, which was to check if pain was assessed appropriately.

A major project this year for the Endoscopy Department was the transition from paper charting to computerized documentation. We went live in July.

The nursing staff helped to promote the health of the community for colon cancer awareness by setting up the 1st Annual Boxer Rebellion which was a 5K Fun Run/Walk that raised awareness for colon cancer month. They raised over $1,000 that they donated to Festival of Hope.

Promoting continuing education is an ongoing goal of the nurses which was evident by:

Lucrecia Spady, Pam Engelhaupt, Amber Gomez, and Rebecca Robles represent Endoscopy on the Shared Governance Councils.

Lucrecia Spady, Unit Manager, graduated October 25 with her Master of Nursing degree

with an emphasis on nursing management.

Joni Bruce is our new safety coach and will help us stay educated on our safety culture initiatives.

Pam Engelhaupt, RN is working on her Bachelor of Nursing degree and will graduate in December 2015.

Lucrecia Spady, Unit Manager, became the Management Advisor for the Quality and Safety Council.

ENDOSCOPY UNITLucrecia Spady, MSN, RN, CGRN Unit Manager, Endoscopy


Pre-Admit Testing staff saw over 6,300 patients in 2013. This number includes

those we saw in advance of the day of surgery and those whose preliminary visit had been via telephone with the completion of the visit on the day they came in for their procedure.

In February we implemented the use of a pre-surgical questionnaire in an effort to streamline the information we collect as well as save time for patients and staff. We had hoped we could put this questionnaire online and have the

results available to us in advance of the patient’s Pre-Admit visit but the questionnaire contains Protected Health Information (PHI) and at this point in time we don’t have a secure way for the patient to return the information to us.

August brought us Expectation Management of Medical Information, or EMMI for short. EMMI is an online education tool that is assigned by the surgeon’s office staff. Patients can access educational material concerning their operative procedure and ask questions about their procedure.

Pre-Admit Testing staff then do a follow-up with patients to see if they watched EMMI and if they have any questions that EMMI did not answer. We are finding that the patients who watch EMMI really like the program and most feel that EMMI answered any questions they had.

PERIOPERATIVE SERVICES

Judy Bowlin, BSN, RN Pre-Admit Testing

Janet Lewis, MA, BSN, RN, CNOR Director, Perioperative Services


T he title Outpatient Surgery (OPS) is a little misleading for our particular unit. We do

not actually perform the surgical procedures in the unit but in the past year the OPS staff admitted 3,791 patients for surgery, of which 1,540 remained in the hospital after surgery for recovery while 2,251 patients returned to OPS after their surgery and were discharged home the same day.

In addition, the OPS Unit continues to provide the pre- and post-procedural care of patients undergoing outpatient cardiac catheterization, pacemaker placements, and pacemaker generator changes. As Dr. Sorensen explained, we are seeing a decrease in in-patient volumes and we are experiencing some of the same with outpatient surgical volumes.

The biggest challenges though this past year are the significant increase in the outpatient infusion therapy services provided in OPS. In 2012, 957 patients received blood transfusions or medication infusions in the OPS Unit. In 2013 that number increased to 1,323. Patients’ needs for the treatment of MS, immune deficiency disorders, migraines, chronic medical conditions, or acute and persistent

infections, (such as MRSA) range from monthly to as frequently as three times a day. Those patients requiring 24/7 antibiotic therapy usually are treated for a minimum of six weeks. We strive to provide consistent and high quality care to these patients and their families.

2013 HighlightsObtaining certification in the national organization, American Society of PeriAnesthesia Nurses (ASPAN), is a goal for OPS staff. Membership to this organization provides resources for certified new nurse orientation programs and up to date evidence-based practice recommendations. Certified PeriAnesthesia Ambulatory Nurses (CAPA) in OPS are Roxie Shaul and Michelle Keener.

Michelle Powell maintains a Medical Surgical Nursing Certification. She also remains to be one of the original Safety Behavior trainers, presenting Safety Behavior training to new hires on a monthly basis during employee orientation.

Michelle Keener represented OPS in the efforts to complete the ER 12 upgrade, dedicating time to screening review, testing upgrades, and mentoring staff during go-live.The newest members of the OPS

team are Mary Duncan and Alicia Snelling. Both are experienced nurses who are great additions to the unit.

Individual employee participation includes: Staffing committee: Jennifer Meyer and Kris Ferguson Safety coaches: Michelle Powell and Kendra Vera Concurrent chart review: Michelle Keener and Bobbi Decker Patient follow-up calls: Kelsey Judy

OPS UPC: Kendra Vera, Bobbi Decker, Mary Duncan, Kris Ferguson, Linda Doughty, and Aggie Collopy Nurse/Pharmacy Committee: Marlyce Burkey

Shared Governance Councils: Michelle Powell, Kelsey Judy, and Mary Duncan Informatics/ER 12/MU: Michelle Keener Nursing Finance: Roxie Shaul Service Excellence: Shon Peterson and Alicia Snelling. Hand hygiene monitoring, correct antibiotic selection being administered at the correct time, DVT prophylaxis, attention to on-time start for the first cases of the day, and patient satisfaction are the focus of OPS Process Improvement.

OUTPATIENT SURGERY (OPS)Karna Kleager, BS, RN Unit Manager, Outpatient Surgery


Providing care to patients within the perianesthesia setting is demanding in

nature. The nurses need to be well-equipped with the skills in assessment, planning, and critical thinking required for this fast paced environment as well develop other competencies. These competencies include skills in mentorship, communication, management of crisis situations, and being the champions for patient safety. Regional West’s PACU nurses work to maintain high quality in these areas by developing skills to deal with high patient acuity, fast patient turnover, and communication challenges between units and collaboration with surgeons, anesthesia providers, and the entire perioperative team.

2013 Highlights Chris Micheels was the recipient of the Exemplary Professional Practice award for Nurses Day 2013.

PACU continues to be highly recognized for its learning opportunities. Students completing rotations for

completion of their degrees, transitioning from student to graduate, and summer internships are provided with challenging situations with one-on-one mentoring. Staff mentors completed the Core Curriculum for Clinical Coaches-Preceptor Development program. Chris Micheels and Tracy Payne serve as CSIs for the University of Nebraska Medical Center student nurses.

Obtaining certification in the national organization, American Society of PeriAnesthesia Nurses (ASPAN), remains a high priority in PACU. Membership to this organization provides resources for certified new nurse orientation programs and up-to-date evidence-based practice recommendations, to name a few of the benefits. Currently our Certified PeriAnesthesia Nurses (CPAN) are: Sandy Hebbert, Chris Micheels, Tracy Payne, Kay Lemons, and Andrea Ray. Katherine Tuttle is scheduled for the certification examination in 2014.

Staff members continue to work on completing the ASPAN Competency Based Orientation Program. The program is designed for orientation of new staff, but long standing staff felt a need to also complete the program growth and development.

The newest members to the unit, Julianne Meisenburger and Regina Rutter, both started in August 2013. Julianne transferred from 2W and we immediately drew upon her experience to provide guidance on central line dressing changes.

Laura Wright, Simulation Coordinator, will be working with PACU and OPS on patient education dealing with low volume/high risk situations, such as Malignant Hyperthermia.

Katherine Tuttle and Nancy Ross were instrumental in the ER 12 upgrades, spending hours reviewing the screen content, testing the changes, and mentoring staff during the go-live.

PERIANESTHESIA CARE (PACU) Karna Kleager, BS, RN Unit Manager, Perianesthesia Care Unit



PACU staff involvement in Regional West activitiesStaffing committee: Laura Wright and Andrea Ray

Safety Coach: Chris Micheels

Service Excellence: Tracy Payne and Kellie Witcofski

Informatics, ER 12 and MU: Nancy Ross and Katherine Tuttle

UPC: Katherine Tuttle, Sandy Hebbert, Kay Lemons, Ginny Blackburn, and Andrea Ray

Shared Governance Councils: Sandy Hebbert, Katherine Tuttle, and Kellie Witcofski

Nursing Peer Review: Ginny Blackburn

Nurse/Pharmacy Committee: Kay Lemons

Process Improvement activities such as hand hygiene monitoring, correct antibiotic selection being administered at the correct time, DVT prophylaxis, and attention to on-time start for the first cases of the day remain of utmost importance to the PACU.



Operating Room personnel provide surgical care for members of our

community as well as regions surrounding Scottsbluff. Procedures performed can be simple or extremely complex with newer, bigger, and better technology. Approximately 5,151 cases were performed in 2013. November and December kept staff very busy with 426 and 500 cases done concurrently.

2013 Highlights Patient safety is at the forefront of our daily activities. The surgical safety checklist has been implemented as a planning tool for staff, surgeons, and anesthesia. This checklist is comparable to a pilot’s checklist. Surgical checklist posters are posted in each operating room as a visual job aide. Circulating nurses are verifying needs with the surgeon before the patient is taken to the operating room to ensure all equipment is available. Safety coaches Nate Walker and Kim Mann provided updates to enhance our awareness of safety behaviors needed to provide a safe environment for our patients.

Daily Huddles are held at 6:30 a.m. before cases begin so any safety issues can be discussed.

As surgical procedures and technology become more complex, our need for education expands. Rhonda Groshans, Clinical Educator, continues to provide vital education and competency testing for staff.

Competency testing round robin involved the use of specialty tables, the set-up of suction dilatation and curettage machine, laser safety, and sterilization.

Set-up of the pediatric bronchoscope was required by all staff as this is a high risk, low volume procedure.

Emergency craniotomy procedure set-up was performed by all staff as well, due to the number of cases performed as a result of traumatic injuries.

Annual education provided for the year included a program on concussion, Stryker equipment, Atrium chest collection system, Neptune suction, TURP Bipolar, wound vacs, Code Silver,

Documentation-MSM, sternal saw, rib and facial plating system, laser safety, AIDET, wound classification, CLABSI, Malignant Hyperthermia, Bupivacaine Liposomal, liposuction machine, I-Stat, and the use of emergency manuals.

Highlighting the year for education was our first simulation demonstrating Malignant Hyperthermia. A simulation brief was presented incorporating safety behaviors for the actual simulation. Staff was divided into groups and simulations were held and recorded. All staff then reviewed the videos, critiqued, and debriefed. Staff embraced the simulation and voiced the need for further experience with simulations related to Operating Room scenarios.

EducationStephanie Poole and Angie Kelley completed the PeriOp 101 program designed to educate nurses new to the perioperative environment.

Dayna Dondelinger and Kim Mann have both been accepted

OPERATING ROOM (OR) Kim Brown, BSN, RN, CNOR Unit Manager, Operating Room



into the UNMC LEAD (Nurse Leader/Executive Advanced Development) Master in Nursing program.

Colleen Kelly passed the certification exam for Operating Room nursing.

Regional West Medical Center was the first hospital in Nebraska to be awarded the CNOR STRONG status from the Competency and Credentialing Institute (CCI). To qualify, the institution must have 50 percent of their eligible Operating Room nursing staff CNOR certified. Because of the high percentage of certified nurses, “The facility advances a culture of patient safety.”

Our certified nurses are:

• Kim Brown, BSN, RN, CNOR

• Christy Jay, BSN, RN, CNOR

• Dayna Dondelinger, BSN, RN, CNOR

• Rhonda Groshans, RN, CNOR

• Darcy Haslam, BSN, RN, CNOR

• Colleen Kelly, BSN, RN, CNOR

• Janet Lewis MA, BSN, RN, CNOR

• Mary Lockwood, RN, CNOR

• Kim Mann, BSN, RN, CNOR

McKesson Surgical Manager (MSM) was successfully updated to version 16. Dayna Dondelinger and Peg McFarland were instrumental in the build, implementation, and education of staff. Randy Levendofsky, Bobbi Armstrong, Cheryl Kostman, and Project Manager Doug Rupp were the IT members involved in the support for the implementation.

Darcy Haslam, Rhonda Groshans, and Janet Lewis attended the national Association of Perioperative Registered

Nurses (AORN) Congress in San Diego, Calif. Joy Stuckert and Pam Adams attended the national Association of Surgical Technologists (AST) meeting in New Orleans, La. Both conferences provide staff with education related to safe care of the perioperative patient, advances in surgical techniques, and new technology.

Process Improvement activities continue to be a priority for staff, which includes monitoring of hand hygiene, use of immediate sterilization, and on time 7 a.m. starts. The Operating Room staff is also responsible for assuring compliance with the SCIP core quality measures. Fifty chart audits are performed monthly and feedback is given to staff to ensure compliance with documentation.



In 2013, the Scottsbluff Surgery Center (SBSC) provided care for over 1,700 patients. Our

specialty list includes Orthopaedics; Ear Nose and Throat; Plastic and Reconstructive Surgery; Pain Management; Dental; and Gynecology.

Our unit continues to explore new technology and advance with current and new recommendations for providing patient care. We strive to maintain efficiencies not only for the patient but also the physicians with the ever-growing change in medicine. It is of utmost importance that we have positive patient experiences when entering our facility, throughout their stay, as well as return visits to our organization. 2014 will highlight many opportunities for improvement and we are ready for the challenge to provide even better patient care.

2013 HighlightsParticipation in a Lean Six Sigma project identified the need to adopt the Pathways Healthcare Scheduling (PHS) system. This change saved our organization money not only for the software, maintenance, manual billing, and coding processes, but also helped aid in the continuum of care for the patient.

Medication Reconciliation was always a process that was completed at the SBSC, however not in the Horizon Health System (HHS). Therefore, we implemented use of HHS for Medication Reconciliation for every patient, every time.

A surgical safety checklist was implemented successfully in the Operating Room with the help of Dr. Jonathan Morgan, Chief Medical Officer. This helps ensure that patients being prepped for their surgical procedure have a checklist of certain tasks performed before transport to the operating room, before induction of anesthesia, before skin incision, and before the patient leaves the operating room.

Hard work and diligence was poured into the process of converting from paper to electronic patient documentation. We were very involved with many departments in the McKesson Surgical Manager upgrade. This is still an ongoing process as we have had to convert all of our physician preferences, supplies, unit specifications, level charges, and many more items into this new system.

Individual employee participation includes:

• Carmen Benavides, Peg Jackson, and Spring Sherrell serve on our Staff Scheduling Committee.

• Danielle Brown is safety coach for the Surgery Center.

• UPC Committee consists of Danielle Brown, Spring Sherrell, Carmen Benavides, and Peg Jackson.

• Falls Committee is represented by SBSC employee Leslie Ilg.

• Perioperative and Women’s Value Analysis consists of members Carmen Benavides and Crystal Kildow.

• Kelsey Winger serves on the Evidence-Based Practice Council.

• Tara Harpold serves as a CSI through the UNMC precepting program for nursing students.

• Amy Henke and many volunteer staff members for chart reviews.

• Cheryl Darst serves on the Unit Secretaries Committee.

• Carisa Crawford demonstrated diligence in her learning skills by cross training for dental procedures.

We look forward to a prosperous 2014 and hope that we can continue to provide this community with wonderful surgical experiences.

SCOTTSBLUFF SURGERY CENTER (SBSC) Crystal Kildow, BSN, RN Clinical Coordinator, Scottsbluff Surgery Center


Critical Care and Progressive Care staff is unique in their desire and

love for controlled chaos and the utilization of crisis management skills during every shift. Regional West Medical Center is blessed to have this talent. These nurses promote and help patients achieve the highest healthy outcomes possible while being efficient and adaptable to optimize individualized care. Leadership continues to promote advancing knowledge and skill through continued education, review of current knowledge, and passing knowledge to new students and professionals.

Stephen Matthews, BSN, RN, has been with our organization since January 2012. Stephen brings leadership and consistency to the unit. He has successfully decreased the number of travelers to one, and is looking forward to being fully staffed with Regional West employees in early 2014. Stephen continues to provide expertise clinically

and in leadership to all on the unit. The collegial relationship with all disciplines has grown and continues to foster excellent patient outcomes. Stephen sets the example for continuing to expand his knowledge through pursuing a master’s degree in nursing leadership.

Linda Fowler, BSN, RN, continues in her role as clinical coordinator for Critical Care Services, coordinating advanced education and mentoring. Linda has been instrumental in the success of so many new graduates and seasoned nurses. Education based on simulation was implemented successfully. The sepsis treatment bundle was the first of many simulation trainings. This multidisciplinary approach has fostered communication and our culture of safety. Linda has been instrumental in encouraging staff to return to school and/or become certified in their specialty. Linda is also pursuing a Clinical Nurse Specialist degree.

Specialty certification is one way competency is recognized for nurses. The CICU/PCU has nine nurses who have achieved the CCRN certification. This achievement is recognized as the “Gold Standard” of excellence in critical care nursing. Congratulations to Stephen Matthews, Linda Fowler, Leigh Miller, Cheryl Patrick, Cheryl Hoxworth, Teal Smith, Jackie Delatour, Marilyn Stoddard, and Travis Hargreaves.

Our staff includes 34 registered nurses with bachelor degrees, three with diplomas, and eight with associate degrees. We also have five health unit coordinators and 15 telemetry technicians. We have a medical director and pulmonologist who have been instrumental in helping our team improve patient outcomes with new protocols and education continuously. We have a dedicated social worker to ICU and PCU, case management, pharmacist, medication reconciliation nurses, dietician, therapy staff, and

CRITICAL CARE AND EMERGENCYNancy Hicks-Arsenault, MBA, BSN, RN Director, Critical Care and Emergency Services


many more to make the team complete. This team cared for 1,109 patients and families in the Progressive Care Unit (PCU) and 922 patients and families in the ICU.

Staff members in school pursuing higher degrees include Nancy Hicks-Arsenault, Stephen Matthews, Linda Fowler, Kristen Ferguson, Meghan Blaylock, Teal Smith, Matthew Schneider, Kristene Perrin, and Travis Hargreaves. Telemetry technicians in school pursing higher degrees include Emily Aragon and Mary Acosta. Congratulations to all who balance work, school, and home life!

The CICU/PCU has an active Unit Practice Council. They are currently working on a sedation vacation protocol, sepsis order sets, and managing delirium in the ICU patient. The council also sets guidelines to assist management in

selecting professionals to attend conferences. The council has been very active in on-boarding our new staff and creating an environment of support and growth.

The Scheduling Committee has been active in balancing schedules and advising management leaders as we build in the flexibility of flexing staffing needs to match census that may vary greatly in 12 hours. They are very much appreciated!

Emergency Services The Emergency Department had a record year in the number of patient visits, with more than 17,000. With increased volume came the need to utilize hallway beds more than ever. This problem was mitigated in October when five additional Emergency Department rooms were opened. The new area also gives expansion capacity of seven more beds in high census

days and times working closely with our radiology partners.

Alicia Kunz, MSN, RN, joined the Emergency Department as nurse manager in November. Alicia came to us from the Education Department with high recommendations and great experience. Alicia is an excellent communicator and brings leadership and consistency to the unit. She has successfully decreased the number of travelers to one, and is looking forward to being fully staffed with Regional West Medical Center employees in early 2014. Alicia has collegial relationships with all disciplines and fosters excellent patient outcomes.

Alice Fillingham, BSN, RN, is our clinical coordinator and has been amazing. She works very hard to bring quality education programs to the unit and hospital-wide audiences. This year she brought more



simulation learning opportunities to our staff. These opportunities have included quarterly education tied to our staff meetings, pediatric case reviews with CEUs and CMEs, and a transition to critical care class for our new staff. Alice has a contagious smile and positive attitude. ‘Thank you’ seems so small for all the work Alice has done.

We have nine nurses who have obtained specialty certification. Congratulations to Alice Fillingham, Linda Fowler, Lorrie Joplin, Sheri McDonald, Sarah Paetow, Laura Wolfe, Erin Hill, and Linda Borelli. This makes 38 percent percent of our RNs who are certified!

The Unit Practice Council has worked diligently on improving our emergency care and improving our patient outcomes and core measure scores. The council worked hard on implementing a subcutaneous rehydration protocol in appropriate cases. Education included the

physician clinic staffs and has helped many patients.

The council worked hard to ensure a week full of celebration during Nurses’ Week and coordinated many activities. The celebration also included an EMS week celebration with a cook out!

Dr. David Cornutt assumed medical director duties in January. He worked hard to help manage the hallway overflow patient concerns. He was also instrumental in finding additional physician staff to fill our needs until we hire permanent staff. Dr. Cornutt also was very helpful in opening our five new exam rooms and the flow changes accompanying that opening.

The Emergency Department continues to have better than national averages for door to triage to exam room discharge decision to out for discharged patients. Much work is being done to improve our decision to admit to out the door.

Our documentation analyst, Kathy Jacobsen, BSN, RN, continues to do a fabulous job giving feedback to staff appropriately after 100 percent chart review. Our documentation reviews demonstrate an improvement year after year. We have successfully optimized billing by $53,000 a month with feedback to RN staff in real time relating the documentation to care provided.

The emergency team continues to amaze me with their focus on improving our quality and safety care initiatives.



Air Link continues to provide service in partnership with Med-Trans Corporation.

Air Link welcomed a new pilot, Nash Saunders, and a mechanic, Chris Farrier, to our team. We are also proud to announce two new team members. Amanda Lashley was hired as a full time flight nurse and Anthony (TJ) Krajewski II was hired as a full time flight paramedic. Both are currently working on their advanced certifications.

The Air Link management team consists of Doug Carrell, Director; Tracy Meyer, Chief Flight Nurse; and Dr. Peter Meyer, Medical Director. Dr. Meyer continues to fly as an active crewmember of the flight team.

The Air Link Team• Sean Shirley is Air Link’s

Safety Officer and Safety Coach. Sean has been deployed to Germany to serve for the military until mid June 2014.

• Trish Garner is very active as the Clinical Educator of the flight team, and has been instrumental in coordinating on going educational events.

• Wade Wells compiles quality improvement data.

• Natalie Arnold coordinated public relations events and the Air Link Mentoring Program (which include over 80 hospital and EMS agencies).

• Jason Rairigh and Howard McCormick continue to coordinate the equipment and inventory needs of the program.

• Dee Vogel assists with policy review and time and attendance. Dee is Air Link’s representative for the Nebraska Association of Air Medical Services (NEAAMS).

• Dan Hughes is responsible for collecting quality improvement data as well as completing the action reports for the PAIPs (Post Accident Incident Plan).

• Kyla Ansley has taken over assisting the flight team with Marketing and Public Relations. She has been a great addition to our team.

Every member of the Air Link flight team has additional responsibilities that directly relate to the quality of the service we provide.

In May 2013, Air Link was surveyed by the Commission on Accreditation of Medical Transport Systems (CAMTS) for the purpose of reaccreditation. Air Link was awarded full accreditation.

The Air Medical Transport Conference (AMTC) was held in October 2013 in Virginia Beach, Va.

Air Link hosted TNATC (Transport Nurses Advanced Trauma Course). Flight team members from many different flight programs attend the certification course.

Air Link places an emphasis on quality patient care, continued learning, and mandatory advanced certifications. One hundred percent of the Air Link flight team is CFRN (Certified Flight Registered Nurse) or FP-C (Flight Paramedic Certified) certified, with the exception of Amanda Lashley and TJ Krajewski II (new hires). Both will be taking their respective certification exams in 2014.

Air Link had a very busy year, and looks forward to having another successful and SAFE 2014.

AIR LINK TRANSFER CENTERDoug Carrell Director, Air Link and Transfer Center


2013 was a year of positive forward motion for Regional West Home Care as it began

the long awaited process of joining forces, literally and figuratively, with Prairie Haven Hospice and the newly implemented Palliative Care program at Regional West Medical Center.

Beginning the first of the year Linda Rock, Lisa Rien (Finance) and Diana Rohrick began to discuss and prepare for a merging of the two existing entities along with the birth of the new Palliative Care program. The first retreat for all participants came about in March 2013. The second retreat was in April.

Linda Rock announced her plans to retire in July 2013. Orientation began in January for Diana Rohrick to become Director of not only Home Care, but Prairie Haven Hospice (PHH) and Palliative Care as well. Linda agreed to stay on as a consultant, assisting with orientation for Diana as well as involvement in the creation and implementation of the Palliative Care program.

From the retreats and the joint efforts at partnering in care, came the incept of the Partnership Unit Practice Council (UPC). This group, with representatives from Home Care (HC) and PHH has met monthly working on format and structure as well as issues involving all three entities. The chairperson for this group is Diann Lauder with Kathy McLellan as co-chair. The Levels of Authority and Concensus Scale were introduced, accepted, and utilized at all meetings. Shirley Knodel, CNO, has been instrumental in lending her support to the whole partnership movement and has attended Partnership UPC meetings and retreats to offer encouragement as well.

Due to the restructuring of leadership with this new group, it was determined that Diana would need Clinical Team Leaders to assist in the day to day running of each agency. These positions were filled by Chris Centgraf, RN, for Home Care and by Suzy Solano, previous Spiritual Care Coordinator for Hospice, in the new CTL role for that department. Being new to leadership roles has meant significant orientation and ongoing mentoring but has resulted in

consistency and growth for both of these professionals.

Throughout all of this important work, both agencies have continued to provide exceptional care, deal with new regulatory changes, and even manage a move for PHH from Medical Plaza North to an adjoining space on the second floor of St. Mary Plaza with the current Home Care office.

Palliative Care has seen the hiring of our physician, Dr. Connie Beehler and an APRN, Deb Moore. Despite the many hurdles that arise when beginning a new program, it is now providing much needed care to Regional West Medical Center patients on a consulting basis, and working with Prairie Haven Hospice as well. A steering committee was established and has been meeting to work through issues and gain support of leadership and staff in this vital program.

All in all it has been a busy but productive year for Home Care, Palliative Care, and Prairie Haven Hospice and 2014 will continue to show changes in the evolution of these programs.

HOME CAREDiana Rohrick, RN Director, Home Care, Palliative Care, and Prairie Haven Hospice


In 2013, Imaging Services has expanded to include a Prep and Recovery Area. This area is

utilized, not only for prepping and recovering our patients, but also as a hospital-based clinic for Radiology Imaging of Nebraska, fully staffed by Imaging Services staff. We have also changed our process to include a “Pre-procedure Assessment” visit (similar to PAT) for all of our procedures requiring sedation. This has greatly reduced the number of cases requiring cancellation on the day of the procedure, and better equips us to give the safest possible care with the best possible outcomes. It has also decreased patient anxiety by educating in advance, thereby increasing our patient satisfaction.

Nurses saw a total of 2,519 patients this past year. In the Angio Suite, there were 98 angio/venograms, eight arterial declots, 83 central lines, 84 dialysis grafts, eight tumor embolization/ablations, 11 endografts, 29 IVC filters, and 75 kyphoplastys for a total of 416.

In CT, there were 150 sedated biopsies, 115 drains, and 162 hydrations for a total of 431. In our main department, there were 653 pain management cases, 186 myelograms and LPs (the myelograms were also imaged in CT), and 96 miscellaneous for a total of 710. MRI saw 178 patients and NM had 49. US were 122 biopsies and 126 centesis for a total of 248. There were also 279 patients seen only in our clinic and prep and recovery areas.

Of these patients, 508 were added on, 311 were inpatients, 50 received stents, and 39 were with anesthesia.

Imaging Services nurses continue to be involved in our IR Council as well as chairing the Shared Governance Committees. We are active in our professional organizations, and together strive to be strong patient advocates, providing the safest care possible.

We recently implemented a new hemodynamic monitoring system that has the capability to better monitor a patient’s respiratory function during procedures. It is versatile enough to be used with all our patients, not just those in the Interventional Suite, making our practice more consistent and safer. It also has the capability to generate letters for the ordering physician, the patient, our clinic for follow-up needs, and our nursing staff for follow-up phone calls. The system keeps a comprehensive list of all procedures done for each patient, helping us be better prepared for each new procedure.

IMAGING SERVICESKari Flom, RN Radiology Supervisor, Imaging Services


PICTURED L TO R: Brooke Borgman, Michelle Rairigh, Lenna Booth.

CATH LABBrooke Borgman, BS, BSN, RN Cardiac Cath Lab

2013 was again a time of transition for the Cardiac Cath Lab staff.

In February, Colorado Health Medical Group (CHMG) returned to Regional West Medical Center to provide cardiology coverage for both inpatients and outpatients. In August, we welcomed Mandi Barry, BSN, RN, to the Cath Lab staff. In September, Dr. Chris Lambert joined the CHMG team as a full-time cardiologist based in Scottsbluff. Cindy McCumbers, APRN-NP, transitioned back to the CHMG team from the hospitalist program.

Policy changes were made implementing the trans-radial approach for heart catheterizations performed by several of the CHMG cardiologists. Chart audits were implemented. Education was completed for the staff that would be seeing the trans-radial approach patients. Educational posters were made for the

procedures performed in the Cath Lab.

New treadmill equipment was successfully installed. Cath Lab staff underwent certification in the insertion and management of the intra-aortic balloon pump.

Other• All staff maintain ACLS

certification.

• Brooke Borgman teaches classes for the New Grad Nurse Residency program: Cardiac Assessment, Cardiac Simulation, and Basic EKG. Brooke also is a member of the Care and Practice Committee.

• Mandi Barry serves on the Quality and Safety Committee and the Meaningful Use Committee.

• John Vidlak has undergone education on the Zoll Life Vests, Medtronic Pacemaker interrogations.

• Brooke Borgman is currently working on her master’s degree in Adult Acute Care Nurse Practitioner with plans for a May 2015 graduation.


New faces that began their employment in Cardiac Rehab this year:

• Nancy Leisy, RN, MSHS, CHES-Cardiac Rehab Manager

• Kara Lemoine, RN, BSN-Education Coordinator/Care Coordinator

2013 was our preparatory year for national recertification of the Cardiac Rehab Program. With this came some changes in the way we complete and track staff competencies as well as learning and implementing new regulations and certification requirements related to our daily practice.

Staff worked diligently to incorporate the Nursing Care Coordinator model in their care of patients this year. By moving to this type of coordinated care, patients are followed by the same staff person through their entire rehab program. This type of coordination of care allows staff as well as patients to get to know each other better, and creates more continuity of care as well as ownership in progressing

patients and meeting the required core components of cardiac rehab; as well as addressing the exercise, nutrition, education, and psychosocial needs of the patient.

Through our safety meetings and staff observation, the cardiac rehab treatment area was rearranged this year to facilitate a safer path for patients to find their way and maneuver within the department.

The cardiac rehab team continues to strive toward the best care possible by showing their commitment to education as Pam Zitterkopf, RN, BSN is working on her master’s degree in nursing and will graduate in May 2015.

We are looking forward to 2014 as we submit all of our supporting documentation for national re-certification of our Cardiac Program.

CARDIAC AND PULMONARY REHABILITATIONNancy Leisy, RN, MSHS, CHES Cardiac and Pulmonary Rehabilitation Manager


2013 was a year of great change for the Case Management team with

the release of new rules and regulations by the Centers for Medicare and Medicaid Services. These regulations set forth specific requirements for physician certification related to level of care status and medical necessity for hospitalized patients. The RN Case Management staff work diligently to remain current on these rapidly changing regulations so they can provide support and education to our medical staff in order to maximize compliance. This includes daily review of patient medical records and consistent communication with providers to ensure all required elements for physician certification are met.

In addition, the RN case managers also provide clinical review to insurance companies and communicate with providers, nursing staff, patients, and ancillary services to move the

patient through the continuum of care. This includes daily review of clinical criteria for continued hospital stays and communicating with the patient as necessary regarding insurance certification for their hospital stay. As strong patient advocates, they deliver written information and provide a full explanation to patients regarding observation status and Medicare rights so patients can be fully educated on their rights/responsibilities in these areas. These are just a few of the multifaceted responsibilities of the RN case manager.

The Case Management Team includes Julie Kautz, RN; Irma Walter, RN; Jessica Brumbaugh, RN; Nichole Hoesing, RN; Vicki McLamb, RN; Lois Cannell, RN; Karen Houk, RN, CM Supervisor; Jodi Willats, MSW, and Stephanie Hawley, RN, Interim Co-Directors. Case management physician advisors are Dr. Lisa Scheppers and Dr. Erica Gelgand. The physician

advisors provide support and will advise on cases that are not otherwise supported by Executive Health Resources (EHR). EHR is Regional West’s contracted physician advisor group which gives direction and support on Medicare and Medicare Replacement plan claims that do not meet criteria for medical necessity on admission or continued stay.

During the past year Lois Cannell, RN, and Karen Houk, RN, obtained their ACM Certification through the National Board for Case Management.

2013 was a promising year for the Clinical Documentation Improvement (CDI) nurses. While they continued to review charts daily for documentation improvement opportunities, they also began to quickly gear up for the upcoming implementation of ICD-10. Recently, the implementation of ICD-10 was delayed by the Centers for

CASE MANAGEMENTKaren Houk Case Manager


Medicare and Medicaid Services (CMS) which will allow the CDI nurses to better prepare the providers in their service lines for the now 2015 implementation date.

The changes in ICD-10 will impact our ability to capture the acuity of our patients and the hard work of our providers. Some of the verbiage required to relay this information will be changing and while it may all mean the same thing in the medical world, it does not translate that easily into the coding and billing world where our facility and physicians are being graded. This specific verbiage is also required to be in the medical record in order for Regional West Medical Center to be reimbursed appropriately.

Some of the ICD-10 preparation activities have included intensive on-line training courses (totaling over 100 hours) as well as attending multiple in-house ICD-10 modules. The CDI RN case managers were fortunate enough

to attend the 2013 Sixth Annual ACDIS Conference in Nashville, Tenn. The CDI RN case managers continue to meet with medical staff routinely to distribute tidbits of information throughout the year so that when the implementation does finally occur it will not appear to be such a drastic change in their practice.

With the assistance of multiple entities throughout the facility, the CDI team was able to surpass their goal of a Case Mix Index of 1.4514. We actually ended the year at 1.4854 (up from 2012 at 1.3823) which equates to a financial impact of about $3.8 million for the facility and more accurate profiles for the providers and facility being reported out to consumers.

The current CDI RN case managers are Andrea Arellano, RN, who covers the general medical service lines; Jackie Carter, RN, who covers the surgical service lines; and Mollie

Thompson, RN, who covers the hospitalist service line. Stephanie Hawley, RN, ACM, directly oversees the CDI program and coordinates the medical necessity appeals for the facility. The CDI RN case managers continue to prepare for obtaining their professional certification (CCDS, Certified Clinical Documentation Specialist) during their down time.

PICTURED L TO R: Alane Britt, Julie Kautz, Lois Cannell, Karen Houk, Shannon Brown, Nichole Hoesing, Irma Walter. Not pictured: Shelly Thomas


The Community Health Department at Regional West Medical Center is unique in that the staff provides services to both the hospital and to the Scotts Bluff County Health Department. This creative contract arrangement allows both entities to be active in the public health of Scotts Bluff County.

This past year, multiple programs were coordinated for the community and hospital.

In 2013 Community Health saw a change in management. Martha Stricker, RN, BSN, transferred to Regional West Physicians Clinics. Paulette Schnell, RN, who has worked as a Community Health Nurse for many years, became the new manager. Through this process, two new employees became a part of the staff. Hannah Weisgerber, RN, BSN, and Terri Allen joined us late in 2013. Both Hannah Weisgerber and Paulette Schnell are in the graduate nursing program at UNMC.

The Community Health Immunization Clinic continues to

provide immunizations for both the Vaccine For Children’s Program and for privately insured clients of all ages. We have expanded our immunization services to cover all travel vaccines as well. Nurses hold routine immunization clinics on Tuesdays with both daytime and evening clinics available. Approximately 3,300 vaccines are delivered to children from birth through age 19 annually. Sandy Preston, RN, BSN, Immunization Coordinator, attended the Nebraska Immunization Conference in Omaha for continuing education in the area of vaccine preventable disease.

Colon cancer awareness and a screening kit distribution campaign took place with information being shared on risk factors. Deb Keener, RN, is the project coordinator. There were 258 fecal occult blood test (FOBT) kits distributed throughout the community.

Community Health is an active partner in the Panhandle Regional Medical Response System (PRMRS), attending monthly

meetings and assisting with the coordination of both the county and hospital’s bio-terrorism and all-emergency preparedness plans.

Throughout the year, Community Health also coordinated quarterly genetics clinics with Munroe-Meyer Institute, a part of the University of Nebraska at Omaha. Seventy-six clients and their families were served in 2013.

The department also coordinated several health screenings at area businesses through its involvement with the Panhandle Worksite Wellness Council. In 2013, people received a variety of preventative screenings including lab work, bone density screening, glaucoma checks, and blood pressure checks.

Community Health partnered with Regional West Physicians Clinics to provide another annual drive-thru influenza clinic. This event allowed over 500 residents to receive an immunization against flu without ever having to leave their car. A walk-in flu clinic at St. Mary’s Plaza provided an

COMMUNITY HEALTHPaulette Schnell, RN Nurse Manager


additional 300 more residents this protection.

One area on which Community Health focuses is providing flu shots at the worksite. In 2013, 56 businesses held onsite flu clinics for their employees. This resulted in over 1,400 more immunizations against influenza being delivered to residents of Scotts Bluff County.

The injury prevention coordinator continues to function in partnership with Trauma Services. Holly Johnston, RN, BSN, reaches out to the community with information on the top 10 traumas in the region as well as educating on current hot topics such as concussion legislation and distracted driving. Regional West Medical Center is one of 100 hospitals across the nation that is contracted with the Consumer Product Safety Commission (CPSC) to review Emergency Department visits for accidents and trauma related to commercial products. This data is supplied to the CPSC and utilized to develop safety recalls for consumers.


Activities for 2013-2014• Pharmacy has six RNs who

work from the Pharmacy Department to obtain the patients’ home medication list at admission.

• There is one nurse in the Emergency Department daily and two nurses up on the floors from the hours of 8 a.m. to 6:30 p.m. daily.

• The nurses obtain a complete list of the patient’s home medications and allergies and update the electronic medical record for all inpatients.

• The nurses make calls to outpatient pharmacies for information regarding medications and dosages.

• They also search multiple electronic medical record databases to determine the medications the patient took at home (NextGen, NeHII, NRX-QS1, Home Health, Hospice, Palliative Care, and HPF).

• After comparing the patient’s home medications with the medications ordered in the hospital, the pharmacy medication reconciliation

nurses intervene when needed by making calls to the physician to clarify any medication discrepancies.

• The pharmacy medication reconciliation nurses also complete initial screening for influenza and pneumococcal vaccines and forward information obtained from the patient and from NESIIS to the pharmacists for review and follow-up to order needed vaccinations.

• Historically, the pharmacy medication reconciliation nurses screen more than 7,600 patients annually. They are here every day, including holidays!

Our pharmacy medication reconciliation nurses include:

• Tammy Cox, RN• Yolanda Gonzales, RN• Consuelo Hernandez, RN• Marilee Monohon, RN• Karen Perkins, RN• Ron Ward, RN

PHARMACY MEDICATION RECONCILIATION NURSES Kelsey Kriewald, Pharm D, RPH Clinical Coordinator, Pharmacy Department

L to r: Tammy Cox, Ron Ward, Marilee

Monohon, Yolanda Gonzales, and Consuelo

Hernandez. Not pictured: Karen Perkins.


The Quality Resource Department consists of 11 employees who support

performance improvement, infection prevention, and related quality and safety activities throughout Regional West Medical Center. Seven of the 11 employees are RNs with distinct areas of focus within continuous quality improvement initiatives and regulations. Department staff RNs are:

• Janelle Schroeder, MSN, RN—Clinical Quality Improvement (CQI) Nurse Coordinator

• Linda Armstrong, BSN, RN—Clinical Data Quality Analyst

• Vicky Stoll, RN—Clinical Data Quality Analyst

• Kris Henkel, RN—Clinical Data Quality Analyst

• Janice Casey, RN—Clinical Data Quality Analyst

• Jeanie Miller, RN, BC—Clinical Data Quality Analyst

• Amanda Sabo, BSN, RN—Infection Prevention and Epidemiology Nurse

The nurses have responsibility for aspects of Centers for Medicaid and Medicare (CMS) and Joint Commission (JC) quality reporting requirements including Core Measure chart abstraction, provider and staff education, and Opportunity for Improvement (OFI) reporting. Nurses prepare documents and/or reports for review at a variety of committee meetings, including Medical, Surgical and Perinatal/Peds, M&M, and committee meetings. Additionally, nurses participate in the Root Cause Analysis Team. Each nurse in the department serves as a content expert, resource, and support to other departments.

Work highlights of 2012 for the Quality Resource Department• Data collection began on

new Core Measures: stroke, VTE, and inpatient-based psychiatric measures

• Ongoing education and training for new Core Measures

• Meaningful Use collaboration

• Concurrent infection prevention

• Infection prevention policy revisions

• Implementation of Infection Control Committee

• Implementation of Central Line Insertion Practice (CLIP) checklist

• CLABSI education for staff with a target goal of ZERO

• Annual infection prevention risk assessment

• Ongoing implementation of the Midas DataVision and Stat It modules

• Development of the Procedural Sedation documentation improvement audit

• Fall prevention program support and collaboration

QUALITY RESOURCEMargo Ferguson, MT (ASCP) Director, Quality Resource


The 2013 risk assessment was conducted in March. I want to thank the units that

participated in the assessment. Our next scheduled risk assessment is planned for the first quarter of 2015.

In the second quarter of 2013, the Risk Management and Guest Relations Departments worked closely together to standardize the patient grievance process. Risk Management, Guest Relations, and members of the Regional West Physicians Clinic are now working to implement a similar process in the Physician’s Clinic as well.

Timely and thorough responses to concerns are very important to our patients and their families.

In 2012, a defensive documentation was presented to the Med/Surg areas. Throughout 2013 this education was provided to most of the nursing units. There were great questions and dialog during these sessions. If you would like this presentation presented to your department please do not hesitate to contact the Risk Management Department at 308.630.2895.

If you have any other questions or concerns regarding Risk Management or want to report any concerns please feel free to call Austin Engel at 308.630.2895. If you have any Guest Relations concerns please call Connie Ruff at 308.641.7556.

RISK MANAGEMENT Austin Engel, BSN, RN Director, Risk Managementt


Regional West Medical Center is a Level II Trauma Center, and has

been verified by the American College of Surgeons since 1996. Regional West is the lead Level II Trauma Center in Region 4 of the State of Nebraska.

The Trauma Services Department includes Rommie Hughes, MD, Trauma Medical Director; Shermaine Sterkel, RN, Trauma Program Manager; Deana Spreier, Trauma Registrar and Performance Improvement (PI) Coordinator; and Holly Johnston, RN, Injury Prevention Coordinator.

In 2013, Regional West Medical Center treated 538 trauma patients. Of those patients, 207 were trauma team activations with 55 full trauma team activations and 158 partial trauma team activations.

In 2013, the top 10 causes of injury from most to least were:

1. Falls

2. Motor Vehicle Crashes (MVC)

3. Livestock related

4. Motorcycle Crash (MCC)

5. All-Terrain Vehicles (ATV)

6. Assault

7. Motor pedestrian

8. Sports related

9. Farm/heavy equipment incident

10. Bicycle crash

Deana enters all of the trauma patients into the trauma registry and performs 100 percent review of the cases for performance improvement opportunities. This information determines the trauma cases that go to review at Trauma PI and Patient Safety (TPIPS) as well as to Trauma Peer Review (TPR). Deana also has responsibility and oversight of approximate 275 trauma patients and their data that is entered into the trauma registry of our 10 Region 4 hospitals.

The Trauma Service at Regional West Medical Center has been busy educating and training our region’s new trauma nurse coordinators/registrars. We held our Region 4 PI meeting in

September 2013 and March 2014 at Regional West Medical Center.

Holly Johnston, injury prevention coordinator, made presentations to students at Scottsbluff High School about “Teens in the Driver Seat.”

Trauma Services had our re-verification visit by the American College of Surgeons as a Level II Trauma Center in November 2013.

Trauma Services is implementing a new trauma registry software “Image Trends.” We are also implementing a new Trauma Quality Improvement Program called (TQIP). We anticipate these new programs to better support our PI and patient outcomes.

Trauma Services is also working with our Marketing Department on a formal Marketing plan.

This will be to facilitate outreach of our Level II Trauma Center and our compliment of surgical services to take care of our trauma population.

TRAUMA SERVICESShermaine Sterkel, BSN, RN, CCRN Trauma Nurse Coordinator


The Skin Integrity Team meets to discuss and educate staff concerning factors that

compromise skin integrity, whether that is due to a pressure ulcer, disease process, skin tears, etc. They discuss education, charting screens, reporting, bed surfaces, products (new, house-wide, and/or samples), data collection, PI projects, pilot projects. Members assist with the Quarterly Magnet Prevalence Pressure Ulcer Studies, keep their units informed of education opportunities offered for wound and ostomy care, and update their units on new skin care and pressure ulcer prevention strategies.

There is representation from the following units: PCU, ICU, 2W, 2E, 3rd, 4th, Dietary, Education, Interventional Radiology, and Purchasing. Goals of the Skin Integrity Team are to educate staff to focus on skin issues, not only the issues that are present, but interventions needed to prevent skin breakdown.

Attendance: The average number of members at each monthly meeting is seven, which is 50 percent of the active members. The average

participants helping with the quarterly pressure ulcer prevalence studies is 10.

Education opportunities coordinated and presented for employees included:

• “Wound Care 2013.” This free presentation was open to area nursing homes and care facilities, sponsored by KCI.

• New SWANK pressure ulcer prevention competency PowerPoint with quiz.

• Revised “Pressure Ulcer Facts” sheet that is in the admission packets.

• Writing “Skin Care Notes” articles for each Magnetic Times publication.

• Coordinated, presented, and participated in the Wyo-Braska Wound Care Conference. This conference is open to the region.

• Sage representative here to demonstrate chair slider and Prevalon heel off-loading boot.

• Calmoseptine and Silvasorb gel now in medical pyxis.

• SWANK courses for Excel Care bed and bariatric bed.

• Looked into getting wound numbers on SBAR.

• Revised and distributed laminated decision tree for heel pressure relief.

• Information shared about free CEUs on ostomy care through Hollister.com.

• Viewed “Targeting Zero Made Easy! Your Path to Prevention.”

• Bi-monthly presentation to newly-hired nursing staff, “Pressure ulcer staging, how to make referral, pressure redistribution devices, Braden Scale.”

• Bi-yearly presentation to nursing residency program on ostomy care, wound care, and pressure ulcer staging.

• Reporting topics to care and practice.

WOUND CARE/OSTOMY REPORT Jeanette McFeely, RN, BSN, CWOCN Skin Integrity Team Committee


Magnet quarterly prevalence pressure ulcer studies

At each quarterly study, the auditing nurses review pressure ulcer staging along with the importance of providing an accurate study and doing a thorough assessment on all patients. Prevention interventions are recommended to staff nurses along with stressing the importance of charting ulcers present on admission (POA). Below are the statistics of this year results:

February 26 Hill-Rom National Study

• 10 skin team members participated

• Assessed 56 out of 69 patients

• 6 patients (patients) with 13 pressure ulcers (PUs)

• 7 Present on Admission (POA) pressure ulcers in hospital

• 6 Hospital Acquired (HA)

April 23



• 0 patients with Pus

• 0 HA

• 0 POA

July 23



• 6 patients with 9 PUs

• 3 HA

• 6 POA

October 22, 2013



• 6 patients with 6 PU

• 5 HA

• 1 POA

Outpatient Wound/Ostomy ClinicThe Outpatient Wound/Ostomy Clinic is located at Regional West Medical Plaza North, Suite #1400. The clinic is held on Monday, Wednesday, and Friday of each week. New patients are seen by the rotating medical staff and follow-up visits are scheduled as needed. The medical staff include: Dr. Melissa Stade and Dr. Jason Walsh with

Regional West Physicians Clinic-Surgery, Vascular Diagnostics; and Dr. Mark Willats with Western Plains Foot Center. Dr. Walsh remains the medical director and is certified as a wound specialist. The nursing staff include: Rachelle Noe, RN, BSN, CWOCN; Amy Mosteller, NA-C; Sheila Kihlthau, RN; and Jeanette McFeely, RN, BSN, CWOCN. PRN staff include: Pat Takuski, RN, BSN; and Carrie Snygg, RN, BSN.

The Wound/Ostomy clinic has increased the number of new patients seen each year, as demonstrated in the table above. We use advanced dressings and skin substitutes to facilitate closure in difficult non-healing wounds. We see ostomy patients who have skin breakdown or pouching issues, and counsel patients with incontinence issues.

Year 2009 2010 2011 2012 2013Consults (Initial appt) 165 (16%)* 151 (8%)* 209 (11%) 255 (12%) 260 (12%)

F/U with physician 118 (12%) 348 (20%) 376 (19%) 369 (17%) 499 (23%)Wound/Ostomy F/U 726 (72%) 1,254 (72%) 1,374 (70%) 1,522 (71%) 1,425 (65%)TOTAL 1,009 1,753 1,959 2,146 2,184

Number of patient appointments a year


Coordinating Council & Care and Practice Council

Elizabeth Ossian, BSN, RN Chair

Coordinating Council Mission The Shared Governance Coordinating Council will collaborate to lead, coordinate, and communicate the activities of nursing Shared Governance Councils to keep patient care the central focus of all we do.

Vision Statement We are the voice of nursing staff by facilitating communication, collaboration, support, delegation, leadership, and education through Shared Governance.

Values Empowerment | Responsibility Accountability | Shared Decision-making

Care and Practice Council

Mission Promote, facilitate, and coordinate patient care

Vision statement The council is actively seen and utilized as a resource for patient care issues to ensure superior clinical performance resulting in outcomes that outperform benchmark data.

2013 was a year full of accomplishments for the Nursing Shared Governance Councils. The Coordinating Council is a group made up of chairs and chairs-elect of each of the councils, with Shirley Knodel as our management advisor and Jacqulyn Robison, the new Survey Preparedness/Magnet Coordinator. (Jordan Colwell held this position previously.)

The Quality and Safety Council was instrumental in launching Nursing Peer Review last year. The Nursing Peer Review Committee (NPRC) is made up of bedside nurses and meets monthly to review select cases to determine where we can improve our care. This is a confidential process which includes reviewing the medical record and interviewing nurses involved to determine if we need to change any part of our processes.

Additionally, Quality and Safety continued working on the Hand Hygiene project using the Targeted Solution Tool from the Joint Commission. Originally piloted on the Med/Surg floors, this is now being utilized house-wide to identify the right interventions for each unit to improve hand hygiene. Hand hygiene compliance is improving and we will continue to monitor this as we move forward.

Care and Practice launched the new fall prevention program based on the Hindrich 2 model for assessing risk of falls. This is a great example of an evidence-based nursing practice change. In the computer charting, there is now a different fall assessment and suggested interventions to improve our ability to predict a patient’s propensity for falling. This also better reflects our actual interventions being performed. In addition to the newer fall assessment tool, the Falls Committee has been

SHARED GOVERNANCE


reorganized to examine post-fall huddles and what improvements we can make to our current practice following a fall.

Evidence-Based Practice researched nursing fatigue and the importance of meal breaks. This group compiled a recommendation that was presented to Nursing Leadership. The nursing fatigue project has now been handed over to the Quality and Safety Committee. Last fall, the Coordinating Council decided to combine Evidence-Based Practice with Care and Practice. The new combined committee kept the name Care and Practice.

Professional PracticeProfessional Practice has their hands full each year with keeping the clinical ladder up-to-date and relevant. They also plan the Nurses’ Week activities and Nursing Awards. Another visible project is the single-color uniforms you may have seen the nurses from 2nd and 3rd floors wearing. This is part of a research project for UNMC MSN students to determine if single-color matching

scrubs would help patients more easily identify their RNs, hopefully in an effort to improve patient satisfaction scores. All nurses, regardless of home unit, had the opportunity to vote for one of four possible colors, with pewter being the final selection. Questions were inserted into the Healthstream questionnaire for measuring data at baseline, then again following the uniform change. So far there has been positive response from both staff and patients!

Night Shift CouncilThe relatively new Night Shift Council worked on improving the night food cart rotation and selection, ensuring lunch breaks, improving transfer times, and so on. This is a particularly special committee because it specifically addresses concerns for the night shift that previously had no good way to be addressed.

Nurse Finance Council Another exciting new committee is the Nurse Finance Council. This brand new committee creates a closer working relationship

between Nursing, the Finance Department, and Purchasing to improve how we utilize our resources. This council created a link on the Regional West Intranet for anyone to suggest ways to use our dollars more wisely. Currently, the ED is piloting a plan to return to the re-usable blood pressure cuffs and pulse-ox sensors. There have been many good suggestions through the Intranet link and the committee is now working on a way to communicate the progress of those ideas as well as the total dollar amount saved.

Going forward into 2014, we are focusing on two major goals in accordance with the goals presented by Dr. Sorensen last fall: “How can we reduce Serious Safety Events (SSE) to zero?” and “How can we achieve 90th percentile patient satisfaction rating?”

I would like to take this opportunity to encourage all nurses to join one of the Shared Governance Councils. This is the best opportunity to have a positive influence on nursing practice at our hospital and we can best do that if all areas of the hospital are represented. If you have any


questions you can email me at [email protected]. Thank you, and here’s to a successful 2014!

Quality and Safety Council Christy Jay, BSN, RN, Chair

Mission To promote and maintain best practices for patient safety and quality care.

Vision Outcomes measures consistently outperform benchmark data.

Projects Quality and Safety finished our part of the hand-washing project last September. We then started Nursing Peer Review. We developed the reasons why the committee was needed, and the criteria for how to choose members. We then had meetings with Leadership and talked to all the nurses at their floor’s staff meetings to let everyone know what NPRC was. The committee was formed on recommendations from directors and has been going well. The committee celebrated NPRC’s progress and success during our October meeting.

Future Projects Our next project was and is Nursing Fatigue meal/breaks project. A survey was developed in Survey Monkey. We had meetings with nursing leadership and nursing directors to address questions and get feedback. After that meeting it was decided to include all departments in the hospital that had 24/7 coverage like lab, radiology, etc. A purpose statement was developed, as well as a letter written to managers and staff explaining about the survey. A timeline for the project was also written and revised. Posters have been made to alert staff of the survey. The survey will run from June 8-30. We hope to start analyzing data in July.

Professional Practice Council Lenna Booth, BSN, RN, Chair

Mission The Professional Practice Council’s mission is to promote and support the professional nurse through a positive work environment and staff development activities.

Projects The Professional Practice Council looked at issues like

dress code and social media. We have emphasized to staff members and the leadership on this council to remember HIPAA laws and respect when using the Internet and social media sites like Facebook. Confidentiality is very important and we must remember to be professional at work and when at home. Not posting pictures of the hospital with patients is a very crucial part of maintaining confidentiality. The council addressed this as social media is a part of everyday life and we must emphasize this.

The education on use for IV tubing was approached. After investigating the practice of when to change new IV tubing, it was discovered that all IV tubing throughout the hospital (unless it is blood tubing) is good for 72 hours, including IV antibiotic tubing. This should be kept sterile with capping of the tubing when not in use and should also be labeled to show its date and time to follow the 72-hour rule. This is something that continues to take education, practice, and accountability from the staff members throughout the hospital.


Other subjects discussed throughout the year by the PPC included

• Emergent/trauma call response time

• Safety stories shared at the meetings

• Medications should not be given through the blood tubing during blood transfusions

• Education on chest tube drain systems

• Initiating mentor programs such as a nurse residency program that was shared by Alicia Kuntz, RN, who was with the Education Department at the time

Future Projects The colored scrubs research is something that will be looked at. The proposed project will be to institute color-coded scrubs for the different departments. The hope is to promote patient safety. This will happen because patients, their family members, and visitors will know who to contact for information and questions while eliminating confusion and time spent searching for the proper person in their loved one’s care. This

will also help staff members, physicians, and midlevel providers distinguish the difference between a licensed provider and a non-licensed provider.

Revisiting the dress code policy will also help in promoting a professional environment that is also ensuring a safe practice facility when patients choose Regional West Medical Center for their primary health care facility.

Nurse Retention This is something that Lucrecia Spady studied for her master’s degree. It is always a changing practice as society changes, however, and this council is open to any suggestions or research in how to keep nurses on staff.

Night Shift Council Matt Blaylock, BSN, RN, Chair

Mission The Shared Governance Night Council will focus on evidence-based behavior, environment, and practice changes to influence patient satisfaction scores, consistently achieving top-box score in all areas.

Vision Excellent patient satisfaction

scores as a result of change, researched and initiated by Night Shift Council.

This past year the Night Shift Council worked on helping ensure that staff takes its meal breaks and ways to include the night shift on food options. Out of this, the staff encouraged their co-workers to take breaks and also placed more clocks around units to remind staff to utilize this time to recharge so they can be ready to provide safe patient care.

Another big topic that this council discussed was related to changing the medication pass times. Collaborating with the Pharmacy Department, the Night Shift Council was able to see positive results in the time change for medication cart exchanges. This time was shifted from the time frame of 10-11 p.m. to 11:01 p.m., which created effective workflow for both departments.

Facilitating discharges was the last topic that the Night Shift Council has been involved with, to better serve patients and getting them discharged to home. At night, the staff does not see as much of the process for discharges and have worked


with educational opportunities in seeing this process through. They have also gained team member support with the hospital’s social workers to help increase the momentum of this process.

Future of Night ShiftThe night shift team members here at Regional West are an important part of the puzzle that serves our patient population. The atmosphere of working night shift is such a blessing to our community. It would be great to see more involvement of the different night shift members as we remember their part in what they do in serving this hospital system and community. Thank you for all that your team does, night shift.

Nurse-Finance Council Paul Adams, BSN, RN, Chair

MissionThe Nurse-Finance Council will serve as a collaboration to optimize fiscal responsibility across all areas of nursing while maintaining the delivery of safe, quality, and efficient patient care.

VisionCost effective management of labor and supply resource utilization.

The Nurse-Finance Council was created in 2013. The common goal from the Nursing Department and Finance Department is to collaborate on ideas that would create a cost-effective environment here at Regional West. This would include ways to become more efficient in labor costs and with use of medical supplies.

Projects The council came up with some great avenues for cost-effective ideas during their first year. Non-usable blood pressure cuffs and pulse oximeters for patients in non-isolation rooms were instituted that with proper disinfectant education amongst staff members could be re-used for patient care. Another innovative idea was the standardization of IV trays. These trays were built to suit the needs for nurses in initiated IV access. The staff created one universal IV tray kit for the nursing units that would hold the supplies and cut down in waste of products.

An Intranet link was also created for employees to submit their input to the council for cost-cutting ideas to save waste and money. These submissions have been automatically going to the council and are able to be presented to the council for discussion.

Future ProjectsTrash bins for waste: Linda reports that they have bins that they can use and place on the units for a pilot project for clean waste, so employees can see what/how much we waste as far as supplies. Paul asks how education will take place on units when bins are placed. Linda states they will educate at the time they are placing the bins. This may generate ideas from staff on cost-savings ideas.

Scott Wentz from Finance was able to share areas of cost that were calculated with the different avenues of lunch breaks, overtimes, meetings, and education. Out of this it was determined that different units could watch for clocking in and out. Making sure to not clock in more than


seven minutes early from the assigned shift can help with over shifts. Directors of the different departments have been educating their staff on this and holding them accountable. An automatic deduction for a 30 minute lunch break was also brought into the discussion at one time that could be a potential avenue as well.

Value-based purchasing is another important aspect of health care in the future. As time goes on, this council will be able to come up with important ideas and ways to promote money saving channels that also institute the growth of patient satisfaction.


2013 REGIONAL WEST MEDICAL CENTER CERTIFIED NURSESAccredited Case Manager (ACM)

Lois Cannell

Stephanie Hawley

Karen Houk

Antigua and Barbuda Midwifery Association

Claudia Mack-Simon

Certified Ambulatory Perianesthesia Nurse (CAPA)

Michelle Keener

Roxie Shaul

Certified Bariatric Nurse (CBN)

Ramona (Mona) Urwin

Certified Case Manager (CCM)

Jackie Carter

Certified Clinical Health Coach (CCHC)

Pamela (Pam) Zitterkopf

Certified Critical Care RN (CCRN)

Joshua Beals

Jessica Conn

Jacqueline (Jackie) Delatour

Linda Fowler (dual certifications)

Travis Hargreaves

Cheryl Hoxworth

Jessica Slaght-Langworth (triple certifications)

Stephen Matthews

Leigh Miller

Cheryl Patrick

Teal Smith

Shermaine Sterkel

Marilyn Stoddard

Certified in Electronic Fetal Monitoring (C-EFM)

Vivianna Palomo (dual certifications)

Shari Rogers

Certified Emergency Nurse (CEN)

Melissa Amateis

Linda Borelli

Alice Fillingham

Linda Fowler (dual certifications)

Trisha Garner (dual certifications)

Erin Hill

Kathy Jacobson

Lori Joplin


Amanda Lashley

Sherry McDonald

Thomas (Tom) Moore

Laura Wolfe

Sarah Paetow

Certification in Field Epidemiology

Paulette Schnell

Certified Flight Registered Nurse (CFRN)

Trisha Garner (dual certifications)

Tracy Meyer

Jason Rairigh

Sean Shirley

Dee Vogel


Certified Gastroenterology Registered Nurse (CGRN)

Lucrecia Spady

Certified High Risk Neonatal Nursing

Stacy Ingersoll (dual certifications)

Certified Inpatient Obstetrics Nurse (RNC-OB)

Mary Coon

Ramona Giles

Robin Cushing

Krissa Randall

Certified Lactation Counselor (CLC)

Keara Brunner

Stacy Ingersoll (dual certifications)

Cynthia Francisco (dual certifications)

Vivianna Palomo (dual certifications)

Certified Medical Interpreter (CMI-Spanish)

Sarah Shannon

Certified Nurse Operating Room (CNOR)

Dayna Dondelinger

Rhonda Goshens

Darcy Haslam

Christy Jay

Colleen Kelly

Mary Lockwood

Kim Mann

Janet Lewis

Kim Brown

Leslie Ilg

Joann Walter (new)

Certified Pediatric Emergency Nurse (CPEN)


Certified Perianesthesia Nurse (CPAN)

Sandy Hebbert

Peg Jackson

Billie Kniss

Katharina Lemons

Tracy Payne

Chris Micheels

Andrea Ray

Certified Professional Utilization Reviewer (CPUR)

Julie Kautz

Kristi Henkel

Certified Rehab Registered Nurse (CRRN)

Darlene Cooper

Pam Cover

Cindy McGaughy

Certified Wound Ostomy Continence Nurse (CWOCN)

Jeanette McFeely

Rachelle Noe

Clinical Nurse Specialist Adult Health and Illness (ACNS-BC)

Susan Backer

Emergency Medical Tech-Basic (EMT-B)

Vanessa Rhembrandt

Gerontology Nurse Certified (BC)

Irma Walter

Kathi Yost

GI Technical Specialist Certificate from Society for Gastroenterology, Nurses, and Associates (SGNA)

Donna Klein, LPN

Kathy Mackrill, LPN


International Board Certified Lactation Consultants (IBCLC)

Cynthia Francisco (dual certifications)

Medical-Surgical Board Certified Nurse (CMSRN)

Delfina (Tina) Delgado

Lisa Fabricius

Michelle Powell

Tara Shallenberger

Christina Walters

Oncology Certified Nurse (OCN)

Megan Anderson

Ione Beavers

Leslie Biggs

Susan Schoeneman

Orthopedic Nurse Certified (ONC)

Christine (Chris) Buhr

Kimberly (Kim) Meininger

Marilyn Noel

Outcome Assessment Information Set Certified Nurse (OASIS)

Michelle (Shelly) Meisner

Peripherally Inserted Central Catheter (PICC) Insertion Certification

John Beard

Michael (Mike) Bokelman

Psychiatric and Mental Health Certified

Sheli Goodwin

Tamara (Tami) Lewis

Resident Assessment

Coordinator – Certified (RAC-CT)

Sheila Kihlthau

Sharon Marlow

Sexual Assault Nurse Examiner/Sexual Assault Forensic Examiner (SANE/SAFE)

Mandy Shaul-Bolek


4021 Avenue B | Scottsbluff, NE 69361

nursing annual report 2013

Documents

restorative care

infant care center

critic care

home care

alth services

imaging services

rehabilitation unit

perianesthesia care