welcome from cheryl reinking, cno - el camino …...my name is cheryl reinking and i am the chief...

©2015 El Camino Hospital E-2127_NursingAnnualReport_May15

www.elcaminohospital.org/NAR2015

My name is Cheryl Reinking and I am the Chief Nursing Offi cer of El Camino Hospital. It is my pleasure to welcome you to the 2015 Nursing Annual Report, sharing the accomplishments of our nurses. We have had many excellent outcomes this year, and there are three that I would like to highlight.

Within our Quality Aim, we have had remarkable outcomes with reducing our reportable hospital acquired pressure ulcer rate. In fact, we have not had a reportable hospital acquired pressure ulcer since June 30, 2014. This outcome has been achieved by a team of staff… fi rst and foremost led by our certifi ed Wound and Ostomy Nurses. It has also occurred because of the diligent care of our nurses and CNAs in protecting our patients’ skin. And we cannot forget the contributions of our support departments… from partnerships with Respiratory Therapy and Rehabilitation Services to trial new equipment, to Central Services delivering specialty beds in a timely manner, to Value Analysis and Materiel Management bringing in new products to trial. This has been a broad collaboration!

Within our Service Aim, we continue to make great improvements in Medication Communication satisfaction. We achieved our goals in 2014, and were able to pay out an incentive bonus to the nurses for their hard work at being sure patients understand new medications we administer to them, and the side effects of those medications.

In achieving our Workforce Development goal, we invested in three El Camino Hospital nurses to train to become Operating Room Nurses. This unique opportunity occurred through a partnership with University of San Francisco and demonstrates our on-going commitment to professional development and career advancement opportunities for our nurses.

Finally, I want to thank our nurses for always putting patients fi rst and for their commitment to Achieving Our Goals Together!

Welcome from Cheryl Reinking, CNO

NURSING ANNUAL REPORT 2015 Achieving Our Goals Together

For over 30 years American Nurses Credentialing Center (ANCC) has administered the Magnet Recognition Program for hospitals throughout the United States and the world. El Camino Hospital has a long history with the Magnet Program, first as one of the original 41 Magnet Hospitals, designated after a nationwide study in 1981.

We renewed our commitment to the Magnet Journey in the early 2000s, and in 2005 became the first Bay Area Magnet Hospital. We received our second designation in 2010. We are now working diligently to receive a third designation and join just over 100 hospitals worldwide that have achieved this goal.

The Magnet Committee is proud to honor our nurses and the excellence they have achieved. This was reflected in our Magnet Documentation and Site Visit, and is also reflected in this 2015 Nursing Annual Report.

Please enjoy exploring this site and join us in celebrating nursing excellence at El Camino Hospital!

– Magnet Committee

Magnet Committee MessageLETTER

Magnet Committee MessageCOMMITTEE MEMBERS

Jennifer Borelli, RN

Christine Cave, RN

Jody Charles, RN

Pamela Fiehmann, RN

Monica Hite, RN

Sherrie Karleskind, RN

Vivian Low, RN

Kelsey Martinez, MPA

Audrey Prairo, RN

Cheryl Reinking, RN

Kim Tabellion, RN

Chris Tarver, RN

Catherine Walke, RN

Lynn Worsham, RN

Magnet Committee


Research

LORI STORY, RN, AND JUDY MORENO, RNAbstract: Identifying Clinical Complications in PACU Recovery to Guide Best Practices

CHRIS TARVER, RNAbstract: Factors Leading to Rapid Response Team Intervention in Medical-Surgical Patients

SCION MANGUBAT, NP, AND SHERRIL HOPPER, NPAbstract: Mandatory Depression Screening on Stroke Patients

ALIDA LORENZ, RNAbstract: Santa Clara County Assessment of Missed Posterior Strokes (SCAMPS) Trial

NANETTE MALGESINI, NP, AND CRAIG CLEMENS, EPAbstract: Assessment of Nustep Submaximal Test Accuracy for Predicting Exercise Intensity

LUIS BARBERIA, RN (RIGHT) WITH RN TRAINEESAbstract: Creating a Sustainable Workforce: An OR Residency Program for RNs


The Magnet Model consists of Five Model Elements which provide a framework for practice. Within this report, you will fi nd nursing highlights for each Model Element:

• Tranformational Leadership

• Structural Empowerment

• Exemplary Professional Practice

• New Knowledge, Innovation & Improvements

• Empirical Quality Outcomes

As an independent, nonprofi t community hospital with campuses in Mountain View and Los Gatos, we are empowered to do whatever it takes to bring you the fi nest quality care. Our leadership helps foster a dynamic, collaborative, innovative environment.

El Camino Hospital physicians actively seek out the latest treatments and technologies to benefi t our patients. And all of our nurses, staff, and volunteers share our commitment to quality, patient and family centered care. Together, we bring you compassionate, comprehensive medical care that is truly state-of-the-art. Our key medical specialties include behavioral health, cancer care, heart and vascular services, orthopedic and spine surgery, rehabilitation services, senior health, urology and men’s health, and women’s health.

Magnet Committee MessageMAGNET MODEL

Organizational OverviewABOUT EL CAMINO HOSPITAL

El Camino Hospital, Mountain View

El Camino Hospital, Los Gatos


In June 2014, El Camino Hospital embarked on an exciting journey: the Road to iCARE implementation, with

a “Wizard of Oz” theme. The second six months of the year were occupied with design sessions and building the new electronic medical record system. Workflows, order sets, clinical documentation and enhanced functionality have been addressed as we move toward implementation of the new EMR. Nurses, physicians and clinical support departments have worked side by side to create a system that will benefit our patients.

Key Takeaways

• Over 100 El Camino Hospital staff joined the iCare team in June 2014.

• Every unit has “Subject Matter Experts” (SMEs), nurses who have given input into the design of the system.

• iCare goes live in November 2015.

Transformational LeadershipICARE

Transformational LeadershipLAUGHTER YOGA TRAINING

Maria Gonzalez, RN, Kathleen Faubion, RN, and Nancy Yan, RN, work together to build iCare for nurses, physicians, staff and patients.

In May 2014, the first Diana K. Russell Leadership Award was presented to Karen Roman, RN, Cardiac & Pulmonary Wellness Center. Karen was honored for her initiative to train El Camino Hospital nurses and staff to become certified in “Laughter Yoga.” In October 2014, nearly 20 nurses and staff became certified, and patients throughout the hospital now benefit from this technique.


Structural EmpowermentCCI RECOGNITION

JoAnn Medina, RN, Clinical Nurse in the OR on our Los Gatos campus, attended a CNOR Conference and learned about

From left, front row: Masha Pavlov, JoAnn Medina, Yuet Ho

Back row: Cindy Harmer, Nancy Kenny, Andrea Margolis, Caroline Pinchon

OR Los Gatos Certified Nurses not shown: Eunah Kang, Hong Shi, Susan Beck

the True North Award. She returned to her unit with great enthusiasm, offering to become the unit’s champion for certification. The goal that was set was to have at least 50 percent of eligible OR nurses become certified.

With the support of PACU Assistant Manager Judy Moreno and Perioperative Director Cindy Harmer, JoAnn filed the application for the True North Award on behalf of her unit. This included an endorsement letter written by Cheryl Reinking, CNO.

While the OR at Los Gatos did not win the True North award, they did receive Competency & Credentialing Institute (CCI) official recognition. CCI stated in the recognition that “this facility advances a culture of patient safety.”

Key Takeaways

• The OR on our Los Gatos campus received the “CNOR Strong Hospital” designation due to achievement of a high percentage of certified nurses on its staff.

Seen by two critical care nurses at a national conference, the Non-Invasive Cardiac Output Hemodynamic Monitoring System (NICOM) is a piece of equipment the nurses felt would greatly improve our ability to safely monitor patients.

Transformational LeadershipCHEETAH NICOM

Key Takeaways

• In September 2014, nurses completed online training.

• Training occurred in critical care, progressive care, and emergency services on the Mountain View campus; intensive care and emergency services on the Los Gatos campus.

• Metrics that will be measured as a result of the Cheetah implementation include CLABSI rate and LOS.

The Cheetah NICOM, which staff refer to as “Cheetah,” allows for non-invasive hemodynamic monitoring and fluid management. The technology of Cheetah is called “bioreactance” and uses signal frequencies collected through four patches placed on the patient. This system replaces the traditional “invasive” Swan Ganz lines, which put patients at risk for complications including central line infections, sepsis and possible death.

Fanny Ng, RN, manages the NICOM machine.


2014 was a banner year for new certifications. El Camino Hospital nursing staff has now exceeded over 400 certified nurses enterprise-wide! Managers and educators supported new certification by holding onsite review courses and, in the NICU area, even administering the test onsite!

Structural EmpowermentNEW CERTIFICATIONS 2014

Laura Apolinar, RN, Mother-Baby Unit – Lactation Certified

Juniper Arnold, RN, NICU – RNC-NIC

Alix Atwell, RN, Mother-Baby Unit – Inpatient OB

Michelle Baraso, RN, L&D – High Risk OB

Luis Barberia, RN, PeriOp – CNL

Jill Byrne, RN, NICU – RNC-NIC

Carol Cavins, RN, ED – CEN

Yenari Chung, RN, Mother-Baby Unit – Lactation Certified

Anne Cincotta, RN, Medical/Surgical Oncology – OCN

McKinsey Cirulink, RNC, L&D – Inpatient OB

Judith Coaquria, RNC, L&D – Inpatient OB

Daisy DeLa Pena, RN, OR – CNOR

Terence Dzelambong, RN, Behavioral Health – Psych and Mental Health

Maria Gonzales, RN, Telemetry/Stroke – CNRN

Sisi Guan, RN, Telemetry/Stroke – CNRN

Siobhan Guillory, RN, ED – CEN

Kimberly Grossweiler, RN, PACU – CPAN

Laura Haselden, RN, NICU – RNC-NIC

Danielle Herbst, RN, ICU – CCRN

Denise Ho, RNC, L&D – Inpatient OB

Alexis Honey, RN, NICU – RNC-NIC

Nikki Howell, RN, Mother-Baby Unit – Lactation Certified

Jamie Huang, RN, Mother-Baby Unit – Lactation Certified

Shawn Kelley, RN, ICU – CCRN

Helen Kidane, RNC, L&D – Inpatient OB

Becky Kondo, RN, OR – CNOR

Allison Layton, RN, Surgical/Pediatrics – Pain Management

Maridel Liang, RN, Medical/Surgical Oncology – OCN

Gabriella Mancebo, RN, Telemetry/Stroke – CNRN

Lora Lee Marlow, RN, Medical/Surgical Oncology – OCN

Joel McCoy, RN, PACU – CPAN

Judy Moreno, RN, PACU – CPAN

Kariann Mun, RN, Telemetry/Stroke – CNRN

Sandy Nakata, RN, ICU – CCRN

Sara Pane, RN, ED – CEN

Gilda Primero, RN, NICU – RNC-NIC

Ronda Robertson, RN, ICU – CCRN

Karen Roman, RN, Cardiac & Pulmonary Wellness Center – CV Nurse

Janice Santos, RN, Surgical/Pediatrics – Medical Surgical

Mara Severi, RN, Palliative Care – CHPN

Andrea Taffe, RN, NICU – RNC-NIC

Jane Truscott, RN, Nursing Education – Nursing Professional Development

Therese Vander Vennet, RN, PACU – CPAN

Jinghua Zhang, RN, Mother-Baby Unit – Lactation Certified

Partial list


Structural EmpowermentCENTRAL PARTNERSHIP COUNCIL

Marissa Szyslowski, WOCN, and Karen Roman, RN, co-chairs of Central Partnership Council

El Camino Hospital nurses participate in an active shared governance model. The Central Partnership Council (CPC) is the overarching council for all shared governance, and includes clinical nurses from every nursing department, as well as one management representative per service line, and then representatives from various other councils such as Nursing Research Council. CPC meets monthly and is chaired by two clinical nurses: Karen Roman, RN, and Marissa Szyslowski, WOCN.

New BSN Degrees 2014:

• Pamela Fiehmann, RN, Intensive Care

New MSN Degrees 2014:

• Antonette Lesaca, RN, Behavioral Health

• Angelita Romasanta, RN, Telemetry

Structural EmpowermentNEW NURSING DEGREES 2014


El Camino Hospital nurses created standardized workflow for reviewing daily medication lists, partnering with unit-based pharmacists for patient teaching, and developing medication side effect “picture” sheets for non-English speaking patients. The end result was medication communication satisfaction scores exceeding the goal, which led to nurses receiving a contractual bonus for their hard work to improve satisfaction.

Exemplary Professional PracticePATIENT SATISFACTION

Caring Nurse Award Winner: Hannah Crocker

Choosing the winner was a difficult decision this year with 24 nominations for the Caring Nurse Award, but the work of Hannah Crocker with her oncology patients was selected as the best example of excellent, caring nursing in 2014. Hannah works in the Outpatient Infusion Center and not only is a team member valued by colleagues, but is also highly regarded by her patients. Hannah exemplifies caring and compassionate nursing that is a hallmark of the El Camino Hospital Nursing Professional Practice Model.

Exemplary Professional PracticeCARING NURSE AWARD

Hannah Crocker, RN, with one of her thankful patients

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Using Lean Methodology and supported by Patient Centered Transformation (PaCT), a group of clinical nurses in the Mother-Baby Unit (MBU) formed a team to improve the discharge process. They felt these efforts could increase patient satisfaction and relieve the patient flow bottleneck

New Knowledge, Innovation & ImprovementsIMPROVING DISCHARGE PROCESS

Exemplary Professional PracticePROFESSIONAL PRACTICE MODEL

El Camino Hospital’s nursing Professional Practice Model (PPM) emphasizes the patient being at the center of all care. Words chosen by nurses to reflect their professional practice - Caring and Family - spiral outward from the patient. Excellence refers to the goal to deliver the highest quality care to patients. Next, Community represents the hospital’s history as a community-built organization and its future: broadening delivery of care across the continuum and into the community. Next in the outward spiral is Compassion - a word nurses often use to describe how they and their colleagues deliver care. Science and Innovation reflect our legacy as the first hospital in the world to implement an Electronic Medical Record in 1971, and the current strong support of Nursing Innovation through the Nursing Research Council. Patient Care Team captures the collaborative nature of care at El Camino Hospital. Four key aspects of care enclose the labyrinth: Preventative, Restorative, Psychological-Spiritual, and Growth-Collaboration-Education.

Nursing Professional Practice Model

in Labor & Delivery. The MBU nurses invited an L&D nurse and a supervisor representing housekeepers to join the team in order to capture their unique perspectives.

The discharge team put several processes in place designed to increase the patient’s satisfaction, such as:

• Standardized discharge plan starting with admission to L&D and extending through discharge from MBU.

• Standardized teaching, timing and key messages by all staff.

• Creation and implementation of the “Perfect White Board.” This large laminated board is at every bedside and is initiated by the assigned RN when the couplet arrives on MBU.

• Standardized training including observation and return demonstration, for all MBU nurses and support staff.

Louella Zavalla, RN, reviews discharge teaching with a new mom.


This graph demonstrates El Camino Hospital critical care nurses collaborating with respiratory therapists and rehabilitation therapists to assist ventilated patients in getting out of bed. Through the ABCDE bundle work, patients are less sedated and early activity is promoted and achieved. Next steps in the ABCDE bundle work are to add “FG” (F= Family, G=Good Nutrition). By partnering with dietitians, the goal is to improve nutritional status of critically ill patients.

New Knowledge, Innovation & ImprovementsIMPROVING CRITICAL CARE

“On Demand Interpretation” (ODI) employs medical interpreters who are available to be “on camera” for interpretation. The interpretation streams real time video through an iPAD for the patients and family, as well as nursing and other clinical staff. The audio comes through the iPAD, and family and staff can gather around and see and hear the interpreter. This aligns with our goals to personalize each patient’s experience and provide culturally appropriate care. Since ODI implementation, interpretation services now average 4,600-6,300 minutes/month!

New Knowledge, Innovation & ImprovementsVIDEO TRANSLATION

Karen Cheung, RN, uses streaming video translation while working with patients.

% CCU ABCDE Patients Out of Bed

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Behavioral Health’s innovation for patients, “My Safety Plan,” allows patients to have a more participative role, and more control, over their illness and plan for recovery. “My Safety Plan” is completed by the patient with the support of staff, and is used by nurses, physicians and social workers to support the patient in achieving optimal wellness.

Empirical Quality OutcomesMY SAFETY PLAN

Through the work of the NICHE Committee and based on information learned at a NICHE conference, items to aid in patients’ sleep are now used enterprise wide. Nurses recognize the importance of quality rest for healing, so resources are available to help aid in comfort and provide balance to the patient’s more hectic schedule during their hospital stay. Implementation included working with Central Supply to stock items (such as lavender lotion and eye masks) and with the El Camino Hospital Auxiliary volunteer staff to help offer items to patients.

Empirical Quality OutcomesBEDTIME BASKET

Ashley Muniz, RN, and her patient discuss the benefits of the eye mask to support restful sleep.

Shirley Luong, RN, supports a patient completing her Safety Plan.


An intraprofessional team of nurses and pharmacists, facilitated by the PaCT team, examined the chemotherapy administration process from “order-to-documentation” and implemented changes to reduce the turnaround time and improve the experience for patients. Some of the improvements implemented include:

• Oncology pharmacist relocated to the main pharmacy (from decentralized model) to improve communication between oncology pharmacist and pharmacy staff.

• Expedited order processing (entering and verification).

• Improved handling of chemotherapy orders for both Oncology unit and Infusion Center.

• Chemo order checklist integrated into the new workflow.

• Established and educated chemo nurses on standard work.

• Creation of a charge nurse chemo acuity assignment tool.

Empirical Quality OutcomesCHEMO TURNAROUND TIME

Irene Gotgelf, RN, and Jonathan Johansen, Pharmacist, coordinate administration of chemotherapy.

welcome from cheryl reinking, cno - el camino …...my name is cheryl reinking and i am the chief...

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