Journey of Excellence · the Press Ganey Guardian of Excellence award for excellence in Patient Experience. Additionally, NEBH was the first hospital in Boston to achieve advanced

Journey of Excellence

2 0 1 8 a n n u a l n u r s i n g r e p o r t

I am pleased to present the 2018 Nursing Annual Report. This was a year of incredible growth and continued excellence at New England Baptist Hospital. We had unprecedented surgical

volume and experienced recognition through a variety of distinctions and awards. Our nurses make a difference every day throughout our organization by delivering compassionate, comprehensive, and evidence based care.

We have celebrated several key accomplishments this past year which included CMS five-star rating, U.S. News & World Report distinction, Premier Award for Quality and Patient Safety, and for the 11th year the Press Ganey Guardian of Excellence award for excellence in Patient Experience. Additionally, NEBH was the first hospital in Boston to achieve advanced certification designation in total hip and knee replacement by The Joint Commission.

Another major milestone has been our Journey of Excellence towards Magnet designation which is granted by the American Nurses Credentialing Center (ANCC). NEBH nurses embarked on our Journey of Excellence toward Magnet in October 2014 and we submitted our document October 1, 2018. We are preparing for an accreditation site visit April 24 through April 26, 2019.

I am proud of NEBH nurses and all their achievements in 2018. It is my privilege to work along side such talented and compassionate professionals. Their innovation, exemplary practice, leadership, quality and research efforts make a difference at New England Baptist Hospital. You are sustaining a culture of excellence, which is changing lives every day.

Best,

Mary Sullivan Smith, MS, RN Senior Vice President, Chief Operating Officer, Chief Nursing Officer & Chief Compliance & Privacy Officer

New England Baptist Hospital experienced an extraordinary year in 2018. We were able to finish the year with good growth and corresponding financial success. We participated in an intense regulatory

review of our merger into Beth Israel Lahey Health and many of our leadership team were asked to do more; such as, participate in design groups for the new system. This year has left us with a renewed understanding of how strong the Baptist team is when we all work together in the face of change.

We enter 2019 with a tremendous amount of opportunity that will come from being part of a larger organization. This is very exciting. Together, as a team, we will hold true to our core values and continue to provide the legendary service and high-quality care that is the “Baptist Way.”

Every day I am contacted by patients and families who are so grateful for the quality and thoughtfulness of the care we deliver. Nursing is at the heart of that care. Our nursing department is a source of great pride for our institution.

This annual Nursing Report highlights the great work our nurses do everyday and in every way. I want to thank Mary Sullivan Smith and her team for another outstanding year.

I look forward to a very bright future for the Baptist as we continue along this journey together.

Sincerely,

David A. Passafaro President

N E B H A n n u a l N u r s i n g R e p o r t 2 0 1 8

2

★★★★★Centers for Medicare and Medicaid

Services Five-Star Rated

Nursing Professional Practice ModelThis is a visual representation of NEBH’s Professional Practice Model. The model includes values and goals that define our professional nursing identity. The model captures the professional elements and identifies the what, how and why of what Baptist nurses do.


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Model is surrounded by

the NEBH Mission

NEBH core values are at the center

of the model

The five elements of our nursing practice are

highlighted

Nursing Vision We will be recognized as a leader in exemplary nursing practice, compassionate care delivery, research and innovation. We will foster a professional practice environment that engages nurses in improving the quality of life for patients and in enhancing the clinical environment.

Nursing Mission Nurses will transform lives through an unwavering commitment to excellence in patient care and outcomes.

Empowered LeadersShared Decision Making

Shared Decision Making Councils at NEBH continue to focus on improving patient care and outcomes. Unit-based councils work to improve the patient experience, support the professional development of the registered nurse, establish standards of nursing practice and improve patient outcomes through process improvement and implementation of evidence-based practice projects. All shared governance councils work collaboratively with the interprofessional team to achieve identified goals and to improve the patient experience. Communication between the council is multi-directional with information shared at the unit as well as organizational level. Nurses at all levels are included in interprofessional councils, committees and task-forces designed to improve care, patient outcomes and nurse satisfaction.


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NEBOCC Clinical nurse Joanne Petrillo, BSN, RN, CPAN, CAPA and 5 West Clinical Leader, Margaret McCarthy, MSN, RN, writers for our Magnet document.

NRC/EBP

Chairs Members

Kathy McCarraherChris Bell

Tricia IdeBetsey DraperKatie CorriganIrene ChapskiMarcia Robertson Margaret Russell

GreeneKeri O’BrienMargaret McCarthyLinda CunninghamNancy HartnettJoanne PetrilloAnn EllSusan BoudreauGina UrsoleoMaryanne Cole

Unit Based Council and Central Council Members:

UNit BasEd CoUNCil

Chairs Members

5 West Castella Edward, MSN, RN

Lauren Kirk, BSN,RN

Haley Mason, BSN, RN

5 East Kate Elias, BSN, RN

Lauren Jasminski, MSN, RN

Dante Mendoza, BSN, RNTricia Peters, BSN, RN

Intensive Care Unit

Sue DeBerardinis, BSN, RN

Ginny Williams, MSN, RN

Sam Babchuck , BSN, RNAnn Ell, BSN, RN

4 West Jensen McKee, BSN, RN

Laura Morgan, MSN, RN

Lauren Callahan, BSN, RNErin Rull, BSN, RNJill Wasylow, BSN, RN

4 East Alyssa Ruta, BSN, RN

Lisa Spencer, BSN, RN

Stacy Bottary, BSN, RNPaula Cote, BSN, RNChristina Riccio, BSN, RN

Bond Chris Bell, MSN, RN

Tricia Fitzgerald, BSN, RN

Mary Dillon, RNHelen Bartkow, RN

Operating Room Maryanne Cole, MSN, RN

Kate Doller, RN

Caroline Davey, BSN, RNSherry Gomes, BSN, RNJacque McManus, BSN, RNKatie Pelgrin, BSN, RNKristina Rutherford, BSN, RNLauren Townsend, BSN, RN

Post-Anesthesia Care Unit

Jayne Campbell Beaudet, BSN, RN

Melanie Hughes, BSN, RN

Susan Boudreau, RNCiara Lordan, BSN, RNJennifer Weaver, BSN, RN

Pre-Admission Screening

Jan Mills, MSN, NP

Marcia Robertson, BSN, RN

Cathy Botts-Deegan, RNMargaret Rice, APN

NEBOCC/Pain Janet Bridges, BSN, RN

Jeanne Capone McCabe, BSN, RN

Jane Donegan, BSN, RNNancy Hartnett, BSN, RNMarci Kling, BSN, RNMarie Reed, RN

PRofEssioNal PRaCtiCE CoUNCil

Chairs Members

5 West Sharon Connolly, BSN, RN

Sherry Gomes, BSN, RN

Andrea Machado, BSN, RN

Castella Edward, MSN, RNMargaret McCarthy, MSN, RN

5 East Lauren Jasminski, MSN, RN

Intensive Care Unit

Sue DeBerardinis, BSN, RNKeri O’Brien, JD, BSN, RN

4 West Cathy Donovan, MSN, RNJensen McKee, BSN, RNLaura Morgan, MSN, RN

4 East Paula Cote, BSN, RN

Bond Chris Bell, MSN, RN

Operating Room Joanne Cassiani, BSN, RNBarbara McKinnon, BSN, RN


Denise Cody, MSN, RNMelanie Hughes, BSN, RN


Sheila Querfurth, MSN, NP

NEBOCC/Pain Janet Bridges, BSN, RNJane Donegan, BSN, RNMarie Reed, RN

Information Technology

Rhonda Adams, MSN, RN

Nursing Office Sharon Connolly, BSN, RN

IV Access Gloria Cottreau, RN

Coumadin Noreen Howie, BSN, RN

Quality + Patient Safety

Lauren Koloski, MSN, RN

Case Management

Janet Niccoli, RN

Clinical Education and Professional Development

Marjorie Bennett, MS, BSN, RN

Ed Burch, MSN, RN


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Continued on next page

JoURNEy of ExCEllENCE CoUNCil

Chairs Members

5 West Margaret McCarthy, MSN, RN

Joanne Petrillo, BSN, RN

Lauren Kirk, BSN, RN

5 East Kate Elias, BSN, RN

Intensive Care Unit

Ginny Williams, MSN, RN

4 West Laura Morgan, MSN, RN

4 East Alyssa Ruta, BSN, RNLisa Spencer, BSN, RN

Bond Chris Bell, MSN, RNTricia Fitzgerald, BSN, RN

Operating Room Maryanne Cole, MSN, RN


Jennifer Weaver, MSN, RN


Janet Mills, MSN, NP

NEBOCC/Pain Jeanne Capone McCabe, BSN, RN

Case Management

Patti Holbling, RN


Tricia Ide, MS, RN

Nursing Leadership

Mary Sullivan Smith, MS, RN

QUality & PatiENt safEty CoUNCil

Chairs Members

5 West Katie Corrigan, MSN, RN

Lauren Koloski, MSN, RN

Haley Mason, BSN, RN

5 East Dante Mendoza, BSN, RN

Intensive Care Unit

Sue DeBerardinis, BSN, RN

4 West Jensen McKee, MSN, RNLaura Morgan, MSN, RN

4 East Alyssa Ruta, BSN, RN

Bond Tricia Fitzgerald, BSN, RN

Operating Room Sherry Gomes, BSN, RNKatie Pelgrin, BSN, RN


Jennifer Weaver, BSN, RN


Sheila Querfurth, MSN, NP

NEBOCC/Pain Marci Kling, BSN, RN

Nursing Office Sharon Connolly, BSN, RN


Alyssa Powers, MEdTricia Ide, MS, RN

CooRdiNatiNg CoUNCil

Chairs Members

Tricia Ide, MS, RN

Unit Based Council and Central Council Members: continued

NURsiNg REsEaRCh aNd EvidENCE BasEd PRaCtiCE CoUNCil

Chairs Members

Chris Bell, MSN, RN

Susan Boudreau, RNEd Burch, MSN, RNMaryanne Cole, MSN, RN

Linda Cunningham, BSN, RNBetsey DraperAnn Ell, BSN, RN

Tricia Ide, MS, RNMargaret McCarthy, MSN, RNKeri O’Brien, JD, BSN, RN

Joanne Petrillo, BSN, RNMarcia Robertson, BSN, RNGina Ursoleo, RN

Chris Bell, MSN, RNMarjorie Bennett, MS, BSN, RNJanet Bridges, BSN, RNEd Burch, MSN, RNJayne Campbell Beaudet, BSN,

RNJeanne Capone McCabe, BSN,

RNDenise Cody, MSN, RNMaryanne Cole, MSN, RNSharon Connolly, BSN, RN

Katie Corrigan, MSN, RNSue DeBerardinis, BSN, RNKate Doller, RNCathy Donovan, MSN, RNCastella Edward, MSN, RNKate Elias, BSN, RNTricia Fitzgerald, BSN, RNSherry Gomes, BSN, RNMarybeth Hamilton, MSN,RNMelanie Hughes, BSN, RN

Lauren Jasminski, MSN, RNLauren Kirk, BSN, RNLauren Koloski, MSN, RNAndrea Machado, BSN, RNMargaret McCarthy, MSN,RNJensen McKee, BSN, RNBarbara McKinnon, BSN, RNJan Mills, MSN, NPLaura Morgan, MSN, RNJudi Moscatel, MSN, RN

Keri O’Brien, JD, BSN, RNJoanne Petrillo, BSN, RNSheila Querfurth, MSN, NPMarcia Robertson, BSN, RNAlyssa Ruta, BSN, RNGail Sebet, MSM, RNLisa Spencer, BSN, RNMary Sullivan Smith, MS, RNGinny Williams, MSN, RN


6

At NEBH, our goal is to be the best. Our numbers tell the story when we review our patient quality and safety data. In all areas we show strong and steady gains, leading in our efforts to deliver exceptional musculoskeletal care. There were many nursing-led initiatives focused on quality and safety, our journey to zero harm and in becoming a high reliability organization. By incorporating quality process analyses, evidence-based practices and research, we are leading and witnessing improved patient outcomes. Our exemplary outcomes enabled us to successfully meet and in many instances exceed the requirements for The Joint Commission’s Advanced Certification for Total Hip and Knee Replacement. Our strong patient outcomes and particularly the nurse sensitive indicators, favorably position us to meet the ANCC Magnet requirements.

Our commitment to patient safety, extraordinary quality, patient related outcomes and fiscal responsibility distinguish the Baptist within a competitive marketplace. Our collective focus on high reliability, transparency and continuous improvement are the foundation of our success. We continue to actively utilize and display data/dashboards in a meaningful manner so that staff at all levels understand and act.

Each year we have a strategic goal that centers upon improvement: to create high reliability care processes, utilizing Continuous Improvement (CI) methodology and tools and incorporating organizational intelligence data.

To meet this goal, we have multiple, interprofessional projects underway utilizing our continuous improvement methodology, nomenclature and tools for rapid cycle improvement, change management, project management and sustainability. We have also trained key leaders and staff in project management and provided a Yellow Belt, Green Belt and Black

Belt certification program. All unit-based council co-chairs and many members have successfully completed the Yellow Belt program with several nurse leaders who have successfully completed their Green and Black Belts. Within all unit-based councils, nurses are using the CI roadmap to depict their improvement project work.

Quality Achievement


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PACU Clinical Nurses from left to right: Shannon Hurley, BSN, RN and Susan Boudreau, RN

Our collective focus on high reliability, transparency and continuous improvement are the foundation of our success.

AIM

SUSTAIN

CHANGE

MEASURE

•MeetwithspinesurgeonsindividuallyduringthemonthofOctober(5Wteam)

•Reviewnursingpolicyregardingpostopdressingcare(UBCmembers)

•Uponapproval,presentNDPtoProfessionalPracticeCouncilforreviewinNovember(Castella)

7. follow-UpHow will this change be sustained?

•Closemonitoringofincisionaldrainstomaintaindrainintegrity.

•Staffeducationonpracticechangeregardingspinedressingcareorders

• Ifsuccessfullyimplementedontheunit,UBCwillconsiderhospital-wideimplementation.

•Followupwithnursechampionsforongoingissueswithpracticechangeandconductpostimplementationsurveys.

1. Background Why are you talking about it?Postopspinedressingordersinclude:Donotchange,changedayofdischarge,changePOD#2andinrarecases,reinforcedressingifsaturated.Thesevariationsindressingordersdonottakeintoaccountpatientswithincisiondrains.Nursingdressingchangessometimescompromiseincisiondrainintegrity.Additionally,gauzewithtransparentfilmdressingdoesnotabsorbdrainageandrequiresmultiplereinforcements.Thereispotentialforincreaseriskofinfectionandimpairedskinintegrity.

3. sMaRt goalWhat outcome is required?

5WUBCisseekinggreaterthan90%approvalratingfromspinesurgeonsfortheproposedNDPdraftbyOctober31.

2. Current state Where things stand today.5WUBCwouldliketoproposeaNurseDrivenProtocol(NDP)forspinedressingcaretoallspinesurgeons.Analgorithmwascreatedtoguidenurseswithdressingcareforpatientswithandwithoutincisiondrains.Itincorporatescurrentnursingpracticeandcurrentspinedressingorders.Todate,theNDPhasbeenapprovedbythree(3)spinesurgeons.

5. Proposed Countermeasures

Teamcollaboration(UBCmembers,clinicalleader,nursemanager,surgeons)workingtogethertoachievegreaterthan90%approval.

6. Plan Who needs to do what by when?

4. analysisWhat’s the top root cause?

TheproposedNDPisintendedtoimproveefficiencyofpatientcarebyeliminatingunnecessarycallstoLIPfordressingcareorders.Nurseshavetherequiredskillstoprovideexcellentpatientcarebutcareisoftendelayedintheprocessofobtainingandclarifyingpostopdressingorders.Additionalbenefitsoftheproposalaremaintainingskinintegritybyeliminatingmultipledressingreinforcementsandearlyskinblisterinterventions.

Change dressing day of drain removal and day of dischargeDressing type: Dry sterile dressing (Island/Gauze with Tegaderm)

All Incisional Dressings: Reinforce PRN/change if saturated*Notify physician for drainage requiring more than one dressing change per shift

Nurse Driven Protocol for Spine Dressing Care

Change POD #2 and day of dischargeDressing type: Dry sterile dressing (Island/Gauze with Tegaderm)

ACDF: Do not change dressing for POD #1 discharge

CI Roadmap: Spine Dressing Care Owner: 5 West

NoYes

Drain present?


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1 Hospital Consumer Assessment of Healthcare Providers and Systems, Source: Press Ganey

2 Press Ganey, National Database of Nursing Quality Indicators

3 Source: National Healthcare Safety Network (NHSN)4 Premier Inc., National Quality Database5 Press Ganey, National Database of Nursing Quality Indicators

1.51

1.38

0.84

0.82

0.92

FY2017

FY2017 FY2017

Total hip replacement

Benchmark: <1.000

0.150 0.192

FY2017 FY2018

Total knee replacement

Benchmark: <1.000

0.3200.434

FY2017 FY2018FY2018

FY2018 FY2018

Hospital acquired pressure injury prevalence study: Stage 2 and aboveNEBH vs. NDNQI All Hospital Peer Group5

FY2017 FY2018

99 99

NEBH Percentile Ranking

FY2017FY2017 FY2018FY2018

HCAHPS1 — Percent of patients who responded “Always”NEBH vs. Press Ganey Large Database Peer Group2

71.2

90.991.1

71.6

2.72

2.82

0.32

0.89

94.495.2

Overall RatingLikelihood to recommend

Surgical site infections Standardized Infection Ratio (SIR)3

Infections that were not present or incubating at the time of admission to the hospital that occur within 90 days of surgery.

Falls per 1,000 patient daysNEBH vs. NDNQI All Hospital Peer Group2

Perioperative Pulmonary Embolism (PE) or Deep Vein Thrombosis (DVT) per 1,000 patientsNEBH vs. Premier Inc., Bed Size 101-200 Beds4

LOWeris better

LOWeris better

HIGHeris better

LOWeris better

LOWeris better

Number of hospital acquired Stage 2 or Above pressure injuries per number of patients assessed

Quality Data


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6 Premier Inc., National Quality Database7 Premier Inc., National Quality Database

8 Source: Premier Inc., HIIN Database9 Premier Inc., National Quality Database

Average Length of Stay (ALOS) Hip, Knee, SpineNEBH vs. Premier Bed Size 101 – 200 Beds 6

FY2018

87

71

FY2017

85

Overall Hospital Rate Hip, Knee and Spine

FY2018

79 78

FY2017

74

FY2018

82 78

FY2017

79

FY2018

82 78

FY2017

81

Discharges — Percent of Patients Discharged to Home or Home with Home CareNEBH vs. Premier Area- Northeast Hospitals 7

CAUTI Utilization RatioNEBH vs. Premier HIIN Benchmark 8

30 Day Unplanned Readmission Rate — All CauseNEBH vs. Premier Bed Size 101 – 200 Beds 9

FY2017 FY2018

0.19 7.27

0.14

0.17

HIGHeris better

FY2017

0.47

FY2018

0.66

3.07

FY2017

0.31

FY2018

0.44

LOWeris better

LOWeris better

LOWeris better

FY2017 FY2017FY2017 FY2018 FY2018FY2018

2.19

3.17

2.663.142.94

3.23

2.60

1.882.07

Knee SpineHip

Hip Arthroplasty Knee Arthroplasty OverallSpine Surgery: Back and Neck, Spine Surgery - Dorsal/Lumbar Fusion

Quality Data

Due to a combination of case complexity, a high volume of revisions, and sending most patients home, length of stay for knee patients is slightly higher than the national rate.


1 0

Integrating new knowledge and evidence into clinical practice is essential to continued professional development. Creating a culture of clinical inquiry requires that nurses frequently ask questions about their practice. Our Nursing Research and Evidence Based Council leads the charge and is responsible for the tremendous work to date. The number of studies conducted and the articles, presentations and posters disseminated show that NEBH is dedicated to innovation backed by evidence-based research.

Innovation

CURRENt NURsiNg REsEaRCh aCtivitiEs

Research Title Principle Investigator

The Effect of Composite Hydrocellular Foam Dressing with Silicone Gel Adhesive to Prevent Tissue Damage in the Prone Surgical Spinal Fusion Patient

Kate Doller, RN

Pre-operative Screening Urinalysis Practice Change and Its Effect on Surgical Site Infections and Catheter Associated Urinary Tract Infections in an Orthopedic Population

Chris Bell, MSN, RN

Understanding Pre-Operative Patient Education (Patient Education for TKR)

Tricia Ide, MS, RN

Identifying Contributing Factors of Presyncopal Episodes in Post-Operative Patients

Ann Ell, BSN, RN

Pre-Operative Warming and Its Effects on Meperidine Usage in the PACU

Linda Cunningham, BSN, RN

The Effects of a Skin Barrier Film Product on Incidence of Post-Operative Skin Blister Development in Spine Surgery: A Randomized Study

Maryanne Cole, MSN, RN

The Effects of Patient Controlled Pre-Operative Warming Linda Cunningham, BSN, RN


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Operating Room Nurses from left to right: Terri Corina, RN, Kayla Kilcommons, BSN, RN and Katie Pelgrin, BSN, RN

1300 Employees

418 35New RNs

48 Students from 3 schools in clinical BSN rotations Precepted

118Licensed Beds

77% BSN in 2018

22BSN students

2 MSN students

16 APN students

New England Baptist Hospital has long prided itself on continuing to advance professional development for its nursing staff. To achieve our mission of transforming the lives of those we serve by promoting wellness, restoring function, lessening disability, alleviating pain, and advancing knowledge in musculoskeletal diseases and related disorders, a well-educated nursing workforce is required. Education and professional development is a key component of the

organizational mission. Through our ROSE qualities (Respect, Ownership, Superior Service & Excellence), NEBH nurses are expected to achieve excellence through reaching ever higher levels of performance through all that they do in continuous improvement in care delivery, education, and support processes.

The NEBH Clinical Education & Professional Development (CEPD) Department oversees both the

clinical affiliations with schools as well as in-house education needs and improvement work. NEBH partners with numerous education institutions for clinical placement and serves as an educational hands-on provider for many students.

The CEPD currently manages eight affiliation agreements with neighboring schools.

Lifelong Learning

NEBH Nursing at a Glance


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• Resto r in g Fun c t io n • Le ss e n i n g D is a b i l i ty • A

l l evi

a ti n

g Pa

in •

Prom

ot ing Wel lness • Advancing Knowledge

Expert

Caring

Innovation

LearningLifelong

Achievem

ent

Quality

Empowered

Leaders

OWNERSH

IP

EXCEL

LENC

E

SU P E R I O R S E R V I CE

RESPECT

65RNs involved in monthly Journey of Excellence

Registered Nurses

Erin RullAn excerpt from her 2018 exemplar

At 2300 I began caring for a post-op left total hip arthroplasty (THA) patient. At approximately midnight the patient complained of a frontal headache, which she rated as a 3 out of a 10 (10 being the worst) on the pain scale. Any time a patient complains of a headache I think back to a prior 4W patient who, after complaining of increasing migraines throughout the day, became unresponsive with a dangerously high blood pressure. That patient was transferred to a higher level of care, diagnosed with posterior reversible encephalopathy syndrome (PRES). Wanting to avoid a worsening clinical situation, I completed a full head-to-toe assessment and found that my patient was otherwise asymptomatic. She denied any visual changes and her vital signs were stable and within her baseline.

I medicated her with her prescribed and scheduled Tylenol and, thinking that her headache could possibly be related to dehydration or caffeine withdrawal, I encouraged oral fluids and offered the patient a caffeinated beverage, which she declined. She also declined her as needed narcotics for pain. On reassessment of the Tylenol, she reported her headache had improved to a “dull” 2/10.

Expert Caring

At 0130 the patient became nauseous and vomited 300 cc. I wasn’t too concerned because our general anesthesia patients often have postoperative nausea/vomiting. She already had a scopolamine patch on, so I medicated her with IV Zofran and her nausea resolved. I checked on her frequently and noted her to be resting quietly for the next few hours. Her 0400 vital signs were benign; however, the patient became nauseous again at 0620 after getting out of bed to the commode with the nursing assistant. She complained of blurry vision in her left eye and a “sore” left eye socket when I came in to assess her. She continued to report her “dull” headache. Concerned, I assessed her pupils and noted them to be large, equal, and reactive to light. The patient had not mentioned these symptoms to the orthopedic resident who had seen her before I was informed of her nausea by the nursing assistant, so I discussed my assessment and concerns with the resident. Because it was too early for the patient to receive IV Zofran again, the resident ordered Compazine but did not address the eye concerns.

I was uncomfortable leaving the patient’s eye pain/blurriness and persistent dull headache unaddressed, so I took an updated set of vital signs (BP 124/78, HR 66) and paged the hospitalist to discuss my concerns. The hospitalist ordered another medication. When the hospitalist arrived on

the floor, I was administering the Reglan and together, we assessed the patient. By then her left pupil was noted to be nonreactive and dilated to approximately 7mm. At the direction of the hospitalist I removed the scopolamine patch. I gave report to the oncoming day shift RN, detailing the events of the night and relaying my concerns. I also informed him that a neurology consult had been ordered.

When I returned later that night I learned that the patient had a CT scan, which did not reveal an ischemic or hemorrhagic event. She was transferred to BIDMC where she was diagnosed with acute closed angle glaucoma and underwent a left eye laser iridotomy with resolution of symptoms. We did neuro/pupil checks every 4 hours upon her return to NEBH


1 3

4 West Clinical Nurse Erin Rull, BSN, RN

Continued on next page

Expert Caring,continued

and added scopolamine as an allergy to avoid further use and additional problems for the patient in the future. The following day the patient returned to BIDMC for a prophylactic right eye laser iridotomy.

The clinical situation described was a significant, potentially critical event because the patient’s intraocular pressure had increased and was causing concerning symptoms. Her vision could have been permanently compromised without timely, decisive intervention. I listened to my intuition and had the confidence to advocate for my patient by

notifying the physician teams. Doing so allowed the patient to be evaluated, transferred and treated in a timely manner and likely made a difference in her outcome.

After caring for this patient, I learned about acute closed angle glaucoma, particularly risk factors, clinical presentation, causes and treatment. I did not previously have an appreciation for fluid

volume shifts and the impact that medications our patients receive both in the OR and postoperatively can cause it, aside from scopolamine. Having learned this information I was able to share it with my coworkers for the benefit of future patients who might receive these medications or show similar symptoms.


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From left to right, Orthopedic Nurse Navigator, Noreen Howie, BSN, RN, ONC and Tara Mounsey, NP

Having learned this information I was able to share it with my coworkers for the benefit of future patients who might receive these medications or show similar symptoms.

2018 Nursing Excellence AwardsNational Nurses Week was celebrated May 7 through May 13. The week celebrates the role nurses play in delivering high quality care to patients. Congratulations to all who were recognized!

Nurses as LeadersSharon Higgins, MSN, NP, Hospitalist Service

Jan Woodbury Sliby, MSN, RN, Excellence in Clinical Nursing Practice and Department AppreciationJanet Power, RN, OR Clinical Nurse

Boston Globe Salute to Nurses RecognitionCastella Edward, MSN, RN, 5 West, Clinical Nurse

Mary Sullivan Smith, MS, RN, Spirit of InquiryLauren Koloski, MSN, RN, Quality Performance Manager

Nurses as Teachers Lauren Jasminski, MSN, RN, 5 East Clinical Nurse

Empowered Leaders


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125 Parker Hill AvenueBoston, Massachusetts 02120617.754.5000www.nebh.org

New England Baptist Hospital is a regional and national center of excellence for orthopedic care. The hospital is a teaching affiliate of Tufts University School of Medicine and conducts teaching programs in collaboration with Harvard Medical School.

The 2018 Annual Nursing Report was produced by the Office of Public Affairs at New England Baptist Hospital.

Office of Public Affairs New England Baptist Hospital 125 Parker Hill Avenue Boston, MA 02120617-754-5400

© 2018 New England Baptist Hospital. All rights reserved.

• Resto r in g Fun c t io n • Le ss e n i n g D is a b i l i ty • A

l l evi

a ti n

g Pa

in •

Prom

ot ing Wel lness • Advancing Knowledge

Expert

Caring

Innovation

LearningLifelong

Achievem

ent

Quality

Empowered

Leaders

OWNERSH

IPEX

CEL

LENC

ESU P E R I O R S E R V I C

ERESPECT

Documents

Journey of Excellence · the Press Ganey Guardian of Excellence award for excellence in Patient Experience. Additionally, NEBH was the first hospital in Boston to achieve advanced