In This Issue:

Nurse Practice Council—An important aspect of Shared Governance

Meet Our Nurses-Dziurda

SVMHS successfully completes simulated evacuation of NICU

Partners in Care—Infection Prevention and Control

What's New

Improving patient care through advanced technology

Meet Our Nurses-Denbow

Publications & presentations by SVMHS nurses

Evidence Based Practice Council Update

Project Focus—New Alcohol Withdrawal Protocol (AWP)

Nurse Volunteer Opportunities:

Paraiso Vineyards Winery Walk/Run
June 4
9:00 a.m. to 1:00 p.m.

Relay for Life
June 11 and 12
10:00 a.m. Sat. to 10:00 a.m. Sun.
Salinas Sports Complex

Community Health-Wellness & 5K Run
October 8, 2011
9:00 a.m. to 2:00 p.m.
Rancho Cielo

Nurses Making a Difference
Infanta Rogers, RN, Pediatrics

Infanta Rogers, RN"I decided to go into nursing when I was 12 years old," remembers Infanta Rogers, RN, Pediatrics. "My parents instilled in me the importance of a good education, and my grandmother was also a great influence. She worked at a mental hospital and took me with her a few times. I saw how much she cared about the people there and knew that I wanted to be a nurse. I started volunteering at a hospital and loved to 'practice' being a nurse by bandaging up my grandma."

While working as a LPN in Gainesville, Florida, Infanta completed nursing school at Santa Fe Community College in 1985. She came to SVMHS as a traveler in May 2007. "I love caring for children," she says smiling. "They're inspiring and enjoy giving and getting hugs." Infanta is PICC line and ACLS/PALS certified. She is an instructor at Hartnell's Nursing School and a volunteer for the Red Cross disaster team. All while balancing a life between the Salinas Valley and Mobile, Alabama.

Married for 27 years, Infanta's husband Darryl lives in their family home in Mobile, Alabama. "I go back every 6 to 8 weeks, and he comes here to see me," says Infanta. "He is so supportive of me pursuing my love of nursing. It's not a job, it's my passion, but I couldn't do it without his great support of me and my career." She and Darryl have four grown children; all are in college, including one in nursing school.

My wife Molly and I had an awesome experience at Salinas Valley Memorial. We are new parents and brought our two-month old son to the hospital because he was having trouble breathing and had a terrible cough. We were at our wits end and Infanta Rogers took a great deal of time to put us at ease. She is an AWESOME nurse. She went out of her way to make us feel at ease and comfortable in a highly stressful situation. Kudos to you Infanta. We think you are THE BEST!
—James Nichols and Molly Weaver, and baby Liam


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Nurse Practice Council—An important aspect of Shared Governance

"When I joined the Nurse Practice Council (NPC) in 2007, it was largely made up of AHNs and nursing directors," remembers Marie Marbach, RN and chair of the NPC since August 2009. She is a charter member of the MSCV3 Unit Practice Council (UPC) and was its chair for two years. "As we moved to shared governance, nursing administrators were very supportive in recruiting more bedside nurses to the NPC," Marie says. "Today, the NPC is comprised largely of UPC chairs and most are staff nurses."

The NPC and its working groups discuss issues and actively seek solutions. The meetings typically include presentations by UPCs on challenges and successes on their units. Other hospital departments such as Pharmacy and IT are also invited to share their expertise to increase nursing knowledge. "Serving on the Council has really opened my eyes to the big picture and why certain things are important," says Marie. "It helps me grow, provide better care and understand where each unit is coming from."

"As a staff nurse, serving on the NPC gives me a broader perspective of issues not only on my unit, but also house-wide," says Nicosia Brake, BSN, RN, Pediatrics. "The collaborative approach allows nurses from various areas to identify issues and brainstorm solutions. As a group, thoughts and suggestions are collected and then proposed to leadership for approval and implementation. Information from presenters, usually the change agents, also allows us to remain informed so we can help implement changes on the unit."

"I enjoy the Nurse Practice Council because of the participants: our leaders and colleagues," says Lisa Garcia, MSN, RN, CNS, Pediatrics. "UPCs share their new and exciting projects and we spend time collaborating on important hospital issues such as pressure ulcer prevention and documentation. Other spotlight issues include patient care, outcomes, quality and safety. This is an incredible opportunity for us to help guide projects, make decisions and focus on the needs of our patients, staff and the hospital."

For more information on these volunteer opportunities, contact Health Promotion at 759-1890.


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Meet Our Nurses

Amanda Dziurda, BSN, RNAmanda Dziurda, BSN, RN, Float Pool

After graduating with her BSN in 2004 from Lakehead University in her hometown of Thunder Bay, Ontario, Canada, Amanda Dziurda, BSN, RN, float pool for Med/Surg and Pediatrics, worked as a surgical nurse for two years. She moved to Carmel and joined SVMHS in 2006. "I was attracted to the float pool because I can use all my nursing skills and work with a variety of different patient populations," Amanda says. "When I first started floating to Pediatrics, I knew that's where my heart was."

A lover of technology and computers, Amanda currently shares her time between the float pool and Clinical Informatics, focusing on the BMV aspect of Meditech 6.0. She is also secretary of the Float Pool Clinical Practice Council.

Following the earthquake that devastated Haiti in early 2010, Amanda spent 10 days that summer there on a medical mission helping people in whatever way she could. "It was incredibly humbling," she says. "It's incredible to see how fortunate we are here and how amazing our hospital is." Amanda is currently planning a mission trip with Laura Bomarito to Africa. "It's a great way to use your nursing skills, and give back."


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SVMHS successfully completes simulated evacuation of NICU

Every year, the Emergency Medical Services Authority (EMSA) and the California Department of Public Health (CDPH) select a focus for an emergency preparedness drill for hospitals around the State. They provide general directions, but it is up to each county to decide how to carry out the drill. "This year, the focus was reacting to a bomb threat to a hospital or multiple healthcare facilities within the community," says Jeremy Hadland, RN, Administrative Supervisor and chair of the Emergency Management Committee at SVMHS. Lorraine Shields, RNC, MN, NP, CNS for the Neonatal Intensive Care Unit (NICU) was in the process of finalizing a disaster plan for the NICU. "This was the perfect opportunity to trial the evacuation plan for the NICU," she says.

Representatives from the hospitals and clinics in Monterey County as well as the County Office of Emergency Services met to plan the drill and determine roles. Then, each facility created an internal plan specific to their role. "Our hospital was chosen to have the direct threat and the other hospitals practiced receiving a surge of patients," says Lorraine. Clinica de Salud del Valle de Salinas was one of the area clinics that also had a simulated call of a bomb threat.

Planning began last summer and the drill took place in October 2010. While developing the disaster plan for our NICU, Lorraine visited Good Samaritan Hospital. "The NICU Nurse Manager generously shared what she had developed and we adapted the plans to fit our needs," says Lorraine. "We assigned a role for each person involved: neonatologist, charge nurse, staff nurses, respiratory therapists and support staff. When the call was received, each member was given an assignment card outlining their specific responsibilities. Everyone followed the directions on the cards and the evacuation went extremely smoothly. We're proud of what our staff did to make the evacuation go so well."

Five mannequins were used to simulate the babies. Two mannequins, designated as seriously ill babies, were evacuated in transport isolettes. "These babies require two people—one pushing and one managing the baby and life sustaining equipment," explains Lorraine. "Other, more stable babies were evacuated in transport vests and one in an open crib."

The simulated infants were evacuated to an area near the Heart Center where, in a real emergency, they would be picked up for transport to Natividad Medical Center's (NMC) NICU. Calls were placed to the ambulance company, NMC and other hospitals.

"All the loops were closed," says Jeremy. "It went very well at SVMHS. If it had been a real event, we would have been successful in safely evacuating and transporting the infants in our care. We are now evaluating our process as well as the county-wide drill to see if there are areas for improvement."


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Partners in Care—Infection Prevention & Control

The Infection Prevention and Control department (IPC) is a tremendous resource not only to nursing but to every department of the hospital. They are responsible for ensuring a safe environment for our patients, staff, volunteers and visitors. And that runs the gamut from patient care processes and hand hygiene to facilities, equipment and food.

Debra Johnson, BSN, RN, OCN, CIC, Manager of IPC and Janis Magers, RN, Infection Prevention Analyst, work as a team to ensure that we are meeting all regulatory and CDC guidelines, and using evidence based practices that promote a safe environment and support high-quality care.

"We look at what we know to be high risk areas for infections such as catheter insertions and hip surgeries," Debra says. "If we see a trend, we research it and work with nursing and other staff to change the related processes. Nurse input and involvement is critical to everything we do."

One of the more visible issues that IPC impacts is hand hygiene. "As we all know, hands are major transporters of germs," says Janis. "We're proud that our house-wide average for compliance with hand hygiene policies was 95 percent for January this year."

One of the department's goals is to develop a system for interacting with nurses in real time while the patient is still in-house. "Ideally, we'd like to provide patient education on how infections occur, at the bedside," Debra says. "This is especially important for patients who are in isolation."

IPC staff performs daily surveillance of charts and data for inpatients, outpatients and those who have been discharged to see if any infections were hospital acquired. Debra and Janis do rounds throughout the hospital to observe the environment.

"Nurses partner with Infection Prevention and Control to stay updated on the most recent CDC recommendations to ensure patient safety and quality of care," says Teresa Woodrow, RN, AHN for Pediatrics. "They stay on top of evidence based changes and regulations and share their knowledge with the bedside nurses. They round daily on units monitoring and speaking with the staff regarding infection control issues and are a great asset to the SVMHS team."


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What's New

New competency validation process

The process of validating nursing competence at SVMHS has changed. Starting in late 2010, the Competency Committee and the Education/Patient Care Systems Department reviewed the existing validation process and determined that it needed revision. The updated process reflects the current practice environment and supports the role of the professional nurse resulting in:

  • Increased cost effectiveness by reducing the amount of time required to complete competencies
  • Decreased use of environmental resources by shifting from printed packets to electronic references and recordkeeping
  • Increased staff satisfaction

Welcome Trini Juarez, BSN, RN, MBAWelcome Trini Juarez, BSN, RN, MBA

Trini Juarez, RN, BSN, MBA joined SVMHS as Director of Nursing Operations on January 17. He earned his AD in 1979 and BSN in 1988 from Pacific Union College, Angwin, CA and a MBA in 2005 from the University of Phoenix. Trini brings 32 years of clinical and leadership experience to this position, having served as a staff nurse and later Director of Emergency Services at Kuweah Delta District Hospital in Visalia, Director of Medical Surgical Services for Adventist Health-Hanford Community Medical Center and Central Valley General Hospital in Hanford, and as Clinical Manager of Orthopedic-Spine, Surgical, Medical Inpatient Units, Rehabilitation Outpatient, Inpatient and Acute Rehabilitation Services with El Camino Hospital Los Gatos. He and his wife of 32 years live in Prunedale and have two grown daughters and a four-year-old grandson.

Color-coded wristbands enhance patient safety

On March 1, SVMHS began using standardized colors for wristband safety championed by the American Hospital Association and endorsed by the California Hospital Association. Based on the needs of our patient population, we also added two colors—pink and orange.

RED = Allergy Alert
YELLOW = Fall Risk
PINK = Limb Alert
ORANGE = No Blood (Transfusion)

Kathleen Finnigan, RN, MS, CNS, Clinical Nurse Specialist, Oncology, researched and developed the color-coded wristband system for SVMHS, and created a patient information sheet and related nurse education that was presented by PCCs. More information can be found under Key Policy Statements: CPM 2641.

Pediatric crash carts updated

Two years ago when working on the Pediatric unit, Vanessa Irwin, MSN, RN, CLC, CNE, Peds/Med-Surg, helped identify areas for improvement during mock code exercises. "It was a two-year collaborative process between education, risk management, pediatrics, ICU, emergency department and physicians to identify the needed improvements," says Vanessa. On March 21, an interdisciplinary group, led by Susan Brajkovic, RN, BA, MJ, Senior Administrative Director of Quality, Risk, Safety reconfigured all Pediatric crash carts. Specifically, drawers were labeled according to weight, excess supply items were removed, and necessary resuscitative items corresponding to an appropriate weight were added to each drawer, improving the overall utility of the cart. According to Susan, a former emergency nurse, the reconfiguration should assist in easier identification and should decrease the time needed for providers to retrieve the appropriate equipment during pediatric codes. Training was done on the units by the Education Department, and plans are underway to evaluate the changes during pediatric mock codes.


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Improving patient care through advanced technology

Meditech, our system that records and manages documentation of all patient care and used by physicians, nurses and other clinical professionals, is undergoing a major upgrade. The transformation from Meditech Magic to Meditech 6.0 is scheduled to go live on August 1. The benefits are significant for you and your patients and it lays the foundation for a fully-integrated Electronic Health Record (EHR).

A closer look at Meditech 6.0
• Meditech 6.0 is a "role-based" system. When you log on to the system, it opens a specific desktop that automatically takes you to the areas you need to document care for your patients. It integrates information for each patient throughout the hospital system, simplifies workflows by putting more information at your fingertips and creates a complete record of each patient's care. In Meditech 6.0, documentation and terms are standardized so that everyone is using the same language for diagnoses, tests, treatments and other care.

What is an EHR?
• An electronic version of a patient's ongoing medical record including demographic and clinical information such as medical history, medications, conditions and all other details relevant to that person's care.

• It is a way to securely send the patient's medical record electronically to other healthcare facilities, physician offices and healthcare regulatory agencies, while protecting patient privacy and confidentiality.


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Meet Our Nurses

R.J. Denbow, BSN, RN, CCRN, EMT-P; Level II

Originally from the Denver area, R.J. Denbow, BSN, RN, CCRN, EMT-P who works on Level II, joined SVMHS three years ago. "It seems like I was barely out of diapers when I knew I wanted to be in healthcare," says R.J. with a grin. "My dream is to be a flight nurse and I'm heading in that direction."

Graduating from Regis University, Denver in 2004 with his RN/BSN, R.J. acquired certification as an EMT-P. He is a Paramedic for AMR in Monterey in addition to being a staff nurse at SVMHS—gaining the experience needed to achieve his ultimate goal. "My heart has always been in critical care and I'd like to work in the ICU," he says. "It's profound to help people who are seriously ill or injured and see the difference I can make. I enjoy being part of the SVMHS team and appreciate that everyone looks out for each other."

R.J. and his wife of two years are avid SCUBA divers. He also enjoys hiking, mountain biking and pretty much anything outdoors.


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Publications & presentations by SVMHS nurses

An article manuscript, authored by Rachel Failano, MSN, RN, Jeff Adams, PhD, RN and Irene Neumeister, MSN, RN, describing the Primary Language and Rapid Response Team Outcomes nursing research conducted at Salinas Valley Memorial Healthcare System, was submitted to the Hispanic Healthcare International journal. The article—Exploring Differences in Rapid Response Team (RTT) and Code Blue Occurrence Rates within the Context of Nurse-Patient Linguistic Compatibility—was accepted for publication in an upcoming 2011 issue. Results from this study are encouraging as they are an initial step in defining a new knowledge for nursing practice, research, and theory. Implications of this study are far reaching and suggest a need for additional research and interventions aimed at improving linguistic compatibility and thus patient outcomes.

Dana Rogers, RN-SNIII and Patti Garcia, RN, ICU/CCU, presented their poster—An Evidence & Role Based Approach to a Culture of Safe Patient Handling—at the 2011 BEACON Annual Exchange. Held April 26 in Burlingame, the 5th annual event, entitled Renew, featured keynote speakers and breakout sessions designed to educate, inform and inspire. BEACON, The Bay Area Patient Safety Collaborative, is "a peer-to-peer learning network of hospitals focusing on improving the quality of hospital care to end inadvertent harm to patients by accelerating the adoption of evidence based and innovative practices."


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Evidence Based Practice Council update

Over the past year, an Evidence Based Practice Council (EBPC) subcommittee—led by Gloria Lochridge, MSN, RN, FNP in Education, and Lorraine Shields, RNC, MN, NP, CNS for the NICU—has pursued the possibility of establishing a local chapter of Sigma Theta Tau International (STTI). This international nursing honor society provides a forum and opportunities for nurses to advance evidence based practice and research, and increase nursing knowledge.

Chapters are typically based out of university nursing programs. Currently, the closest chapter is in San Jose which makes it a challenge for our nurses to actively participate in meetings. "Having a local chapter would make it feasible for more nurses to be involved in this elite nursing organization," says Gloria. Nurses with a BSN, and RNs with another Bachelor's degree or a higher nursing degree are eligible to join.

STTI leaders are supportive of a local chapter, but do not have a provision for local non-university chapters. "We're excited that we will be part of the STTI Phi Gamma Virtual chapter," says Lorraine. "Members of Virtual chapters around the country operate in much the same way as their physical counterparts by electing officers, participating in meetings online and sending representatives to national functions."

"Many nurses have expressed interest in participating, but have found it challenging to commute to San Jose for meetings," Gloria says. "With a Virtual chapter, we're confident that we could attract a large number of nurses. Our nurses have a great deal to contribute to elevating and enhancing the nursing profession."


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Project Focus— New Alcohol Withdrawal Protocol (AWP)

A new Alcohol Withdrawal Protocol (AWP) was put into place at SVMHS on March 1. It follows the Clinical Institute Withdrawal Assessment-Revised (CIWA-Ar) scale, which is based on the latest evidence and best practices. The CIWA-Ar standardizes questions nurses use to objectively assess the patient, resulting in a score on the scale. The new AWP makes it easier to assess and recognize withdrawal symptoms and then medicate patients based on their specific symptoms.

"Withdrawal adds complications to what's already going on with a patient," says Amy Bonano, BSN, RN, MBA, Administrative Supervisor, who initiated research on the AWP in August 2009. "As a member of the restraint committee, I saw data confirming that AW patients needed restraints or sitters much more often than other patients. Also, the length of their hospitalization was often double the time they were expected to stay. I thought it was a good idea to look to see if there's a better way to manage these patients.

Working with Michael Mahig, MD, a Hospitalist at SVMHS, and Linda Plummer, Medical Librarian, Amy located the CIWA-Ar scale—considered the gold standard in assessing patients. "Dr. Mahig shared my concerns and he was instrumental in putting together order sets for patients in alcohol withdrawal," Amy says. The order sets are on the portal showing standard lab tests, medications and consults to be done. "Clinical Informatics made sure that the protocol will be accessible on Meditech 6.0." The collaboration also included the Pharmacy and Therapeutics and Policy and Procedure committees.

Amy enlisted the help of Wendy Ogden, MSN, RN, CCRN, PCCN, Clinical Nurse Educator, Progressive Care. Together, they presented the new protocol to Patient Care Champions who educated the nursing staff. "The new AWP has been very well received by nurses as it helps them more quickly provide the most effective care to their patients," Amy says.

"Right after the new protocol went into place, I had two patients in alcohol withdrawal," says Janette Miguel, BSN, RN, TNCC who works on Level II. "It addresses more of the patient's specific symptoms than the previous protocol and helps me better control my patient's agitation level. It's much better and safer for our patients and our nurses."

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