EXEMPLARY PROFESSIONAL PRACTICE focuses on how nurses throughout the organization are involved in shared governance and shared decision-making, and explores how interprofessional collaboration promotes quality excellence in a culture of safety.
Mission, Vision and Philosophy Statements Undergo Revision
Every few years, sooner if warranted, nursing’s mission and vision statements, and nursing philosophy, are reviewed to determine if they continue to accurately reflect nursing at Valley. Do they still define what we do, who we care for, where we are going, and what we aspire to be?
In 2022, a group of clinical nurses and nurse leaders met to review Valley’s current statements. The group determined that key components were missing including patient safety, self-care, resilience, holistic nursing, diversity, and inclusion.
Each component went through several revisions as members of the committee further identified and crystalized their ideas. The group also made minor edits to ensure the statements continue to be concise and easy to understand.
In the end, an updated mission statement, vision statement, and philosophy were approved. Please click here to see them.
Special thanks to the following for their insight and input: Kate Amaisse, RN; Bonnie Weinberg, RN; Jordan Minemma, RN; Joyce See, RN; Ruth Harrell, RN; Casey Sanders, RN; Maria Vierneza, RN; Lora Bognar, RN; Stephanie Faurot, RN; Carolann Clancy, RN; Tiana Duran; and Stephanie Ardito.
Central Line Culture Huddle (Cuddles)
Are ordered blood cultures always necessary for patients with central lines? That’s the question a new process started in 2022 aims to answer.
Each time a patient has a blood culture ordered and has a central line present and/or removed within the past two days, a Central Line Culture Huddle, or Cuddle, is enacted to review the criteria for culturing the patient.
At the heart of the Cuddle is the HRO tool of STAR (Stop, Think, Act, Review) which is used to determine if a blood culture is warranted and how to escalate when it is not. Cuddles are now in place on all inpatient units including critical care, med/surg, heart and vascular, and the clinical decision unit.
The process was developed by the Hospital Acquired Conditions Task Force to not only help identify and avoid unnecessary culturing of patients but to potentially prevent a CLABSI.
Each “culture huddle” takes approximately 5 minutes. A corresponding cuddle form is completed by the patient’s primary nurse in collaboration with the charge nurse, PCA, unit-based APN/CPS, CLABSI Champion, and other staff. Questions on the form include “Did this patient previously have a positive blood culture?” and “If the patient’s culture came back positive, would this change the patient’s treatment?”
Each huddle results in a recommendation that is shared with the patient’s physician who ultimately determines if the culture is required.
CAUTI Diagnostic Stewardship
In 2022, the CAUTI Diagnostic Stewardship Program was developed and launched with a goal of reducing the number of urine specimens sent to the lab for testing. Prior to the program, all urine samples sent to the lab from patients with a foley catheter were automatically tested for CAUTI. The Stewardship Program inserts a new step in the process.
Now, all samples that are collected from patients with a foley catheter, have their charts reviewed by Infection Control and Infectious Disease, typically Dr. Neil Gaffin, to determine if the urine sample and testing are required. These very in-depth chart reviews look at white blood cell counts, how long the catheter as been inserted, and numerous other factors. Prior to the new program, charts were not reviewed, and all patients’ urine was analyzed.
This successful effort is a collaboration between infection control, nursing, our infectious disease doctors and other members of the medical staff. The overall goal is to reduce the number of urine cultures that were unnecessarily sent to the lab for testing. Since the program’s inception, all but one of the cultures were canceled for testing.
AUGi: A Powerful Tool for Falls Prevention
Valley’s Fall and Mobility Task Force continually reviews evidence-based practice, technology, and efficiencies in workflow to improve care delivery and enhance safety. Their recent efforts led them to a nurse-founded company, Inspiren, and its AUGi platform. The technology supports Valley’s fall prevention efforts.
The AUGi platform combines a hybrid sensor, artificial intelligence, computer vision, a smartphone application, an integrated smart lanyard, and Bluetooth low energy into a powerful tool for nurses. AUGi passively observes patient behavior and predicts bed and chair exits, helping to stop falls before they happen.
The Bergen Neuroscience team was the first unit to pilot AUGi and they quickly embraced the technology after experiencing a 36% reduction in total falls and no fall-related serious safety events when compared to the same time period in 2021. AUGi is now live on these additional units: Bergen 2B, Bergen Oncology, 4A Ortho and 2A Cardiac.
KPI Portal Tracks Important Measures
In 2022, nursing partnered with Information Systems to develop a dashboard to communicate performance on key metrics.
Quality team members educated unit leadership, socialized the measures, explained the story that the data tells, and worked to increase engagement around performance improvement related to these measures. The hope is to use the platform to add data as new projects and initiatives begin, creating a central location where staff can get feedback on their performance.
All unit-based APNs, CSS/Supervisors, Managers, Directors, AVPs, and CNO can see performance by measure and unit. Data is unblinded, meaning everyone can see how other units are doing.
Each measure has established targets/benchmarks that will shade the measure green (good), yellow (either improving or at risk of worsening), and red (poor performance).
- CAUTI (count YTD)
- CAUTI (percentile ranking)
- CLASBI (count YTD)
- CLASBI (percentile ranking)
- Falls (YTD)
- Falls (percentile ranking)
- Staff Worked Together to Care for You (a Press Ganey measure)
There is also a Quality Combo Goal that looks at the total percentile improvement points from baseline for CAUTI, CLABSI, and Falls.
The platform will be expanded to include measures over time.
Valley Teams Up with Cleveland Clinic for Value Stream Analysis in Cath Lab
Valley’s Quality & Performance Improvement Department (QPI), in collaboration with a continuous improvement specialist from Cleveland Clinic, conducted a value stream analysis (VSA) for the cardiac catheterization laboratory in September of 2022.
The VSA, a lean six sigma event, is an assessment of where value is added and where non-value (waste) accumulates in a process. It is used to highlight improvement areas for process innovation. The VSA required multidisciplinary representation and participation from different areas including scheduling, patient access center, pre-admission testing, same-day medicine, cardiac cath lab, environmental services, nursing, and transport. These areas all play a role in the value stream for the cardiac catheterization laboratory. Each representative spent three full days in the event and participated in the report-out at the end. Through the VSA, charters for improvement work were created based on participant feedback. Planning and implementation of improvement work will continue throughout 2023.
APP Council Established
The Valley Hospital Advanced Practice Provider Council was first started September 20, 2022, to support and empower our Advanced Practice Providers (APPs). The idea arose from an observed need to provide inclusivity for all APPs throughout the system including those who are employed privately but are privileged at The Valley Hospital.
The Council was facilitated by Robin Giordano and now chaired by Brianna Tremblay. Monthly meetings have consisted of building a strong framework (Vision, Mission, and Goals) to direct our efforts. The APP Council aims to encourage professional development and advocate for full scope of practice to fulfill the goals of the Quintuple Aim. The Council is working toward offering educational opportunities to ignite culture change and advance the understanding of APPs. This includes mentoring students, and educating physicians, managers, and the community on the role of the APP.
The APP Council strives to provide opportunities to participate in research and promote clinical advances. The APP council also provides a formal organizational structure for the advancement of professional and quality practices by utilizing evidence-based care and functioning at the top of licensure. In the future, it will aim to create policies, procedures, and privileging to assure the integrity of the role. The council strives to be valued members of the medical staff by elevating, promoting, and advocating for the role of the APP. The council aims to have a voice at all tables, fostering constructive conversation and multidisciplinary collaboration.
Currently the Council is forming a board and finalizing roles. As the council grows so will the interest in expanding membership. Stay tuned!
The Valley Hospital in Paramus
Construction of The Valley Hospital in Paramus continues, with the structure now completely closed in and teams working inside to build each nursing unit. Many staff tours of the new hospital have taken place to allow staff the opportunity to see their workspace first-hand and better understand the patient rooms, nurse stations with team rooms, clinical support areas, and patient and staff flow throughout the units.
Central to the new hospital will be the provision of private rooms. Single-patient rooms enhance patient privacy and provide a superior environment for patients and their loved ones. A 75-inch footwall with a digital whiteboard, which will serve as a key communication tool between the patient, their care team, and their family, has been included in the design of each room. The digital footwall, located on the wall across from the foot of the bed, will display care team information, clinical information, and the patient’s plan of care; feature entertainment options; provide patient education; and allow for meal ordering. A bedside companion tablet will offer the capability for video meetings with family members.
Work groups of nurses and others have been instrumental to every phase of the project. Work groups include women’s and children’s, the emergency department, perioperative, procedural, med/surg, critical care, and CDU with a key focus on workflows, processes, and path of travel that will change as a result of the new hospital. Several groups are also meeting to standardize clinical workstreams to include admission/discharge/internal transfer process, medication administration, handoff and communication alarm and notification responses, and charge RN role and patient/staff assignments.
In the current hospital, 2A and 2B have been designated “innovation units” where technology can be implemented and trialed and use cases developed before installation and use at the new hospital. A key project implemented in 2022 is the West Com nurse call system.