EP - Exemplary Professional Practice

EP13: Interdisciplinary Care-Describe and demonstrate how nurses have assumed leadership roles in interdisciplinary collaboration.

Teamwork is a core value of our organization and one that the Division of Nursing embraces. Developing collaborative relationships with our physicians and colleagues is essential to our nursing practice and our professional practice model. Interdisciplinary relationships are embedded in the culture of our organization and our nurses regularly assume leadership roles on interdisciplinary teams with diverse composition. A listing of nurses in committee leadership roles can be seen in Reference OO15-A.

Critical Care

Claudia Garzon-Rivera MSN, RN, CNL, CCRN, Clinical Nurse Leader for Critical Care, Chairs the Critical Care Committee collaboratively with Dr. Rao Mikkilineni MD. This committee is the core of the Critical Care Division and important decisions regarding the operational aspects of the unit are discussed at this Committee. Overall, they review statistical information regarding Rapid Response Teams, Code Blues, Sepsis, Readmissions back into the critical care areas as well as policy revisions. Recently, the Committee developed a Critical Care Admission, Transfer and Discharge Policy (Reference EP13-A) and all disciplines collaborated to develop this policy. Representatives from surgery, medicine, trauma, and cardiac participated in creating guidelines to insure that the appropriate level of care was given to each patient. A list of participants in this committee is listed below:

Critical Care Committee

EP13-Table 1

Trauma Teams

<i>Jennifer Jones MSN, RN, CNL<br /><em>“Communication and teamwork are essential elements for critically injured patients.”</em></i>
 Jennifer Jones MSN, RN, CNL
“Communication and teamwork are essential elements for critically injured patients.”

Jennifer Jones MSN, RN, CNL is our Trauma Program Manager. She exerts a strong influence and assumes a leadership in our trauma program. Ms. Jones organizes a monthly interdisciplinary Peer Review meeting (Appendix EP13-A) which is chaired by Dr. Molino, Director of Trauma, and which she facilitates. Ms. Jones role in this process is obtaining the data necessary, reviewing the chart and gathering information. A recent example of this process was the review of an event whereby a patient (child) had sustained a head injury and was to be transferred to another facility. There was a delay in the transference process, not because of the MedicalCenter, and the outcome obtained was not good. The peer review team determined that a policy needed to be developed (Reference EP13-B) to stabilize the patient prior to transfer. The patient would remain in the operating room until transfer could be arranged. Ms. Jones was instrumental in proposing and developing this procedure. Members of the Peer Review team are listed below:

Trauma Peer review Team

EP13-Table 2-Trauma Peer review Team

Ms. Jones also leads a weekly multi-disciplinary team for Core Coordination Rounds. All inpatient trauma patients are discussed and a plan for the week is developed. Whatever issues may be impeding the continuum of care is discussed at these sessions. Discharge Planning, for example, where by determining what resources are available for the patients discharge. Team members include:

Trauma Core Coordination Rounds Team

EP13-Table 3-Trauma Core Coordination Rounds Team

Ms. Jones also is the Chairperson of the Multidisciplinary Trauma Committee Meeting (Appendix EP13-B). This meeting addresses operational issues connected with the Trauma Department. Ms. Jones initiates the agenda and action items; trauma scorecard, new policies, performance improvement issues and emerging trends. A recent issue was addressed regarding the time to perform tracheostomies on trauma patients. New guidelines recommend 3-7 days in order to prevent Ventilator Associated Pneumonia and a decrease in ventilator days as well as Intensive Care Unit Length-of-Stay. Ms. Jones discovered that our patients are waiting sometimes up to two weeks to receive a tracheotomy. Ms. Jones is in the process of developing a clinical guideline as a performance measure to be in compliance with evidence-based practice. The guideline will be presented and discussed at this meeting. Ms. Jones also initiates educational sessions with this group dependant on the immediate needs. The same physicians participate in this committee as participate in the Peer Review Committee. The nurses and other persons who are active in this committee are:

Trauma Committee

EP13-Table 3-Trauma Committee

Nurse Leadership in Surgical Services

Pam Barrera BSN, RN and Elise Campanella BSN, RN both staff nurses in the operating room
Pamela Barrera BSN, RN<br />Operating Room
 Pamela Barrera BSN, RN
Operating Room

have been champions of the Universal Protocol since its inception. This is a National Patient Safety Goal and requires pre-procedure verification of the patient, confirmation of the site and type of surgery and a “time-out” immediately prior to the surgery. Vicki Ebanks MSN, RN CNOR, Nurse Educator of Perioperative Services recently developed a preprocedure form with staff input (Appendix EP13-C) Ms. Barrera and Ms. Campanella inform staff and physicians about appropriate pre-procedure verification, site marking and insuring that all items needed for the procedure are readily available. The other interdisciplinary team members are: Dr. Holmes MD, Vice President of Surgery, Dr. Molino MD, Director of Trauma Services, Dr. Landauer MD, Chair of Anesthesia Department, and Kelly Loo BSN, RN, CGRN Nurse Manager of the OR. Ms. Barrera states about this process:

“When the patient first arrives we introduce ourselves and confirm the name of the patient. We use two types of ID to confirm that we have the right patient. We also confirm the site/side of the proposed surgery. The physician arrives and marks the site. We do not move the patient into the OR unless all team members are satisfied that this is our patient. We further do a time-out in the room prior to starting the procedure. Everyone stops and identifies the patient, the surgery and the site and if films are needed. Any team member can stop the process if they perceive a problem. Our scrub nurses do not move their mayo trays over to the sterile field until this process is completed.”

Stroke Team

Kelly Sietsma BSN, RN Stroke Coordinator leads an interdisciplinary Stroke Team. She chairs the Stroke Committee whose membership includes:

EP13-Table 5-Stroke Team

Ms. Sietsma provides the agenda and discusses core measures, patient education, an update on the education for the year, practice improvements and a case review if indicated. Daily rounding is performed by the stroke team members and also includes nursing and case management from the particular unit involved.

Further evidence of Ms. Sietsma’s interdisciplinary leadership relates to the Neurology conferences held on a monthly basis. This meeting is held primarily for the residents; however, anyone else can attend. Dr.’s Khan (neurologist) and Brown (radiology neurologist) discuss a case with this group. Ms. Sietsma frequently selects the case and prepares all the particulars for the group discussion.

Maternal-Child Health

The Maternal-Child Health Department has several multi-disciplinary teams led by nurses. One is the Baby Friendly Task Force. This team is determined to achieve recognition as baby-friendly and has been working toward that end. The team is comprised of:

EP13-Table 6-Maternal-Child Health

The Perinatal Policy Committee is chaired by Randa Francis MSN, RN, Nurse Educator for Maternal-Child Health. Other members of this committee are co-chairperson Dr. Bimonte MD, Michelle Dickerson MSN, RN, Nurse Educator in the NICU, Lillian Reyes BS, RN, Nurse Manager in Maternal-Child Health, April Major RN, Breastfeeding Coordinator, and Vivian Chang BSN, RN Staff Nurse on L&D. This committee initiates, develops and implements policies relating to the Obstetric Department. The most recent addition was Code OB. This is called overhead when a pregnant mother is in the process of delivering or had delivered outside of the Obstetric Department.

The Perinatal Safety Committee includes Dr. Bimonte MD as Chairperson, Rachele Dalalian RN as co-chairperson, Randa Francis MSN, RN, Nurse Educator on Maternal-Child Health, Michele Dickerson MSN, RN Nurse Educator in NICU, Lillian Reyes BS, RN, Nurse Manager in Maternal-Child Health, and all obstetric and attending residents. This committee conducts safety rounds on L&D, Postpartum and the NICU and meets monthly to review changes/improvements resulting from issues resolved.