Remember The Mission

By Clarissa Herrera, RN, BSN, Hartman Pavilion, Clinical Nursing Director

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On October 6, 2006, the Hartman Pavilion, with the assistance of the Emergency Center, General Medicine, Transitional Care, Intermediate Progressive Care, MICU/CICU, and Reeves Rehabilitation units, hosted its 2nd Annual Stroke Fair in the Foundation Room at University Hospital.

Every year, UHS nurses gather together from all units to make it happen. These nurses all have an interest in stroke prevention.

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We saw more than 218 people in two hours. We provided blood pressure screening, education, and body mass index measurement.

The stroke fair attracted employees, patient-visitors, doctors, as well as other allied healthcare services within the hospital community. We had stroke education videos playing and educational material to pass out to our patrons.

It was an exciting turnout and the group enjoyed their contribution to the nation’s number one silent killer, stroke.

We look forward to the 2007 Stroke Fair!

On February 9, as the gavel passed from Mary Anne Peinemann, MSN, RN, to Pamela Higby, MSN, MBA, RN, chair of the newly designed Nurse Cabinet, we entered a new era of shared governance at University Health System.

The new chairs of each of the councils discussed the meaning of shared governance and its importance to them. Their comments included:

• Empowerment




It's ALL About Shared Governance

• Bedside Nurse determine practice – make decisions best for patient


• Accountable for practice and work


• Decisions made by those responsible for patient care


• Grassroots BSN democratic process
  
  


• Ownership of process from beginning to end


• Circle of communication


• Not only feeling but participation – participation of decision making at all levels


• Right to be heard


• Voice of nursing


• Autonomy


• We decide our practice


• Passion to make things happen


• Partnership between administration and clinical staff to make decision in the right place


• Shared partnership for decision making


• Provide organized structure fashion method to forward and resolve issues – how to get from unit to cabinet


• Recognition that all are recognized for professional conduct, accountable, make voice heard, to help improve/rectify problems


• Change of environment, enrichment of resources, appreciation of all roles in nursing, increase commitment to UHS


• Change BSN mindset to understand ability to make changes


• Responsible/accountable for actions, whether good or needs improvement or change in behavior

You can view the new schematic for Shared Governance committees by clicking here and the list of all of chairs and contact information can be found by clicking here.

Additionally new unit shared governance councils will be defined by throughout patient care services. No end of opportunity for you to have your voice heard!

“I received the following from Mel Harkin, a charge nurse in labor and delivery. It was one of those hectic days that can only be managed by excellent leadership as exhibited by Mel as the charge nurse and a team dedicated to working together to provide safe, excellent care for our patients. I’m so proud to have each and every one of the staff in Labor and Delivery. It is an area where it can be quiet one minute and the next minute, it is chaos. The day described below is one of the chaotic days.”
—Pam Higby, Administrative Director for Women’s Health

Dear Pam,

I have been meaning to type you a letter over the last couple of weeks, but with everything that has been going on, it just didn't happen. But, better late, than never! And for this group of people, it means a lot that I do.

On Saturday, January 13, we were actually very well staffed for a weekend, and had we NOT been, I’m not sure what we would have done. I was in charge that day and we came into a fairly full board and several laboring patients in OB triage. I will lay it out as it was for us that day and try and recreate the chaos that was occurring—here it goes!

The scenario: Linda Sanderson was the nurse in Ob triage. The staff was Irma Sanchez, Lisa Fortmann, Valerie Ramirez, Deb Wehrly, and Veronica Trias in Gyn Triage. Tony Arredondo was our scrub tech. Consuelo Torres was the unit clerk and Mary Houston was the med tech to float between triages. Fortunately, we had an extra nurse that day. It was Maria Guerra, whom I assigned to be OR/float.

We immediately had two c-sections by 7:15 a.m. At this point, room 2 was our only vacant room and Linda was running a full triage of eight beds by 7:45 a.m. We had the stat section in the OR and all eight labor rooms were full.

• One almost ready to deliver


• A patient at 30-weeks ready to deliver


• A patient with severe preeclampsia SROM


• An active laboring pt at 6cm


• A patient at 28wks for r/o abruption, term IUP twins in labor


• A term severe preeclampsia patient being induced

It was also a saving grace that gyn triage only had a couple of patients and Veronica was able to help out in OB.

Long story short, we had room #2 ONLY. We called it our imminent, multiple delivery room for the day. And, my hat goes off to not just EVERYONE that was part of the "team" that day, but especially Irma Sanchez. Out of the nine deliveries we had in that 8 hour shift, Irma had "4" on her own. All of which were in the revolving doors of Labor Room #2.

All any of us could do was either laugh or cry. And, we had no time to cry, that is for sure. I’m so proud of everyone that worked that day, everyone really pulled together, watched whatever rooms they possibly could and went anywhere I asked or needed them to.

But, even in saying this, they just KNEW and I didn't really have to ask. We functioned as a team and we functioned to the best of our ability. It was very hairy most of the day and there was much chaos going on in a constant flow, but including the doctors (led by Dr. Funk and Dr. Prisacaru), Anesthesia, our secretary, and techs, we made it through.

Linda remained full in triage with no where to admit patients. At one time, I believe she had two SROM's in early labor—someone that was 6cm, someone that was 9cm and two that were 4cm. Mary Houston spent most of her shift helping Linda and keeping that room running and moving. Consuelo, who has not been at the front desk for very long, did an exceptional job as well. Not only was she managing the phone, intercom, making charts and admitting patients left and right, she was also transporting patients to the ward for us and running all of our labs to the 3rd floor, as the tube system was down for over half the shift.

It was amazing. As you can imagine, I have included many "details" of the goings that day but I have also left out so many of the details. I only hope you get a feel for what the staff was experiencing. All-in-all, my thanks goes to EVERYONE working that day and for their efforts in all they did to ensure that EVERYONE was well taken care of. And they were.

Staff members deserve more than just a pat on the back.

Sincerely,

Mel Harkin, RN.

Practicing your passion at University Health System

By Kate Robertson

Why nurses are the most trusted professionals? Perhaps, because the public knows they can count on them.

On January 16, the San Antonio “Ice Storm” provided multiple examples of how nurses at University Health System demonstrated their dedication and teamwork to ensure that their patients still received excellent care.

Multiple kudos and thanks were extended by directors to their staff for all they did to make it to work. Most nurses arrived to work on time to relieve their fellow staff members.

Pam Higby, Director of Women’s Services, wrote to her staff and thanked them. She wrote, “Thank you for spending the night here, driving extra miles, weathering the storms, skidding across slick bridges and scrapping the ice from cars to get up and make it to work.” Even for those who couldn’t make it, she added, “I know you would’ve if you could’ve!” The spirit of dedication runs deep.

Wen Pao, Director for MCCU, IPCU, TCU and CDU, reported that despite the terrible weather for three days, no RN called in. Some nurses traveled all the way from the hill country. She had nurses volunteer to come in, if others couldn’t make it. That for her was professionalism.

The great efforts made by staff to get to work did not stop there, Barbara Sutherlun, NICU Magnet Champion, described it as “Our admirable nurses are heroes for braving the icy roads in the dark, leaving several hours before their shift to make sure they arrived on time. Some staff members who live out of town made arrangements prior to the freeze, so they could stay in San Antonio and lessen their stress of driving the frozen tundra.”

I have great appreciation for staff members who extend themselves to ensure that quality healthcare delivery is not interrupted by the weather and the multiple life challenges nurses face.

For example, Marilyn Green, RN in Radiology, routinely books lodging in San Antonio, so she can ensure that she will be here for duty and avoid the drive from Pipe Creek.

But, it is also important to recognize that for many employees, it was not safe or do-able to get to work. However, the “wonderful alchemy” of those who could, and did, is what our teamwork is all about. So, kudos to those who made it and to those who wisely stayed in place and came in when it was safe to do so!

It is obviously more than a paycheck that fuels our presence. Marian Wright Edelman said, “I’m doing something that I am passionate about and that I think is profoundly important.”

Thanks to all of you for practicing your passion at University Health System—in good weather and in bad. Our patients depend on us! We depend on each other!

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On February 7th Charles Reed MSN RN, Patient Care Coordinator of the Surgical Trauma Intensive Care Unit, will be in Dallas, Texas, speaking about a national web cast for “Best Practices in Point-of-Care Testing.”

This will be the largest web cast Roche Diagnostic has sponsored with more than 900 registered listeners.

Charles and the STICU have been recognized for their successes in TGC and this makes Charles’ second speaking engagement. His first opportunity was back in November when he was asked to speak at Valley Baptist Hospital in Harlingen, Texas, on implementing a tight glycemic control program.

By Deborah Gruendler BSN, R.N.

In December 2006, the Cardiac Catheterization Lab at University Hospital sent care packages overseas to U.S. soldiers and medical staff at Balad Air force Theater Hospital (ICU) in Iraq.

The care packages contained food, toiletries and goodies. As part of the UHS Cardiac Cath lab holiday tradition, we either adopt a family or support U.S. military soldiers overseas.

Staff on the day shift in STICU got a great treat in January!

This staff was treated to a pizza party by Charles Reed, RN, MSN, PCC of the unit to celebrate the hard work the staff provided during their recent “glucose challenge.”

During the past year, Charles Reed and Dr. Ronald Stewart have been working closely on examining the effects of a newly implemented STICU blood glucose protocol.

A challenge was made between Charles Reed, day PCC and Randy Beadle, night PCC as to which shift would have the best percentage of blood glucose values to stay within 80-110 at the end of two months.

The night shift had a slightly higher percentage, but the overall efforts made by both shifts resulted in glucose levels of 80-110 in October were 50% and in November around 46%.

Everyone had a great time celebrating GREAT results.

You Rock!

Congratulations to STICU for their work with the glucose protocol! Making a difference in patient's lives! YOU GUYS ROCK!

Pamela Higby MSN, MBA, RN

Administrative Director

Women's Health

University Hospital

By Elma Fonseca

On December 6, 2005, Dr. Ronald Stewart and Charles Reed, RN, MSN, attended the 118th Annual Session of the Surgical Association in Palm Beach, Florida.

They presented a paper entitled, “Intensive Insulin Protocol Improves Glucose Control & is Associated With a Reduction in ICU Mortality.” They reviewed a random sampling of SICU patient’s blood glucose levels measured by point of care testing from 2003-2005.

We hypothesized that, by use of a protocol, achievement of tight glucose control could be achieved in the surgical ICU (SICU), and that improved glucose control would be beneficial to the patients.

Over the study period we implemented a progressively more rigorous approach to glucose control culminating with an implemented protocol in 2005. The results of our study were an increase in the percentage of blood glucose values within the target range of 80-110 mg/dl and a 30% reduction in patient mortality in 2005.

STICU continues to strive to maintain patient’s blood glucose levels between 80-110mg/dl. The study was accepted for publication in the Journal of the American College of Surgeons.