Remember The Mission

By D.R. Holman, BS, RRT, RCP
Assistant Professor, Anesthesiology
Director Respiratory Care\Pulmonary Function Labs

This year marks the fourth consecutive year that University Health System’s (UHS) Department of Respiratory Care is recognized for providing quality respiratory care.

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The department earned national recognition by the American Association of Respiratory Care (AARC), an organization helping consumers identify facilities using qualified respiratory therapists to provide respiratory care.

The organization’s Quality Respiratory Care Recognition (QRCR) program is aimed at helping patients and families make informed decisions about the quality of the respiratory care services available in hospitals.

Only 500 hospitals or 10% of hospitals in the United States applied and received this award. Our Respiratory Care Department has been delivering quality healthcare to patients who are hospitalized and/or treated at University Hospital for respiratory care.

Hospitals earning the QRCR designation ensure patient safety by agreeing to adhere to a strict set of criteria governing their respiratory care services.

To qualify for the recognition, UHS had to demonstrate that it met the following conditions:

• All respiratory therapists employed are either legally recognized by the state as competent to provide respiratory care services, or hold the CRT or RRT credential


• Therapists are available 24 hours a day to provide services


• A doctor of medicine or osteopathy is designated as medical director of respiratory care services
  
  

Respiratory therapists are specially trained healthcare professionals who work under physicians' orders to provide a wide range of services which include, but are not limited to:

• Members of the Code Blue team


• Ventilator (Life Support) set-up and management


• Oxygen Therapy


• Medication delivery via breathing treatments


• Lung Expansion Therapy


• Education for the patient and family in Asthma and Chronic Obstructive Lung Disease (COPD)


• Smoking Cessation Program


• Pulmonary Function Studies


• Home Respiratory Care Services


• Pulmonary Rehabilitation Services


• Research

Respiratory therapists provide quality healthcare to patients in need of respiratory care including:

• Premature infants


• Geriatrics (the elderly)


• Asthma


• COPD


• Cystic fibrosis


• Lung cancer


• AIDS


• And, other diseases of the cardiopulmonary system

The AARC is a national organization, representing more than 42,000 respiratory therapists nationwide.

For more information about AARC, visit their Web site at The AARC is a national organization, representing more than 42,000 respiratory therapists nationwide. 

For more information about AARC, visit their Web site at http://www.aarc.org.

By Suzanna Feliciano, RN, CCRN, PACU, Magnet Champion

Photos taken by Cielo Ascio, RN, PACU

Staff members in the Post-Anesthesia Care Unit (PACU) at University Hospital celebrated Peri-Anesthesia week in early February.

Employees decorated, ordered bags, pens, posters and balloons to promote the event. Plus, they proudly displayed the Peri-Anesthesia logo. Peri-Anesthesia includes all areas that provide conscious sedation and general anesthesia.

They celebrated with a special lunch. In addition, Drs. Bracken and Gurkowski provided everyone on the unit with lunch later in the week. Everyone had a great time. ASPAN offered free CEU's to members of ASPAN.

We also had a drawing for a bag. 

Another celebration!

Staff nurses also celebrated Peri-Anesthesia Nurse Awareness Week (PANAW) by posting a nice Flash AD on the Employee Intranet.

From Terry Card: I’m sure that all floors receive letters and cards of appreciation, but I wanted to share a hand written note that we received dated March 3, 2007. Read on…

To Whom it may Concern:

I would like to thank University Hospital for your service and giving my life back. I’m just writing this letter to let you know that the 7th floor has the best, wonderful, caring staff. Also there are some staff members that we would like to really thank for their love and support, also for going out of their way to do the best job for me in feeling wonderful. Nurse Sylvia, Kinin and Techs Denise and Dana.

This journey has been a battle but I thank University Hospital for ending this battle. May God bless all in every single way. Thank you all.

By Rudy Jackson, RN, Emergency Center, UH

At approximately 1400 hours, while I was on my lunch break, my patient, a 26 year old male MVC was being moved from bed 23 to bed 22. While preparing the patient for transport, Rick Cerda, ECT noted the patient’s cardiac rhythm had changed from a normal sinus rhythm to an elevated ST segment. 

Rick took the initiative to complete an EKG and had it confirmed by Dr. Zeballos, who also confirmed the ST elevation and diagnosed the patient as having an acute MI.  Excellent work such as this has made and continues to make Rick an essential part of our team. 

Just thought you guys should know.

by D. R. Holman, BS, RRT, RCP

Assistant Professor, Anesthesiology

Director Respiratory Care\Pulmonary Function Labs

Respiratory Care has implemented a process that has improved patient care and reduced the length of stay of patients in isolation. It has also improved the working relationship between the nurse and therapist by increasing communication between the two professionals.  

To assist Patient Care Services in the turnover of isolation rooms, the department of Respiratory Care developed a sputum culture report. This report is faxed to the nursing units each day to inform them of patients that have three negative sputum specimens and can be removed from isolation.  

The department of respiratory care reviews all orders for AFBs (R\O tuberculosis) on patients in isolation, all sputum specimens collected and the status of those specimens. If there are additional specimens to be collected the therapist collects the remaining specimens. Specimens are collected every 8 hours which allows for the turnover of an isolation room within 24 hours if all specimens come back negative. 

By Susan Pawkett RN and Kelly Ham-Shelton RN

Winning teams don't just happen; they take planning, dedication, strong leadership and most importantly, a common goal.  An obvious example of a winning team is the Indianapolis Colts.  

Each member of that winning team was willing and committed to winning the game, and it was the combination of all their efforts that got them the title. Selecting players for a professional football team may seem completely different from hiring future employees at University Health System but in reality both teams are looking for the best players available to fill vacancies. 

Professional sports teams may have scouts that seek out potential players and entire departments for recruiting new players , but the overall process of matching a potential recruit to an open position isn't much different than what happens in Human Resources at UHS.  HR is responsible for maintaining a list of all open positions and doing the initial screening of all potential applicants.  It is here that the selection process begins. 

A team comprises any group of people linked in a common purpose.  It is the common purpose or goal that differentiates a group from a team.  The goal of a football team to win the game must be valued by every member on that team. The common purpose or goal at UHS may be more complicated (the mission statement), than winning the game but plays just as important part in the selection of new employees.  Human Resources begin the selection process with the signing of the application which contains general expectations on integrity and commitment to excellence.

INTEGRITY

In word and action throughout the employment process, the candidate is honest and forthright in all dealings with the System.

COMMITMENT TO EXCELLENCE

Applicant exhibits a commitment to treat all UHS customers, including patients, families, physicians, co-workers and all outside contacts, with courtesy, dignity, respect and professionalism. Applicant will be introduced to the Health System’s specific customer service behaviors and standards during the orientation process. The attached document outlines the commitment to service excellence standards which all employees must practice and demonstrate.

With the Health Resources and Services Administration (HRSA) releasing projections that the nation's nursing shortage would grow to more than one million nurses by the year 2020 and the estimated cost of 30% of the annual salary to replace an employee, it is vital that the impulse to fill vacant positions doesn't minimize the importance of commitment to the systems goal.   It is the belief and commitment to our mission that is essential for creating a winning team.

The next step is matching qualifications with needs.  Each applicant's preferences are looked at and an appointment is made with the Director of the unit that matches.   Every department in the University Health System is as unique and diverse as the population it serves.  Some are large with many members and some are small containing only a few.   Each area has its own unique culture that forms its own smaller team.  These smaller teams may focus on a specific population but each member must be committed to the mission of the system.  Each  area has a different system for choosing new members, but most incorporate staff nurse input in that process.   Very few staff nurses have had experience with interviewing potential employees, but their input into the selection process is vital.  They are the unit's greatest asset into its culture. 

The responsibility of choosing new team members has such an impact on the entire system that a class is offered in Learning Resources developed by Lynn Lindemann. The class is based on the video, "More Than a Gut Feeling" and is coupled with practice exercises.  The class is not being offered currently, but the video alone is very informative.  The video can be checked out from Jim Dixon.

University Health System is an organization of talented people who are dedicated to improving the health and well-being of the citizens of Bexar County, South Texas, and beyond.   It is more than just a group of employees that work in the same place.  It is a team that shows dedication and commitment to the mission.  It is this dedication and commitment that creates and fosters team work and makes us the winners that we are.

Grace Cookson took the opportunity this month, to present several staff members with their five years pins. This is quite an honor and accomplishment when one sees the high turn over and staff shortages on all the floors and in so many hospitals. It is this core of staff that is so helpful to the new employee, as they adjust to the heavy demands that our patient care requires.

Although we have many new staff joining us and staff that has been with us over 30 years, we hope our five year employees will be around for their 10 and 25 year celebrations.

Poster Presentation at the

21st Annual Southern Nursing Research Society Conference

“Translational Research: Bridge or Destination”

Galveston, Texas

Evelyn Swenson-Britt, MS, RN, Doctoral Student and her dissertation chair, Carol Reineck, PhD, CCRN, CNAA-BC, from the University of Texas Health Science Center at San Antonio School of Nursing (http://nursing.uthscsa.edu/)presented a poster entitled Evaluation of the Critical Reading of Research Publications Plus (CRRP-P) Course using Nursing Research Self-Efficacy Scale (NURSES).   

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The poster was designed by JS Media, detailed results from a group of ICU nurses (N=17) who participated in this pilot study. These nurses were interested in ventilator-associated pneumonia and specifically the oral care of these patients. They were instructed in searching in a bibliographic database. Then they reviewed oral care research articles using the six lessons of the CRRP. 

NURSES is a self-rating 5-point response format that was administered before and after the course. The Cronbach’s alpha coefficients for the NURSES subscales are Literature Search = .96, Quantitative Methods = .96, Using Theory = .95, and Using Evidence = .94.  Paired t-tests comparing pre and post test scores showed significance in research self-efficacy within the Quantitative Methods, Using Theory, and Using Evidence of the NURSES subscales.

This initial pilot study demonstrates that a course that reviews the components of research can increase the research self-efficacy of practicing nurses.  Further study will be conducted to determine if this increase in confidence will increase research utilization. 

The birth of Unit Councils on the 7th floor was initiated with a visit from CNO Nancy Ray. Nancy and Grace Cookson answered many of the staff’s questions about Magnet Certification and what it means for the hospital and staff in general and unit council in particular.

Catering provided delicious breakfast tacos and coffee while Magnet Rep Fran Card hung Chinese New Year decorations since this was the beginning of the Chinese Year of the Golden Pig. Since both the Pig/Boar and the element gold symbolize prosperity and success and they come together every 60 years, we hope that this is an indication that our Unit Council will prosper and grow. Nancy Ray also added to this theme in one of her many lovely Asian outfits.

Recruitment & retention is an issue on 7th floor, like many other floors we are struggling with a nursing and medical tech shortage. Staff took the moment to impress upon Nancy the need to consider more flexible hours for older or more senior RNs who would like to work less than 80/84 hrs in 2 weeks yet retain their same PTO accrual rate. Several 7th floor RNs have left for Christa Santa Rosa where they work a 76 hour week yet accumulate full time PTO.  Staff feels strongly that this is a benefit we could offer and retain many of our staff.

The Unit Councils are the backbone of Magnet. It is through the Unit Councils that the nurses experience empowerment and make their needs known. Nancy encouraged the staff to look at developing unit councils to address these issues.  The Retention, Recognition and Recruitment Council is the PCS council where these ideas and issues can be brought to gather support on the wider front.p>

By Wen Pao, MSN, RN

The Discovery Group of ICU nurses that began last year with the Critical Reading of Research Publications Plus (CRRP-P) course has now progressed to initiating our first research study (See Blog Story Reading Research! Yes we can! 4/17/06) .

The focus and concern has been how the oral care of the ventilated patient may be related to ventilated-associated pneumonia. Ventilator-Associated Pneumonia (VAP) is the leading cause of morbidity and mortality in the intensive care units across the country, according to the US agency for Health Research and Quality (AHRQ). 

Oral comfort and hygiene measures have long been an important aspect of nursing care for patients receiving mechanical ventilation. But a gap exists between what oral care measures are indicated and the actual care patients receive. When talking to staff nurses from different ICUs in the hospital, there is no consistent method, no consistent frequency, and no guideline for the nurses to follow in performing oral care. Nurses are depending on the more experienced nurses to show them how oral care is performed. No official or consistent education activity exists to teach the oral assessment or oral care.

This initial study, which currently involves collecting survey data among nurses, is going to give us the baseline information about oral care practices in the ICUs. We intend to find out the nurses’ definition of oral care, the frequency of oral care, the nurses feelings about performing oral care, how the nurses learn to perform oral care and the barriers to perform oral care. Staffs in the STICU, PICU, MCCU, and TICU are being invited to complete Oral Care in Ventilated Population Questionnaire (OCVPQ) that was developed and pilot tested by the research team. We look forward to sharing our results as we move forward further studies reviewing medical records and implementing a standard oral care assessment and educational programs in providing oral care for ventilated patients. 

Principal Investigator:

Wen Pao, MSN, RN, CCRN

Co-Investigators:

Rick Sambucini, BSN, RN

Charles Reed, MSN, RN

Janet Kramer, RN, CCTN

Maureen A. Laughlin, RN, CCRN

Christie L. Harper, BSN, RN

Randy Beadle, BSN, RN

Josefina Gitamondoc, BSN, RN

Consultants:

Carol Reineck, PhD, CNAA-BC

Evelyn Swenson-Britt, MS, RN