Ventilator‐associated Pneumonia as a Nurse‐sensitive Outcome: The Role of the Clinical Nurse Specialist in the Development and Implementation of Clinical Systems to Reduce Ventilator‐associated Pneumonia

2005 NACNS National Conference March 9–12, 2005, Orlando, Fla KATHY BALDWIN, PhD, RN, PAT BIELECKI, MSN, RNC, AND SUE B. DAVIDSON, PhD, RN, Conference Co-Chairs This year’s annual NACNS conference is planned for Orlando, Fla, March 9–12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, costeffective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year’s conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year’s call for abstracts and consider submitting an abstract for presentation at NACNS’s next conference in Salt Lake City, Utah, March 15–18, 2006. Description: A multidisciplinary and interdepartmental pediatric committee developed strategies to increase competence and confidence in pediatric resuscitation using code drills. After analyzing baseline assessment data, the committee identified department-specific learning needs. Clinical scenarios, competency checklists, and an evaluation tool were used to ensure consistent pediatric standards of care throughout the organization. Currently, 2 committee members proctor and evaluate drills in the ED 6 times a month. Evaluation: The involved committee members present an evaluative report of the drill process to the entire committee monthly. Increasingly complex scenarios are developed and introduced into the drills based on demonstrated performance improvement and increased confidence. Following every pediatric patient code, a designated committee member evaluates the emergency team response through data analysis, documentation review, and discussion to ascertain ongoing education and training needs. Conclusions: Ongoing support, development, and education assist staff in providing expert care to critically ill children. The ED staff reported increased levels of confidence and abilities to manage children requiring emergent resuscitation. This project empowered the ED staff to take ownership of a program that addresses their learning needs and improves communication among members of the multidisciplinary and interdepartmental team. Clinical Nurse Specialist–Initiated Smoking Cessation Program Donna C. Bond, MSN, RN,BC, Carilion Health System, Roanoke, Va Problem: Cigarette smoking is the most prevalent health risk behavior in the United States, with tobacco-related disease and disability accounting for $50 billion in medical expenditures and 400,000 deaths annually. Carilion Health System in Virginia did not have a systematic protocol for providing education on smoking cessation. Purpose: Through collaboration between the pulmonary CNS, cardiac CNS, cardiac rehabilitation nurses, and respiratory therapy practitioners, a program for smoking cessation was developed for Carilion Health System. Significance/Justification: Seventy percent of current smokers want to quit smoking, but lack the information for success. Research has shown that smoking cessation counseling lasting as little as 10 minutes can significantly increase smoking cessation rates. In addition, recent studies have shown that utilizing a systematic protocol for identifying and addressing tobacco use facilitates the delivery of smoking cessation interventions. Practice Innovation/Methods: Hospitalized patients are referred to the program by nurses, physicians, or other health care workers, as well as self-referral. Registered nurses or respiratory therapists, who are trained interventionists, assess the level of nicotine dependence and behavioral activities associated with the use of tobacco. Based on the assessments, the following information is discussed, the smoker’s motivation to quit, review personal risk factors, smoking triggers/ behaviors, identification of an individual to provide support, quit date, and other pertinent information. The patient is then assisted in selection of a method for nicotine cessation. Written materials are provided and tailored to each patient who may then view a closed circuit television program. Follow-up telephone counseling occurs after discharge. Total time investment is approximately 30 minutes per patient. Outcomes/Evaluation: Since this program started in 2001, more than 100 patients have received the intervention. Of the patients we have been able to follow, 27% continue to abstain from tobacco 1 month following the session. Implications for Nursing Practice: This system change demonstrates how to create and implement a system-wide smoking cessation program based on research, the importance of involving different disciplines in change, and developing partnerships within a health system. Instituting an Electronic Nursing Plan of Care, The ImPaCTT Project at Integris Health—Improving Patient Care Through Technology Daphne Burnett, MS, RN, CCNS, CNS, Marci Winningham, MS, RN, CCNS, CNS, and Doug Hartzell, MHR, RN, Integris Health, Mustang, Okla Purpose: To provide clinicians with a comprehensive electronic Nursing Plan of Care (POC) for acute care patients utilizing NANDA nursing language. Background/Significance: Providing adequate documentation of patient care is always an ongoing struggle in any institution. Meeting Joint Commission on Accreditation of HealthCare Organizations (JCAHO) requirements is also a struggle when it comes to documentation of the POC. Integris Health in Oklahoma City has worked with the Cerner system toward providing an electronic medical record (EMR). Integris Southwest Medical Center achieved great success with the placing the Admitting Patient History form online and making pertinent fields required items in order for the history to show complete during electronic auditing. The CNSs identified the Nursing POC as an important part of the patient medical record that is not always completed by the nursing staff with their current documentation utilizing the FOCUS system. Creating an EMR Nursing POC that would compliment the pieces of medical record currently electronic would not only benefit the nursing staff but would achieve all the JCAHO requirements necessary in planning patient care. Description of the Project: Together with the Care Net Systems manager, the CNSs worked to provide a comprehensive POC looking at each system identified within the current FOCUS documentation. The group initially met with Nursing leadership and the leadership of the ImPaCTT project at Integris Health.