RN, CRRN, CNRN
Barbara is the Assistant Nurse Manager in our ICU / Critical Care Unit. The Critical Care Center has a very high acuity due to the severity of the patient's illness, comorbidities, and the interventions such as vasopressor agents and limited mobility. As a result, our patients are highly susceptible to the development of CLABSI, CAUTI, ventilator-associated infections, and hospital-acquired pressure ulcers. As a result, our patients are highly susceptible to the development of pressure ulcers due to prolonged bed rest decreased protein and albumin levels, and the use of vasoconstriction medications to maintain their blood pressure. Our National Data Nursing Quality Indicator (NDNQI) report indicated that we are above the 75th percentile compared to other hospitals.
In 2009 Barbara volunteered to be a unit co-champion to assist Rosmarie Pinlac, champion lead. Referencing evidence-based practice, Barbara implemented monitoring to assure all team members were identifying the wound correctly, measuring and documenting accurately in the patient's medical record. During our last Magnet site visit, the surveyor was very impressed and commended Barbara and the team for implementing a shared governance approach to improving care and outcomes. Data results revealed for the 3rd and 4th quarter of 2019, ZERO hospital-acquired pressure ulcers, and for the 1st quarter of 2020 ZERO pressure ulcers. During the COVID pandemic, proning of the vented patients proved to be challenging. With the assistance of the orthopedic operating room team, education on proning the intubated patients was arranged. For those team members who were unable to attend the educational session, Barbara arranged for a YouTube video to be available for staff as well as several FaceTiming during the session. Barbara also worked with our materials manager and wound care ANP for proning devices, especially the face to prevent skin breakdown.
In June 2019 HMH rolled out EPIC documentation for the central regional hospitals. Barbara, trained as a superuser spent endless hours training physicians, nurses, and ancillary staff. She came in on the night shift, weekends and very often was requested to assist physicians when needed. Barbara was also part of the HMH Critical Care team-building of chapters, flow records, and revising protocols for the implementation. She continues to work with the IT department with the intention of eliminating unnecessary documentation allowing for the professional registered to be at the bedside educating patients regarding the plan of care, discharge instructions, and medications.
Barbara currently co-chairs RMC's code blue committee. The committee structure allows for the focus to be on education, quarterly mock codes, critiquing every postcode with a focus on quality improvement. During the COVID pandemic, Barbara worked with our pharmacy director addressing medication and supplies need during a cardiac arrest. Emergency code resuscitation medications were being placed in a bag in every code cart throughout the hospital. This process allowed for the code team to bring the emergency bag of medication into the patient’s room with further containing the code cart contents.
Barbara is also very instrumental with decreased CLABSIs and CAUTIs in the Critical Care Unit. NDNQI data for Critical Care has shown no CAUTIs since the second quarter of 2019. A process was developed for early discontinuing of Foley catheters using Purwicks and external catheters, and established bladder scanning algorithm for patients who may have developed urinary retention.
NDNQI CLABSI results were ZERO for the 3rd and 4th quarter of 2019 as well as ZERO CLABSIs for the first quarter of 2020. Barbara consistently works with the VATS team rounding, assuring chlorhexidine baths are given to patients with central line access, blue caps are on all ports, biopatches are changed and updated per policy, and TLCs are removed when appropriate.
Critical Care has not had a ventilator-associated infection since 2015. Barbara was very instrumental with HMH product value analysis team in purchasing 24-hour mouth care products for all vented patients. She intubated an educational program that included the respiratory therapist. Barbara also developed a documentation system and monitoring toll to assure all disciplines were adhering to the policy.
Barbara, as an assistant nurse manager is often looked upon to help mentor her peers new to the role. She is well respected for her knowledge in financial, staffing and communication. She adds a little humor to the day.
Nursing education frequently reaches out to Barbara to lecture to our new orientees in the HHM ICU academy.
As you can see Barbara wears many different hats in her role as an assistant nurse manager, critical care nurse, patient advocate, financial wizard, and preceptor to new orientees joining the critical care team. She is often recognized by patients and her families for her outstanding personality and professionalism.
Barbara leads by example when it comes to implementing protocols for positive patient outcomes!! She is a treasure at Riverview Medical Center.