Patient Resources

New Knowledge, Innovations, and Research

As an academic medical center and Magnet organization, we embrace new knowledge, innovation, and research – each of which plays a vital role in the current and future state of medicine and patient care. UT Southwestern nurses at all levels seek new knowledge and current evidence to frame their practice in leadership, clinical education, advanced practice, and direct patient care. Structures have been developed and implemented to involve more nurses in the research process, and new nursing knowledge gained through research efforts and contributions is regularly disseminated.

UT Southwestern’s Nursing Research Program has three strong departments supporting nursing research throughout our organization, along with a variety of resources to help support integration of current evidence into practice. The UT Southwestern Health Sciences Digital Library and Learning Center provides electronic, web, and personnel resources to assist with searching and acquiring relevant evidence to guide and transform our professional nursing practice.

Neuroscience Nursing Research Center

The Neuroscience Nursing Research Center (NNRC) opened in 2013 and is dedicated to ensuring that nurses at all levels can provide vital research contributions to caring for patients with a neurological illness. Under the leadership of Director DaiWai M. Olson, Ph.D., RN, FNCS, the NNRC provides guidance to nurses who are interested in engaging in research by leveraging and coordinating existing research-related resources.

NNRC Leadership:

DaiWai Olson, Ph.D., RN, FNCS

Maria Denbow, CCRP
Lead Research Coordinator

NNRC Advisory Board:

Amy Weaver, M.H.A., RN, CEN, PMH-BC
Donna Tilley, Ph.D., RN, CA-CP SANE, FAAN
Kelly Murphy, B.S.N., RN, NE-BC
Molly McNett, Ph.D., RN
David Wyatt, Ph.D., RN, NEA-BC, CNOR

In 2023, NNRC nurses participated in 52 publications (including 12 chapters in five textbooks), 30 scientific abstracts, and 33 platform presentations at conferences in nine U.S. states and eight foreign countries (Japan, Iceland, India, Colombia, Poland, Kenya, Ireland, and the Philippines). Also, during 2023, the NNRC hosted a three-month international visiting nurse from Kenya as part of a neuroscience nurse training program with the Moi Teaching and Referral Hospital in Eldoret, Kenya.

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Establishing the APP Research, QI, and EBP Committee

Over the past several years, the Office of Advanced Practice Providers (OAPP) has been actively developing innovative ways to improve staff APP engagement in scholarly endeavors. In December 2021, a group of staff APPs passionate about research created the APP Research, QI, and EBP Committee, which is executively sponsored by the OAPP. The following year, the OAPP successfully recruited a Ph.D. APRN scientist, who is coordinating APP research activities and providing mentoring to APP staff who wish to be involved in scholarly activities. With the move from the Clinical Ladder Program to the APP Incentive Program in 2023, the OAPP emphasized APPs' involvement in research, QI, and EBP by including those activities in the professional contribution domain.

In 2023, our APPs participated in 69 publications, 75 presentations, 30 abstracts, and 38 research projects, serving either as a principal investigator or sub-investigator. The standout achievement of the year was the $2.5 million grant awarded to Bradley Goettl, D.N.P., APRN, FNP-C, AGACNP-BC, ENP-C, FAANP, by the Health Resources and Services Administration. This grant, spanning 2023 to 2028, aims to enhance postgraduate training for APPs in mental health and substance use disorders.

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Magnet Program and Nursing Research Department

After merging the Magnet and Nursing Research programs in 2022, UT Southwestern is on the upswing and continues to expand nursing research efforts throughout the organization. The Magnet Program and Nursing Research Department’s goal is to broaden opportunities and resources for every nurse to pursue research and scholarly activities throughout the UT Southwestern Health System in every patient care setting. Cultivating and instilling nursing research expertise, in a framework of nursing administrative support, attests the value UTSW places on both research and excellence in professional nursing.

The expansion of UTSW nursing research efforts reaches throughout local nursing schools. Our academic partnership with Texas Christian University (TCU) is an example. Through the TCU Evidence-Based Practice Fellowship, fellows attend hybrid sessions scheduled with TCU faculty and have UTSW mentors, who assist them with their PICO (population, intervention, control, and outcomes) question, linked to organizational goals and mission. The fellow and nurse leaders together develop the clinical question, nursing strategic plan, and patient performance indicator to enhance clinical practice and outcomes. A formal graduation for the entire fellowship class will be held in September 2024 at TCU.

Kateleen Collins, B.S.N., RN 
Assistant Nurse Manager, Inpatient Psychiatry 
Mentor: Amy Weaver, M.H.A., B.S.N., RN, CEN, PMH-BC   

Maddie Leimbach, B.S.N., RN  
Staff Nurse, 8 Blue MICU 
Mentors: Jose Alejandro-White, Ph.D., M.B.A., RN, NEA-BC, CCM, CNE, FACHE, FAAN 
Ramona Baucham, Ph.D., M.S.N., M.S.O.R.D., RN  

Unni Mary Kurian, B.S.N., RN, CMSRN 
Staff Nurse, 6 Orange 
Mentors: Jose Alejandro-White, Ph.D., M.B.A., RN, NEA-BC, CCM, CNE, FACHE, FAAN  
Ramona Baucham, Ph.D., M.S.N., M.S.O.R.D., RN

Hunter Jackson, B.S.N., RN, CCRN  
Staff Nurse, 8 Blue MICU 
Mentors: Jose Alejandro-White, Ph.D., M.B.A., RN, NEA-BC, CCM, CNE, FACHE, FAAN 
Ramona Baucham, Ph.D., M.S.N., M.S.O.R.D., RN  

Amy John, B.S.N., RN-BC 
Assistant Nurse Manager, 12 Green 
Mentor: Punitha Wilson, D.N.P., RN, GERO-BC 

In spring 2023, the Magnet Program and Nursing Research Department collaborated with the Office of Quality, Safety, and Outcomes Education to develop a six-month Nursing Quality Improvement (QI) Fellowship. The fellowship comprised a one-week QI Bootcamp in June that included lectures, discussions, and applications of QI and systems engineering (SE) methodologies, and project activities in group settings. Following the QI Bootcamp, fellows were tasked with developing and implementing a department, unit, or organizational project leading to new processes of patient care delivery and enhanced outcomes. The fellows’ final projects will be showcased internally at the UTSW Celebration of Excellence and possibly published in academic journals or presented at industry conferences. Graduation from the fellowship will be held during Nurses Week in May 2024.

Providence Mathew, M.S.N., RN, RN-BC 
Unit-Based Educator, Outpatient Surgery Center 
Mentors: Ramona Baucham, Ph.D., M.S.N., M.S.O.R.D., RN 
Teresa Phan, M.S.H.C.M., M.S.I.T.M., CLSSGB 

Rincey Daniel, B.S.N., RN, CMSRN 
Unit-Based Educator, 8 Green Pulmonary/Telemetry  
Mentors: Ramona Baucham, Ph.D., M.S.N., M.S.O.R.D., RN 
Teresa Phan, M.S.H.C.M., M.S.I.T.M., CLSSGB 

Rowena Cruz, M.S.N., RN, CCRN-CSC
Assistant Nurse Manager, 9 Blue CVICU 
Mentors: Ramona Baucham, Ph.D., M.S.N., M.S.O.R.D., RN 
Teresa Phan, M.S.H.C.M., M.S.I.T.M., CLSSGB 

Sini John, B.S.N., CCRN 
Staff Nurse, 8 Blue MICU 
Mentors: Ramona Baucham, Ph.D., M.S.N., M.S.O.R.D., RN 
Teresa Phan, M.S.H.C.M., M.S.I.T.M., CLSSGB 

As research interests and skills populate throughout clinical settings at UTSW, the Magnet Program and Nursing Research Department continues to grow as a center of research-intensive activities and to provide the skills and capacity for nurses to pay it forward by mentoring and inspiring more nurses to think differently, ask the right questions, and pursue research.

UT Southwestern’s Nursing Research Fellowship program was established in 2021 to prepare nursing professionals from multiple specialties for nursing research. Fellows are immersed in the nursing research process, from the clinical question to the study initiation, including regulatory and compliance components. The goal is for clinical nurses to understand that evidence is essential to nursing practice and that every nursing specialty can apply research to improve an agreed-upon department/unit-level/organizational goal to enhance patient care and clinical practice and build the nursing body of science. UT Southwestern’s four Nursing Research fellows and their mentors in 2023 were:

Cynthia Porcari, M.S.N., RN, CNOR 
Patient Safety Coordinator, Health System Patient Safety 
Mentors: Linda Denke, Ph.D., RN, CCRC
Yingzi Zhang, Ph.D., RN 

Janet Liebman, B.S., RN 
Ambulatory Triage Nurse, Movement Disorders Clinic 
Mentors: Linda Denke, Ph.D., RN, CCRC 
Yingzi Zhang, Ph.D., RN 

Sonia Joseph, M.S.N., RN 
Staff Nurse, 8 Orange ASU 
Mentors: Linda Denke, Ph.D., RN, CCRC 
Yingzi Zhang, Ph.D., RN 

Savannah Silvas, B.S.N., RN, CCRN 
Staff Nurse/Charge Nurse, 2 Orange SICU 
Mentors: Linda Denke, Ph.D., RN, CCRC 
Yingzi Zhang, Ph.D., RN 

Nursing-Led Research in 2023

Throughout 2023, UT Southwestern nurses were involved in research and evidence-based practice initiatives in specialized areas. As in recent years, our nursing research output increased exponentially. Nursing research leaders review the annual research needs assessment and all nurses’ submissions and recommend research mentors, when appropriate, to cultivate the next generation of nurse researchers.

Outcomes  2023 
Research Studies (Ongoing)  33 
Research Studies (Completed)  20 
Nursing TCU EBP (Evidence-Based Practice) Fellowship
Nursing Research Fellowship 
Neuroscience Nursing Research Fellowship 

Disseminations of Research in 2023

The Neuroscience Nursing Research Center, Office of Advanced Practice Providers, and Magnet Program and Nursing Research Department lead and support multiple research studies and projects. Accomplishments include various disseminations and collaborations of research in peer-reviewed journals and podium and poster presentations.

Number of poster presentations by and/or including UT Southwestern nurses in 2023: 48

Number of podium presentations by and/or including UT Southwestern nurses in 2023: 82

Number of publications by and/or including UT Southwestern nurses in 2023: 100

Outcomes  2023 
Poster presentations 48 
Podium presentations 82 
Publications   100 (including 12 chapters in five textbooks)

RRT Shortens Time to Assessment and Response for Inpatient Strokes

Effectively identifying and managing in-hospital strokes is crucial for minimizing the risks of both morbidity and mortality. This challenge is complicated by multiple factors, such as concomitant diagnoses, workflow obstacles, and stroke mimics. An important strategy for managing in-hospital strokes is to use a dedicated team of responders to attend Code Stroke pages. The time-sensitive, responder-driven Code Stroke model has been used at several academic medical centers worldwide with substantial success. Implementing the model, the Rapid Response Team (RRT) at UT Southwestern has become the key driver for the in-hospital Code Stroke pathway at both Clements University Hospital and Zale Lipshy Pavilion since 2016.

A study led by nurses analyzed data extracted from the UTSW Stroke Coordination’s database. Preliminary results showcase how the RRT helped expedite the care delivery process for inpatient strokes. Findings reveal that the new pathway driven by RRT shortened arrival-to-CT imaging time by 8 minutes compared to non-RRT-driven cases. Among cases receiving emergency resuscitative thoracotomy (ERT) intervention, RRT-driven cases showed a shorter time-to-groin than non-RRT-driven cases, with the latter taking twice as long to reach the angio suite for ERT.

This research abstract was not only accepted for presentation at two prestigious conferences, the International Neuroscience Nursing Research Symposium (INNRS 2024) and the National Teaching Institute & Critical Care Exposition (NTI 2024), but it also received the esteemed NTI 2024 Research Poster Abstract Award!

Study started: March 2023

Abstracts accepted for presentation:

  • NTI 2024 – poster – submitted September 2023
  • INNRS 2024 – poster presentation – submitted October 2023

Abstracts being written:

  • AANN Stroke Conference 2024 – poster presentation
  • Magnet 2024

Presentations scheduled:

  • UTSW Stroke Best Practice, September 2024
  • UTSW Front Line Leaders, September 2024

Manuscript being written, target journal: AHA Stroke


Principal investigator: Kat Siaron, B.S.N., CCRN, SCRN

Study members:

  • Melinda Alford, B.S.N., CCRN
  • Tracy Heineman, B.S.N., CCRN
  • Lillian Otieno, B.S.N., RN
  • Cara Pulliam, B.S.N., CCRN
  • Norma Sonier, B.S.N., RN
  • Suzanne Stone, RN, Manager, UTSW Stroke Coordination

Faculty sponsor:

  • Mark Johnson, M.D., Neurology Stroke/Vascular Faculty

Study coordinator:

  • Emerson Nairon, NNRC Research Assistant


  • Leah Cohen, M.D., RRT Medical Director; MICU Faculty
  • DaiWai Olson, Ph.D., RN, FNCS, Director, Neuroscience Nursing Research Center; Faculty, Neurocritical Care

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Improved Processes Keep Therapy on Track

The day a patient is admitted to the Inpatient Rehabilitation Unit at Zale Lipshy Pavilion can be hectic. Sometimes the patient’s transfer is delayed or the patient is too tired to participate in therapy. Inpatient Rehabilitation (IPR) has specific requirements, which include that a patient experiences 180 therapy minutes in five out of seven days. When a patient is not seen on the first day, his or her care can be deferred, which stalls overall progress from a therapy perspective. In 2022, IPR managers noted that such deferments were happening far too often and that part of the reason was because the unit had no clearly defined process to ensure that patients admitted earlier in the day were evaluated by therapy on that day. Instead, an email blast went out notifying the team that a new patient had arrived and that if “anyone has time, please evaluate.”  That lack of process resulted in only 30% of patients being seen on the day of admission.

The IPR developed a plan to change that. The initiative aimed to increase the percentage of patients seen by therapy services on the day they were admitted to IPR. The new, clearly defined process included having a core team of therapists with a later shift start time (and later shift end time) to see patients on the day of their admission if they were accepted before 3 p.m. This core group of therapists left an open timeslot in their schedule for the end of the day to complete this task. The entire team, including nurses and physicians, was educated on this initiative, and the results showed dramatic improvement.

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Overall outcomes in self-care and mobility improved:

PEM 2022 (Program Evaluation Model)

  • Change in self-care: 12.7 (up by 0.5 from the previous year)
  • Change in mobility: 34.7 (up by 1.8 from last year)
  • Overall PEM score: 91.4 (up by 2.4 from last year)

  • Kasey Rehme, M.Ed., CCC-SLP, Assistant Therapy Manager
  • Melinda Malone, M.S., CCC-SLP, Therapy Manager

ASU Multidisciplinary Rounding

Multidisciplinary rounding (MDR) is a valuable tool that helps ensure effective and comprehensive care of neurological and neurosurgical patients. Despite multiple articles describing the benefits of MDR in critical care settings, our literature search found little evidence exploring the benefit of MDR in a progressive care or acute stroke nursing unit (ASU). Coordinating care with a large multidisciplinary team in an advanced-care ASU is complicated. Our team works hard to promote effective communication within care coordination-focused multidisciplinary neurovascular rounds. Still, there is no organized setting for the bedside registered nurse (RN) to attend and contribute to these rounds.

This project aimed to improve teamwork, stroke knowledge, and empowerment of RNs by improving effective multidisciplinary communication in the ASU. To accomplish this, we initiated a pilot project to establish formalized RN-led MDRs that included a nurse-driven communication tool in the electronic medical record (EMR).

Before pilot implementation, two separate surveys were sent to all RNs and neurovascular providers (physicians, advanced practice registered nurses, and physician assistants) who care for ASU patients to compare perceptions from each group about the team's knowledge regarding patient diagnosis and plan of care. A workgroup of leadership, bedside RNs, and neurovascular providers collaborated to develop the ASU communication tool and bedside MDR workflow for pilot implementation. The communication template was documented in the EMR by each RN every shift and used as a guide to format MDRs. During the pilot, the team frequently conducted check-ins with nurses and providers to seek feedback and make any necessary adjustments.

The results of the initial perception survey showed a mismatch, with the providers scoring perceptions much lower than what the RNs perceived their knowledge to be regarding their patients. After the pilot, we measured staff’s knowledge and confidence in caring for stroke patients and compared the results to the pre-pilot data. The surveys demonstrated positive results to show our pilot effectively increased understanding, communication, and empowerment.

Following the pilot study, the ASU implemented a new communication template and MDR strategy into standard practice. Standardized multidisciplinary rounding for the ASU has been identified as a potential solution to enhance collaboration in the unit. Future implications of this pilot have highlighted the need for more research on the effect of multidisciplinary nurse-led rounding on progressive care and acute stroke units.

  • Alexa Collins, M.B.A., B.S.N., RN, SCRN, Manager, 8 Orange
  • Marie Cuffee, RN, 8 Orange
  • Kaitlyn Dupriest, B.S.N., RN, CCRN, Assistant Nurse Manager, 8 Orange
  • Melissa Panter, M.S.N., APRN, AGACNP-BC, Lead APP for Inpatient Neurology

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Improvement on Transplant Teaching

When a patient receives an organ transplant, many life changes occur for them and their families. To adjust to these changes, patients on the 7 Green Unit at UT Southwestern are provided education and training to support the uptake of new skills and knowledge needed for post-transplant life. Among the various treatments and new medications, many patients are discharged with steroid regimens that require tapered dosing over time. These steroids can severely increase blood sugar levels and have detrimental long-term implications.

The 7 Green nursing leadership team noticed a rise in readmissions associated with uncontrolled blood glucose levels at the beginning of 2023. After reviewing relevant data and identifying key stakeholders, an interprofessional workgroup, the “Diabetic Task Force,” was commissioned to explore ways to decrease readmissions for this vulnerable population of patients. Task force members consisted of pharmacists, a diabetic nurse practitioner (NP), the unit-based educator (UBE), care coordinators, leadership, and several nurses representing both shifts.

The intended goal for the Diabetic Task Force was to decrease the readmission rates of newly transplanted patients due to uncontrolled blood sugars. The team determined quickly that they could decrease blood glucose-related readmission by ensuring every patient had the appropriate information prior to discharge. Also, they noted this information should be received through consistent education and knowledge checks.

Using evidence-based adult learning principles, several initiatives were put in place. The Diabetic Task Force established that someone from the team should assess every patient going home with insulin and provide instructions to ensure the patient felt comfortable with their insulin sliding scale prior to discharge. To facilitate early identification, unit pharmacists began providing notification to the unit staff of pending discharges through secure chats. The Diabetic Task force agreed that teaching would be started as soon as possible, usually once the anesthesia wore off and the patient was alert and oriented. This early instruction better prepared the patient for discharge and allowed for the patient’s remaining time in the hospital to be used more efficiently and effectively, with follow-up and reiterative education. For tracking purposes, a “Diabetic Binder” was created containing pre- and post-diabetes questionnaires to assess the patient’s knowledge regarding insulin. Pamphlets were given to the patients along with QR codes containing links to easy educational information. Each patient is now provided training and guidance on how to administer insulin according to the prescribed sliding scale orders. All these tactics were combined into a comprehensive teaching discharge plan to address the needs of this specific patient population.

Through the Diabetic Task Force’s collaborative interventions, 7 Green has seen a decrease in the readmission numbers for newly transplanted patients. The unit’s patients themselves have expressed they feel more comfortable with the separate teaching on how to follow their prescribed sliding scale. An added benefit and indicator of this project’s success was noted in the improvement of 7 Green’s Press Ganey scores throughout the year related to medication administration and medication side effects teaching.

  • Lilie Anne, B.S.N., RN, CMSRN
  • Hannah Barentine, B.S.N., RN
  • Kelly Baxter-Duke, B.S.N., RN
  • Sanjit Dhakal, B.S.N., RN-BC, Assistant Nurse Manager 7 Green
  • Rashanda Eddington, B.S.N., RN
  • Mary Garcia, M.S.N., RN, WCC, Unit-Based Educator 7 Green
  • Manju George, M.S.N., RN, CMSRN, Nurse Manager 7 Green
  • Alice Johnson, B.S.N., RN, CMSRN, Assistant Nurse Manager 7 Green
  • Courtney Little, B.S.N., RN
  • Anitha Litty, D.N.P., CDCES, APRN (diabetic NP)
  • Eshah Newman, B.S.N., RN, CCTC
  • Van Ngo, Pharm.D., BCPS (main pharmacist)
  • Jocelyn Ponce, B.S.N., RN, CMSRN, Assistant Nurse Manager 7 Green
  • Kirsten Venghaus, B.S.N., RN

Ambulation of Post-Op Patients

Frequent ambulation of cardiovascular and thoracic postoperative patients has been shown to improve patient care outcomes and prevent complications. Ambulating this population of patients for the recommended three to five times per day can be challenging for nurses and patient care technicians. 9 Green is a 32-bed unit that consistently maintains a high census. Due to the high volume of postoperative patients, staff were having difficulty ensuring patients were ambulating frequently as recommended while also meeting all the other patient care needs. Nursing leadership also noted this led to an increased stay length and a higher fall rate.

The goals of this project were to reduce the length of stay for cardiac and thoracic surgical patients and to reduce falls by ensuring increased staff responsiveness. Nursing leadership began investigating ways to meet patients’ postoperative mobility needs and improve outcomes. After reviewing staffing acuity and ratios, it was determined that having someone dedicated strictly to ambulating patients would best enable meeting the recommended goal of three to five times per day.

Nursing leadership conducted a review of the literature to find evidence-based practices regarding frequent ambulation and the role of a mobility technician. Research showed frequent ambulation as an important intervention in preventing complications, decreasing length of stay, and promoting a culture of safe ambulation. This information was presented to the nurse executive leadership council, and the new position was approved.

The mobility technician's role was implemented in September 2022. Initially, the 9 Green mobility technician was scheduled Monday-Friday for eight hours per day to serve the times of greatest need and for optimal patient accessibility. The expectations for this role included safely ambulating postoperative patients as ordered and assisting with toileting needs before and after ambulating as needed. Eventually, a second technician was added to work weekends. The mobility technicians were trained by both nursing leadership and the unit-based educator (UBE) to ambulate postoperative patients with chest tubes, portable suction, drains, and any other special needs or equipment the patient might require.

Implementing this role has resulted in several positive outcomes. For FY 2022, 9 Green had 19 patient falls, while in FY 2023, the unit had 10, a reduction by almost half. By fall rate, in Q3 2022 the NDNQI falls indicator rate was 2.52 (total patient falls per 1,000 patient days); for Q1 2023 the rate was 0.75, for Q2 2023 it was 0.76, and for Q3 2023 it was 1.11, all of which were well below the national benchmark for this metric.

Additional improvements have been noted since the mobility technician position was initiated, including Press Ganey results for 9 Green showing an increase in response of hospital staff from the 37th percentile the previous year to the 96th percentile currently. An 8.84% increase in help with toileting has been noted as well.

Most notedly, the success of the role has resulted in the approval of a second recently filled weekend position to provide 9 Green with coverage of a mobility technician seven days per week. Overall, there have been positive outcomes, and hope we continue to see improvements.

  • Brandy Cole, M.S.N., RN
  • Elizabeth Mastropiero, B.S.N., RN
  • Shalini Rane, B.S.N., RN
  • Deshonna Taylor, D.N.P., RN, CCRN
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Improving RN Skills in PH Medication Administration

Pulmonary hypertension (PH) is a complex and progressive disease characterized by the remodeling of small pulmonary vessels. Treatment includes administering lifelong potent intravenous medications in high concentrations and slow infusion rates. Because of the low frequency and substantial risk status of administering these medications, registered nurses (RNs) inexperienced with PH medication administration could experience a lack of confidence and compromise patient safety.

On the 8 Green Pulmonary Unit, the unit-based educator (UBE) noted a decreased confidence level in some nurses. Based on data, personal interviews, and direct observation of IV administration during PH care, the UBE identified potential gaps in knowledge, skill, and understanding of current nurse PH competencies. A pre-survey was conducted to assess nurses’ confidence level using a five-point Likert scale to measure the distribution of confidence levels from “No Confidence” (1) to "High Confidence" (5).

Pre-survey data collected in July 2023 showed only 35% of nurses indicated “Confidence” or “High Confidence” in administering PH medications, which was significantly less than half. Analysis of event reports from June 2022 to June 2023 related to medication errors on 8 Green revealed that 50% of those events were related to PH intravenous medication dose calculation.

To maintain safety of the PH patient population, a need was identified to provide further education of RNs on PH intravenous medication administration and dose calculation. The goal of this project was to improve the confidence level of RNs to administer PH intravenous medication and to reduce dose calculation errors related to PH medication. The project was aimed at RNs with less than two years of experience in PH patient care. Therefore, a sample of 25 RNs from 8 Green with less than two years of experience in PH patient care was selected for the project.

The quality improvement team led by UBE Rincey Daniel, B.S.N., RN, CMSRN, incorporated lean principles to identify areas for needed changes and process improvements. Through the team's collaborative efforts, a multimodal educational approach was developed to initiate practice changes. The team, composed of PH medical providers, clinical educators, pharmacy staff, and safety team members, gathered data and guided the interventions.

The team developed an educational toolkit to use during an interactive training program. A didactic course was offered with a PowerPoint presentation and hands-on learning. Attendees also received instruction via case scenarios and participated in simulation for medication pump programming setup and medication calculation. The team incorporated a detailed checklist outlining the PH medication administration steps into the toolkit and class.

A post-survey conducted in November 2023 to assess nurses’ confidence level demonstrated an improvement from 35% (pre-survey) to 76% (post-survey) of nurses having “Confidence” or “High Confidence” in administering PH medications. Data collected from event reports in November 2023 showed only one PH medication calculation error.

Data collection will continue into FY 24 to demonstrate further trends in reducing medication errors and increasing confidence levels.

  • Ramona Baucham, Ph.D., M.S.N., M.S.O.R.D., RN
  • Michele Bullard, M.S.N.-Ed., RN, MEDSURG-BC
  • Rincey Daniel, B.S.N., RN, CMSRN
  • Rojimol Elengical, M.S.N., RN, RCIS
  • David Finklea, M.D.
  • Clarita Hangos, B.S.N., RN
  • Hayden Huckaby, B.S.N., RN
  • Jiji Mathew, B.S.N., RN, PCCN
  • Gustavo Ortiz, D.N.P., RN, NPD-BC, CCRN-K, CNRN
  • Teresa K. Phan, M.S.H.C.M., M.S.I.T.M., CLSSGB
  • Brenda Pope, M.S.N.-Ed., RN, NPD-BC
  • Lyra Rosos, RN
  • Manuel A. Sosa, M.S.-Fin., M.S.-Econ.
  • Jaimol Sreedharan, M.B.A., M.S.N., RN, CCRN
  • Deshonna Taylor, D.N.P., RN, CCRN-K
  • Shinto Thomas, M.S.N., RN, PCCN-K
  • Anie Varghese, B.S.N., RN
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Heparin Study

Magnet-designated hospitals are commonly places where nurses at the bedside not only identify opportunities for improvement but are the leaders who investigate and implement any changes needed. On the 11 Blue Bone Marrow Transplant (BMT) Unit, a bedside nurse exemplified this ideal when she brought an important initiative forward. Meredith Allen, B.S.N., RN, BMTCN (PI), recognized a difference between hospital policy and bedside nursing practice on 11 Blue. Bedside nurses were not flushing peripherally inserted central catheters (PICCs) with heparin sodium according to Clements University Hospital’s policy. Allen wanted to ask her peers who worked on 11 Blue how their nursing practice for PICC lines compared to hospital policy. She sent an anonymous survey to 11 Blue staff nurses, and responses confirmed that the nursing bedside practice was different from the hospital policy.

A literature search was undertaken and revealed a lack of evidence in this BMT patient population. Afterward, a study team came together to develop a research study to be performed on 11 Blue. The team included bedside nurses, nurse management, nurse scientists, physician champions, and pharmacists. Allen served as principal investigator (PI) and worked closely with nurse scientist Linda Denke, Ph.D., RN, CCRC, to design a research study to test potential for clotting and any complications between normal saline compared to heparin flushing of PICC lines on 11 Blue. The goal of the study was to evaluate the hospital policy and bedside nursing practice to determine the evidence-based best practice for PICC line flushing.

The study included the collection of about five years’ worth of data performed by 11 Blue clinical bedside nurses and nurse leader champions. The results were, as hypothesized, the use of sodium chloride in maintaining PICC line patency is equal to that of heparin sodium, if not superior.

Upon the study’s completion, an abstract was submitted to the Infusion Nurses Society (INS) and accepted for its conference in Kansas City, Missouri, in May 2024. A manuscript draft was submitted to the INS and is currently under review. The research study results have been presented to several committees related to hospital policy to evaluate a change in practice, including the CLABSI Committee, the Nurse Practice Council, the Anti-Coagulation Committee, and representatives from the Office of Continuing Education and Professional Practice. A practice change proposal will be presented in February 2024 to the pharmacy team to update policy to match bedside practices.

  • Meredith Allen, B.S.N., RN, BMTCN (PI)
  • Linda Denke, Ph.D., RN, CCRC
  • Miriam S. Gonzales, B.S.N., RN, BMTCN
  • Kavitha Nair, M.S.N., RN, OCN, NEA-BC
  • Ramona Warkola, B.S.N., RNC, OCN, BMTCN
  • Jancy Wilson, B.S.N., RN, OCN

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Zen in 10

Nurses’ well-being was identified as a focus area for the oncology service line by input received from frontline nurses. Results from the October 2022 organizational-wide Glint employee engagement survey indicated that oncology nurses were concerned about their well-being, with oncology ranking much lower than the organization as a whole, scoring 62 versus 71, respectively, which reflected a decline organizationally by four points from the February 2022 survey. While the organization has launched several well-being initiatives, including support through the Employee Assistance Program, mindfulness exercises, and in-person counseling, bedside nurses are often unable to utilize the resources due to time constraints and the location of resources. With an unprecedented RN vacancy rate of 31% across the three inpatient oncology units, implementing sustainable, evidence-based strategies was critical to addressing the well-being of our bedside nurses. The Zen in 10 well-being initiative was implemented on 11 Orange with the support of the oncology service line leadership.

The Zen in 10 initiative aimed to improve nurses' anxiety and stress through a wellness bundle comprising a relaxation room, aromatherapy, mindfulness exercises and music, shared journaling, yoga, snacks, and restful lighting. The Office of Nursing Research assisted with developing a pre- and post-survey on wellness; the Music Therapy program created three mindfulness exercises; and the NOMAD clinical program coordinator provided yoga resources. The intervention was presented over several months during 11 Orange staff meetings, and an invite was sent to all staff to attend the official opening. The Zen in 10 relaxation room opened on Sept. 28, 2023, with the initial eight-week pilot phase ending November 25, 2023. Pre- and post-surveys on wellness were sent to all staff permanently assigned to 11 Orange.

The November 2023 staff satisfaction survey results indicated a unit well-being score of 75, up from the previous score of 71 and 12 points above the benchmark. In comparison, the two inpatient oncology units without the well-being intervention noted well-being scores of 57 and 62, with the combined oncology service line scoring 63.

It is expected that inpatient oncology nurses will experience improved psychological well-being by participating in this initiative. However, this will be validated after pre- and post-survey data analysis.

If the pilot is successful, the well-being initiative will be shared with the inpatient service line leaders and bedside staff during the oncology service line staff meeting. Additionally, the results of the Zen in 10 evidence-based practice project may be disseminated to nursing leadership, utilizing different internal organizational committees such as the Shared Governance Coordinating Council and Nursing Research Committee.

  • Ruben Castillo, D.N.P., RN, CCRN, NE-BC
  • Rachel Kelley, M.A., B.A.
  • Chelsea La Fond, B.S.N., RN, OCN
  • Sharon Le Roux, M.S.N., RN, OCN
  • Jasmyne Marshall, MT-BC
  • Morgan Parker, B.S.N., RN, OCN
  • Teresa Phan, M.S.H.C.M., M.S.I.T.M., CLSSGB
  • Christina Shocklee, M.M.T., MT-BC
  • Christina Stock, M.A., MT-BC
  • Nerissa Uy, B.S.N., RN, OCN