Journey to Excellence

In 2023, the 8 South Inpatient Rehabilitation Unit of NewYork-Presbyterian Brooklyn Methodist Hospital renewed its accreditation granted by the Commission on Accreditation of Rehabilitation Facilities (CARF). CARF International is an accreditor of rehabilitation teams around the world. Achieving CARF accreditation demonstrates the hospital’s commitment to delivering the highest level of safe and effective services, ongoing performance improvement, and the satisfaction of the persons served. The 8 South unit had received its first accreditation from CARF during the summer of 2022, but with the campus’s full integration into NewYork-Presbyterian Hospital, 8 South was required to renew its accreditation in 2023. Rather than simply renewing the same accreditation, the team decided to apply for specialty program status for patients with brain injury. This involved a collaborative effort of an interprofessional team of nurses, therapists, physicians, physician assistants, social workers, and others from departments throughout the hospital who create an amazing environment every day for our patients and families. The nursing team was represented by bedside leaders on both the day shift and night shift and included charge nurses, clinical nurses, and nurse technicians. The team showcased accomplishments in quality and safety to the CARF surveyors, highlighting our collaborative work with physical therapy to prevent falls during inpatient rehabilitation stays. The nurses also demonstrated use of the Agitated Behavior Scale assessment, a new policy and nursing assessment that the team initiated to better care for our brain injury patients. This is one of many ways that the nurses are stretching, learning new skills, and expanding their professional practice to ensure the highest level of care is given to each patient.

Outcome

The CARF International team granted NewYork Presbyterian Brooklyn Methodist the specialty program status, an incredible accomplishment by the entire 8 South team. Alan Levin, DNP, MBA, RN, NEA-BC, Vice President and Chief Nursing Officer, recognized the 8 South nursing team, which was led by the Patient Care Director, Jarrett Mylander, MSN, RN.

The NewYork-Presbyterian Brooklyn Methodist Center for Community Health perioperative team aspires to be positioned as pioneers in the field of minimally invasive surgery and to be the first ambulatory center to offer robotic surgery to our patients in the NewYork Presbyterian organization. Robotic surgery has numerous benefits, including precision and accuracy, efficiency, cost effectiveness, and decrease in length of stay for patients. The perioperative nursing leadership team collaborated with our physician partners, anesthesiology, supply chain, the Central Sterile Processing Department, facilities, nursing professional development, and several other teams. Educational workshops were developed to engage and train nurses, surgical technicians, and surgical team members. The training sessions provided opportunities for hands-on experience and virtual review courses to demystify any concerns. In addition, robotic training was integrated into the nursing onboarding process to ensure all team members were competent in the robotic service.

Outcome

The use of robotic surgery at the Center for Community Health expanded in 2023. The program went live in Q4 2022 and by the end of 2023, the number of robotic surgeries had a significant increase. By embracing robotic surgery at our ambulatory center, we are not just adopting advanced technology, we are also investing in the well-being of our patients, the professional growth of our perioperative team, and the future success of our ambulatory center.

Central venous catheters (CVC) and indwelling urinary catheters (IUC) are vital components of patient care. In the intensive care unit (ICU) setting these devices are essential for a multitude of reasons, including close hemodynamic observation, intake and output monitoring, and medication administration. Despite their many obvious advantages, these devices present significant risks to the patient and are also very costly for an organization if an infection develops (Mudd, Slater, and Curless, 2022). Prevention of central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) is a central focus within health care and the problem is ongoing. The ICU at NewYork-Presbyterian Brooklyn Methodist spearheads the effort to reduce the incidence of CLABSIs and CAUTIs by employing a variety of strategies that include daily interdisciplinary rounds as well as continuous assessment of device usage by unit nursing leadership. Purposeful assessment by nursing leadership aims to “close the loop” by providing follow-up on CVC and IUC usage and advocating for discontinuation of these devices as soon as possible. In many cases, these devices are still indicated and are unable to be removed. If this is the case, our ICU ensures strict adherence to all best practices surrounding CVC and IUC care and maintenance. For CVCs, best practices include timely dressing changes, chlorhexidine gluconate (CHG) bathing, capping hubs and scrubbing them for all uses, minimizing the frequency of accessing the line, assessing patency, and educating patients as appropriate for the ICU setting. ICU maintenance includes securing the line properly to prevent tugging, keeping the drainage bag below the level of the bladder and off the floor, as well as CHG bathing and perineal care.

Outcome

The ICU has seen a downward trend in CLABSIs and CAUTIs since 2019. As of September 2023, the ICU has had zero CLABSIs and CAUTIs year-to-date and it has been a full year since the last infection. This marked improvement in metrics is not only due to the standardization of rounding and proper device care and maintenance but is also a direct result of the efforts of our ICU clinical nurses. The reduction in CLABSI and CAUTI rates is a product of the tremendous work of our nursing and medical teams, as well as unit leadership.

This past summer, the nursing and pharmacy departments collaborated to bring a series of interactive and informative sessions to our frontline nursing teams. The program was initiated to foster collaboration between pharmacy and nursing to improve patient experience scores and quality outcomes. Close to 90 nurses from 27 different departments participated in a total of eight sessions held across both day and night shifts. It was a great opportunity for nurses to step away from the bedside and focus on relevant topics that affect nursing practice, patient safety, and patient experience. The program sessions provided an open forum where many different issues were discussed and clarified such as communication about medications and bar code medication administration (BCMA).

Outcome

The feedback on the education series was very positive, and we look forward to furthering the connection between nurses and pharmacists in other such forums in the future.

Podium Presentations

• Wuerz, L. Presenter, Beating Burnout: Empowering Nurses in 2023 and Beyond. March 2023: Baxter Inc. National Webinar.
• Wuerz, L. Keynote speaker, Beating Burnout: Empowering Nurses in 2023 and Beyond. June 2023: Association for Vascular Access New York Metro Network (AVANY), Vascular Access Education Conference, Flushing, NY.
• Wuerz, L. Presenter, Beating Burnout: Empowering Nurses in 2023 and Beyond. September 2023: Society of Pediatric Nurses and Baxter International Inc. Webinar.
• Wuerz, L. Keynote presenter, Nursing Healthcare Trends. October 2023: Baxter Inc. Advisory Group Meeting.

Poster Presentations

• Katherine Cesario, MA, RN, CWOCN; Danielle D’Alessandro, BSN, RN, CWOCN; Joshua Deal, BSN, RN, CCRN-K, CWOCN; LaVaughn Prevatt, BSN, RN-BC, CWOCN; Allison Salomon, BSN, RN, CWON. Pressure Injury Prevention Bundle Survey: Promoting Accountability on Nursing Units. December 2023: Northeast Region Wound, Ostomy and Continence Nurses (WOCN) Society 2023 Annual Conference, Pocono Manor, PA.
• Debra Guss, DNP, ANP-C; Jill Lombardi, MSN, RN; Lorelle Wuerz, PhD, MSN, RN, VA-BC, NEA-BC; Kasey Jackman, PhD, RN, PMHNP-BC; Ray Gannon, PhD, AGPCNP-BC. Descriptive Study of Brooklyn Methodist’s Healthcare Providers’ Knowledge, Attitudes, and Preparedness in Caring for LGBTQ+ Patients. May 2023: NewYork-Presbyterian Brooklyn Methodist Hospital Parade of Posters, Brooklyn, NY.
• Fehintola Orisamolu, DNP, CPNP; Micaela Dussel, MD; Charles Tyshkov, MD; Sheera Minkowitz, MD, MBA; Revathy Sundaram, MD. Long-Term Management of Stroke in Pediatric Patient with Sickle Cell Anemia, Hemoglobin SC. June 2023: Foundation for Sickle Disease Research 18th Annual Sickle Cell Disease Research and Educational Symposium and 47th National Sickle Cell Disease Scientific Meeting, Fort Lauderdale, FL.
• Tzipora Schwartz, MSN, RN, CPHQ; Mary Gallagher, DNP, RN; Cosme Taipe, MPA, BSN, RN, CCRN-K. RID Project – Removing Indwelling Devices to Decrease Both HAPIs and CAUTIs. September 2023: New York Organization of Nursing Leadership (NYONL) Annual Meeting and Leadership Conference, Tarrytown, NY