In 2023, the Maternal Child Health (MCH) Unit achieved significant milestones, including the Baby Friendly Redesignation and the Cribs for Kids National Safe Sleep Certification, proudly earning recognition as a Silver Safe Sleep Hospital.

This accreditation affirms that the MCH team has demonstrated a continued commitment to implementing best practices to support infant safe sleep and reduce the risk of Sudden Unexplained Infant Death (SUID) in the community. This goal was accomplished through multidisciplinary team member training, family/caregiver education, distribution of wearable newborn blankets, and a pledge to maintain the quality improvement initiative incorporating 2022 American Academy of Pediatrics (AAP) recommendations. Being together gives parents more opportunities to learn about normal baby behavior knowing that knowledgeable staff can answer their questions about their baby and breastfeeding.

Outcomes

To continually improve and expand services at NewYork-Presbyterian Hudson Valley Hospital, the MCH team upgraded their Safe Sleep status to Silver in 2023 from Bronze status in 2018. Furthermore, to resume inclusivity and to increase labor support in the community, MCH clinical nurse Jennifer Polk, RN, BSN, has initiated classes for birthing people and partners delivering at NYPHV.

The 2023 Escape Room Competency Days was an experiential learning strategy that promotes teamwork, engagement, and critical reasoning. Teams moved through seven stations. Each station took 30 minutess to complete, with each team opening mystery envelopes, solving clues and puzzles, reviewing policies, watching videos, solving problems presented in case studies, and demonstrating competency using peer-to-peer feedback tools. Once a station was completed, the competency was validated by the station facilitator, managed by the Nursing Professional Development (NPD) team, Infection Prevention team, and RN staff facilitators. Each station block was used to build a team competency tower as a final challenge.

Collaborating with NYPHVH’s Infection Prevention team (Nadia Jagnatnarain MS, RN, AGNP-BC, CIC and Maureen Donohoe MS, RN), the Professional Development team (Barbara Reynolds MS, MA, RN-BC, CPN, Asha Sundeep MSN, RN, CCRN, PCCN and Kathryn Asadoorian MSN, RN, CNOR) designed the Escape room format to focus on teamwork and core principles of infection prevention. The NPD team utilized principles of constructivism and adult learning theory plus the core concepts of QSEN (knowledge, skills, and attitudes) to provide an opportunity for staff (support Staff and RNs) to demonstrate clinical competence and improve clinical performance.

Outcome

Aligned with NewYork Presbyterian’s nursing strategic priority of supporting professional development, the clinical nurse champions facilitated learning by promoting staff engagement and improving critical thinking and knowledge retention.

In “remote settings with no anesthesia equipment”, anesthesia personnel must transport equipment such as the anesthesia machine, monitors, warming devices, and other equipment, as well as anesthetic agents and other medications to the remote location. Potential clinical problems that might require special anesthetic equipment or specific pharmacologic agents must be anticipated. As New York Presbyterian-Hudson Valley Hospital (NYPHVH) continues to expand their Anesthesia Provider services to nonoperating room areas such as the Interventional suites such as Radiology which have expanded the types of procedures that require anesthesia to be given in these areas to provide quality safe care during their procedures, a need to improve the process of medication retrieval and handling in these non-operating room areas was identified.

Chief Nurse Anesthetist, Arif Mohammed DNP, MBA, CRNA, NE-BC, with the assistance of Pharmacy Manager Ben Lukens, PharmD, MBA, BCPS, collaborated on a plan to provide Omnicell services for Anesthesia providers and the medication they would require covering modalities of anesthesia delivered in these nonoperating room areas, as well as drugs that may be necessary or required during an emergency. This would eliminate the need for Anesthesia Providers to remove and charge patients for medications from the Operating Room Omnicell and bring the medications with them to other patient care areas. It also provides the security of having medications immediately available at the point of use rather than relying on transport of medication from pharmacy or having staff obtaining these medications from another area in that department.

Outcome

After implementing multiple Omnicell services throughout the Interventional Radiology suites, the team noted a decrease in medication retrieval and improvement in safety at the point of care. This new process also ensured that a wide array of medication was made accessible if in need of an emergency that ranged from sedation to general anesthetics.

Clinical Nurses in PACU identified a problem with receiving post-operative orders in a timely fashion for patients transferred to Phase 1 Recovery Care. This was also identified as a safety concern for post-operative patients and inconsistent with the recommended standards by the American Association of Nurse Anesthesiology (AANA) of reporting postoperative orders as part of the hand-off report to the PACU Nurses. Clinical nurses Eve Holderman BSN, RN, CPAN, Shannon Cestone, RN, BSN, CEN and Blessy Benjamin-Mammen, RN, BSN, along with the Clinical Nurse Manager Julia Gorman RN,BSN, and Chief Nurse Anesthetist Arif Mohammed DNP, MBA, CRNA, NE-BC, worked with the EPIC Anesthesia team to design and implement an enhancement to EPIC documentation that would facilitate reminders to the Anesthesiologist in charge of each patient if PACU orders were not entered on time. The staff was educated on using EPIC haiku to get alerts and message the Anesthesiologist to place orders.

Outcome

With this improved EPIC enhancement in place and a functional automatic system in place, the standard for continuity of care is met and prevents delays in care.

Publications

Norful, A. A., Brewer, K. C., Adler, M., & Dierkes, A. (2023). Initial psychometric properties of the provider-co-management index-RN to scale registered nurse-physician co-management: Implications for burnout, job satisfaction, and intention to leave current position. Journal of Interprofessional Care, 1-10.

Poster Presentations

Jagnatnarain, N., Warunek, M., Al-Awwad, O., Foley, K., Rosenberg, D., Skariah, M., Jackson, E., Janda, B., Rush, T. A Multimodal Approach To Reduce The Incidence of Healthcare-Associated Clostriodiodes Difficile (C. Diff). 2023: Institute for Healthcare Improvement, Orlando, FL.