Ramona Baucham, Ph.D., M.S.N., MSORD, RN
Director, Magnet Program & Research Department
UT Southwestern Medical Center
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 is regularly disseminated.
UT Southwestern’s Nursing Research Program has two strong components 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.
Nursing Research Team
Linda Denke, Ph.D., M.S.N., RN, CCRC
Nurse Scientist
Magnet Program & Nursing Research
Teresa Phan, MSHCH, MSITM
Research Manager
Magnet Program & Research Department
Haley Bush, B.S.
Clinical Research Assistant
Manuel Sosa, M.S.E., M.S.F.
Senior Data Analyst
Nursing-Led Innovation and Research
The Neuroscience Nursing Research Center (NNRC) opened in 2013 and is dedicated to ensuring that nurses at all levels are able to provide vital research contributions to the science of caring for patients with 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
Director
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 2022, NNRC nurses had a fantastic year with 41 publications, one book, and 29 abstracts presented at 12 conferences, including three international conferences, six in different states, and three virtual conferences. There were seven publications with an NNRC first author and 18 with an NNRC last author. One of the major publications was the American Association of Neuroscience Nurses Core Curriculum (7th edition). The AANN Core is the No. 1 reference book for neuroscience nursing, and UTSW nurses were the strongest publishing team in this edition. With 13 different UTSW nurses as authors in the book, our teamwork and strong presence clearly shows that UTSW is a key force in telling the world how care should be delivered to patients with neurological or neurosurgical conditions.
The 2022 Neuroscience Nursing Research Center Fellows
Shannon Chalk, B.S.N., RN, CCRN-CMC, NE-BC
SICU
Thanh “Alice” Cubria, B.S.N., RN, CMSRN
ASU/EMU
Peggy Fairchild, M.B.A., B.S.N., RN, CPN
Assistant Nurse Manager, UH Clinic PMR
Mary Hoth, B.S.N., RN, PMHN-BC
Psychiatry
Clara Dohee Kwon, B.S.N., RN, CCRN
NSICU
Toniqua Richardson, AGACNP-BC, FNP-C
Physical Medicine Rehab
Collaborative Research
The UT Southwestern Division of Nursing had lofty ambitions in 2022 and continues to expand nursing research to every nurse in every patient-care setting and every nursing specialty throughout the organization. The division’s accomplishments include various disseminations of research to the general public via publications, presentations, abstracts, and posters. Nursing research at UTSW continues to expand through academic partnerships with Texas Christian University (TCU), Texas Woman’s University (TWU), and the University of Texas at Dallas (UTD).
UT Southwestern’s Nursing Research Fellowship program prepares 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 departmental/unit-level/organizational goal to enhance patient care and build the nursing body of science.
As part of the fellowship, the fellows submit a Clinical Ladder letter of intent and participate in the Nursing Research Fellowship Track. The fellowship and track together are designed to build research-intensive workplaces and to provide the skills and capacity at the unit level for nurses to pay it forward by mentoring and inspiring more nurses to think differently, ask the right questions, and pursue research.
The 2022 Nursing Research Fellows
Tanya Farmer, B.S.N, RN, OCN, CCRP, CBCN, BHCN (left)
Ramona Baucham, Ph.D., M.S.N., MSORD, RN (right)
Mentor
Marina Hoffman, M.S.N., RNC-OB (left)
Mentor
Taryn Wiles, M.S.N., RN, RNC-OB, C-EFM (right)
Anna Zita Magdalena Alayon, B.S.N., RN, CNOR (left)
Linda Denke, Ph.D., RN, CCRC (right)
Mentor
TED Talks at Magnet: How Nurse Educators Captured a National Audience
During the second wave of COVID-19, a team made up of two unit-based educators – Katie McInnes, B.S.N., RN, and Emily Pickett, B.S.N., B.B.A., RN – was tasked with providing annual continuing education on heart and lung transplant topics to the nursing staff on 10 Blue and 9 Blue. The two nurses had noticed an increased amount of stress and an overwhelming, shared feeling among colleagues that they had less time to absorb knowledge from long-form presentations.
The traditional conference format consists of around eight 50-minute lectures at an all-day event. “Given the state of our tired, stretched-thin nursing staff and the fact that we had both sat through these long seminars, we knew we had to do something different,” Ms. McInnes said. She and Ms. Pickett sought additional research to support their theory that long-form seminars might not necessarily be the most effective. They discovered knowledge retention is reduced after the first 10 minutes of a lecture and students’ attention during lectures tends to wane after approximately 10-15 minutes (Bradbury, 2016).
They recalled reading an article about why TED Talks are so impactful. “TED” stands for technology, entertainment, and design. The talks are short speeches designed to share “ideas worth spreading.” Presenting information in a mostly nontraditional way, the talks are typically creative, innovative, and often funny. The team’s goal was to replicate the TED Talk idea with transplant education. They called their version “TEDUTSW”:
T - Transplant
E - Education
D - Discussion
The team’s plan came together quickly around this new format. They selected speakers from a variety of colleagues – physicians, physical therapists, transplant coordinators, surgeons, nurses, music therapists, and patients themselves. Each speaker chose a single topic related to heart or lung transplantation and kept their presentations to 18 minutes or less. The “TED” theme became a recognizable hit, and the nurse duo submitted their “TED”-themed idea for a podium presentation at the annual Magnet conference.
“We had an incredibly positive response during the Magnet presentation,” Ms. Pickett said. “We took the entire allotted time after the presentation answering questions from nurses from hospitals all over the U.S. and some foreign countries, as well.”
The team eagerly shared the educational goals reached and feedback with the Magnet audience, demonstrating how they, too, could create a more engaged staff at their own facilities through the TED approach. They also noted how the cost for nursing education was effectively cut in half since their units at UTSW moved from full-day to half-day seminars using the TED Talk format.
“We told the audience that success stories sustain the drive to continue this difficult job,” Ms. Pickett recalled. “Nurses walked away reenergized and connected to providers over their shared mission.”
Work cited: Bradbury, NA (2016). Attention span during lectures: 8 seconds, 10 minutes, or more? Advances in Physiology Education, 40(4), 509–513. doi.org/10.1152/advan.00109.2016
Automating Flu Vaccinations and Improving Inventory Tracking
Tracking flu vaccinations by logging information on paper might sound behind the times in the digital age, yet until relatively recently it was still being used in the clinic setting. Ambulatory clinical leadership at UT Southwestern decided 2021 would be the last year paper would be used to track this process and strategized a way to eliminate manual inventory tracking. The Ambulatory Operations team discovered a tool that could be leveraged for automating the management of clinics’ annual flu vaccine stock. The Lot Manager activity within Epic, UTSW’s electronic medical record system, allows for clinics to view inventory and balance history, and it automatically updates the balance based on administrations. In addition to eliminating the need for paper logs, Lot Manager will populate a vaccine’s NDC, lot number, and expiration date in the medication details, reducing opportunity for error in documentation.
The success of this automation process is the result of a multidisciplinary team, including Ambulatory Operation nurses, ambulatory clinical educators, clinical workflow informaticists, and members of the pharmacy team. In addition, the Ambulatory Epic team assisted with tipsheets and demonstrations for clinic leaders. As a result of this initiative, the pharmacy team now updates Lot Manager with the specific flu vaccine lots received prior to distributing them to the clinics. Clinic leaders can then update their storage unit with their flu vaccine inventory, eliminating the need for clinic nurses and certified medical office assistants to sign out each vaccine prior to administration.
Streamlining Stroke Patient Care Plans from Clements to Zale Rehab
Nurses care for stroke patients in both the acute and post-acute phases. As treatment plans were handed off to the next phase of caretaking – from short-term plans to long-term plans – it was becoming evident that patient handoffs were not seamless, especially from a vascular neurology perspective. Thus, two small workgroups began identifying viable solutions to improve the handoff between care teams.
The work groups identified that by modifying the discharge template to include in-depth discharge instructions geared toward each patient, as well as concise details for the rehabilitation team, acute and post-acute goals became clearer to all parties. The details provided to the rehabilitation team on the new template include start and stop dates of antiplatelet agents, anticoagulation medications, and other medications that need to be administered within specific time frames. The new template also includes patient-specific blood pressure and percent rate reduction over time for both primary and secondary stroke prevention. As a result of this initiative, rehab nurses, residents, and faculty have reported a better understanding of the plan of care. Importantly, patients and their families also have reported better understanding of their long-term plan of care due to the stroke education reinforced at the time of discharge from the hospital.
Using Color Codes to Identify a Leader During Code Blue Events
During a code event, a timely response increases overall patient safety and health outcomes for patients experiencing cardiopulmonary arrest. According to evidenced-based recommendations from the American Heart Association, a clear role designation of the leader during a cardiopulmonary arrest (a code event) is crucial to create an organized and timely response in the crisis. The high-reliability team works to close all patient safety gaps such as leader identification during a code. The team developed a phased approach to guide nurses and the interdisciplinary team to quickly organize during a code to improve the team’s response.
The project's first phase took place in all resuscitation events in inpatient hospital units outside the ICU. In Phase I, two different visual identifiers were tested to determine which was more effective in clearly identifying the code leader. Based on responses from stakeholder surveys, a red bouffant hair cover was selected as the more effective visual identifier over a bright green sticker labeled “Leader.” In Phase II, the use of the red bouffant to identify the leader was instituted in the adult Intensive Care Units for use during cardiac arrest events. At the end of both phases, the code leader was identified in less than one minute of arrival in more than 70% of resuscitation events. The early identification of the leader with the visual indicator improved the workflow, thus decreasing confusion that could contribute to delays in treatment and organization of supportive resources. Overall staff satisfaction improved.
The use of a visual aid to identify the leader has become a recognizable standard of practice and will be added to the hospital's Standard Operating Procedures and Policy. In addition, the use of the red bouffant has now expanded to other departments and has been added to all crash carts.
Improving Nurses’ Confidence on Central Line Care on 8 Green
In 2021, 8 Green experienced four central line-associated blood stream infections (CLABSIs) on the unit. CLABSIs are linked to increased and prolonged hospital stays. To improve outcomes, the unit goal was to have two or fewer CLABSIs in 2022. Nurses utilized personal interviews and direct observation of care to help identify potential gaps in knowledge, skill, or understanding of current processes. Action items from the gap analysis included reinforcing education in staff meetings and the development of a tip sheet. The team also initiated one-to-one education with nurses on hand-washing techniques, dressing changes, and the daily evaluation of central line necessity.
New processes were also introduced, including having a second witness for dressing changes, adding a daily chlorhexidine gluconate (CHG) bath to all patients with central lines, and using the Curos tips. After implementation, the current CLABSI rate is 0.00 per 1,000 central line days for quarter two of 2022 and has been maintained below the NDNQI (National Database of Nursing Quality Indicators) benchmark for the full year. A post-implementation survey showed that 90% of nurses are confident following the evidence-based practice changes in central line care and maintenance.
Maintaining Supply Needs and Identifying the Most Efficient Use of Crash Carts
Simulated code events are one resource the high-reliability team uses to increase frontline user competency. Crash cart management is critical to the staff providing medical care in life-threatening emergencies. Concerns about crash carts having adequate supplies and working equipment elevate staff anxiety and affect the workflow of the event. Nurses are part of the multidisciplinary teams who perform walk-throughs to identify needs before these events happen. These teams identified gaps such as needing better visual cues to help in the quick identification of supplies, improving the standardized process for cleaning items after a crash cart event, and removing unnecessary items from the crash cart.
Creating a standardized process improves reliability and reduces the amount of time and labor to clean, replenish, and audit the carts. Increasing the reliability of supply exchange and restocking of utilized carts, trays are now being assembled by a medical supply vendor. The trays are also wrapped so no items are moved in or out of the tray. This requires less time performing equipment checks and more time providing patient care. This standardized process has saved 8,586 personnel hours annually and improved patient safety.
Lowering Readmission Rates with Remote Patient Monitoring for Clinical Heart Failure
Patients recently diagnosed with clinical heart failure (HF) can find themselves returning to the emergency department or even readmitted to the hospital when they are first adjusting to titrating medications. In 2022, a new program allowed for eligible HF patients to participate in a remote patient monitoring (RPM) initiative in which patients were given medical equipment to self-measure daily biometrics. UT Southwestern RNs review measurement readings and perform patient outreach according to prescribed parameters.
A nurse-led team delivered patient education on the use of the provided weight scale, blood pressure monitor, and pulse oximeter. Once the therapy regimen was initiated, nurses contacted patients via multiple modalities for nonadherence to validate biometric readings and verbal assessments. Depending on the assessment findings, care was escalated to the provider and plans were swiftly adjusted. The average adherence rate remained at 70% for patients who completed the prescribed program regimen. The impact while actively participating in RPM on ED visit rates with a heart failure primary diagnosis demonstrated a decrease from the benchmark by 56% to 0.206, and the hospital admission rate increased from the benchmark by 5% at 0.172. At 60 days, the RPM continued to trend below the benchmark.
