Quality Corner: St. Michael Avera’s Quality Collaboration

Tyndall, South Dakota is a small town with a population of approximately 1,072 residents. The median age is 50 years or older and many have unique health care needs. St. Michael’s Hospital Avera is a critical access hospital located on the southeast edge of town. This year St. Michael’s will celebrate being a part of the community for 75 years. The hospital has proven to be a great resource for their community by offering services such as emergency, inpatient, outpatient, same day procedures, wound care, retail pharmacy and ambulatory clinic. They recently added Rising Hope counseling services 3-4 days a week by appointment.

They have 3 staff members that work in the quality department. Candice Crownover, RN, DPS has worked at St. Michael’s for over 25 years and with quality over 13 years. Dawn Jensen, RN has worked at St. Michael’s for over 13 years, with 5 years as the Quality Clinical Coordinator. Kalleen Wasson, RN has worked at St. Michael’s for over 10 years and as their Infection Preventionists for 2 years. Together as a team they incorporate quality and infection control with their many other duties including working shifts with front-line staff, employee health, disaster coordinator, trauma registrar, utilization review, assist with outpatient procedures and coordinate discharge planning. They often get pulled in many directions each day and need to be flexible and utilize skills with multi-tasking.

Dawn Jensen, RN (L) and Kalleen Wasson, RN (R)

Kalleen and Dawn often collaborate during daily multi-disciplinary rounding. Their multi-disciplinary rounding includes pharmacy, front-line nurses, physical therapy, provider, CEO, DPS, discharge planner, quality coordinator and infection preventionist. They have found these rounds have brought consistency with patient advocacy and have seen the level of communication improve significantly. During these rounds the pharmacist and Kalleen will discuss appropriate antibiotic utilization based on the antibiotic stewardship guidelines. The team will discuss if probiotics are indicated for prevention of C-diff. Kalleen monitors isolation compliance and completes any necessary audits during this time ensuring patient and staff safety. She also will monitor appropriate catheter usage and the team will discuss when the catheter can be removed to prevent any potential catheter associated infections. Kalleen also monitors any central lines, such as Port/PICC lines, to ensure proper technique with dressing changes and maintenance care. These interdisciplinary rounds have helped the facility address safety concerns by monitoring for potential falls with physical therapy’s input on transfers, ambulation, and independence. The physical therapist can make direct recommendations to the team about the patient’s physical/strengthening needs. The team will discuss outpatient services needed for the patient to be successful in their home environment with potential of avoiding readmissions. During this time a post hospital appointment is discussed to ensure they follow up with the provider 1-2 weeks after discharge. The staff and patients have voiced their appreciation of this multi-disciplinary approach because everyone understands the expectations of each patient and the hospital staff has noticed increased compliance with the goals set for each patient. The pharmacist will review and offer additional education on any new medication and offer compliance packs for home medication administration. These interdisciplinary rounds have proven to be highly successful because the departments work closely together daily to improve the patient’s outcomes. The staff at St. Michael’s have voiced their appreciation for the quality clinical coordinator and infection preventionists by their diligence and dedication to providing quality patient care.

Other duties of the quality clinical coordinator include gathering and monitoring data for the HQIC and MBQIP programs including utilization review every month. Dawn brings concerns to med staff with any patients who use the ED services greater than 3 times in 30 days. She reviews all deaths, admissions, observation hours, inpatient hours, and readmissions to ensure the hospital is compliant with regulatory standards. She does a chart audit on all sepsis patients to ensure the 3-hour sepsis bundle is completed by all staff involved and reports any concerns discussed during med staff to prevent reoccurrence. The work of the quality clinical coordinator is very important as it brings the data together for communication, education, and prevention of incidences.

St. Michael’s Avera infection preventionist includes other duties such as monitoring potential infections via Theradoc that uploads into NHSN. Kalleen reports catheter and central line days along with any reportable infections and diseases. Hand hygiene monitoring is an important part of her role in preventing possible transmission of infections. She does an average of 50 to 60 hand hygiene observations throughout the facility per month. Education is provided immediately with any missed opportunities identified by Kalleen or a secret surveyor. If a catheter is being placed on a patient, Kalleen is called to help monitor and assist to ensure proper sterile technique is performed. This has decreased their catheter associated infections. She audits central line dressing changes on a regular basis when appropriate. St. Michael’s has not had any central line infections for an extended period. Kalleen designed a binder for each patient room to include the following hand hygiene, cough etiquette, community services, hourly rounding, and general information about Avera, helpline resources, and dispensary of hope for medications.

Kalleen also serves as the Disaster Coordinator using EICS and SD Health Care Coalition Partners to ensure quality patient services during an unforeseen incident that may occur in the community. This allows her to educate staff on performing effective and high-quality care during any potential disaster.

The Director of Nursing, Candice Crownover, states “St. Michael’s is grateful to have dedicated staff who consistently put our patient’s health and wellbeing at the forefront of their work. We take a collaborative approach involving staff from across the facility to provide the highest quality of care possible.”

This sentiment is also reflected in the Press Ganey Surveys “I would thank each and every person from all departments at St. Michael’s. The care there is phenomenal.” “Everyone treated me with respect and were so helpful! Wonderful staff! Couldn’t have been happier with their service!”

St. Michael Hospital Avera’s quality collaboration has improved patient outcomes. The staff are very proud of the work they do every day, and it shows in the quality of their patient care.