The Joint Commission (TJC) Pain Management Project
Clinical nurses and nurse leaders proactively revised nursing pain assessments, policies and procedures to ensure full alignment with the new Joint Commission pain standards. The Interprofessional TJC Pain Management Project Do It Group (DIG) team, led by Julie Jacobsen, BSN, RN, CCRN, Intensive Care Unit Clinical Nurse, completed a thorough review of all nursing pain assessments, policies and procedures at Goshen Hospital. The team made multiple revisions, based on evidence and new standards.
One important revision was the addition of a functional pain assessment. This assessment focuses on the patient’s ability to complete routine tasks such as walking, feeding themselves, getting dressed, etc.
It also determines whether the current level of pain is impeding the ability to function. Patients actively collaborate in the assessment to set realistic, measurable and understandable goals of care related to function.
Another key revision increased pain screenings for all patients. Patients who report having pain receive a full pain assessment. The group focused on improving education about non-pharmacologic measures to reduce pain, as well as safe use of opioid and non-opioid medications when prescribed. Other revisions included improved patient education on safe storage and disposal of unused opioid prescriptions.
Smoke Evacuation in the Operating Room
Electrocautery is routinely used in the operating room to minimize bleeding during surgical procedures. The process produces surgical smoke that contains toxic gases. It is important to remove these gases from the abdominal cavity during laparoscopic procedures. Removing them from the air is also essential, as these gases can be harmful to Colleagues when inhaled.
Nurses in the operating room spearheaded efforts to decrease risk to both patients and Colleagues from inhaling surgical smoke. Nurses, surgical technicians and physicians trialed a variety of smoke evacuation products and identified a product that is effective in eliminating surgical smoke. Colleagues implemented use of the new product in 2018, decreasing exposure and minimizing risk for all in the operating room.
Development of the new Meditech Expanse electronic documentation system was an enormous undertaking in 2018. Clinical nurses were at the forefront of improving the way information is documented and processed in the new system. Many nurses transitioned from their primary clinical roles to new positions on the Meditech team in 2018.
Clinical Nurses on the Meditech Expanse build team include:
- Heidi Stoffel, BSN, RN, OCN, Clinical Nurse – 2 North
- Kathy Turco, BSN, RN, CEN, Clinical Nurse – Emergency Department
- Celia Impey-Delagrange, BSN, RN, CEN, Clinical Nurse – Emergency Department
- Michelle Lambright, BSN, RN, Clinical Nurse – Care Coordination
- Dianne Hogan, BSN, RN, RNC-OB, Clinical Nurse – Circle of Caring Birthplace
- Lindsey Swinehart, BSN, RN, RN-BC, Clinical Nurse – Medical Surgical
- Linda Young, BSN, RN, CAPA – Clinical Informatics
- Lisa Smith, BSN, RN, Clinical Nurse – Day Surgery
- Amy Culp, BSN, RN, CNOR, Clinical Nurse – Operating Room
- Brenda Toews, BSN, RN, RN-BC – Meditech Core Team
- Barb Stutzman, BSN, RN, RNC-OB – Meditech Core Team
- Shelly Rubo, RN – Meditech Core Team
Nurses on the Meditech team brought proposed new processes and documentation updates to the Professional Practice Council, Professional Development Council, and Informatics and Electronic Documentation Committee. Clinical nurses on these councils and committees provided additional feedback and valuable insight as a basis for the changes.
Representatives from Navin-Haffty, our consultants on the Meditech project, were impressed with the active involvement and commitment of Goshen Health Colleagues throughout the Meditech build.
Bedside Report in the Emergency Department
Laverne Moore, RN, BSN, CEN, Clinical Nurse in the Emergency Department (ED), recently completed her Bachelor of Science in Nursing at Goshen College. She spearheaded an evidence-based project as part of her degree completion requirements. Following review of the evidence, Laverne brought the proposal to begin bedside report in the Emergency Department to nurses in the Unit Practice Council (UPC).
The UPC reviewed evidence-based practices using the DIG process. The literature identified that bedside report can improve nurse satisfaction with report and have a positive impact on patient safety. The UPC approved the proposal to begin bedside report, implementing it in April 2018. Data collected from ED nurses prior to implementation and 60 days post-implementation showed an overall increase in satisfaction after bedside report was implemented.