Exemplary Professional Practice Archives - Page 2 of 7 - Kaiser Permanente Northern California 2024 Annual Nursing Report

Family Birth Center: Cesarean section rate reduction

The objective of this project was to reduce the C-Section Core Measure PC-02 from 24.8% in the Safety Priority Index (SPI) year 2023 to 23.9% by the end of the 2024 SPI year. This goal was successfully met with a final Core Measure PC-02 rate of 22.3%. A root cause analysis identified several factors contributing to the high C-Section rate, including inconsistent adherence to the American College of Obstetricians and Gynecologists (ACOG) guidelines, variations in Fetal Heart Rate interpretation, and insufficient dissemination of committee updates and supportive labor techniques among staff.

To address these issues, the Family Birth Center implemented several changes. These included intermittent auscultation, outpatient dual ripening, and the creation of a Safe Birth Checklist. Additionally, a monthly Interdisciplinary Fetal Strip review was initiated to standardize strip interpretation. The Supporting Vaginal Birth Committee developed “Position of the Month” posters and hosted Spinning Babies workshops to educate staff and providers. A Birth Circuit was also introduced to encourage movement during labor, improving fetal lie and descent.

These interventions collectively contributed to the successful reduction of the C-Section rate, demonstrating the effectiveness of targeted strategies in improving maternal and fetal outcomes.

Throughput improvement in the emergency department

We are excited to announce the launch of the Low Acuity Throughput Improvement Project. This initiative aims to enhance the care experience for our patients aged 18-42, who frequently visit our emergency department (ED) with less severe issues (classified as Emergency Severity Index (ESI) 4 and 5). It was identified that compared to regional data our patients aged 18-42 with less severe issues experienced long wait times in our Vacaville Emergency Department.

Abby Geiger, RN Staff Nurse III and co-chair of our Emergency Department Experience Committee proposed a solution to expedite care for these patients. Her innovative idea was to establish a dedicated evaluation chair, allowing low acuity patients to be seen promptly, even when all Rapid Care beds are occupied. A Rapid Care physician would then assess them and swiftly order necessary treatments.

Abby collaborated with doctors, nurses, and administrators to create a new system, train the staff, and monitor the project’s progress. Weekly meetings were conducted to gather feedback and make necessary adjustments. Several nurses volunteered to help oversee the new process and ensure it achieved our objectives.

For patients without additional tests like lab or radiology orders, our goal was to reduce their stay to less than 60 minutes. Before the project, only 20-25% of these patients were seen within this timeframe. Following the implementation of the new system, this improved to 43%.

Introducing a wellness room designed by frontline staff using evidenced based practice: Caritas Zen Room

The Ambulatory Surgery Unit (ASU) team demonstrated a commitment to RN wellness by actively engaging in an Evidence-Based Practice (EBP) process. Leveraging the art and science of nursing, they developed an SBAR and project plan that prioritized RN well-being while integrating the principles of Caring Science – specifically, Caritas processes – into their intervention.

The team proposed the creation of a dedicated meditation room. This tranquil space would serve as a quiet retreat for staff, facilitating relaxation, stress reduction, and improved mental health. By embracing Watson’s Human Caring Theory, the initiative aimed to foster a caring environment where staff could prioritize self-care and support each other.

Enhancements

The Zen Room will serve as a dedicated space for relaxation and meditation, aimed at reducing stress and anxiety among health care providers. Equipped with calming essentials, the room will create a soothing atmosphere conducive to mental rejuvenation. By promoting self-care and emotional balance, the Caritas Zen Room aims to improve staff morale, foster stronger team relationships, and ultimately enhance the quality of patient care. Studies have shown that meditation has healing effects and is effective in stress reduction, the promotion of self-healing, while building trusting working relationships.

Testimonials

“The Zen Den has been a relaxing retreat from a stressful day. Having a room for a mental break to focus on myself is an option I’ve never had available in my workplace. It has provided quiet time during a busy day that I am grateful for. The room is clean, smells great, and has a relaxing atmosphere. Thank you to the team that envisioned this space for all of us to unwind and take care of ourselves which helps us provide better care for others.””

—Ashley Silva, RN, Dublin ASU – Recovery

“I am so thankful for the opening of our Zen Den here in Dublin. This is the first time in 21 years with Kaiser that we have actually had a room to ‘chill’ in. After a particularly busy day, I was able to sit and relax in the Zen room. In 15 min I actually fell asleep to the calming music, the dimly lit room and a super comfortable recliner chair. It recharges me every time I use it, and I have encouraged others to take advantage of it as well. Thank you, Angeli and Kaiser for this relaxing zone that is much appreciated.”

—Kelley Brandley, RN, Dublin ASU – Recovery

“I appreciate the Zen Den for its accessibility so I can use it during my breaks. I do stretches and exercises to avoid workplace injury.”

—Jeffrey Wilson, Sr. Surgical Tech, DUB ASU – Outpatient Surgery

“I love it. It is quiet. Having soft soothing music and dimmer lights would be great.”

—Maryann Quebral, RN, Dublin ASU – Outpatient Surgery

“Room smells nice, Chairs are comfortable, good for a nap.”

—Ryan Stormes, RN, Dublin ASU – Outpatient Surgery

Corner of the new zen room with a lounge chair

Redesigning communication boards: A nurse led intervention

In 2024, we discovered something exciting. Our patient population had grown to include a much wider variety of medical conditions. This presented an incredible opportunity for our unit to embrace innovation while staying true to evidence-based practice (EBP).

We started with a simple yet impactful change: relabeling the communication boards from “What do you want from us?” to “My Goal.” This subtle shift immediately made things feel more patient-centered, and we were thrilled with the results.

To further enhance this approach, we embarked on a redesign of our communication boards. Our goal was to create a board that truly reflected the “My Goal” concept and aligned perfectly with EBP.

To ensure a smooth transition and maximize the impact of these changes, we prioritized staff education. By empowering our team with the knowledge and tools to effectively use the new boards, we aimed to cultivate stronger patient-provider relationships and create an even better patient experience. We’re so excited about the positive impact these changes will have.

1 North Unit Base Council members

Alcasabas, Sophia, BSN, RN
Alesna, Lerma, BSN, RN
Fowler, Jacquelyn, BSN, RN
Frenklakh, Kathryn, BSN, RN
Hakimzada , Zohra, BSN, RN
San Pedro, Melvin, BSN, RN
Zhao, Jiaxin, BSN, RN

Nurse handing a newborn to mom as dad looks on.

Creating safe spaces in maternity care

Lawonda Brown-Lucas, DNP, RN spearheaded the Equity, Inclusion, and Diversity (EID) Committee while serving as a frontline nurse in the Family Birthing Center (FBC). Her commitment to fostering a compassionate and inclusive environment led to meaningful discussions on unconscious bias and its impact on maternity care.“

The most impactful thing we’ve done is create a safe space for people to acknowledge their racial biases and ask questions,” Brown-Lucas reflected.

These discussions, enriched with teach-ins, book readings, and terminology examples, empowered clinicians to confront stereotypes and gain cultural understanding. Topics like mental health trauma’s influence on pregnancy care showcased the committee’s forward-thinking approach.

After her promotion to FBC Manager, Brown-Lucas entrusted the leadership to Roseanna Ainsley, BSN, RN, SN III in January 2024. Under Ainsley’s guidance, the committee continues to create judgment-free spaces where participants can share experiences, reflect, and challenge biases collaboratively. The group remains focused on advancing professional growth and ensuring more inclusive and compassionate care.

The EID Committee’s work is transformational by fostering empathy, improving patient-provider connections, and addressing disparities. Its impact reaches beyond individual clinicians, reshaping maternity care delivery with equity and understanding.

Our Professional Practice Model: The foundation of nursing excellence

At Kaiser Permanente South San Francisco, our Professional Practice Model (PPM) is more than a framework—it is the foundation of how our nurses deliver exceptional, patient-centered care every day. This dynamic model reflects our commitment to evidence-based practice, collaboration, and continuous innovation. Rooted in our hospital’s mission and values, the PPM empowers our nurses to lead with clinical expertise, uphold the highest standards of quality and safety, and advocate for the well-being of every patient and their family.

This year, we saw remarkable examples of our nurses embodying the principles of the PPM. Through shared decision-making councils, nursing teams were critical in implementing new protocols and innovations to improve nursing quality indicators (e.g., Hospital Acquired Pressure Injuries, Falls, etc.) and patient satisfaction scores. Interdisciplinary collaboration flourished as nurses partnered with physicians, therapists, and social workers to ensure seamless care transitions. Our mentorship initiatives also thrived, fostering professional growth and supporting our newer nurses in developing critical skills and confidence to succeed in today’s complex healthcare environment.

The adaptability of our PPM continues to shine as we face the ever-evolving challenges of healthcare. Whether adopting cutting-edge technologies or spearheading community outreach programs, our nurses exemplify resilience and a commitment to excellence. This year’s accomplishments reaffirm the PPM’s role as a guiding light, ensuring patient outcomes remain at the heart of everything we do. As we celebrate these successes, we look forward to new opportunities to innovate, lead, and provide unparalleled care for our patients and community.

Elevating care in the OR with Association of periOperative Registered Nurses guidelines

OR nurses Josie Mangarin, BSN, RN and Miranda Wyatt, RN, CNOR are active members of the Association of periOperative Registered Nurses (AORN). Their commitment to ongoing education and evidence-based practice directly enhances patient care and safety.

Mangarin demonstrated leadership in maintaining normothermia to prevent Surgical Site Infections (SSIs). By implementing and reinforcing AORN guidelines on active warming devices and prewarming techniques, she ensured that patients at risk of hypothermia were effectively managed throughout the perioperative period. Her collaborative approach with the surgical team and multi-modal warming strategies, including warming blankets and fluid warmers, played a key role in reducing infection risks and improving patient outcomes.

Wyatt successfully implemented AORN’s Sterile Technique Guidelines to reduce environmental contamination in the operating room. Recognizing the impact of door openings on room pressurization and airflow, she encouraged the team to open the door when necessary and minimize movement around the sterile field. Additionally, she worked with perioperative leadership to install door swing counters, which tracked door openings and helped raise awareness about their potential effect on maintaining a sterile environment. This initiative improved infection control and fostered a culture of vigilance and adherence to sterile technique.

These examples highlight nurses’ vital role in ensuring high-quality, evidence-based care. Their involvement in professional organizations enables them to stay informed on best practices, advocate for patient safety, and lead improvements in clinical outcomes, further solidifying their indispensable contribution to the healthcare team.

Nurse with an educational table about delirium

Innovative approaches to delirium prevention

We are proud to highlight Sherie Domingo, BSN, RN, for her continued leadership in preventing and reducing the duration of delirium in patients. Last year, Domingo developed the Delirium Prevention and Care Cart, which was introduced across SSF. This innovative initiative provides nurses with non-pharmacological tools to help reduce delirium in at-risk patients.

The cart includes a range of evidence-based items designed to support cognitive and sensory needs, such as sensory aids (eyeglasses, hearing amplifiers), cognitive stimulation tools (puzzles, drawing materials), fidget devices, music therapy tools (headsets for calming music), and occupational therapy aids (finger exercises, adaptive devices).

In addition to the cart, Domingo has continued to lead education efforts on the Confusion Assessment Method (CAM), ensuring nurses are equipped to diagnose delirium and implement effective interventions. Her ongoing training has empowered nurses to apply non-pharmacological strategies, confidently promoting high-quality, evidence-based care.

Domingo’s work has made a lasting impact on both patient outcomes and nursing practice. As she continues to lead this initiative in 2024 and beyond, her dedication ensures that clinical nurses are equipped with the resources and knowledge necessary to deliver the best possible care to patients at risk for delirium.

CALM Initiative aims to minimize delirium risk

The CALM Initiative is a project by the NICHE committee, who collaborated to create a bundle of interventions to minimize delirium risk in patients 70 and older on the 4th floor.

The focus was on clustering care, assessing alarms, offering calming items such as essential oils, eye masks, herbal teas, ear plugs to help improve sleep quality, reduce interruptions during sleep, and prevent delirium symptoms over three months. NICHE committee nurse champions for this project were Anecia Mayes, BSN, RN; Febe Rios, BSN, RN; Happy DePalma, BSN, RN.

Red meat allergy in the OR

Romel Jimera, MSN, RN, CNOR, perioperative nursing professional development specialist, partnered with the perioperative team to ensure a safe surgical environment for a patient with an anaphylactic allergy to red meat.

Using evidence-based practice, the team reviewed medications, supplies, and equipment and ensured that everything used for the procedure was safe for use on this patient, which led to a successful procedure in the operating room team.

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