ICU nurses showcase their commitment to quality in reducing falls and HAPIs
Pictured above: Amalia Ramos, BSN, RN, and Sheila Kadel, BSN, RN
Nasogastric tube and BIPAP mask-related pressure injury in adult care services
The Adult Services tackled the rising issue of medical device-related pressure injuries with a targeted project focusing on nasogastric tubes and BiPAP masks. Despite a reduction in nasogastric tube injuries from 2022 to 2023, BiPAP-related injuries doubled, signaling the urgent need for standardized guidelines and collaborative interventions. The initiative is spearheaded by the Inpatient Wound/Ostomy Department team — Raisa Pangilinan, BSN, RN CWON, Lindsay Fletcher BSN, RN CWON, Dawn Davis Clinical Wound Associate under the leadership of Charity Shelton DNP, RN, NE-BC.
Led by wound-certified nurses, the initiative united nursing leadership, respiratory therapists, and shared governance councils. For nasogastric tubes, the team introduced the “CLEAN” framework: correct tube positioning, stabilize tube, evaluate area under/tube, alleviate pressure, and note date and time. This evidence-based approach became the cornerstone of updated workflows. Medical-surgical staff received hands-on training to ensure adherence during annual skill days.
In BiPAP care, challenges like opaque foam padding that obscured skin assessments were addressed with a clear gel barrier, selected after collaborative trials with respiratory therapy. This change allowed for real-time skin evaluations while maintaining patient comfort. A new standardized workflow defined the roles of respiratory therapists and nurses, ensuring seamless communication and accountability.
By mid-2024, the project achieved zero pressure injuries for both devices, highlighting the success of interdisciplinary collaboration and evidence-based interventions. With plans to expand regionally, this initiative demonstrates how targeted strategies, teamwork, and frontline engagement can drive sustainable improvements in patient safety and care quality, setting a higher standard for device-related injury prevention.
Project aims to increase exclusive breastfeeding rate at hospital discharge
In 2024, Keshni Lal, DNP, RN, SNIV spearheaded a quality improvement project aimed at enhancing exclusive breastfeeding (EBF) rates at hospital discharge within the Family Birth Center. Focused on implementing uninterrupted skin-to-skin contact (SSC) within the first hour of life post-cesarean delivery, the initiative addressed a significant practice gap affecting breastfeeding outcomes.
Guided by the Plan-Do-Study-Act (PDSA) paradigm, Keshni collaborated with an interdisciplinary team of pediatricians, anesthesiologists, lactation consultants, and nurses to develop comprehensive training and workflows. This included pre- and post-tests, mock OR simulations, and live workflow sessions. By ensuring mothers and infants bonded immediately after delivery, the project fostered early breastfeeding success and maternal confidence.
The project achieved an impressive 85% EBF rate at discharge, surpassing the initial goal of 80%. Furthermore, 100% of eligible mothers and infants experienced SSC in the operating room. These outcomes highlighted the critical role of SSC in supporting breastfeeding success and fostering healthier communities. By prioritizing uninterrupted SSC and deferring non-essential care, the project demonstrated how early bonding supports natural newborn behaviors and long-term breastfeeding success.
Emergency department innovation: Breaking barriers with Ultrasound-Guided IV Access
The Ultrasound-Guided Intravenous (USGIV) Access Program, a nurse-driven initiative in the Emergency Department (ED), has revolutionized care for hard-stick patients by reducing delays in treatment and improving patient satisfaction. Previously, only 14% of ED nurses were trained in USGIV access, leading to multiple unsuccessful attempts that delayed care and caused discomfort for patients. Research shows that USGIV training significantly decreases delays while boosting satisfaction—a challenge embraced by the ED team.
This innovative program is the brainchild of Marta Suarez, BSN, RN, and Vanessa Alvillar, BSN, RN, who collaborated with Jonathan Chen, MD, Supervisor of Medicine, and Ruben Quitoriano, BSN, RN, Clinical Nurse Educator, ANM, to bring it to life. Their goals included training ED nurses in USGIV, standardizing the practice with evidence-based guidelines, implementing a department-wide policy, and ensuring proper supplies for safe and effective IV placement.
Since its inception, 15 ED nurses have been trained, with plans to expand the program in 2025. A comprehensive policy now guides the practice, ensuring safe and consistent application. All USGIV-performing nurses have been signed off following rigorous training, and they assist during night shifts when the Recuperative Skills team is unavailable. Nurses with prior experience were also proctored and signed off, expanding the pool of super-users in the department. Additionally, new supplies, including a variety of catheters and sterile covers, have enhanced safety and efficiency.
Testimonials from nurses and patients underscore the program’s success. Patients express gratitude for fewer pokes and faster care, while nurses share how the skill has boosted their confidence and efficiency. “Many things in emergency care hinge on IV access. USGIV saves time, reduces patient discomfort, and prevents delays,” shared Josh, ED RN.
Research: Finding the third space through gardening
Research: Finding the third Space through gardening: strengthening relationship mutuality and lowering stress in the caregiver and care recipient who has a disabling injury or illness through gardening
Authors:
- Samantha P. Avecilla, MSN, CRRN, CNL
- Katelynn Campbell, CTRS, RTC
- Michelle Camicia, PhD, RN, CRRN, FARN, FAAN
- Anita Catlin, PhD, FNP, CNL, FAAN
Abstract:
Caregivers of patients who experience a disabling condition often experience adverse health effects as a result of their caregiver role. Further, decreasing mutuality in the caregiver/care recipient dyadic relationship has been reported across the trajectory of caregiving. There is strong evidence that illustrates the health benefits of gardening. However, gardening to improve mutuality & caregiver strain and health has not been studied. The purpose of this study is to evaluate the relationship between gardening and mutuality in care recipients (CR) and mutuality, health & strain in the caregiver (CG) post discharge home from an inpatient rehabilitation facility. Participants included patients with a sudden disabling condition and their family caregivers who participated in a gardening intervention and were compared to a cohort of CGs who received usual care and with published benchmarks. A qualitative component of the study explored the lived experience of the CG/CR’s gardening activities. The intersection of quantitative and qualitative findings was evaluated. The pre-post quantitative results revealed 1) CR mutuality decreased, though was higher than a published benchmark, 2) CG mutuality was higher than the published comparison, 3) the CR reported higher mutuality than the caregivers, 4) caregiver strain was 14% lower (favorable) compared to the 2023 annualized facility 90-day follow up data (historical comparison) 5) CG health decreased, though study participants reported 16% better health than the historical comparison, 6) study participants reported 6% better physical health than the historical comparison, and 7) study participants reported 20% better mental health than the historical comparison. The qualitative themes revealed that 1) gardening activities created a sense of CR/CG mutuality, 2) assisted in the recovery process, and provided motivation, 3) allowed growing/eating healthy food, and 4) adaptive tools contributed to success. The quantitative findings intersected with the qualitative findings which revealed gardening provided a positive impact on persons with sudden disabling events and their caregivers.
Empowering nurses to utilize data for change: Acquiring an antisiphon valve to enhance patient comfort and safety
Hospitals can be noisy, disrupting patients’ sleep and affecting their recovery period. Studies have shown that noise in hospitals can lead to sleep loss, which is a particular problem in the adult oncology population at KP Santa Clara. Were noisy alarms often disturbed patients receiving intravenous IV medications.
A new pump introduced at KPSCL caused excessive air-in-line alarms (AIL) leading to complaints from both nurses and patients. Despite various attempted solutions, the problem persisted, significantly impacting patient satisfaction and sleep. However, our focus on improving patient satisfaction and sleep quality provides reassurance about the goal of this proposal.
To address this issue, clinical nurses and nursing leadership identified the anti-siphon valve (ASV) as a promising solution. A literature review highlighted the potential of ASV to reduce the number of air-in-line (AIL) alarms and improve patient satisfaction, instilling hope for a resolution.
Participants: Alia Bana, MSN, RN, CNS, AG-CNS, OCN, GERO; Jennifer DeLozier Smith, DNP, CNS, CPNP PC/AC; Sarah Fried, MHA, BSN, RN, OCN; and Shaowen Zhu, BSN, RN, OCN
Save our planet: Recycle knowledge
Innovation drives change by recycling knowledge and establishing professional governance principles. Evidence-based in-services were implemented for the Patient Care Coordinators to improve transition care. The first in-service provided an algorithm for transitioning workers’ comp patients from hospital to home. This five-minute session equipped coordinators with the knowledge to address care needs and prepare patients for discharge.
Distraction techniques in the pediatric population
Imagine a world where getting a shot or an IV wasn’t such a scary experience for our little patients.
We noticed that many children felt anxious, upset, and even experienced more pain during these procedures. A big reason for this was the lack of fun and engaging ways to distract them.
Our unit’s distraction tools were a bit limited. We dreamed of having a whole toolbox filled with exciting things like bubbles, pinwheels, those cool Buzzy Bees, maybe even some virtual reality headsets. Our Unit Practice Council (UPC) got really excited and did some research to see if distraction could actually help our young patients. And guess what? They found that it could make a big difference.
Our goal was simple: create a more positive and less stressful experience for everyone. And the distraction toolbox has been a huge success in helping our nurses achieve that.
Streamlining care for renal biopsy patients
In 2024, a collaborative effort led by Interventional Radiology (IR) nurses Donna Pon, BSN, RN, and Ana Dubon, RN, along with Imaging Services Director Assistant Director Alven Cheng, PACU nurses Maureen Crehan, RN, CPAN, CAPA, and PACU Nurse Manager Rowena Guarino, BSN, RN, and guided by Care Without Delay Director Sheree Bayeur, MS, RN, BSN, NE-BC, resulted in an innovative workflow for renal biopsy patients. This new process allows patients to recover safely in the Surgical PACU instead of being admitted, eliminating unnecessary hospital stays. By creating a streamlined recovery pathway, the team prioritized patient safety and efficient resource use while maintaining the highest standards of care.
This workflow has significantly improved outcomes for renal biopsy patients, reducing the average length of stay and lowering the risk of hospital-acquired infections (HAIs). Recovering in the PACU enhances the patient experience, resulting in higher satisfaction scores. The collaborative efforts of these leaders and nurses exemplify interdisciplinary teamwork and innovative problem-solving, advancing care delivery and optimizing hospital operations for better patient outcomes.
Published standardizing clinical nurse specialist onboarding across Kaiser Permanente
In 2024, Kaiser Permanente celebrated the success of a groundbreaking initiative led by Dr. Doanh Ly, DNP, RN, APRN-CNS, CRN, SCRN, and a team of Clinical Nurse Specialists (CNSs) from across Kaiser Permanente Northern California. Together, they developed and published a standardized onboarding program for CNSs, now implemented at all 21 Kaiser Permanente hospitals.
This multi-component program addresses challenges such as role ambiguity and inconsistent orientation by offering structured mentorship, preceptorship, competency checklists, and access to essential resources. Designed to support new CNSs during their transition into advanced practice roles, the program ensures a consistent, supportive experience while fostering professional confidence and clarity.
The onboarding program has demonstrated remarkable results, including a 93% retention rate and significant improvements in job satisfaction among participating CNSs. By aligning CNS practice with organizational goals, this initiative has not only enhanced the integration of CNSs into their roles but also contributed to better patient outcomes and system-wide quality improvements. Dr. Ly’s leadership and the collaborative efforts of CNSs across KP exemplify a commitment to excellence in nursing practice, advancing evidence-based care and professional development across the organization. This initiative reinforces Kaiser Permanente’s leadership position in fostering innovation and supporting nursing leadership.