2007 Cherokee Inspired Comfort Award Grand Prize Winner – APN Category
Award Nomination
| Recipient: | Margaret Talley, RN, CNS, CWCN-AP |
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| Job Title: | Clinical Nurse Specialist |
| Employer: | Palomar Pomerado Health, Escondido, Calif |
| Nominated by: | Kim Colonnelli, RN, BSN, MA, CAN-BC |
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| Title: | Service Line Administrator for Emergency, Trauma & Forensic Services |
| Employer: | Palomar Pomerado Health, Escondido, Calif. |
Our Nominee is the Clinical Nurse Specialist for Wound Care for the Health District. Nominee took the existing skin team to a higher level by being an expert facilitator, teacher, mentor and role model. She took an existing program to a higher level by encouraging nurses to become passionate about their work, empowering them to be autonomous and to be accountable for their practice outcomes.
In 2003, our nominee discovered that our 2 acute care hospitals had a much higher-pressure ulcer prevalence rate than the national benchmark. We began collecting and reporting the Hospital Acquired Pressure Ulcer (HAPU) data. The indicator target for improvement was our at-risk population. Our nominee began a 1:1 mentoring process with the RN skin team members and by June of 2005 the skin team members were competent to independently perform pressure ulcer prevalence assessment and data collection. They also serve as consultants to their peer nursing colleagues regarding skin care.
Our nominee prioritized her team's activities:
- Team chose a new skin and incontinence product and conduct a large scale education program
- Team worked on accurate identification and documentation of community acquired pressure ulcers
- Modification of computerized charting system to fully capture pressure ulcers during admissions assessment
- Second major education endeavor was for bedside staff to be able to accurately assess skin and stage lesions
- Team co-developed with the Wound Care Center, standardized order sets for pressure ulcer care and system standardization of the wound care product formulary.
By 2006 skin care was a major strategic initiative for our Hospital System's Nursing Division. The skin team had representation from each nursing unit across the district, including acute care, long-term care, and home health. Our nominee introduces new staff to skin care upon hire with skin care basics and NDNQI data presented in nursing orientation. She mentors undergraduate nursing students on-site, and presents in their classroom setting, and also serves as a preceptor for graduate nursing CNS students.
Our nominee had initiated interdisciplinary skin team rounds with the medical staff leader, which includes both acute hospitals as well as Home Health and the Skilled Nursing Facilities. Our nominee has mentored her staff to the point that the rounds are coordinated by a staff RN skin team member; additionally, nursing grand rounds for the skin care has been presented by staff nurses with the mentorship and guidance of our nominee. Skin team members are recognized for their involvement with embroidered lab coats identifying them as professional members of the skin team. Our nominee approaches each individual in a non-threatening way and looks for those "teachable moments". She provides others with the rationale behind why things are being done a certain way and encourages others to get involved so that she may be used as a facilitator. She also has established excellent relationship with physician and other healthcare team members and is frequently consulted by them.
Our nominee works very closely with the Geriatric CNS and Palliative Care CNS for an integrative, comprehensive approach for this patient population. Additionally, she has worked closely with the district CNS team to increase their knowledge regarding skin care practices and innovations.
Nominee has disseminated our program innovations regionally, statewide, and nationally. Her skin team program was recently published in the ANA publication "Transforming Nursing Data into Quality Care". She has also presented at the national WOCN Conference. The district skin team continues to use NDNQI data to evaluate individual unit and aggregate program practices and to make practice changes as appropriate. We are pleased that the percentage of medical patients with hospital acquired pressure ulcers has been reduced from 10% to 3% in 2006 and that we are able to share best practices among our units as well as externally to other nurses.