Exemplary Professional Practice

Image of Roxy Phung, RN
Los Gatos Acute Rehabilitation staff preparing mocktails. Pictured from left: Kevin Chuang, RN; Joanne Landicho, RN; Lele Zhang, RN; Sandra Riise, RN; Juli Yamansaki, RN and Alex Tungol, RN

Increasing Hydration in Acute Rehabilitation Center

Bridget Samano, RN, led an initiative to increase oral fluid intake in the Acute Rehabilitation Center in Los Gatos.

Nurses on the unit discussed increasing fluid intake among their patients in an effort to decrease urinary tract infections (UTI) and reduce orthostatic hypotension and the risk of falls. After a review of recent literature, Bridget worked with the Unit Partnership Council to implement a "Mocktail Hour" each evening, serving infused water to the patients. Post-intervention data was reviewed in March 2019 and indicated a 10% increase in fluid intake among patients.

The unit will continue working on ways to increase fluid intake even more in the future.

Championing Early Hand Expression of Colostrum for Neonates

Evidence demonstrates that hand expression of colostrum in the first hours after birth can increase breast milk production. Labor & Delivery and Neonatal Intensive Care Unit (NICU) nurses partnered in an interdisciplinary initiative to introduce early hand expression of colostrum for mothers of infants admitted to NICU.

A number of nurses became champions for the initiative and helped teach concepts and techniques to their colleagues, and develop education for mothers.

The team began measuring improvements in the percentage of mothers hand expressing colostrum, the time interval of hand expression after birth, and the delivery of the colostrum to NICU so it could be given to the infant. In the first six months of practice, there was a 68% increase in the number of mothers hand expressing colostrum in the first hour post-delivery.

Mountain View NICU early hand expression nurse champions
Mountain View NICU early hand expression nurse champions (from left): Jennifer Ereno, RN; Laurie Stricklin, RN; Laura Haseldon, RN; Ellen Keohane, RN, and Suzanne DeSandre, RN

Alysse Zrebski, RN, utilizing new tools for violent/aggressive patients in the Emergency Department
Alysse Zrebski, RN, utilizing new tools for violent/aggressive patients in the Emergency Department

Decreased Workplace Violence Against Nurses

According to the Occupational Safety and Health Administration (OSHA), approximately 75% of nearly 25,000 workplace assaults reported annually occurred in healthcare and social service settings, and workers in healthcare settings are four times more likely to be victimized than workers in private industry.

In the 4th quarter of 2018, the Workplace Violence Committee developed initiatives to decrease the incidence of violence against nurses:

  • Made changes to the electronic health record  —  adding a specific plan of care for patients who exhibit aggressive/combative behaviors, and a flag that appears on the patient list to notify staff of these patients.
  • Patients in the emergency room who exhibit aggressive/combative behaviors are given a different color blanket as a subtle but quick way to alert all staff to use caution when interacting with the patient.
  • Security developed a more formalized way of rounding in departments.
  • Signs are placed outside the door of patients who exhibit aggressive and/or combative behaviors.

These initiatives were implemented beginning in January 2019, and by April 2019 the rate of incidents of violence toward nurses across the enterprise decreased by 64%.

Workplace Violence Indident Rate for Nurses graph