Generating Evidence for Practice

Here at HCA, nurses are in a unique position to contribute to the body of knowledge that supports nursing practice. Working collaboratively across HCA sites of care, researcher partners collect and accumulate large amounts of data rapidly.

Consistent information systems within the HCA enterprise provide data that further facilitates analysis and learning to help inform and enhance the nursing process and care delivery.

Supports and shares nursing research

The HCA Nursing Research Network (NRN) works to advance and promote evidence-based practice at HCA-affiliated facilities by supporting and sharing nursing research.

In 2010, the NRN sponsored the first virtual research presentation, where nurse researchers at hospitals and facilities affiliated with HCA were invited to share the results of nursing research conducted at their facilities in a virtual presentation format. The virtual sessions are conducted in a web meeting format, recorded and available via the HCA Learning Management System, allowing nurses to attend at their convenience. The sessions provide nurses with continuing nursing education contact hours.

The 2010 session included presentations by four nurse researchers. Each year, the number of nursing researchers submitting abstracts for presentation has grown.

In 2013, two Nursing Research Network Virtual Presentations spotlighted the work of 19 nurse researchers representing 10 different HCA facilities from 6 states. The morning session included studies on the topics of Maternal / Child and Pediatric nursing topics. The afternoon session focused on studies of general nursing topics and care of adult patients.

The 2014 Nursing Research Virtual Presentations included studies conducted by 10 nurse researchers representing 10 different HCA facilities from 9 different states. One study included two HCA hospitals sites in different geographical regions for the exploration of the impact of "no interruption" intervention on safety and efficiency.

In December 2014, the Nursing Research Network Study titled "Validation of the NE1 Wound Assesmsent Tool to Improve Staging of Pressure Ulcers on Admission by Registered Nurses was published in the Journal of Nursing Measurement, Volume 22, Number 3, 2014. This is the first NRN sponsored study to be accepted for publication.

Virtual Presentations Spotlight Work of Nurse Researchers

The HCA Nursing Research Network (NRN) works to advance and promote evidence-based practice at HCA-affiliated facilities by supporting and sharing nursing research.

In 2010, the NRN sponsored the first virtual research presentation, where nurse researchers at hospitals and facilities affiliated with HCA were invited to share the results of nursing research conducted at their facilities in a virtual presentation format. The virtual sessions are conducted in a web meeting format, recorded and available via the HCA Learning Management System, allowing nurses to attend at their convenience. The sessions provide nurses with continuing nursing education contact hours.

The 2010 session included presentations by four nurse researchers. Each year, the number of nursing researchers submitting abstracts for presentation has grown.

In 2013, two Nursing Research Network Virtual Presentations spotlighted the work of 19 nurse researchers representing 10 different HCA facilities from 6 states. The morning session included studies on the topics of Maternal / Child and Pediatric nursing topics. The afternoon session focused on studies of general nursing topics and care of adult patients.

The 2014 Nursing Research Virtual Presentations included studies conducted by 10 nurse researchers representing 10 different HCA facilities from 9 different states. One study included two HCA hospitals sites in different geographical regions for the exploration of the impact of "no interruption" intervention on safety and efficiency.

In December 2014, the Nursing Research Network Study titled "Validation of the NE1 Wound Assessment Tool to Improve Staging of Pressure Ulcers on Admission by Registered Nurses was published in the Journal of Nursing Measurement, Volume 22, Number 3, 2014. This is the first NRN sponsored study to be accepted for publication.

Download Presentations

Using Evidence in Practice

Tools and Resources for Accessing Current Evidence:

HCA nurses have immediate access to resources and references that promote evidence based practice and clinical inquiry. All of these resources area are available from any computer affiliated with the HCA Network. Some also are offered via a smart device or home computer.

  • At least 100,000 literature searches are performed annually by HCA clinical staff using the EBSCO Host Data base. Approximately 30,000 full text clinical articles are obtained from that search annually.
  • Additionally, approximately 50,000 searches are conducted in the New England Journal of Medicine annually with 100,000 articles downloaded or printed from that journal.
  • Annually, over 750,000 pages from Lippincott Procedures are viewed.

The HCA evidence based practice resources are a valued tool for nurses and clinicians. Access to current evidence is fundamental to providing evidence-based care.

VOW to CALL
Improving Sepsis Outcomes

Northeast Methodist Hospital, a campus of Methodist Hospital in San Antonio, TX, has made a commitment to improving outcomes for patients with sepsis outcomes. The Northeast Methodist Sepsis Team includes members from nursing, lab, infection prevention, quality, pharmacy and the medical staff. The Team is coordinated by the hospital Sepsis Coordinator, Susan Holm, BSN, RN.

The Sepsis Team began their work by focusing on the recommendations made by the Surviving Sepsis Campaign, including ongoing patient screening for sepsis and implementation of a bundle of interventions focusing on timely treatment of sepsis.

During a Sepsis Summit held in the summer of 2015, Patricia Cooper, BSN, RN introduced the concept of “thinking sepsis” when assessing each organ or body system. The acronym “VOW to CALL” was introduced to call out the key elements of a sepsis screen, remind the care team to call a Sepsis Alert and to assist in remembering key elements of the Sepsis Bundle.

VOW to CALL

Sepsis Alert

V – Vital Signs
O – Organ Dysfunction
W – WBC’s

C – Cultures x2
A – Antibiotic
L – Lactic Acid within 3 hours
L – Lactic Acid repeat if >2.0

Since introducing the “VOW to CALL”, compliance with implementation of the severe sepsis and septic shock bundle within three hours of a positive sepsis screen has improved. Additionally, mortality rates associated with severe sepsis and septic shock have decreased.

The commitment to reducing sepsis mortality is validated during ICU multidisciplinary rounds and golden hour walking rounds on nursing units. During these rounds, the nurses discuss compliance with sepsis screening on each patient and compliance with implementation of the sepsis bundle.

With focused physician and hospital staff education, a commitment to “VOW to CALL”, and effective multidisciplinary walking rounds, the overall sepsis mortality rate has decreased to 20%. Additionally, the one hour and three hour compliance with implementation of the sepsis bundle has improved.

Congratulations to the Northeast Methodist Team on their continued commitment to improve patient care and outcomes!

Submitted by:
Patrice B. Stark
Director Clinical Outcomes Department
Northeast Methodist Hospital, a campus of Methodist Hospital, Live Oak, TX

The Risk for Resurgence of a Rare Disorder

Since the American Academy of Pediatrics' (AAP) recommendation in 1961, treatment of the newborn with intramuscular vitamin K to prevent vitamin K deficiency bleeding (VKDB) has been the standard of care. There are three variations of this disease: early, classic, and late vitamin K deficiency. Described in the mid-1800's as "hemorrhagic disease of the newborn (HDN)," classic vitamin K deficiency can lead to unexpected bleeding during the first two weeks after birth. Early VKDB of the newborn is an often fatal condition that results from exaggerated physiologic deficiency of clotting factors seen in the first few days after birth. This condition is most effectively prevented through oral or parenteral administration of vitamin K. In contrast, late VKDB is attributable to severe vitamin K deficiency in infants 2-12 weeks of age, and is typically seen in exclusively breast-fed infants who have not received adequate neonatal vitamin K prophylaxis. The rate of late VKDB among adequately protected infants ranges from 4.4 to 7.2 per 100,000 live births.1

Clinical Trials Showed that Vitamin K Protects against HDN

Vitamin K was discovered in the early 1930s and further clinical trials showed that vitamin K protects against HDN. Both parenteral and oral administration have shown efficacy in preventing classic VKDB, yet parenteral vitamin K is most effective against the development of late VKDB with some rare exceptions.1 Vitamin K is synthesized by the bacterial flora in the human intestine; however, there is limited storage capacity. Consequently, patients who cannot absorb vitamin K from the small intestine are at risk for deficiency.2 Newborns have limited stores and limited bacterial flora. They are typically born with immeasurable cord blood concentrations, so they are at risk for VKDB.

History of Vitamin K Studies

Up until the late 1980s, vitamin K administration at birth was mandatory in only five states in the United States. The AAP's statement on the use of vitamin K in the prevention of early and late VKDB was renewed in 1993. However, case reviews continue to lack documented administration of vitamin K to a small but noteworthy percentage of babies at birth. Several reasons have been noted. Declination of vitamin K by parents may stem from awareness of a 1990s study that claimed an association between parenteral administration of vitamin K and a cumulative incidence of childhood leukemia. A follow-up analysis "failed to show a correlation between increased intramuscular vitamin K and the incidence of childhood leukemia or other cancers."1 Subsequent studies draw no clinical relationship between administration of vitamin K to the newborn and childhood cancer. Another pretext behind the refusal is the benefit of exclusive human milk feeding. Small amounts of vitamin K1 (phylloquinone) are known to be present in human milk; however, the concentration of vitamin K in mother's milk of newborns who are exclusively breast-fed would need to increase significantly above a diet that includes portions of green leafy vegetables, some fruits, and soybean oil in order to raise serum levels of vitamin K to provide effective prevention. Moreover, the debate on the concept of the human intestine as a significant source of vitamin K remains. Infant formula is fortified with vitamin K, but not enough to eliminate the risk. Finally, some parents are concerned about the short- and long-term emotional and psychological effects of pain caused by the injection immediately after birth. These concerns, while not supported by science, have certainly gained attention through use of the internet.

Media Helps Highlight the Need

The media has highlighted the resurgence of infant deaths and hospitalizations attributable to neonatal hemorrhagic disease due to lack of vitamin K prophylaxis at birth, forcing healthcare delivery organizations and professionals to take a closer look at their processes.

Within the first six months of 2013, at least four cases of HDN were identified in Middle Tennessee. The infants were admitted for brain or gastrointestinal bleeding. While they all survived, they still face major neurological and developmental challenges.

The Centers for Disease Control and Prevention (CDC) are aware of this cluster of late VKDB and have begun a case study to assess the possibility of other risk factors that may develop as a result of late VKDB in infants.

Strategies to reduce risk of VKDB:

  • Form a committee consisting of Administrative, Medical, Nursing, Quality, Risk, and Legal representatives to discuss parental refusal of vitamin K (as well as other recommended prophylaxis agents).
  • Create an education plan for all providers for neonatal and pediatric care.
  • Align standing newborn order sets with the latest AAP recommendations: Vitamin K should be given within first few hours after birth, 0.5 to 1mg IM.
  • Promote awareness among parents and families of the risks of late VKDB associated with inadequate vitamin K prophylaxis.
  • Provide information to mothers and families of exclusively breast-fed infants on the need for additional research to determine the efficacy, safety, and bioavailability of oral dose regimens.
  • Consider devising a form for declining vitamin K (or other recommended prophylaxis agents) or a process for addressing informed refusal.
  • Document all cases of refusal.

References

  1. American Academy of Pediatrics Committee on Fetus and Newborn (2003). Controversies concerning vitamin k and the newborn. Pediatrics Vol. 112 No. 1 July 1, 2003. pp. 191 -192.
  2. Lippi G. and Franchini M. (2011). Vitamin K in neonates: facts and myths. Blood Transfusion. January 2011; 9(1): 4–9.

Impacting Infant Mortality Through Safe Sleep

The American Academy of Pediatrics (AAP) estimates that before 1992, as many as 6,000 babies would die from Sudden Infant Death Syndrome (SIDS) each year.1 Since the launch of the "Back-to-Sleep" campaign in 1994, healthcare providers and community leaders have made tremendous progress in helping to reduce the incidence of SIDS. In fact, infant deaths related to SIDS have dropped by more than 50% in the United States over the last 10 years. This decline, however, has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death (SUID) occurring during sleep (sleep-related deaths), including suffocation, asphyxia, entrapment, and ill-defined or unspecified causes of death, have increased in incidence, particularly since the 2005 AAP publication "SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for Safe Infant Sleeping Environment."2

HCA's Women's and Children's Clinical Services is engaged in an ongoing effort to identify and deploy resources for hospital-based infant safe sleep education and awareness programs that will assist in achieving the goal of reducing the risk of injury and death to infants while sleeping.

Some of our processes include:

  • Providing accurate and consistent infant safe sleep information to hospital personnel, including medical, nursing, breastfeeding, child birth education, and ancillary staff.
  • Enabling the hospital to implement and model infant safe sleep practices throughout their facility.
  • Providing direction to health care professionals so that safe sleep education for parents is consistent and repetitive.

In some states, sleep-related deaths can impact infant mortality as much as 30%. Infant deaths resulting from unsafe sleep are often attributed to:

  • Infants not being placed to sleep in a crib or bassinette
  • Infants not being placed on their back to sleep
  • Infants being placed to sleep on unsafe bedding or with toys
  • Infants sleeping with other people
  • The caretaker being impaired by alcohol or drugs3

Safe Sleep is Essential

It remains essential to address unsafe sleep and other causes of infant deaths. As physicians and clinicians within our hospitals assess the needs of the infants they care for, they also work to partner with parents and other professionals within the healthcare community to address barriers that may exist in accessing and providing a safe sleep environment upon discharge. In order to continue to impact infant mortality, it is critical to provide this life-saving information about infant sleep safety and to consistently model safe sleep in daily clinical practice.

See what safe sleep looks like


References

  1. Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, DHHS (2006, December). Curriculum for Nurses: Continuing Education Program on SIDS Risk Reduction (NIH Publication No. 06-6005). Retrieved from: http://www.nichd.nih.gov/publications/pubs/Documents/Cont_Educ_Prog_Nurses_SIDS_rev.pdf
  2. Task Force on Sudden Infant Death Syndrome. (2011, October 17). SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics. Retrieved from: http://pediatrics.aappublications.org/content/128/5/1030.full.pdf
  3. Tennessee Department of Health-Division of Maternal and Child Health. (2014). Davidson County Fetal and Infant Mortality Review Program.

Within Arms Reach program gets regional, statewide attention

When Connie Manley arrived as Valley Regional Medical Center's new trauma manager in 2010, she learned falls were a leading cause of injury among patients. Having worked at a Level I trauma facility, she assumed the patient population was adults and the incidents were hip fractures among the elderly. Imagine her surprise when she found the high numbers were largely due to pediatric injuries.

"I began collecting data so we could work on something that would make a difference," says Manley, who teamed up with CNO Holley Tyler to put together a team focused on pediatric head injuries. "I was really shocked by what I was seeing, and knew that we could do something."

At Valley Regional, patients who are 17 and under are considered pediatric. So, the team looked at the total number of pediatric patients, and began to analyze the data. First, the non-head injuries were removed, and then, falls that did not result in head injuries. That left about 1,000 children for the 18-month period being studied. Those injuries were divided into three age categories: 5 and under, ages 6-12, and ages 11-17.

"When we looked closer, we found more than 700 of the 1,000 injuries fell into the 5 and under category, which is referred to as the 'infant' segment," Manley says. "The other groups were a much smaller number, so we focused our attention on this sub-group and developed an action plan."

Prevention becomes focal point

In discussions, hospital staff realized there was a common refrain from parents who were bringing in children after a fall: The child had been left unattended, even if only for a moment, while the parent was distracted. "We felt we could have our biggest impact by preventing those falls, so we called parents who had brought their children in and did more research," Tyler says. "We found that children were falling from furniture, beds, shopping carts and high chairs because they were left unattended. When parents were asked if the injury could have been prevented if they were within arm's reach, they almost always said yes. We decided to call our program WAR, or Within Arms Reach, because it is easy to remember."

For Tyler, the idea was always sound but she wanted data. Once those figures were in front of her, she and Manley set frequent meetings to begin determining what a prevention program would look like, and how information from Valley Regional would find its way to parents and the community at large.

I thought it was a perfect idea

"...because I have a 3-year-old and I know what it's like to turn your back for one minute and they are gone," she says.

Connie Manley, right, Trauma Coordinator, worked with CNO Holley Tyler and many other clinicians to create the Within Arms Reach program.

Working with Dr. Edgar Moncada, the hospital's trauma medical director, Tyler and Manley formed a team that put together some data about preventing traumatic head injury then, worked with Robin Brechot, the hospital marketing director, to create a brochure to be distributed throughout the hospital, at pediatricians' offices, and eventually in the community. In the meantime, Manley presented the team's findings, as well as the brochure, to the Pediatrics Committee of the Governor's EMS and Trauma Advisory Council in Austin.

"They really liked the program, and have released it statewide along with submitting it to regional advisory councils," Manley says. The brochure was published in May 2012, with a regional distribution to healthcare facilities. The Valley Regional staff has ensured that all its clinics have copies of the brochure, and have reached out to local Walmarts and other retailers as well.

It's still early, but so far the data is very positive. "In the first month, head injuries in the targeted age group (age 5 and under) dropped 50 percent," Manley says. "We hope and believe that having this can make a huge impact and keep those babies from falling."

Northwest Medical Center Preventing Maternal Deaths with "Code OB Alert"

Operating a busy and growing Obstetrical Department can be challenging, especially when we have patients who may require more complex care. About three years ago, our facility began experiencing a significant increase in the number of OB emergencies. It became apparent that we needed to treat these cases as we would a "Code Blue." With the full support of our medical staff and executive leadership team, the concept of the "Code OB Alert" was developed. Our investigations revealed that if we could have an "all hands on deck" approach on the front-end and during the event we could possibly prevent unfortunate outcomes. This alert can be called by anyone when a patient or a visitor has an obstetrical emergency, regardless of where the patient is located in the hospital.

Leadership assembled a multidisciplinary team to assess the current process and identify areas for improvement. As a result, the team identified components that needed to be clearly defined.

An OB emergency was defined to include, but not be limited to:

  • Onsite, imminent, unattended delivery
  • Antepartum or post-partum hemorrhage (unstable)
  • Imminent precipitous delivery of a pre-term infant
  • Rapid decompensating of maternal or fetal status
    • Admission to Labor and Delivery with any of the following:
      • Advanced dilation with breech presentation
      • Placenta Previa with active bleeding
      • Suspected abruption placenta (unstable)

OB Alert Procedure

Education was provided throughout the facility on the appropriate procedure to follow when an OB Alert is called. There are two components of the OB Alert procedure:

OB Alert is Called:

First, after the operator calls the OB Alert and the location 2-3 times overhead, the OB Rapid Response Team is activated. Any OB provider, anesthesia, security, and laboratory personnel respond to the nursing unit. Each member of the team has their own role and responsibility. The on-call administrator is also a valuable part of our process, giving special support to families and staff during this stressful time. The entire team includes:

  • OB Director or L&D Charge Nurse - serves as the team leader until the physician arrives. Once the physician arrives, he or she takes on the role of care coordinator. As an example, if this is Post-Partum Hemorrhage (PPH), he or she obtains the PPH cart, clears the hall of clutter and visitors, provides the option of one family member staying with the patient, and acts as liaison with the family to provide emotional support, information, and updates.
  • OB Attending - serves as the team leader.
  • Anesthesiologist - stands by in case the patient needs to go to the Operating Room or needs resuscitative measures.
  • Critical Care Nurse - assists with assessments and preparing medications.
  • Nursery Nurse - transports baby to the nursery so staff can focus on mother.
  • Unit Secretary - does not leave the nurse's station, facilitates the flow of traffic, answers and makes phone calls, enters orders, obtains results.
  • Security - secures the elevator, responds with wheelchair or stretcher if needed, provides traffic control.
  • On-Call Administrator - arrives onsite in order to provide emotional support to the family and staff.

Standby Departments Alerted

Next, specific departments are alerted to standby. Some of the departments include:

  • Blood Bank - to anticipate the need for mass amounts of blood in the event of PPH.
  • Pharmacy - to anticipate stat orders for medications (PPH medications are on a specially prepared PPH cart).
  • Main OR - to anticipate the transfer of the patient for surgery.
  • Radiology - to anticipate stat ultrasounds or any interventional radiology.
  • Laboratory - to anticipate any stat testing needed.
  • Respiratory - to draw arterial blood gases (ABGs) if needed.
  • Neonatologist or Pediatric Hospitalist - available to support infant

Success Rate!

Since putting this policy in place two years ago, we have not had any OB-related deaths, though we have utilized our process numerous times. We have been able to drastically reduce the time it takes to respond to OB emergencies. After implementing this policy, we have seen a 50% or greater reduction in new obstetrical claims. The facility is very aware and supportive of the policy as we hold mock codes quarterly.

Strong staff support ensures continued success of HCA's Influenza Patient Safety Program

Since 2009, HCA has offered flu shots to employees and their household members. Now, with new reporting requirements and an additional focus on patient safety, it's time for everyone to be more aware of the program, and how to participate successfully.

"Two years ago the National Healthcare Safety Network (NHSN), a component of the Centers for Disease Control and Prevention, required hospitals to report influenza vaccinations of employees and non-employees," explains Scott Cormier, CHEP, NRP Director, Emergency Preparedness & Management. "So we revamped our system to give us the capability of tracking employees and non-employees (physicians, contractors, volunteers, students or dependent healthcare professionals) who work any portion of one day in the hospital between Oct. 1 and March 31 of any given year."

Beginning in fall 2014, ambulatory surgery centers, long term acute care hospitals and inpatient rehabilitation units also will be required to report flu vaccines for persons who fall within these classifications.

HCA is well positioned because its tracking system already covers those facilities. Even so, a concerted effort among employees to have the vaccine is our goal, and that means dealing with people who may not be enthusiastic about vaccination due to a lack of understanding or misinformation.

Explaining away myths

"It's been a very difficult year for vaccines as far as preventable diseases in the United States," Cormier says. "There have been outbreaks of pertussis and measles because some people aren't compliant about voluntarily getting public health vaccines like they did in previous eras. It's sometimes confusing for people to sort through information they read in the newspaper or see online about the safety of vaccines. As healthcare professionals, we can provide clear information about vaccine safety and effectiveness, and we are committed to doing so."

Questions about vaccines that often arise include whether or not the vaccine causes flu, or whether the vaccine should be given if the person has an egg allergy. Answers to these and many more questions are in the Emergency Preparedness section on Atlas, Cormier says.

"That information is helpful not only when talking to friends and family, but also in discussions with other clinicians who may not have all the facts," he says. "The data is really stunning. One study of a nursing home (not an HCA facility) showed that 40 percent of employees carried the flu virus within their bodies, but had little or no symptoms indicating they had it. When you get the flu, you can spread it for 24 hours before you even get symptoms. That's important for us to know, because we are concerned about patient safety, and if we are coming to work sick we can worsen their conditions."

Additional safety measures

"We want to keep our patients safe, but also our staff," Cormier says.

Some HCA employees, usually around 5 percent, are unable to receive a flu vaccine or decline to receive one based on their religious beliefs or for some other objection. Under the Influenza Patient Safety Program, these people are required to wear a mask if they are within six feet of patients or work in specific areas such as patient hallways, nurses' stations or registration desks. All employees are advised to stay home when they are sick. These steps, along with segregating patients exhibiting flu-like symptoms, work with vaccinations to help reduce the virus' spread.

"We want to keep our patients safe, but also our staff," Cormier says. "We encourage everyone to visit Atlas and learn more about the flu-tracking program, as well as the effectiveness and safety of the influenza vaccine. All employees and non-employees should also be using the Influenza eForm to record their consent or declination decision, or to upload proof of receiving a flu vaccine from a third party.

The flu season and tracking time period, begins October 1st, and ends March 31st. The start date for employees and non-employees who are to wear a mask is November 3rd, 7:00am local time.

Culturally Competent Care Efforts Improve Patient Experience

Above all else, HCA is committed to providing guidance, knowledge, and access to resources needed to "treat all those we serve with compassion and kindness." Given the ever-shifting demographics of the U.S. population, healthcare providers face unique challenges and opportunities in their commitment to ensure equal access to safe and quality care for all.

Cultural competency requires a profound and ardent commitment to our patients, their families, and our communities. The most significant opportunities in the delivery of quality service and care are in the areas of language, culture and literacy. Working and learning together, we are confident that we can provide every patient with culturally competent care, defined as: the ability of healthcare providers to understand and respond effectively to the cultural and linguistic needs of patients.

In response to this imperative, HCA has developed the enterprise-wide Culturally Competent Care, or C3, initiative. Building new tools and resources to better assess, understand, adapt, and apply new approaches and techniques that will improve communications within our workforce, better serve our patients and enhance our communities, says Sherri Neal, Vice President of Cultural Development and Inclusion.

"Many of our facilities are grappling with how to meet the growing needs of our communities, and we are providing the roadmap to assist with creating an inclusive culture," Neal says. The C3 resource guide, which is housed on Atlas, is one of the tools developed to assist in this learning process. In addition, a new video series, webinars and podcasts will be made available.

"The Joint Commission recently began adding standards around language services and patient- centered communications. We now have language service providers not only helping us to improve communications with patients, but who have also made vital documents, such as our notice of privacy practices, viable in more than 15 different languages," says Neal.

Neal says more than 112 languages were spoken at HCA facilities in 2013. "That's pretty amazing, and why we have made language services such a priority in the last few years," she says. "Now we are working on all the other aspects of culturally competent care to ensure our patient care is a quality experience for our diverse patient populations."

The Committment of Cultural Competency

Cultural competency requires a profound and ardent commitment to patients, their families and communities:

  • Know your demographics.
    The best way to pursue cultural competency is to know the cultural context in which you serve.
  • Identify a champion(s).
    Every great movement requires a leader. Who will champion your cultural competence initiative?
  • Develop and execute.
    Identifying a strategy that is unique to your facility/office and the community you serve is key.
  • Reflect and revise.
    Cultural competence is not an end point, but rather a concept that is constantly shifting depending on your organization's needs, and your plan should reflect that.
  • Be proud!
    Share your successes (and challenges) to help others along their journey.

Nurses Practicing at HCA Facilities have Access to these Online Tools:

Medline Complete and CINAHL Plus with full text access

A Web Link is available on most clinical workstations connected to the HCA Intranet allowing nurses immediate access to the EBSCO Host data base. EBSCO provides access to a large library of online medical and nursing literature. The HCA Subscription includes access via IP address recognition when connected to the HCA Intranet, and also allows access from outside of the HCA intranet via generic password that is changed every 6 months. Nurses may also access EBSCO via a mobile APP downloaded to a personal smart device and authenticated. Nurses have immediate access to search nearly 10,000 journals searched, with about 30% providing immediate access to the full text article.

Indexes 5,645 titles with over 2300 full text active titles

This product allows search of journals covering topics in life sciences with emphasis on Biomedicine including Medicine, Dentistry, Nursing, Health Care System, Public Health etc.

Cumulative Index to Nursing & Allied Health

CINAHL provides search of over 750 full text journals and 4800 international journal titles for Nursing, Physical Therapy, Social Work, Nutrition, Speech Language, Occupational Therapy and more.

A site license to the New England Journal of Medicine may also be accessed via web link through IP address recognition. User must be authenticated to the HCA network for access. The subscription is not available outside of the HCA network.

Up to Date provides access to the most current evidence-based, peer reviewed information and treatment recommendations, including content for over 13 medical specialties as well as a comprehensive drug database. A web link provides direct access Up-to-date from any HCA-affiliated computer with internet access.

A web link accessed via a clinical workstation or from within the HCA electronic medical record provides access via IP address recognition to over 1600 evidence-based procedures and skills for a variety of patient care settings. This resource has been adopted as the clinical procedure reference / manual at most HCA hospitals. The procedures and skills are described in a step by step method with videos, photos and skills checklists. All Lippincott Procedures are also available as learning events in the HealthStream Learning Management System. The learning events are used to document training and validate knowledge of key topics in the competency assessment process.

Clinical Pharmacology provides nurses with a drug reference data base accessed by IP address recognition via web link. Nurses may access patient education materials, drug identification resources and information to assist in the delivery of prescribed medication to patients.