Amy LaCilento, RN, may have started her career at Hughes Health and Rehabilitation as a nursing student, but now as the nurse supervisor, she’s leading the West Hartford, Conn., facility in developing an aggressive slate of cross-team care quality initiatives.
LaCilento’s first program turned the tables on how heart failure was targeted and monitored. The new program allowed the facility to contribute to care plan improvements in conjunction with acute care sites and to avoid readmissions. Instead of limiting assessments and monitoring to Hughes’ recovering heart patients, the new program screens all incoming residents for heart failure—even the residents coming for rehab after knee surgery. Residents who have been treated for congestive heart failure (CHF) are automatically placed in the 30-day program, but any resident who shows signs of pulmonary or cardiac issues is included as well, regardless of diagnoses upon admission.
“Anyone in the program will receive daily head-to-toe nursing assessments—including weights, lung sounds, vital signs and monitoring for edema. That way, if anything changes, we can initiate an action plan immediately to stabilize them. This could include calling the attending physician, cardiology or APRN to determine approprate interventions.”
Gathering meaningful, comparable clinical data from the moment a resident walks in the door allows caregivers to notice exacerbations early and to provide early interventions, she explains. Working closely with local hospitals has allowed both sides to understand the realm of heart failure better and slash readmisison rates. During the four years the heart failure program has been in place, Hughes has had only four resident readmissions attributable to CHF.
LaCilento insists that the success of the heart health program rests with the entire clinical team and not with her alone. The initiative’s success is part process and part staff training, LaCilento says, noting that all departments at Hughes—even the non-clinical ones—were brought into the effort. “We provided a lot of education for our nursing staff, but we also educated everyone in the facility, including dietary, maintenance and housekeeping. We wanted anyone in the building to recognize the signs and know when to go get a nurse.”
LaCilento and her staff also have partnered with Yale University on several clinical trials, including the relationship between oral care on pneumonia rates and the effects of cranberry supplements on the prevalence of urinary tract infections. All the new learning fosters a sense of contribution and purpose among the clinical and non-clinical staff, LaCilento notes.
Engagement for quality outcomes
Treating cross-team collaboration as the norm instead of the exception helps to engage everyone in the mission of better resident outcomes. “If everyone didn’t get on board and follow the protocols we’ve put in place, it wouldn’t be as effective.” LaCilento’s leadership embodies the spirit of long-term care’s culture change, something she says has been enhanced by the collaboration with local hospitals and home care teams. She credits her director of nursing, Lina Dureza, for being an outstanding mentor and entrusting her to lead this program. “Lina is an incredible role model and I have been extremely fortunate to learn from her vast knowledge and experience,” LaCilento says.
The new emphasis on shared responsibility for readmissions and resident outcomes inspires her and allows her nurses to become more engaged in their daily jobs. “It’s such a difference from when I started in nursing, especially in the last three or four years,” she says. “There was such a separation between nursing facilities, hospitals and VNAs [visiting nurse associations]. It’s really taught us that if we work together as a team, we’re going to get better results.”
LaCilento also believes in making employee morale an active process—including ways to combat staff burnout and care fatigue. She maintains an open-door policy for staffers who need to talk or vent but also encourages her staff to keep a healthy balance between work and the rest of life. LaCilento and the nursing staff participate in local charities such as the Alzheimer’s Walk and host musical programs performed by local school children. On Halloween, staffers bring their children or young relatives to work and parade their costumes for the residents. Monthly events are held for the staff—maybe a treasure hunt for the night nurses or a surprise breakfast for the morning shift. “It’s so important to make the staff laugh once in a while and know it’s OK to take a break,” she says.
Meanwhile, LaCilento and the nursing team are busy planning the care processes and educational materials for Hughes’ next programs: Diabetes, chronic pulmonary obstructive disease and palliative care. They hope to have all three initiatives in place by the fall. The more her nurses learn, the more apt they are to embrace the initiatives and realize that the protocols make a difference for residents as whole people instead of medical cases, she says.
“Starting with a base of education on why we’re doing things is the first step in helping nurses accept the new roles and programs they’re taking on, and to get us to the positive outcomes we want for our residents.”
Read about the other 2015 Long-Term Living Leaders of Tomorrow here.