Improving outcomes across the lifespan

Nurses treating patient at UCLA Santa Monica Medical Center
Nurses assist a patient with paperwork in Ronald Reagan UCLA Medical Center. (Photo by Josh Sudock/UCLA Health)

Clinical Nurse Specialists (CNSs) are advanced-practice nurses with specialized expertise. In having CNSs as part of the interdisciplinary care team, UCLA Health is able to advance clinical practice using evidence in order to achieve the best possible patient outcomes. 

“CNSs are the subject-matter experts when it comes to patient care,” says Theresa Kirkpatrick, MSN, RN, CCRN, CCNP, CNS, an advanced-practice manager and clinical nurse specialist in the pediatric critical care and pediatric cardiothoracic units. “They help improve the outcomes by looking at the data, looking at current research and working with units that need help with improving their numbers.”

Highlights of clinical nurse specialists work include:

  • Reduced the number of CLABSI (catheter-associated bloodstream infections) 37% across the health care system, from a total of 73 in fiscal year 2021 to a total of 46 in fiscal year 2022; 
  • Reduced the number of CAUTI (catheter-associated urinary tract infections) 25% across the health care system, from a total of 75 in fiscal year 2021 to a total of 56 in fiscal year 2022;  
  • Formed unit-based committees in high-risk units to help prevent HAPI (hospital-acquired pressure injuries);
    Patient with PAC therapy dog
    A patient cuddles a PAC dog. (Photo by Ann Johansson)
  • Reinstated the UCLA People-Animal Connection program to bring weekly pet visits to patients at Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center;
  • Increased integrative therapy visits; and
  • Launched an evidence-based study to determine if the CAUTI risk-stratification tool originally implemented on the pediatric units can be successfully used for adult patients. Kirkpatrick, the lead mentor on the project, says, “The tool was developed to alert physicians to the potential risk of infection based on catheter days.”  

In addition, several CNSs teach classes to improve patient outcomes systemwide, “which has helped decrease our nurse-sensitive indicator rates,” Kirkpatrick says.  

Advancing geriatric care

In 2021, the Institute for Healthcare Improvement (IHI) recognized UCLA Health with its highest designation for excellence in caring for older hospitalized patients: Age-Friendly Health System — Committed to Care Excellence. As the only University of California health system conducting comprehensive geriatric screenings for depression, mobility and function on admission, UCLA Health is continuing its commitment to provide exceptional care for patients age 65 and older.  

In 2022, a team of CNSs and bedside clinicians helped launch GeroBOOST, a report that allows the patient’s primary care physician to view all geriatric screenings completed while the patient was hospitalized. The aim is to "include the patient’s GeroBOOST report and the discharge summary on one screen so the primary care provider can easily see both,” says Tina Mamais, MSN, RN, BC-GCNS, GNP, CNS, advanced-practice manager and geriatric clinical nurse specialist at UCLA Health.

Theresa Kirkpatrick and Tina Mamais
Nurses Tina Mamais, left, and Theresa Kirkpatrick, right, are both involved in efforts to improve relationship-based care and patient wellness. (Photo by Josh Sudock/UCLA Health)

For example, under the risk category of physical limitations, if a patient scores 45 or higher on the Morse Fall Risk Screen, the record would display “high risk for falls.” All positive screenings are displayed in green font to call attention to them. “This will help with continuity across the spectrum,” Mamais says.

Along with Mamais, the team includes geriatric clinical nurse specialists Anila Ladak, DNP, RN, PHN; Lianna Ansryan, MSN, RN, PHN; and Matthew Rieck, MSN, RN-BC, a clinical nurse at UCLA Santa Monica Medical Center.

Work in geriatrics also included:

  • UCLA Health’s fourth annual observance of International Day of the Older Person on October 1, 2022. The theme was Celebrating the Resilience and Contributions of Older Women. Clinicians from the Evidence-Based Practice Council (EBPC) developed posters that were displayed at the entrances of Ronald Reagan and Santa Monica hospitals, the Geriatric Ambulatory Clinic and the Geriatric Adult Psychiatry unit at Resnick Neuropsychiatric Hospital at UCLA;
  • A quarterly EBPC geriatric newsletter is emailed throughout the health system to raise awareness and provide education.

Mamais praises the CNSs and the bedside clinicians with whom she collaborated over the past year. “I’m proud of their contributions to the Evidence-Based Practice Council and helping to put geriatric care at the forefront of UCLA Health.”

Jennifer Karmarkar is the author of this article.

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