Heart failure is the only cardiac disease with increasing incidence and prevalence. It represents 15% of all Medicare hospitalizations and accounts for 40% of all Medicare dollars. In 2004, total direct costs for heart failure patients were $26.7 billion, with an additional $28.8 billion in indirect costs. Heart failure is also lethal accounting for more than 266,000 deaths annually. The 5-year mortality rate approaches 50%, with 70% of women and 80% of men dying within 8 years of diagnosis. Nationally, 23% of heart failure patients are readmitted within 30 days of discharge from admission for decompensation. Our facility rate is approximately 20.3% with estimated un-reimbursed costs of more than $500,000 annually.

Heart failure is the only cardiac disease with increasing incidence and prevalence. It represents 15% of all Medicare hospitalizations and accounts for 40% of all Medicare dollars. In 2004, total direct costs for heart failure patients were $26.7 billion, with an additional $28.8 billion in indirect costs. Heart failure is also lethal accounting for more than 266,000 deaths annually. The 5-year mortality rate approaches 50%, with 70% of women and 80% of men dying within 8 years of diagnosis. Nationally, 23% of heart failure patients are readmitted within 30 days of discharge from admission for decompensation. Our facility rate is approximately 20.3% with estimated un-reimbursed costs of more than $500,000 annually.

The project is being piloted on the PCCU. Patients are screened for heart failure as the primary diagnosis, intact cognitive status and the ability to stand to weigh. If all criteria are met, the patient is issued a solar digital scale for use for daily weights while admitted and for use at home after discharge; patients are encouraged to take responsibility for obtaining their own daily weight and reporting it to nursing staff. At the time of scale distribution, heart failure self-care education is conducted emphasizing the importance/rationale for daily weights.

The project has been underway for nine weeks; 14 scales have been distributed. Four recipients agreed to obtain their own daily weight. There have been three readmissions: 1) Pneumonia (readmit < 24 hrs) 2) Increased edema, chest pain - stents placed 3) Heart failure exacerbation (readmit < 2weeks) There have been no ED encounters among scale recipients,

The outcomes confirm the importance of patient education in behavior compliance and symptom monitoring when living with heart failure.

1. Create an active clinical nurse specialist (CNS) student learning experience to reduce or prevent Ventilator Associated Pneumonia (VAP). 2. Engage CNS students to learn how to change practice by implementing a system change: Research, develop, implement and evaluate the outcomes of a Ventilator Bundle in a small rural institution.

Medical advances save many lives, but good, basic based nursing care such as preventing VAP is more important than ever. VAP, a nosocomial infection associated with morbidity and mortality is costly, preventable, and responsive to evidenced based nursing care. National collaborative initiatives using interdisciplinary teams are addressing VAP prevention. CNS's are an integral part of these teams and CNS students need to prepare for this role.

As part of its 100,000 Lives Campaign, The Institute for Healthcare Improvement (IHI) advocated the use of live-saving interventions (bundles) to reduce or prevent VAP. A senior CNS student implemented the VAP bundle at a rural southeast mid-level facility with a senior BSN McNair Scholar and faculty mentor conducting research on the outcomes. CNS students are replicating the project in small, rural community hospitals.

The education project involves CNS students initiating a change in small, rural community hospitals to reduce or prevent VAP. The CNS students conduct site assessments, research 'best practice', develop interdisciplinary partnerships to establish consensus on a ventilator bundle, implement and evaluate patient outcomes.

1.NNIS risk index rate decreased from 9.85% to 2.67% 2. CNS students effectively integrate the role with active learning experiences that produce improved patient outcomes.

CNS students developed change agent, team building, and mentoring skills by actively implementing this transformation to 'Best Practice'. The implementation of the ventilator bundle achieved significantly better patient outcomes and was an effective tool to demonstrate the ability to change practice.

The concepts and process can be applied to facilitate learning and be effective in any improvement effort.

The purpose of this study was to identify what question registered nurses consider the most effective when screening for IPV in an emergency department setting.

Two to four percent of female patients seen in hospital emergency departments (ED) throughout the United States are victims of Intimate Partner Violence (IPV). Women are more likely to tell a stranger about their abuse than someone with whom they have an ongoing relationship, and direct questioning increases the likelihood of reporting by four-fold.

This was a cross-sectional, descriptive survey. An 11 question survey instrument was distributed to 68 registered nurses who work in the ED at a non-teaching, Level 3 trauma center in Southwest Houston, Texas. Nurses were asked to rank order the questions.

Questions were chosen based on a literature review which included items from the Abuse Assessment Screen that was created by the Nursing Research Consortium on Violence and Abuse. The questions ranged from broad ('Are you safe at home?') to specific ('Have you been hit, slapped, kicked, or punched by a significant other.

A total of 25 surveys were returned for a response rate of 36.8%. Four surveys were unusable. The question ranked as the most effective was 'Are you in a relationship with a person who physically hurts or threatens you?' with a mean rank of 3.16. This finding is consistent with the literature as victims do not generally perceive themselves as being 'beaten' and prefer the term 'physically hurt' when referring to their abuse. The question ranked the least effective was 'Do you feel isolated by your partner?' with a mean rank of 8.47. Questions that ranked lowest used such terms as 'isolated,' 'controlled,' and 'afraid.'

Emergency nurses have an important opportunity to identify victims of IPV and to intervene with ecommendations for appropriate follow-up care. In addition to screening for IPV with effective questions, the emergency nurse may be able to open a dialogue with victims who may otherwise be reluctant to disclose their history.

Consistency in screening with the most effective questions may help implement appropriate interventions and lessen the morbidity and morality rates among victims of IPV throughout the United States.

To increase the number of staff who hold nursing specialty certification, thereby creating an environment of nursing excellence for patients and staff at Virginia Commonwealth University Health System (VCUHS).

Certification is an objective, measurable way to ensure that a professional nurse has the knowledge to practice competently within his or her specialty. Given the complexity of health care and the increasing specialization of nursing practice, certification assures the public of expert knowledge and clinical judgment and increases patient confidence. Employers gain a skilled work force dedicated to career development and patient care, leading to greater job satisfaction and retention.

VCUHS values nurses pursuing professional certification as a demonstration of specialized knowledge and expert clinical judgment. To support the VCUHS nursing strategic plan, a nursing certification task force developed strategies to promote nursing certification, including the removal of potential barriers that may hinder nurses from seeking certification.

A group of Advanced Practice nurses met to develop strategies to change the organizational culture so that it supported staff nurse specialty certification. Strategies were also developed and implemented at the department and unit level and outcome data collected to document the impact of the change.

At the unit level, in January 2005 none of the staff on an acute care unit were certified. By January 2006 67% of eligible RN staff had taken the certification exam and 53% had earned the CMSRN designation. RN turnover rate decreased from 21% to 8% and the RN vacancy rate decreased from 8% to -6% in the same time frame. The unit was recognized by Professional Research Consultants, Inc. as having attained one of the highest patient satisfaction scores in the nation. At the organizational level, having certified nurses assisted in attaining the designation as an excellent organization for nursing practice by ANCC Magnet Recognition Program in February of 2006. In addition, nurses who attained certification reported the experience as providing for valuable personal growth and increased feeling of satisfaction as a professional nurse.

Organization, department and unit-based initiatives to support staff certification had a positive impact on staff and patient outcomes.

Advance Practice Nurses working at all levels of an institution can change organizational culture to support nursing specialty certification. As a result, barriers to certification can be overcome and staff and patient outcomes improved.

Describe a collaborative research study examining the effects of staff education and behavioral interventions on hand hygiene adherence and unit-acquired infection rates.

Clinical Nurse Specialists are responsible for promoting patient safety across the health system. Hand hygiene is the simplest, most effective way to prevent nosocomial infections (Pittet, 2001) and has been identified as a Patient Safety Goal for JCAHO. Previous studies have reported hand hygiene adherence rates varying from 20-80% among healthcare workers (Larson et al, 2000).

Clinical Nurse Specialists collaborated with nursing faculty, staff nurses and nursing students to design the study. A quasi-experimental design examined the effects of education paired with two types of behavioral interventions on hand hygiene adherence.

Three medical-surgical units participated in the study. One control group and two experimental groups were randomly selected. The CNS facilitated baseline and ongoing collection of hand hygiene observations using the Hand Hygiene Assessment Tool (KR = 0.94). Each group completed a self-study hand hygiene educational module. Experimental group 1 received behavioral interventions of individual/ group rewards for improved adherence. Experimental group 2 received a behavioral intervention focusing on the risks of non-adherence with hand hygiene. Hand hygiene adherence and infection rates were monitored for six months following the interventions.

A total of 1203 hand hygiene observations were analyzed using a Z-test. Experimental Group 1 had significant change in hand hygiene adherence after education (p =.01) and sustained improvement in hand hygiene adherence over six months compared to control group (p =.03). The Control Group and Experimental Group 2 showed no statistically significant changes in hand hygiene adherence over six months. No correlation was identified between unit-acquired infection rates and hand hygiene adherence.

Education paired with positive reinforcement improves hand hygiene adherence and impacts clinical practice. The study limitations included non-equivalent study units, higher baseline adherence in control unit and a non-concealed observation method.

Clinical Nurse Specialists are collaborating with the Manager of Accreditation to implement system wide education and positive reinforcement strategies to improve hand hygiene adherence.

Nurse leaders at our tertiary care facility developed a strategic plan to advance nursing practice through the implementation of Chulay's unit based research (UBR) program. In this model, bedside nurses are supported to ask questions about their practice and to conduct research studies as a method of improving patient care.

The critical elements of the UBR model include: 1) active nurse involvement, and ownership of the research projects; 2) group research projects, rather than individual projects; 3) a research mentor who guides the UBR teams through the research process; and 4) research projects that focus on important clinical practice issues.

Clinical Nurse Specialists (CNS) serve as research mentors for UBR teams in their area of clinical expertise. Using classical group facilitation skills, the CNS assists a group of unit nurses to identify common and important patient care issues or problems.

The mentors assist the UBR team to develop a research protocol, navigate IRB, complete data collection, analyze study data, and report their findings to internal and external audiences. Since most clinicians are not experienced researchers, the mentor's role is to accompany the UBR team on their research journey and to assure that ownership of the research project remains vested with the team.

Of critical importance is the ability of the CNS to adapt research methods used when conducting academic research projects so nurses employed in acute care are successful in completing research. Chulay's development of CNS knowledge and skills in guiding UBR teams on their research journey is a major focus of this UBR program. 8 units are involved in the UBR model. Four have received IRB approval for their protocols and are collecting data.

Nurses in UBR projects are: 1) expanding communication, writing and clinical inquiry skills; 2) increasing clinical knowledge; 3) taking responsibility for their practice; and 4) gain a high level of recognition for their research efforts.

The UBR model can be adapted in any acute care setting with adequate research mentor support. One UBR project will be presented in detail.

1)To describe a patient model which incorporates the advanced practice nursing (APN) role and interventions of the Clinical Nurse Specialist (CNS)for high risk, complex patients. 2)describe clinical, cost/financial and process/system outcome measures for patient status and a health care system.

Increased chronic illness, expansion of technology, shorter lengths of hospital stay and complexity of care have resulted in constant change and challenges for health care delivery.

Demand to control rising cost of health care and changes in reimbursement to a fixed payment system necessitate provision of the most cost effective quality care.

A patient model was developed by the author for high risk, complex patients. This then lead to the identification of intervention foci directed at antecedents of perception, coping, supports, function and individual context (attitudes, beliefs and values)within the patient/family illness trajectory. The need and value of the APN in the role of CNS addressing multiple ethical issues and personal experience with specific integrative therapies in clinical practice is incorporated.

Research outcomes have been identified, as well as application of the patient model, with a CNS as clinical case manager for high risk complex patients with congestive heart failure. Measurement of clinical, cost/financial, and process/system outcomes have been delineated as measures of patient status, potential CNS role outcomes, and impact on the health care system.

Advocacy for the value of the advanced practice CNS for high risk complex patients and a challenging imperative quality-cost health care system is extremely important. The CNS a) role can be described, b) interventions and foci can be delineated and C) potential impact on clinical, financial and system outcomes can be identified.

The APN role of the CNS and potential impact is extremely valuable in our health care system. Advanced practice CNS activities, services, interventions and impact need to be described. Key potential aspects for the role of the CNS in health care include a) quality improvement and b) the development and measurement of clinical, system and financial outcomes for health care.

We assessed the hypothesis that a randomized group of cardiac elders, coached by peer advisors (PA), would be significantly more likely to adhere to medical recommendations and less likely to be re-hospitalized than cardiac elders not assigned to the intervention group.

Unmarried elders, over 65 years of age, lack in-home partner support and have poorer health outcomes post-MI and CABG than elders who are partnered. Provision of peer support from another elder who has suffered the same cardiac event may provide sufficient coaching and enhanced self-efficacy to improve adherence and decrease cardiac re- hospitalizations.

Unmarried patients (n= 247) were enrolled and randomized while hospitalized post-MI or CABG in 5 U.S. university medical centers. Subjects assigned to the treatment group were matched with another older person who had been trained by Advanced Practice Nurses (APNs) to be a PA. Data were collected at 6 weeks, 3 months, and 1 year after the cardiac event. Measures included the MOS General Adherence 5-item scale and questions pertaining to re-hospitalization. Data were analyzed using linear mixed model analyses and generalized estimation effects logistic regression.

Subjects were 65% female; 61% were CABG patients; 80% were retired; 9% were minority; and mean age was 76 years (range=65-101). Subjects in the intervention group were significantly more likely to adhere to medical recommendations at 1 year after the cardiac event than the standard care group (p=.011). Although there were no statistically significant differences between the control and experimental groups for the re-hospitalization binary variable, more standard care subjects were re-hospitalized for complications at 6 months after the cardiac event than were intervention subjects.

Unpartnered cardiac elders benefit from a low technology, low cost intervention by peer advisors even 9 months after conclusion of the intervention. However, the intervention does not appear to influence re- hospitalization rates.

Clinical Nurse Specialists provide expert care to patients with complex conditions and advance the practice of nursing in a variety of ways. Our practice is consistently targeted toward achieving quality, cost-effective patient focused outcomes across three spheres of influence: patient, staff and system.

The NACNS statement on CNS Practice and Education mentions cost-effective care at least ten times. But what does quality, cost-effective care mean? What does the CNS need to know about the cost/quality equation? This presentation will answer those questions.

A 489 bed community hospital instituted the role of Clinical Utilization Specialist to guide the implementation of the Clinical Utilization Program. Clinical Utilization is a standardized, structured, coordinated, interdisciplinary process of resource acquisition, allocation and expense management and results in safe, high quality and cost effective patient care. The role was filled by an expert CNS with over 16 years of experience, primarily in critical care.

This presentation will provide an overview of financial outcomes related to the practice of a CNS. It will include the definitions of the types of costs usually applied in the healthcare setting. In addition to costs understanding the reimbursement side of health care is important for the CNS to understand. An overview of the DRG based payment system in included. Understanding these principles help to bring focus to understanding the outcomes related to quality cost effective care. The CNS recognizes that changes to either quality or cost can significantly impact the other component. Examples of completing a DRG analysis with emphasis to improving the quality of care and the resulting impact to cost will be provided.

The program started by looking at approximately 25 different DRGs and identified a goal of reducing the cost of care by $1.5 million. Over the next three years this program expanded the focus to over 50 DRGs and has successfully reduced the direct cost of care by over $19 million.

The role of the CNS as been instrumental in leading various teams throughout the organization to achieve this success.

The importance of understanding financial outcomes is key to demonstrate the impact of the CNS role.

The purpose of this assignment was to provide students with the opportunity to apply change and business concepts learned in class when speaking to organizational leaders. A second purpose was to document the value of CNSs to area hospitals.

CNS students entered the program with a good understanding of the patient and the nursing spheres but not the organizational sphere. As adult learners, this student assignment provided application to the organizational sphere. In addition students needed to learn to demonstrate CNS impact. The cost benefit analysis provided both.

NACNS has identified competencies for CNS students that include Background/Rationale (Clinical) assessing problems and documenting the impact of CNS practice. This assignment helped students to meet both of those competencies. By sharing information with the organization on finances, the impact of CNS practice is documented.

In the final CNS role course, students performed a cost benefit analysis at their clinical site. In the assignment students explained why this issue was chosen, which spheres of influence were affected, and listed outcomes to be measured. Also included was a table of costs and expected savings in dollars. A summary report was sent to VPs of Nursing and CEOs by the college describing the student projects and the savings incurred.

Originally students were apprehensive about this project but on completion voiced how much they learned and the importance of learning this skill. Many of the students' preceptors were excited about the information they received from this project. One preceptor worked with the student in order to learn how to do cost benefit nalysis. The potential savings for the seven projects was $9,303,200 and the actual savings of the four implemented projects was $293,700.

The cost benefit analysis taught students to assess problems and document the impact of CNS practice within the organizational sphere. The cost benefit analysis taught students to assess problems and document the impact of CNS practice within the organizational sphere. The report sent by the college to the organizations demonstrated that CNSs are cost effective.

The NACNS recommends competencies CNS students need to master. This assignment helped students to assess problems and document the impact of CNS practice. It also resulted in positive public relations for the College of Nursing.

This paper describes a required capstone course for all advanced practice students (Nurse Practitioners, Clinical Specialists in Adult, Family and Psychiatric/Mental Health concentrations) in evidence-based clinical research.

Clinical specialists must utilize evidence-based findings as part of clinical decision making and yet students often lack the skills needed to close the gap between finding evidence and utilizing it in clinical practice. This requires the ability to carefully evaluate the literature and develop self-learning skills.

Preparing clinicians who can evaluate clinical guidelines and create policies that keep abreast of current evidence is an important mandate for graduate nursing education today. Issues of geographic variation, cost containment and patient values and preference are import variables to be considered before recommending one intervention over another.

The author will outline the method of instruction, provide examples of projects created and disseminated by students from past semesters and discuss experiences from the past four years. A unique component of the course is the peer group/support which will be explored.

Advanced Practice nurses must be able to efficiently sift through the glut of information in order to decide what is valid and useful for their patients and their practice.

Teaching evidence based research in a creative way can both provide knowledge to students and pave the way for future utilization of clinical research during their career once in practice.

Clinical specialist students need to be offered an alternative to the traditional thesis in order to prepare for their practice reality.

Describe the impact of Institute for Healthcare Improvement central lines bundles in decreasing central line infection. Discuss methods created and implemented for the utilization of these bundles at a metropolitan medical/surgical critical care unit.

Implementation of Institute for Healthcare Improvement bundles in the critical care environment have improved central line outcomes.

Elevated central line infection rates necessitated a root-case analysis and implementation of evidence-based practice standards.

National Institute of Health Services (NIHS) benchmarks were utilized. Initial data was gathered about the nature of central line infections via a Central Line Audit Tool. Interventions based on this audit included the initiation of an Insertion Safety Checklist and the development of a Central Line Necessity assesment tool.

Eight months without a central line infection and a decrease in unnecessary lines (based on criteria) from 12% to 1-4%.

Institute for Heathcare Improvement guidelines, when utilized in creative ways specific to an institution's culture, can improve outcomes.

CNSs must assess and integrate national guidelines into the existing practice environment.

The purpose of this project was to determine if post fall assessment and interventions recommended by an Advanced Practice Nurse (APN) are associated with a decrease in the repeat fall rate.

Patient falls are one of the most common adverse events that occur in acute care hospitals. While assessment of high risk factors can decrease the overall fall rate, it seems not to have an impact on repeat falls.

A review of inpatient and rehabilitation patient falls over a three-month period at an acute care hospital revealed that between 18%-49% of patients had fallen more than once during the hospitalization.

All acute care patients were assigned to an advanced practice nurse for a post fall assessment utilizing a document developed by the project team. All participants received advanced education on patient falls that emphasized risk factors for falls, fall prevention/protection interventions, and physical and environmental post fall assessment. Items reviewed included demographic information, location of the fall, and patient activity at the time of the fall, intrinsic and extrinsic contributing factors and medications. Findings and recommendations were discussed with the clinical nurse caring for the patient.

One hundred and sixty-one patient falls were assessed. The repeat fall rate of patients reviewed by APNs was ten percent for the first six months and in the next three months decreasing to zero percent of repeat falls for the patients assessed by the APN showing a statistical signficance.

Assessment by an advanced practice nurse of a fall patient in an acute care setting can decrease the repeat fall rate.

Analysis of the APN recommendations and the characteristics of the patients who fall twice is being conducted to evaluate the current fall risk assessment and prevention program. One trend seen is the time between the initial fall and the repeat fall. Using Clinical Nurse Specialists and other advanced practice nurses can influence patient safety.

This presentation describes a methodology for teaching spirituality content to staff nurses. Questions addressing key components of a spiritual assessment are identified. Strategies for the inclusion of spirituality and religious practices in the nursing plan of care are provided.

Given that spiritual health is a component of holistic health, nursing professionals must address spirituality in order to provide quality patient and family-centered care.

Very few baccalaureate programs adequately prepare nurses to focus on this dimension (Lemmer, 2002) and the topic is rarely covered in any depth by most nursing textbooks (McEwen, 2004). This lack of professional preparation hampers the delivery of quality care. It also has implications which make adherence to JCAHO practice mandates quite challenging.

This presentation describes how a Diabetes Nurse Specialist with a graduate degree in theology has introduced the topic of spirituality and spiritual care to nurses at a large, tertiary care hospital. The differentiation between spirituality and religion is emphasized due to the facility's non-denominational status. Targeted questions that address the various components of spiritual assessment (hope, purpose, beliefs and practices) are provided. The program encourages staff to consider illness as a soul event, one of life's 'marking moments'. Various meanings attributed to a chronic illness diagnosis are discussed. Spiritual tools drawn from different cultures and religions are described.

Participants learn strategies for providing holistic patient and family-centered care. By introducing the concept of spiritual assessment, staff are also given an opportunity to reflect on their own spiritual journey. The importance of spiritual self-care is emphasized, especially its potential impact on professional resiliency.

Staff evaluations have been extremely positive. While the program was initially developed as a continuing education offering, plans are now in place to include it as part of the graduate nurse orientation. A future educational offering on the spirituality of Florence Nightingale is being considered.

As societal health needs continue to focus on various chronic illnesses, nurses must explore ways to assist patients to 'live well' with these conditions. Attention to the spiritual needs of patients is an important key to this success.

This presentation will provide clinical nurse specialists (CNSs) considering doctoral education at the PhD or DNSc level with information about research-focused doctoral programs and issues to consider in selecting and applying to a doctoral program.

Programs offering the Doctor of Nursing Practice (DNP) grant professional practice degrees to CNSs who wish to focus on application and utilization of existing knowledge. However, there is also a critical need for CNSs to be educated at the PhD level to assume the role of independent researcher to generate knowledge that will improve healthcare safety and quality.

Rationale: CNSs who desire to function as researchers seek education from research-focused programs that grant PhD or DNSc degrees rather than the DNP. There are many options for research-focused doctoral education but, finding the best match for the CNS's personal and professional goals can be a challenge. Selection of the optimal program requires a thorough exploration of the varied characteristics of the program, its faculty and an evaluation of the program's fit with personal and professional values and goals.

This session will provide a brief history the evolution of doctoral education in nursing followed by an overview of the characteristics of research-focused doctoral programs. Challenges and opportunities associated with nontraditional classroom settings will be discussed. Factors to consider and activities to undertake to explore the program fit with personal and professional values, goals and learning styles will be reviewed. Common requirements of the application process will be presented. Resources for information and consultation will be shared.

Knowledge of the characteristics of research-focused doctoral programs, factors to consider and activities to undertake in exploring doctoral programs will assist CNSs to choose a doctoral program to fit their personal and professional goals and values.

PhD or DNSc education is an option for CNSs who wish to prepare for a research role. Prospective students are advised to avail themselves of multiple sources of information to help them select a program to match their values, goals and learning style.

Selection of the optimal educational program will promote successful preparation for the researcher role.

1. Identify steps used to develop a Rapid Response Team. 2. Describe CNS role in development, implementation, and evaluation of a Rapid Response Team.

Institute for Healthcare Improvement (IHI) has recommended the Rapid Response Team as one of six initiatives nationwide to enhance safety and outcomes of patients failing outside of ICU. Studies show that early warning signs of physiological deterioration leading to cardiopulmonary arrests are not always recognized by staff nurses.

Rapid Response Teams have been very successful in Australia and United Kingdom for many years. Teams are gaining momentum in America.

CNS's were challenged as leaders to develop, implement, and evaluate a multi-disciplinary Rapid Response Team. The steps followed in the creation of a comprehensive Rapid Response Team initiative were: _ Reviewed literature _ Engaged stakeholders _ Identified patient condition criteria _ Selected system-wide patient and professional development outcome metrics _ Collected baseline data _ Designed process for ongoing outcome data analysis and program refinement _ Developed Rapid Response Team policy _ Modified supporting protocols and standing orders _ Implemented house-wide education and marketing Special emphasis was placed on the critical role of communication. The design included a process for post event debriefing with team and staff nurses and the utilization of a customized Situation, Background, Assessment, and Recommendation (SBAR) communication format.

Three recommended IHI outcomes were measured: percent of codes outside of ICU, codes per 1000 discharges, and utilization of Rapid Response Team. Survival rate at end of codes was also selected. Ongoing professional development of staff was monitored.

During the first two weeks of implementation, the Rapid Response Team responded to twelve calls, transferred two patients to ICU, and sent one back to surgery. No codes were called. Staff nurses reported appreciation for clinical assessment support at the bedside.

The system and outcome focus of CNS's are vital resources for development, implementation, and evaluation of Rapid Response Teams. The involvement of the CNS in the professional development of staff nurses is producing enhanced assessment skills at the bedside in addition to saving lives.

This session will demonstrate the impact of a CNS-led intervention to change the culture in a 55-bed cardiac surgical intensive care unit.

The culture of the ICU is fraught with technology and the overwhelming goal of saving lives, with the underlying presumption that patients want everything done. Families are captivated by massive efforts to save their loved one, similar to the heroic dramas played out weekly on the television, where almost everyone lives. In reality, the burden to save a life at all costs is often too great. Complicating the situation is an unspoken taboo against even considering the possibility that a patient may not survive, or will survive with devastating consequences inconsistent with his or her values and preferences.

Bedside caregivers identified a need for clinically relevant information and skill building regarding their ability to cope with situations where patients' response to surgery was not as hoped.

The CNS for the ICUs, the medical director, and a CNS with expertise in ethics collaborated to develop a four-part series for nursing and medical staff to address the issues encountered in the ICU setting when surgical interventions did not produce the hoped-for results. The series offered an opportunity for practicing the skills needed to have a caring conversation with patients and families to assess their wishes when the plan and goals of care shift.

This program will provide an overview of the development, implementation and outcomes to date for this project, including examples of behavioral changes that altered patient trajectory at the end of life.

Clinical Nurse Specialists are key figures in the development and implementation of change within their practice environment.

Altering the 'way things have always been done' in regards to patients, families, and their expressed or implied wishes is not as easy as updating a technical procedure. But, if a process must be improved to provide better care to populations, it is the CNS who has the innovative skills and passion to bring about the change.

The Portland VA Medical Center Clinical Nurse Specialist (CNS) committee's purpose for this project was to provide healthcare professionals in clinical settings with a process and tools for incorporating evidence into practice using one page evidence based fact sheets (EBFS). The overall objective was to improve outcomes by integrating evidence.

Innovative tools for integrating evidence at the bedside improve patient outcomes.

The PVAMC CNS committee identified that practice across a variety of specialty areas was not always evidence based. Barriers to utilizing best evidence cited by staff included lack of time to review the literature and difficulty interpreting the evidence. The CNS committee wanted a concise method to educate staff and interpret the evidence needed to improve practice at the bedside. When the EBFS concept was shared by another VA CNS, the PVAMC CNS committee believed it would be a helpful tool to target practice issues. Further, the EBFS development process would serve as mechanism to mentor staff in applying evidence.

The CNS committee developed a process for identifying EBFS topics, a standardized template, and instructions for authors that included criteria for evidence, CNS mentorship, and a renewal timeline. Distribution methods and an evaluation tool were also identified, developed, and implemented.

Several EBFS on the following topic areas have been developed: infection control, wound care, and insulin management. One infection control EBFS was used to implement a system wide practice change. The EBFS was utilized as the primary means of educating staff on the evidence based change. As a result, no formal inservices were required. In addition, the EBFS was available for new staff and as a resource when needed. Evaluations of fact sheets have been positive. Staff were initially reluctant to develop EBFS but recently, CNSs have received requests for mentorship on EBFS development.

The EBFS process developed by the committee appears to be useful in bridging the gap between evidence and practice.

CNSs in all practice settings may find EBFS a useful tool to provide staff education and link evidence to practice.

This presentation explores actual and potential roles for the CNS in improving safety and quality in residential long term care (RLTC). Attendees will (1) achieve clearer understanding of clinical, regulatory and organizational challenges facing the CNS in RLTC and (2) appreciate the CNS role in advancing quality and safety in RLTC.

Despite programs enabling more older adults to age in place, concurrent increases in elders requiring complex care suggests the need for RLTC settings will persist. While the value of CNSs in promoting safety and quality in acute care is well recognized, little has been done to capitalize on their expertise in increasingly challenging RLTC settings.

In RLTC settings, major issues related to patient safety (e.g., falls, infections, wandering) and quality (e.g., pressure ulcers, nutrition and hydration, comfort, ADL function, depression) have been identified. Lack of expertise to guide significant change means that improvement strategies are often 'all-purpose,' and poorly designed, implemented and evaluated. Although expected outcomes for safety and quality are clear, achieving results commonly requires complex interventions that encompass the health care system and nursing practice spheres of influence and demand advanced ability in chronic disease management.

The Summer of 2004 marked the establishment of the Ad Hoc Committee on Long Term Care of the NACNS Gerontological Task Force. Committee meetings, conference calls, consultation with LTC experts, and literature review have resulted in comprehensive understanding of the CNS/RLTC interface that informs this presentation.

Analysis suggests individuals and groups outside and within nursing have tended to devalue RLTC practice. Additionally, organizational and regulatory constraints may hinder CNS practice in RLTC settings.

Addressing barriers is essential to advancing the RLTC CNS role. Role elements include: (1) managing residents with complex chronic care and behavioral needs, (2) developing and promoting RLTC competencies for nursing staff at all levels (3) identifying elements of RLTC that justify specialty practice, (4) functioning as leader/change agent in specific areas of safety and quality.

Delineating and promoting CNS role in RLTC is needed to improve cost-effective care, resident safety, quality of care and quality of life.

This study describes a format for teaching CNS acute care, utilizing the Synergy Model and analyzes the outcomes as professional changes are described by the students and graduates after the completion of the course/program.

As the education of the CNS has evolved, the Synergy Model's educational use is not clearly defined. The perceptions of both the teachers and learners are not clearly studied or documented. Therefore the significance of this study is to explore one format of this educational tool and some professional consequences as perceived by the learners.

A qualitative mixed collection technique is utilized for this study. Data is collected from the students and graduate's academic work, research, open written questionnaire, and personal interview. The study is under the ethical approval of the Florida Southern College Internal Review Board. Issues related to confidentiality of information, are addressed. Graduates and students are reassured that no data is included and their names or pictures will not be used without their written consent.

The data will be interpreted using content analysis. Five themes will be sought: (1) Student's reflecting on their connections within the Synergy Model, (2) Aspects of producing clinical connections with the Synergy Model within their written work (3.) Changes in their professional employment/stature and (5) New nursing connections of local, regional or national influence.

This study will increase the awareness of the Synergy Model among practitioners, educators and students. Hopefully it will assist educators to investigate new interpretation of the model and find its personal use to be both reflective and therapeutic in value. The process of studying our own use of this model allows us to step outside the classroom treadmill to better understand, accept and reshape what we do over and over in the clinical-education arena. This study will support an examination of one's experiences as a means of understanding the Synergy Model and its use in the classroom.

The interpretation of the findings of this study should be viewed with caution given the qualitative design and small number of participants. Other studies of outcomes using the Synergy Model are strongly encouraged.

The purpose of this presentation is to provide CNSs with information specific to workplace violence and to promote an appreciation for proactive strategies that may reduce actual and potential violent events. A secondary purpose is to provide an overview of available resources that may be useful to CNSs interested in better understanding workplace violence.

Workplace violence is recognized as an occupational hazard for health care providers, including nurses. The Bureau of Labor Statistics (BLS) estimates that in 1999 there were 2,637 nonfatal assaults on hospital workers. In 2004, there were 551 workplace homicides in the United States, out of a total of 5,703 fatal work injuries (OSHA, 2005). The rate of nonfatal assaults in hospitals is 8.3 assaults per 10,000 workers as compared to a private-sector rate of 2 per 10,000 workers.

Violence is serious and insidious problem yet remains unregulated and is not nationally tracked. CNSs are obliged to consider the risks of workplace violence and galvanize colleagues within the healthcare system to seriously evaluate risks, plan interventions, and develop programs to respond to crises related to violence.

This presentation is an informative overview of workplace violence with specific information related to the healthcare system.

CNSs need to consider strategies for assessing the risk of workplace violence, monitoring the frequency of violent events based upon typology, and developing action plans that respond to violent victimization and meet the needs of employees affected by the aftermath of violence.

Workplace violence is rarely discussed within healthcare organizations. Patient safety is a priority and yet one aspect of keeping patients safe involves assuring a non-violent healthcare setting. CNSs are in an ideal position to exert influence and minimize the risks and damages associated with workplace violence.

There are many factors that contribute to workplace violence and place nurses at risk. Typical interactions with patients, family, and visits are potentially dangerous depending upon the context of the interaction, the stress levels of the individuals involved, and the personal attributes and behavior patterns of each. Nursing is a 'people business' and, as such, carries risk. This risk is compounded by inadequate or nonexistent policies regarding workplace violence. Assaults, particularly verbal, occur between healthcare workers of all types including physicians, nurses, ancillary staff, and multidisciplinary team members. Lateral and vertical violence occur regularly in the healthcare workplace. Hospitals are microcosms of society and, as such, are socialized to violence. Larger economic forces and resource shortages create circumstances addressed through labor downsizing, layoffs and terminations. Workplace violence is a multifaceted event with the potential to increase in frequency and scope. CNSs need to have a basic understanding of the risk for workplace violence in order to intervene in effective, efficient, and meaningful ways.

The purpose of this clinical improvement project is two-fold: 1) to implement a standardized approach to hand-off communications about patients as they move throughout the hospital 2) to improve compliance in using the newly developed hand-off communications form.

Given the complexity of healthcare environments today, staff is challenged to communicate effectively about patients in order to ensure safety. One of the JCAHO 2006 National Patient Safety Goals requires a 'standardized approach to hand-off communications.' given the number of sentinel events that have been attributed to a lack of communication.

A root-cause analysis was initially completed to look at the management of insulin infusions for patients who move throughout the hospital for tests and procedures. A lack of standardized communication was identified as a root cause of issues surrounding the care and safety of these patients. It was also clear that all patients, not just those with insulin infusions, would benefit from a standardized approach to communication.

A CNS-led team designed a hand-off form to standardize communication about any patient traveling off of the inpatient units for tests or procedures. After a four-month pilot on three units, the form was implemented to be used hospital-wide. Forms are collected centrally for compliance data analysis.

Initial findings indicate that staff use the hand-off form on a regular basis and have increased their communication about patients.

Staff have become more aware of the gaps in communication and the difficulties of communicating within such a complex environment. Dialogue has increased about information that is not being communicated about patients. The volume of forms used reflects an added workload for staff completing the forms as well as for those responsible for data entry.

One of the 2006 National Patient Safety Goals requires that hand-off communications must be communicated in a standardized way. Although a written form imposes more work for those completing it and for those doing data entry, it is more efficient and therefore, completed more often than communications given in person or by phone. An electronic version of the form is a future goal

Develop a process for safe handoff of care to meet the National Patient Safety Goals.

Lack of a standardization process for communication among healthcare providers leads to untoward patient outcomes.

Joint Commission of Accreditation of Healthcare Organization regulations require a standardized hand-off communication between healthcare providers. Lack of processes and communication related to patient care lead the CNSs to put together a task force to further investigate concerns regarding patient outcomes.

A task force, led by the CNSs, was formed and the steps of the nursing process were utilized in changing the organization's culture related to patient safety. The need for a change in handoff of care was identified via sentinel events, staff and physician complaints, and occurrence reports. The CNSs invited staff to describe current practice of patient transfers within the medical center. A current review of the literature was presented and gaps in the current practice were identified. A plan and a policy were developed and a form trialed in various areas of patient care. Changes were identified and made to the process and the form. Currently, the process and form are being further evaluated and revised. Outcomes will be presented at the session.

Standardized definition of transfer of care, a documentation tool to use for when transfer of care occurs, and a policy outlining the practice.

Documentation is not required for every time the patient leaves the patient care unit. CNSs were the best group to lead this culture change. Going through the process of looking at current practice and matching it to national standard and regulatory requirements makes for patient safer care by identifying where we could improve communication among caregivers.

'Report called' and 'report received' are inadequate documentation for patient transfer of care. A consistent communication tool is essential in safe patient hand-offs. Staff involvement in an organization culture is a future goal.

Provena Saint Joseph Medical Center (PSJMC) is a 485-bed, acute care facility in Joliet, Illinois, running an ADC of 355 patients. In 2004, PSJMC evaluated a voice-based technology designed to standardize, automate, and streamline the process of patient reporting among nurses at hand-off.

PSJMC sought a solution to measure improvements in quality, consistency, patient safety, and efficiency of hand-off communication. The hospital implemented OptiVox Patient Reportsr, a voice-based patient reporting tool, on two Medical/Surgical floors.

Challenges with shift reporting include excessive time required to complete Background/Rationale (Clinical) shift reports, lack of consistency and standardization in reports, and interruptions during reports.

PSJMC implemented the following process for hand-off communication: Each nurse going off duty uses a telephone to connect to a server and gives her report following a series of customizable voice prompts. Each nurse coming on duty dials into the system and listens to the applicable patient reports. Nurses can navigate through the report, which is saved on the server for later review. Nurse shifts overlap by approximately 15 minutes to assure an opportunity for face-to-face clarification.

At the end of the 4-month evaluation period, PSJMC observed the following: 1. The time required to conduct shift change reports decreased by 67 percent, from an average of 60 minutes to less then 20 minutes. The overtime required to conduct shift reporting was reduced by more than 40 percent. 2. The technology improved the quality of communication between nurses at hand-off and streamlined the process by providing standardized reporting on each patient. 3. The expectations of the 2006 JCAHO 2E patient safety standards for hand-off communications were fulfilled.

Based on actual results measured while evaluating OptiVox Patient Reports on two floors, the hospital expects to benefit from an annual cost savings of approximately $551,000 and a 50 percent reduction in overtime once it is implemented on all floors.

PSJMC has proven that the significant and long-standing problems plaguing the process of patient reporting can be solved. A substantial overtime savings has resulted in measurable reductions in labor costs, observable improvements in patient care, and much-needed relief for nursing staff during shift change.

Participants will acquire information on an innovative hospital practice model in oncology care and its impact on chemotherapy safety and employee satisfaction.

Position statements from leading nursing and pharmacy organizations describe the shared vision for safe medication use in hospitals. 'Nursing and pharmacy, the nation's first and third largest health professions, respectively, have much in common. They have a shared concern for rational drug therapy, particularly its dispensing, administration, and monitoring. Moreover, members of both professional face a common constraint: Neither pharmacists nor nurses shave the authority to independently affect drug therapy. ASHP 2003. We developed a collaborative practice model to address these issues.

Three disciplines are required ensure timely and accurate chemotherapy delivery to the patient in the hospital environment. Two of those, Nursing and Pharmacy, share many common interests for safe patient outcomes and contribute different perspectives to care. Collaboration provides timely care and enhances the knowledge base of each profession.

A needs assessment tool was developed to analyze our system process for chemotherapy orders. An interdisciplinary team was formed for this analysis. Major elements included: action steps to increase organizational awareness of chemotherapy errors, computerized chemotherapy ordering system review, consultative interventions with office-based staff and data base development for error and near miss capture.

The assessment identified areas for improvement in the chemotherapy process. A collaborative practice model was established by dedicating a pharmacy and advanced practice nurse FTE. Staff retention, patient satisfaction, physician satisfaction, decreased chemotherapy errors were areas to be measured.

Collaboration provides benefits greater than the sum of its parts. Improved patient satisfaction, physician satisfaction, and staff retention were noted. Pharmacy and nursing staff appreciate the model and experience better job satisfaction and confidence in patient care with the addition of this resource.

A novel collaborative role could benefit many institutions that deal with complex patient aggregates. The American Colleges of Nursing, The American Association of Colleges of Pharmacy, the American Nurses Association, the American Organization of Nurse Executives and the American Society of Health-System Pharmacist describe the need for a shared vision for medication safety and improved medication use through better utilization of pharmacy and nursing work forces. We are achieving this through a collaborative practice model in the oncology setting.

Clarify and redesign the CNS role to ensure support where the intersection of the caregiver and patient/family meet. The redesign occurred within the context of the University of Michigan Health System (UMHS) Nursings vision and strategic plan for achieving world-class patient care.

The CNS is accountable for working in partnership with members of the health care team to design, implement, and measure safe, cost-effective, evidence-based care. To achieve these outcomes, the CNS must perform these skills in a competent manner, be visible, and measure the impact.

Current CNS practice revealed significant variations in competence, application of the role, visibility, and measurement of impact. This resulted in lack of understanding of the role by staff and organizational customers, role confusion, overlapping functions with other nursing positions, and insufficient leadership by the CNS for major practice changes.

A redesign team was formed. A CNS consultant was hired to facilitate the process change. An initial assessment of CNS practice and organizational structure occurred. A survey based on the NACNS scope of practice and standards was conducted to determine customer expectations and insight into future challenges with role implementation. From the data, a new job description, performance appraisal, interview process/tool as well as a new CNS orientation plan was created. An implementation team compromised of CNS's and nurse managers convened to design objective measures for the unit based partnership and prepare for the launch. Each CNS was required to perform a skill assessment so an educational plan for professional development could be created.

The redesign achieved standardization of the CNS interview process, qualifications for the role, expectations of practice, and objective measurements of achievement. Through the process, the CNS group became a team focused on advancing the practice of nursing at UMHS.

The CNS redesign resulted in clarity of the role, measurable outcomes to determine success at the unit level and within the organization, and greater job satisfaction for the CNS.

This program provides an organized, data driven method to reduce variations in CNS practice and facilitate accountability for measurable outcomes.

The purpose of this paper is to describe the contemporary theories of social justice and demonstrate how they can be applied in CNS Public/Community Health Nursing Practice.

Nursing leaders in Public/Community Health Nursing have identified social justice as one of the underpinnings of our practice. However, social justice and a method for applying it to practice have not been explicated.

Health departments and agencies across the country are faced with budget cuts and downsizing of staff and programs. In these settings, advanced practice public/community health nurses are challenged to provide health care promotion and illness prevention to a growing population with ever decreasing resources. While it is well documented in the nursing literature that nurses in all settings face ethical conflicts regarding distribution of limited health care resources, little emphasis has been placed on nurses' knowledge of social justice theory and how application of different theories in practice may influence outcomes of care.

This paper summarizes the current literature on social justice theory and describes how each theoretical approach to social justice leads to distinct nursing actions.

In the Socratic spirit of 'the unexamined life is not worth living,' this paper's illustration of the various theories of social justice may help Public/Community Health CNSs to acknowledge what we mean when we say that our practice is founded in social justice and how our approach to practice reflects this knowledge.

At a time when all educators, regardless of content area, are being questioned about their political leanings, it may be necessary for CNS educators in Public/Community Health Nursing to demonstrate the connection between the theoretical basis of our practice and the necessary political means for achieving our desired outcomes.

In order to examine our application of social justice in practice, Public/Community Health CNSs must be able to clearly differentiate the practice implications of contemporary theories and articulate our public stance as promoters of social justice.

The goal of this project was to develop a strategy to introduce the concepts of Relationship-Based Care (RBC) to oncology nurses and integrate them into nursing practice.

It became apparent that a theoretical framework would serve to pull the mission, vision and values together and help the staff truly 'live' these ideals. After much research and discussion, Relationship-Based Care was adopted. This conceptual framework is centered on the patient and family and reflects many of the ideals and practices already embraced by our nursing staff.

A workgroup was charged with updating the Nursing mission, vision and values, a thirty-two-page document. The project included nurses from a variety of practice areas and positions who were able to develop a meaningful and concise one-page document.

A Relationship-Based Care Book Club was started. One of the authors, Colleen Persons, facilitated our kick-off discussion and over the following months workgroup members served as facilitators for each chapter discussion. Ambassadors from all areas of nursing developed knowledge of RBC by participating in discussions and ultimately shared and championed these ideals to their colleagues. Following the success of the book club, ambassadors went on to create posters and unit activities that highlight the RBC concepts. The group decided to present RBC at Grand Rounds. Eight staff nurses came together to discuss the main concepts of each chapter through 'Moments of Excellence', stories about our patients and how the concepts are lived in our everyday nursing practice.

Our nurses have become 're-energized'. RBC has truly united our purpose and passion of caring for oncology patients and their families. Positive outcomes are reflected in increases in both staff and patient satisfaction.

Creating a Relationship Based Care environment and involving staff members as champions of this has proven to be effective in integrating this conceptual framework into our oncology practice. It has heightened awareness of our strengths and challenges as an organization and helps us move forward on our journey to excellence.

The use of Relationship-Based Care principles results in positive clinical quality, patient and family satisfaction, staff satisfaction and retention of staff.

While medication errors have received extensive national attention in recent years, there is little definitive research to identify either what the probable causes of these errors are or the evidence-based interventions to eliminate them. The purpose of this research was to identify factors contributing to medication safety gaps in a complex acute care setting. Specific aims were to uncover systems flaws in order to identify deficiencies in the medication administration process that might lead to error.

Evidence must be utilized to drive professional practice, develop safe and efficient medication administration processes, and promote clinical quality and patient safety. The CNS is key in evaluating systems and improving processes to reduce errors.

A Human Factors Process Analysis was used. It consisted of three phases: (1) analysis of medication error reports, (2) observation of work flow on three inpatient units, and (3) solicitation of insights through focus groups held with staff nurses. Each phase of the research informed subsequent phases.

Key elements which could contribute to medication errors were identified in various systems and processes. These include the physical environment, leadership, education and competence, culture, and individual accountability.

A significant strength of this research was the unique collaboration between CNSs and human factors researchers. A human factors perspective helped to identify critical issues contributing to errors and system flaws. This collaboration resulted in a synergistic analysis of workflow patterns and uncovered some difficulties nurses routinely encounter. Future systems should be designed to optimize professional performance while mitigating unsafe individual performance that occurs outside established parameters of practice.

The researchers' utilized knowledge gained from this study to recommend systems improvements for the safety of administering medications. Immediate interventions that can be implemented to enhance patient safety are identified. Effective educational tools for nurses highlighting safety in the medication administration process will be developed. This study will also lead to future research utilizing simulated scenarios involving medication administration.

ABC Coding is a standardized multidisciplinary coding system that is recognized by the American Nurses Association as supporting nursing practice. NACNS has been working with ABC Coding Solutions-Alternative Link, Inc. to validate ABC codes for CNS practice.

In 2005, Regions Hospital saw a significant increase in the immobile medical bariatric patient, with a resulting increase in staff injuries related to providing care for these patients. Most of these patients weighed more than 550 pounds. Additionally, these patients were placed in surgical bariatric beds, which resulted in a decrease in beds available for all surgical patients.

The Lead CNS formed an interdisciplinary group of providers to address lifting, transfer, and transport needs of the immobile medical bariatric patient. The group was comprised of the CNS, Environmental Services, Director of Nursing Resources, Transportation Coordinator, Psychiatry, Physical Therapy, and Occupational Therapy. The team met to form a system for admission of the immobile medical bariatric patient that: 1) minimized the number of transfers the patient would incur during a hospitalization; 2) placed the patient on the correct unit; and 3) facilitated getting the proper bed set up for the patient's hospital stay. The team also developed a ManPower Team comprised of volunteers from environmental services and transport who would respond to nursing requests for assistance in providing care to the immobile medical bariatric patient.

The ManPower team has been quite successful in getting assistance to the nursing staff in a timely manner. It is too early to tell if nurse injuries have been reduced. Outcomes will be reported at the CNS conference.

Moving and transfers are just one of the needs of the immobile medical bariatric patient that is different from the surgical bariatric patient. Other differences include levels of motivation, discharge placement issues, and overlay of various personality/psychiatric disorders.

With the increasing number of immobile medical bariatric patients, there is an increased need to address care issues of this growing patient population.

ABC Coding is a standardized multidisciplinary coding system that is recognized by the American Nurses Association as supporting nursing practice. NACNS has been working with ABC Coding Solutions-Alternative Link, Inc. to validate ABC codes for CNS practice.

Using nationally standardized codes, such as the ABC codes, facilitates Background/Rationale (Clinical) CNSs fulfilling their responsibilities for documenting interventions in a reportable manner. Codes assist CNSs to document productivity and quality in the work setting, develop billing fees for CNS practice, and generate claims to insurance payment organizations. ABC codes are supported by references to the laws in each state to ensure that the care represented by each ABC code is within the legal scope of practice of CNSs. ABC codes meet HIPPA compliance and electronic claims and support consumer choice for receiving CNS services.

The presentation will provide an overview of the ABC Coding taxonomy Description (Clinical) and describe how codes can be used to describe CNS practice. Specific examples for acute and non-acute settings will be provided. The method for determining a fee structure using relative value units will be discussed.

At the end of the session, the learner will be able to identify ABC codes for Outcomes (Research) CNSs use in acute and non-acute settings, and describe an appropriate fee associated with ABC codes for any practice location or reimbursement contract using the relative value unit system.

CNSs who currently bill for interventions typically use CPT or HCPCS II codes, which are codes primarily used to describe medically directed care. Using codes specifically developed for and validated by CNSs will make CNS interventions visible and will support the productivity and value of CNSs within the healthcare system.

By using ABC codes, CNS interventions will be visible to policy makers. Coding for CNS practice will enable payors to meet consumer demand for greater access to CNS services. Payors will have ability to identify cost-effective options to medical models of care.

Graduate programs should consider including the use of codes for tracking productivity and quality and for billing.

The purpose of this research study was to estimate the reliability and validity of the Newborn Scale of Sepsis ( SOS) to determine its usefulness for predicting and assessing newborns for sepsis.

Sepsis is a devastating, life-threatening disease and a major problem for many newborns and premature infants. Early-onset sepsis appears in the first week of life and generally develops rapidly. When an infant begins to exhibit signs of sepsis, the nurse at the bedside uses clinical expertise to evaluate the seriousness of the infant's condition. Expertise is required to identify subtle signs of sepsis at an early stage in order to prevent newborn death or disability. A reliable and valid tool for early detection of neonatal sepsis would improve the chances of survival of newborns.

This study was a prospective, methodological design used to test the psychometrics of a new criterion-referenced instrument. The sample consisted of 62 infants admitted to a transitional nur