New Era of Care Begins at TCMH with Team-Based Nursing Practice

Texas County Memorial Hospital medical surgical floor has implemented a new team-based nursing approach, board members heard at their monthly meeting on Tuesday.

“An RN, an LPN and a CNA are assigned to a pod of patients,” Doretta Todd-Willis, TCMH chief nursing officer, told board members. “The staff works together to provide the patient care.”

Todd-Willis explained that in the past TCMH medical surgical patients were assigned on an individual basis to certain staff members. Three weeks ago, the hospital implemented the team-based nursing approach which is supported by physicians on the TCMH medical staff. The Missouri State Department of Health and Senior Services also recommends the practice.

“Hospital regulations require that an RN supervise every patient’s plan of care,” Todd-Willis said, noting that many hospitals no longer use LPNs because an LPN cannot supervise the patient’s plan of care.

“We have some great LPNs at TCMH, and we want to continue to use LPNs,” Todd-Willis said. “If we have an RN and an LPN working together as a team to care for patients, we will be in compliance with state regulations, and we will improve patient care.”

Todd-Willis explained that the team-based nursing approach ensures that multiple staff members know what is happening with each patient’s plan of care, and they can communicate that knowledge with the patient, the patient’s physician, the patient’s family members and each other.

“We have had some initial resistance to making these changes, but the team nursing approach builds a positive and supportive atmosphere that is better for patient care and boosts employee satisfaction,” Todd-Willis said.

According to Todd-Willis, communication between nursing staff and physicians has already improved with the new approach.

“This approach to patient care is here to stay,” Wes Murray, TCMH chief executive officer, said. “Doretta and the med surg staff will continue to improve this team-based approach to nursing, improving patient care and overall satisfaction of our patients, our employees and our physicians.”

In other hospital business, Murray presented to the board members information about Missouri Senate Bill 419 prepared by Senator Ryan Silvey of Kansas City to transform the Medicaid program and keep it within conservative principles which concern many members of the Missouri Congress.

Known as the “Healthcare Transformation Block Grant”, Silvey’s bill would create a trust fund that would be used to expand Medicaid rolls in Missouri.

“I know that this board is very much in support of Medicaid expansion in Missouri,” Murray said. “This bill has more traction in our state Senate than anything else regarding Medicaid.”

Murray explained that public polling in the state also shows support of Medicaid expansion. Missouri is one of 22 states in the nation that has not expanded Medicaid coverage under the Affordable Care Act from 2010.

“This bill may not progress beyond the state Senate, but it has the basic components that would help TCMH provide care for patients in our area,” Murray said. Murray urged those present to express personal support for Senate Bill 419 with their representatives.

Murray noted that Kentucky has seen the numbers of uninsured patients drop over ten percent since the expansion of Medicaid in the state, and uncompensated care at Kentucky hospitals has dropped by 60 percent.

Murray has also asked the Missouri Hospital Association to let him know if any Congressional representatives in TCMH districts express any level of support for Medicaid expansion efforts.

“At least some of our state legislators are talking about this,” Murray said. “Anything will help.”

In the medical staff report, Dr. Jonathan Beers, chief of the TCMH medical staff, noted that medical staff members are excited to have Dr. Cory Offutt join TCMH in 2016 when he completes his residency.

“We hope there is continued recruiting success to help with the on call needs of the hospital,” Beers said.

The demands for a physician on call at the hospital vary according to the number of physicians on staff and the specialties of those physicians.

Joleen Senter Durham, director of physician recruiting at TCMH, noted that she continues to look for internal medicine and family medicine physicians to work in Houston and in Mountain Grove.

“Our communitys’ health needs continue to outweigh the number of providers we have available to meet those needs,” Durham explained, adding, “I am trying to leave no stone unturned in the search for additional providers.”

Durham is currently working closely with two physician assistants that are interested in full-time jobs with TCMH. A candidate is scheduled to visit on March 2nd, and the other candidate working with Durham to finalize a site visit date.

“We are very fortunate to have recruited Dr. Offutt to come to work at TCMH next year, and he and Samantha are very excited about finalizing their decision to come to our community,” Durham said.

In the January financial report, Linda Pamperien, chief financial officer at TCMH, reported increased revenues and inpatient volumes.

“We had 19 admissions to our swing bed program in January, and we’ve had 146 admissions year-to-date,” Pamperien said.

Increased expenses in a few departments and three payroll periods in the month of January left the hospital with a negative bottom line for the month and for 2015 of $13,310.25.

Present at the meeting were Todd-Willis; Murray; Beers; Durham; Pamperien; Dr. John Duff and board members, Omanez Fockler; Janet Wiseman; Dr. Jim Perry, OD; Mark Hampton and Russell Gaither.

The next meeting of the TCMH board of trustees is Thurs., March 24 at 12 p.m. in the hospital board room.