Graduates lead quality improvement projects at Madison County Memorial Hospital

Madison County Memorial Hospital (MCMH) in Winterset, Iowa, its administration, staff, and patients are especially appreciative of the recent efforts of three 2015 graduates of the RN-BSN program at the Upper Iowa University Des Moines location.

Stephanie Andrew, Amy Tussey, and Megan Haggard not only achieved their advanced nursing degree from Upper Iowa, but MCMH administrators credit the three nurses’ recent quality improvement projects for benefitting both patient care and the hospital.

While praising the trio’s projects, MCMH director of nursing Cindy Frank explained how a new “LACE” index scoring tool, implemented by UIU graduate Stephanie Andrew helps decrease the number of times patients need to be readmitted to the hospital. The LACE tool looks at each patient’s length of stay (L) in the hospital, the acuity (A) of the admission, what chronic diseases or conditions (C) the patient may have, and how many emergency (E) department visits the patient had over the past six months. A numeric value is assigned to each answer to derive a LACE score for the patient.

A LACE score of 0 to 4 is considered a low risk for readmission; 5 to 9, a moderate risk; greater than 9 a high risk. Based on the patient’s LACE score, the house supervisors work with the patient and family members to help develop a plan of action to decrease the patient’s risk of needing to return to the hospital.

Not only does the scoring tool provide additional care that make keep patients at home, the tool benefits the hospital by removing reimbursement obstacles.

“With the new changes in health care reform, nurses, doctors, and health care organizations face many tough obstacles when it comes to reimbursement from Medicare/Medicaid and insurance companies for care provided in a hospital setting,” said Andrew.  “One such obstacle is non-reimbursement for hospital readmissions within 30 days of previous discharge. The LACE tool was developed to identify those patients early on, so interventions could start immediately.”

The Leon, Iowa, native explained the interventions could include educating patients while they are in the hospital, providing community resources that could help patients live healthier lives at home, prompting follow up appointments with primary care physicians after discharge, and/or scheduling patients with a health coach.

“I choose this subject because I see what a huge impact this could have on a small organization like MCMH and its patients. I wanted to be constructive in preventing readmissions in the future,” Andrew, the hospital’s house supervisor/case manager added.

As another example of reducing readmissions, Amy Tussey developed and implemented a urinary health protocol. Depending on a patient’s history and diagnosis when admitted, the new procedure makes nutritional interventions in the protocol available to nursing staff directly. Nutritional interventions can be implemented without a physician order, while pharmacy interventions must be approved by the physician prior to implementation. For example, nurses can offer patients more water, cranberry juice, and yogurt with meals or provide cranberry extract pills and probiotics to help prevent urinary tract infections.

In addition, Tussey, a Macksburg, Iowa, native, inserted reminders in the electronic health records to remind the nursing staff of these available interventions if a newly admitted patient’s diagnosis is a urinary tract infection (UTI) or if the patient answers “yes” to a history of recurring UTIs.

“The importance of this protocol is related to keeping our patients healthy, plus decreasing the number of readmissions within 30 days,” the medical-surgical nurse explained. “We have a facility-wide push to decrease the number of readmissions within 30 days by identifying patients at risk for readmission, involving our health coach in the discharge process, and providing education to the patient, their family, and/or to the nursing home staff.”

Meanwhile, Megan Haggard’s project focused on providing sound education to patients by utilizing the teach-back method. She chose the hospital’s top admission diagnoses and developed education protocol around prevention, physical activity and healthful diets, when to call a doctor, follow-up appointments, and medications.

A Pleasant Hill, Iowa, native, Haggard developed questions and answers on laminated cards making it very simple for nurses to provide the education to each patient. The diagnosis-specific laminated cards are hung in the patient’s room. This allows the nursing staff to easily review the questions and answers with the patient, while providing medications, care, etc.

The Upper Iowa RN-BSN program not only provided them with the tools and knowledge to be exceptional nurses and develop such projects, each of the three nurses agreed they are better prepared for future management responsibilities because of the UIU program.

Andrew said she initially chose UIU because of its flexible schedule, which more easily coincided with her busy life of working as a nurse, and being a wife, and mother of three young children.

“The UIU nursing instructors were very good at providing real-life experiences to learn from and strongly encouraged everyone that they could be whatever they wanted to be if they had the right mindset,” she noted. “I owe UIU and all the BSN instructors a great deal of gratitude for giving me motivation, courage, and wisdom while attending classes there. It was always my dream to go back to school and finish my BSN, but I never felt like I would find a program that would give me that hands-on experience that I wanted, until I joined the UIU family.”

“I chose UIU because of my fellow co-workers and friends who were returning to college as well to achieve their BSN. My manager and sister-in-law also graduated from UIU with BSN degrees. They each spoke highly about the nursing hybrid program at the Des Moines Center and how much they enjoyed it,” Tussey added.

Although the Upper Iowa RN-BSN program can be taken completely online, both Tussey and Haggard took the hybrid option, agreeing that they appreciated the convenience of the UIU online program, while at the same time having the opportunity to meet face-to-face with their peers and instructors.

Similar thoughts about the positive educational experience at UIU were shared by the nursing director at the Winterset hospital.

Frank also completed the university’s RN to BSN program, graduating in 2009. With a 38-year career in nursing, she was first hired at MCMH as the ED manager/trauma coordinator, before being named the hospital’s director of nursing in 2012.

“Obtaining my BSN had always been a goal of mine. I just had to wait for the right time,” said the 58-year-old. “UIU’s educational programs identified current issues and today’s trends in nursing and provided the tools needed to stay up to date. I was able to bring ideas and evidence-based practices back to my home hospital to benefit the patients as well as my nursing staff.

“I really enjoyed the leadership classes and have been able to use what I learned and put into practice with the nursing staff,” she continued. “Not that I’m going anywhere, but I feel having my BSN makes me a little more marketable. It provides more of a comfort level; and the same thing applies to Megan, Steph and Amy. I think furthering your education makes you do a self-check and helps you see if you are happy with what you’ve accomplished or do you want to continue on.”

“This could definitely be a huge, first step for these three nurses if they have any desire to teach, go into management, or continue onto an advanced practice degree. There are just so many areas for nurses to be involved in,” Frank closed. “I strongly value education and in today’s world, the sky is the limit. Whenever I talk with high school student or young nurses I always encourage them to get the bachelor’s degree. It doesn’t matter if they complete that degree when they are 25 or 55, it’s still quite an accomplishment and something to be proud of. I wish nothing but the best for these nurses, they are top notch!”

For more information about the UIU RN-BSN program, go online to

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