Nurse Quality

Lynn A. Madsen, RN, MSN, CPHQ

* ******* ******

Council Bluffs, Iowa 51503

Home Phone 712-***-****

Cell (402-***-****

E-mail ****.****@***.***

Objective To obtain challenging positions within the areas of performance

improvement.

Work experience 6/2014- Present Alegent Health

Omaha, NE

Quality Improvement Specialist / RN Quality

Alegent Creighton Health Mercy Hospital

Provide leadership and oversight in direct support of

customer-focused, data-driven campus process improvement program

Concurrent chart review to ensure compliance with SCIP/Core Measure

standards

Provide feedback/just in time training for front line clinical staff

and physicians

Perform Heart Failure and Pneumonia data abstraction and effectively

utilize statistical tools / data aggregation / analysis and data

display

Lead process improvement teams and conduct Root Cause Analyses

8/2013- 6/2014 Alegent Health

Omaha, NE

Quality Improvement Specialist / RN Quality

Alegent Creighton Health Midlands Hospital

Provide leadership and oversight in direct support of

customer-focused, data-driven campus process improvement program

Concurrent chart review to ensure compliance with SCIP/Core Measure

standards

Provide feedback/just in time training for front line clinical staff

and physicians

Perform data abstraction and effectively utilize statistical tools /

data aggregation / analysis and data display

1/28/2013 - 8/2013 Alegent Health

Omaha, NE

MDS Coordinator - Alegent Creighton Health - Immanuel Fontenelle Home

Completes assessments, Minimum Data Set (MDS) and care plans for all

residents assigned.

Monitors completion of MDSs by other disciplines within timeframes

prescribed by regulatory guidelines.

Advises supervisor of incomplete and/or untimely assessments by

disciplines other than nursing.

Ensures accurate, timely completion of the MDS/RAPs/Triggers sheet

for assigned residents.

Initiates care plans and supporting activities that will result in

best possible outcome for assigned residents.

Generates and distributes monthly care plan calendar for the

following month.

Conducts care plan conferences for assigned residents.

Maintains and updates all care plans and assessments for assigned

residents on a quarterly basis (at minimum) and adds/deletes issues

as necessary.

Reviews all resident incidents and accidents and the 24-hour report

daily to ensure that care plans for assigned residents reflect

current and changing needs.

At patient care conferences, facilitates and coordinates the

activities of the disciplines of nursing, rehabilitation, dietary,

activities, social services and restorative nursing.

Monitors and ensures completion of 7-day look-back documentation by

nursing staff within prescribed MDS timeframe.

Participates in facility management meetings as requested.

Monitors and audits clinical record documentation on assigned

residents to ensure accuracy and timeliness.

1/2008 - 1/2013 Alegent Health

Omaha, NE

Clinical Informatics Specialist - Alegent Medical Informatics

Uses clinical knowledge, informatics knowledge, practice experience,

research background, critical thinking, and leadership skills to

facilitate a interdisciplinary approach to promote quality care

through the application of nursing informatics

Develops and delivers electronic medical record (EMR) documentation

training (including clinical specialty and new hire training) for

clinical staff and physicians.

Manages all aspects of the informatics system life cycle to plan,

analyze, design, implement, and maintain Clinical Information Systems

related to patient care documentation

Facilitates collaboration/communication between all members of

Management, Patient Care Services, Medical Staff and Information

Systems to achieve the system objectives

Partners with customers to define project objectives and manage

project priorities within the project and time lines

Assists front line staff and managers to develop workflows that

support excellence in point of care documentation to promote quality

outcomes, patient safety and patient satisfaction

Demonstrates skills in coordinating problem resolution activities and

assists customers in problem identification and resolution

4/2004 - 12/2007 Alegent Health

Omaha, NE

Lead Quality Improvement Specialist - Midlands Hospital

Provide leadership and oversight in direct support of

customer-focused, data-driven campus process improvement program

Facilitated process improvements increasing Core Measure compliance

from 40% to 99%

Supervise Quality Resource Specialists and Data Management Analysts

performing related quality functions and maintenance of various

databases and data collection systems

Facilitated Process Improvement, Sentinel Event Root Cause Analysis,

and Failure Modes & Effects Analysis teams across Alegent Health.

Performed data abstraction and effectively utilized statistical tools

/ data aggregation / analysis and data display

Principle trainer: Continuous Quality Improvement course for Alegent

employees including physicians, management and staff

Chair, Operations Performance Improvement Committee

Member, Campus and System JCAHO Steering Committee

Edgerton Examiner - Nebraska State Quality Award - Survey Team

Member, 2006, 2007

Member of Alegent Edgerton (Nebraska State Quality Award) application

team 2008

9/2003 - 4/2004 Alegent Health

Omaha, NE

CPOE (Computerized Physician Order Entry) Design & Implementation

Specialist

Responsible for the successful development of numerous physician

workflow diagrams and order set designs in preparation for

implementation of Computerized Physician Order Entry for Alegent

Health

Facilitated physician CPOE training & work group sessions, researched

best practices and drafted order sets to be used during physician

design sessions

Achieved 97% physician satisfaction rate for Physician Workflow

Rapid Design Teams

1999 - 9/2003 Alegent Health Omaha,

NE

Operations Director, Quality Care Management

Director for Quality Improvement (and Care Management after those

departments merged in 2002) (>60 Care Managers, Social Workers,

Quality Improvement, Data Management and Clerical staff at 4 metro

campuses)

Plan, design, implement, and maintain procedures, policies and

management systems in all facets of Quality Improvement

Member of System Quality Council as well as four campus

Interdisciplinary Quality Committees

Member of System Pain Management Form, and System JCAHO Steering

Committee

Facilitated Root Cause Analysis process improvement teams in response

to Sentinel Events

Trainer for quality staff on Root Cause Analysis and Failure Modes &

Effects Analysis (FMEA)

1998 - 1999 Jennie Edmundson Hospital Council Bluffs, IA

Cardiac Case Manager

Designed and implemented Cardiac Case Management program

Managed average caseload of 150 heart failure patients across the

continuum of care

Developed Access database to manage case load and monitor outcome

data

Facilitated development of population specific care maps

Cross trained to Orthopedic Case Management

1995 - 1998 Jennie Edmundson Hospital Council Bluffs, IA

Discharge Planner

Screened all new admissions for discharge care needs

Collaborated with patients, families, physicians, acute / home health

care / hospice teams to develop discharge plan of care hospital-wide

Cross trained to Behavioral Utilization Review

1991 - 1995 Jennie Edmundson Hospital Council Bluffs, IA

Emergency Room Staff Nurse / Charge Nurse

3 - 11 Staff nurse with rotating charge nurse duties (2 - 4 days per

week) in busy ER of 250 bed acute care hospital

1989 - 1991 Army Recruiting Command Ft. Sheridan, IL

Army Nurse Counselor

Interviewed RN candidates for direct commission as officer in the

Army Reserve Nurse Corps

Submitted written recommendations to the U.S Army Nurse Corps

Selection Board

Area of responsibility included 7 Midwest states and supervising 5

Army Nurse Recruiters

Speaker at numerous colleges, career days, etc.

Awarded Army Commendation Medal for record number of nurses

commissioned

1988 - 1989 Mutual of Omaha Omaha, NE

Case Manager, Catastrophic Claims

Managed average case load of 250 catastrophic medical claim cases

Researched appropriate level of care needed / costs and wrote

proposals for exception to policy to cover needed care

Achieved $1.5 million savings through exception to policy

negotiations

1978 - 1988 Jennie Edmundson Hospital Council Bluffs, IA

Intensive Care Staff Nurse / Charge Nurse

Staff / rotating charge nurse (2 - 4 days per week) for 12 bed

combined ICU/CCU

Rotated to Post Anesthesia Care Unit average of 2 days per month

Staff nurse representative to Patient Care Committee

Member of Care Map Committee

1977 - 1978 Jennie Edmundson Hospital Council Bluffs, IA

Float Nurse

Staff nurse / occasional charge nurse floating to all areas of

hospital except the Operating Room

Major (Retired), Army Nurse Corps

4223rd U.S. Army Hospital (1991 - 2002)

Active Duty (AGR), U. S. Army Nurse Recruiting Command (1989 - 1991)

82nd Field Hospital, medic, then 8A/ICU nurse, 400 bed field hospital

(1975 - 1989)

915th Transportation Company, armored personnel carrier driver (1974

- 1975)

ACLS Instructor / Instructor for ACLS Instructor course

Public Affairs Officer

Unit Casualty Notification Officer during Operation Desert Storm

Editor unit newsletter / Unit Historian / Unit photographer -

awarded Army Commendation Medal for photographs and newsletter

submissions to Army Reserve Command

Education 2006 - 2007 Nebraska Wesleyan University, Omaha, NE

Master of Science in Nursing

1998 Iowa Western Community College, Council Bluffs, IA

Computer Programming Logic

1992 - 1995 Midland Lutheran College, Fremont, NE

Bachelor of Science in Nursing

1978 Defense Information School, Fort Benjamin Harrison, IN

Department of Defense Public Affairs Officer Course

1974 - 1977 Jennie Edmundson School of Nursing, Council Bluffs, IA

Diploma in Nursing

Licensure RN - Iowa - 056470

Certifications

CPHQ (Certified Professional in Healthcare Quality), certification #

00024514 [formerly #9902] - granted by the Healthcare Quality

Certification Board, January 1, 2001

RAC-CT (Resident Assessment Coordinator Certified) - granted by the

American Association of Nurse Assessment Coordinators, October, 2012

Basic Life Support Certification - current through January 2016

Computer

Applications Proficient in numerous applications including: Word, Power Point,

Excel, Access, Visio, Microsoft Project

Presentations

"The Pursuit of Quality" - 2000 to 2008 - provided process

improvement education classes for Alegent staff, physicians and

management

"Making Sense of Control Charts" - Nebraska Association for

Healthcare Quality - Grand Island, NE - April 12, 2002

"Process Improvement Basic Training" - Life Care Centers of America

- Omaha, NE - June 17, 2002

"The Effects of a Nurse Conducted VTE (Venous Thromboembolism) Risk

Factor Screening on Prophylaxis Patterns" - Alegent Health Research

Day - Immanuel Medical Center - Omaha, NE - May 2, 2006

"Thrombosis Risk Assessment, From Failure Modes & Effects Analysis to

Process Improvement" - CIMRO-Nebraska Quality Forum, Lincoln, NE, May

9, 2006

"Concurrent Data Collection for the Appropriateness of Care Measure

Project", CIMRO-NE Webex presentation, November 7, 2006

"Achieving Excellence in Door to Balloon Times for ST Elevation

Myocardial Infarction (STEMI) Patients" - Nebraska Healthcare Quality

Forum, May 15, 2007

"Assessment of Venous Thromboembolism (VTE) Prophylaxis in Oncology

Patients at a Community Hospital" - American Society of Hospital

Pharmacists (ASHP) conference poster presentation, December 3, 2007,

Las Vegas, Nevada

Professional Nebraska Association for Healthcare Quality - 2004 President

memberships National Association for Healthcare Quality

American Nurses Association

Nebraska Nurses Association

Sigma Theta Tau National Nursing Honor Society

American Legion - Member for Life

Reserve Officers Association - Life Member

Recognition Nebraska Nurses Association "Positive Image of Nursing" Award

recipient - 2006

"Nurses Who Make a Difference" Certificate of Recognition, Nebraska

Center for Nursing, 2007

Community Iowa State Master Gardener

activities Loess Hills Preservation Society

References Available upon request

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