Exemplary Clinical Practice

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Glycemic Roller Coaster

Illustration of a roller coaster representing large fluctuations in blood sugar levels.

In 2025 our glycemic care CNSs, Nicole Woodruff, ARNP,CDCES, and Raj Bais, DNP, MSN, ARNP, AGNP-C, BC-ADM, CDCES, BCTP, rolled out a flyer comparing glycemic control to a roller coaster. In the flyer, they shared a case study and learnings, which we will share here:

A 52-year-old patient with Type 1 diabetes mellitus since age 6 admitted for Diabetic Ketoacidosis (DKA). Complications included: chronic kidney disease-stage 4, hypoglycemia unawareness, frequent admissions for DKA, labile glucose levels, and insulin sensitivity. In addition, social determinants of health impacted her resources and therefore ability to take care of herself.

Her insulin needs (doses) were known from pre-admission management on a home insulin pump. Good glycemic control occurred in the hospital while on an IV insulin infusion. Once transitioned to subcutaneous injections, and despite appropriate insulin dose orders, this patient’s blood sugar then ranged from 27 to 465 mg/dL.

Compares blood glucose readings during two phases of treatment. The first phase, labeled “Insulin drip,” shows relatively stable blood glucose values ranging from approximately 72 to 185 mg/dL. The second phase, labeled “SQ basal/bolus,” shows much wider fluctuations ranging from 27 to 465 mg/dL. During the insulin infusion period, values remain relatively consistent. After transitioning to subcutaneous insulin, the graph shows sharp increases and decreases, including severe hypoglycemia and extreme hyperglycemia.

Why was there so much blood sugar variability during her admission?

Illustration of falling dominoes representing the concept that poor coordination in diabetes care can create a chain reaction that leads to unstable blood sugar levels.

Blood sugar management has a domino effect: To be safe and effective it requires continuous consideration & coordination between blood sugar checks, insulin administration, patient intake & communication.

Subject Matter Experts: Nicole Woodruff and Raj Bais

Focus on Oral Care

A selfie of the report authors smiling in a hospital corridor.

Partnership, Progress, & Next Steps

At the beginning of the new year, the UWMC-NW campus implemented new products to standardize oral care delivery, with the goal of ensuring all patients receive oral care at least twice daily. This multidisciplinary initiative was designed to support the independent and dependent patient through promoting safe and effective care practice with the aim of reducing the risk of Non-Ventilator Hospital-Acquired Pneumonia (NV-HAP). Collaboration was central to this effort, with strong partnership with Speech Language Pathologists, Clinical Excellence Coordinators, Clinical Nurse Educators, Center of Clinical Excellence Analytics, and vendor representatives to support education, orientation, and workflow integration.

-Amadae Breaux MSN, RN, NPD-BC, CCRN | Clinical Nurse Specialist – Critical Care; Bridget O’Connor DNP, RN, CHES | Clinical Nurse Specialist – Medical/Surgical

Sepsis Awareness Month

A group of nurses and leaders in a unit posing

Nursing-Led Excellence in Action

During Sepsis Awareness Month in September 2025, nursing teams at University of Washington Medical Center Montlake and Northwest Campuses demonstrated a strong commitment to improving sepsis outcomes through innovation, collaboration, and education. Guided by evidence-based, nurse-driven protocols, the initiative focused on strengthening early recognition and rapid response to sepsis across the organization. The effort highlighted the importance of coordinated multidisciplinary care to ensure timely and consistent treatment for patients with sepsis.

Education and staff engagement were central to the month’s activities. The Sepsis Committee delivered more than 55 hours of sepsis education through rounding, unit skill days, and presentations to leadership councils and committees across 35 units. In addition, a weekly Sepsis Newsletter from nursing and medical leadership kept staff informed about best practices while offering interactive challenges and prizes to encourage participation and learning. These efforts reinforced clinical knowledge and supported consistent sepsis workflows across care teams.

The program also celebrated excellence through the first annual Sepsis Awards, recognizing outstanding contributions from teams and individuals. Awards included the Sepsis is a Team Sport Award for increased workflow use, Super User Provider and Super User Nursing Awards for high utilization of sepsis order sets and nurse-initiated orders, and the Lifesaver Award honoring exceptional dedication to sepsis care. The campaign emphasized that Sepsis is a Team Sport, highlighting interdisciplinary collaboration as essential to saving lives. Looking ahead, interest from 19 staff members in becoming Sepsis Unit Champions will help sustain education, leadership, and continued improvement in sepsis care.

Implementation of the Dynamic Appraisal of Situation Aggression (DASA)

In July of 2024, UWMC Northwest opened the Long-Term Civil Commitment program (LTCC) within their Center for Behavioral Health and Learning. The program launched with 34 patient beds and a long-term goal to provide treatment for up to 75 patients. LTCC patients are typically detained on 90 to180 day civil commitment orders, many of which are extended multiple times, resulting in prolonged inpatient treatment. The population includes individuals with serious mental illnesses such as schizophrenia and bipolar disorder, many of whom transferred from the state hospital following civil conversion. Treatment focuses on recovery through medication management, individual and group therapy, cognitive behavioral interventions, coping skills, and community reintegration.

Identifying the Need

After the first 6 months of operation, staff reported increasing concerns regarding workplace safety and the perceived risk of violence among newly admitted patients. In March 2025, Behavioral Health leadership conducted staff listening sessions to better understand safety concerns and identify opportunities for improvement.

One of the themes that emerged from these sessions was the lack of an objective, standardized assessment tool to identify patients at risk for violence and proactively guide care planning.

Selecting the Right Tool

The team evaluated two validated violence risk assessment tools:

A review of the literature demonstrated that structured, evidence-based violence risk assessments are more effective than clinical judgment alone in predicting aggression and supporting targeted clinical interventions. The LTCC interdisciplinary team selected DASA because it provides a brief, validated assessment that integrates easily into daily clinical workflow while promoting consistent communication among team members.

Implementation Timeline

Impact

DASA was one of the components of our workplace violence prevention improvement strategy. It addressed a key gap identified by the frontline staff that was low-cost, low-risk and easily implemented and adopted.

The implementation timeline is associated with subsequent reduction in total patient assaults on nursing personnel. This demonstrates and supports the value of including a structured violence risk assessment tool into clinical practice.

A chart showing the decline in unit workplace violence incidents from a high of .80 in May 2025 to .10 in December 2025.

ECMO Program Awarded ELSO’s Platinum Level Center of Excellence

In 2025, the University of Washington Medical Center’s ECMO program was awarded ELSO’s Platinum Level Center of Excellence. This is the highest award given by Extracorporeal Life Support Organization (ELSO) to any program, demonstrating the quality of the ECMO program and all the people involved. The ELSO Excellence in Life Support Award recognizes ECMO programs worldwide that distinguish themselves by having processes, procedures and systems in place that promote excellence and exceptional care in providing ECMO to their patients.

To illustrate how distinct this award is, ELSO has over 1300 different ECMO center members worldwide. Of those, 279 have applied for and were awarded some level of designation. Of those 279, only 46 centers currently hold platinum status (16%). And further, there are only 31 platinum centers in the United States (15 adult centers and 16 children’s hospitals). UWMC is the only platinum ECMO center in the state of Washington.

Inpatient Rehabilitation

We’re pleased to share the 2025 Annual Report from our Inpatient Rehabilitation Program: