It is with great honor that I provide this letter of support for your consideration of the Wound Ostomy Nurse Team from the University of Iowa Health Care (UIHC) for the 2019 Institute for Healthcare Improvement's DAISY Award for Extraordinary Nurses. This team of nurses was recognized for their excellent clinical care, which results in positive patient outcomes; interprofessional teamwork; innovative practices and care for medically complex patients; ongoing education of patients and clinicians worldwide; standardization of evidence-based care; and perhaps most importantly, their thoughtful, honest, and respectful interactions with patients, families, visitors, and fellow healthcare team members through receipt of the organization's DAISY Team Award in May 2018.

The current Wound Ostomy Nurse (WON) Team is composed of five adult Certified Wound and Ostomy Nurses (CWON), two retired, hourly CWONs, and one full-time WON for the neonatal/pediatric population. I would like to focus my comments on the impact the work these nurses do has had on our organization. This team has developed productive, collaborative relationships to focus activities on improving outcomes. Several projects they spearheaded were included in our recent Magnet® redesignation application. We have been below the benchmark in the National Database of Nursing Quality Indicators related to pressure injuries for 5 of the past 8 quarters. The work done with our interprofessional perioperative hospital-acquired pressure injury prevention workgroup has been presented as a poster at national professional organization meetings and has won awards for evidence-based practice (EBP) and a practice innovation merit award. The accomplishments were recently shared at an Iowa Organization of Nursing Leaders meeting. The WON team has provided skin, wound, and pressure injury prevention education not only to nurses but to numerous providers, occupational therapists, and respiratory therapists, internally and externally, at the state level. UIHC has had a longstanding heritage of excellence related to skin, wound, and ostomy care.

The current WONs were mentored to have a spirit of inquiry and EBP and continue to emulate that model. Their practice is built on a firm foundation and provides them with the skills to continue to foster a culture of quality and safety. They are visionary, enthusiastic, and always looking for ways to improve outcomes through the care provided. I am always excited to hear their ideas and visions for the future. In closing, I want to share a comment from an internal medicine physician after the 2018 DAISY Team Award recipients were announced, which eloquently sums up the impact these nurses make in our organization, "What a wonderful and well-deserved recognition of your careful, thoughtful, kind, and highly knowledgeable approach to each patient and your responsiveness, collegiality, and willingness to teach all of us who wish we had even a tiny fraction of your knowledge and expertise in this challenging specialty! You are always so great to work with!"

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The success of the Wound Ostomy Nurses (WON) team results from continual, incremental changes in practice. The WONs coordinate hospital initiatives combating hospital-acquired pressure injuries (HAPI); perform perioperative ostomy instruction and care; and provide consultation for challenging wound, ostomy, and enterocutaneous fistula management. Each nurse provides high-quality patient care while supporting each other and the interprofessional team. These expert clinicians help patients and families as they face situations they never expected to experience. These nurses are not only skillful but are compassionate, thoughtful, respectful, patient, and gentle. They have a knack for putting people at ease and helping patients and families find hope and relief during crises and painful situations.

Additional WON activities: Coordinate and conduct the monthly STAR (Skin Team Advocate and Resource) shared governance committee meetings to provide education and collaborate with unit-based skin champions and other disciplines on strategies to improve skin and wound care and reduce HAPI. This committee has been a model of staff nurse engagement in shared governance for many years. Coordinate the quarterly skin surveys where all adult and pediatric inpatients, usually more than 500, are surveyed for pressure injuries. The WONs assess every patient identified as having a pressure injury to describe, stage, and make recommendations for 20-30 patients, along with their daily workload. Assist with the development of an innovative tablet-based application to improve the efficiency of processing skin survey data. Work with Nursing Informatics (NI) and Hospital Clinical Information Systems (HCIS) to improve skin assessment and care documentation and develop pressure injury prevention order sets and protocols. Work with coders, NI, HCIS, and nursing finance to identify and establish a process to capture missed revenue for WON visits in outpatient clinics. Develop smart phrases, in collaboration with hospital coders, to document wound and skin assessments for establishing the severity of illness and mandatory reporting to external agencies. Established an interprofessional committee to address HAPI prevention in the operating rooms (ORs), which have implemented upgraded intraoperative surfaces (OR pads), use of preventive dressings, revision of the OR positioning policy, and coordination of a positioning device fair and campaign to increase the availability of gel positioning devices in all ORs. Participate in the Wound Ostomy and Continence Nurses Society (WOCN) and Iowa Affiliate WOCN, bringing ideas from conferences and implementing practice changes. Our organization showcased these exemplars in the recent Magnet® redesignation documents. Provide evidence-based input to policies, procedures, and protocols. Engage in scholarly work, including authoring peer-reviewed publications and presentations and submitting posters to disseminate accomplishments to help advance the field. Coordinate and facilitate Ostomy Support Group meetings in the community.

In conclusion, the WONs provide exceptional evidence-based clinical care. They lead and guide the practice of all clinicians at University of Iowa Health Care (UIHC) while continually striving to improve and maintain quality wound, skin, and ostomy care. These nurses accomplish all of this through exceptional teamwork!