I am honored to nominate Ms. Dima Afra for the DAISY Award for Extraordinary Nurses in Patient Safety. Dima is a bedside registered nurse who has made significant contributions to patient safety on her unit and across the hospital. Her dedication, commitment, and passion have led to positive changes in patient care that have had a major impact throughout the institution. Dima's expertise as a bedside RN led her to identify an increase in Postoperative Pneumonia rates in late 2021. She brought this concern to the shared governance councils, and through evidence-based research, she determined that certain aspects of patient care needed improvement to improve the experience of surgical patients. She collaborated with an interdisciplinary team to implement new practices that effectively reduced pneumonia rates. These practices were related to early ambulating patients, encouraging oral hygiene before an operation, and observed usage of incentive spirometry.

Following the implementation of the interventions, the Post-operative Pneumonia rate dropped from 2.32 in 2021 to 0.72 in 2022, and from January to October 2023, ZERO incidents of Post-operative Pneumonia were noted. Moreover, the CLABSI rates in 10 South increased in 4Q2021 and 1Q2022 to 6.29 and 6.47, respectively. Dima led a Performance Improvement project along with her colleagues and Nurse Manager to improve this rate. On a daily basis, Dima initiated focused rounds on patients with Central Lines to ensure compliance with the CLABSI bundle. In addition, she did an extensive literature review and identified the effectiveness of chlorhexidine-impregnated dressing in decreasing CLABSI. Dima requested to pilot this dressing on 10 South. Following the use of the chlorhexidine-impregnated dressing and close monitoring of compliance with the CLABSI bundle, the CLABSI rates dropped to ZERO from 2Q2022 till year to date.

Dima's commitment to patient safety extends beyond her unit. As the chairperson of the Medical Surgical Clinical and Professional Advancement Council (CPAC), she proposed to initiate clinical peer-review rounds, where council RNs conduct clinical rounds on their peers from other units to ensure safe care and knowledge sharing. This initiative has fostered a culture of collaboration and continuous improvement among the RNs of the medical-surgical units and empowered the council nurses to identify clinical gaps and rectify them instantly. Dima also recognized the need for enhanced care for patients with physical limitations. She conducted a thorough literature review and developed a comprehensive policy for the care of comatose and debilitated patients. This policy not only improved care for these patients but also educated nurses and support staff across the units. Dima's exceptional contributions to patient safety exemplify her dedication to excellence in nursing practice. Her commitment to improving patient care has had a major impact on the medical center, making her a true candidate for this esteemed award.

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Dima is a pioneer in delivering safe and high-quality patient care. She is the backbone of the floor (surgical unit) and is considered a resource to her colleagues. She shows excellent skills in managing critical patients necessitating a higher level of care and who remain on our unit due to a lack of beds in the ICU. Once, one of Dima’s patients, during the night shift, started showing signs of deterioration. Dima quickly identified the early signs of deterioration and activated the Rapid Response Team (RRT). She urged the responsible medical team to consider transferring the patient to a critical care unit; however, no beds were available. Dima efficiently communicated this issue with the Nurse Administrator during the night shift and coordinated with the critical care nurse to provide a safe and high level of care to the patient, meeting his needs. During her shift, the patient was taken care of as if he were in a critical care unit.

Dima is well known for her caring and compassionate personality. During my rounds as a Nurse Manager, I always receive praise for Dima’s compassionate care from her patients. She listens to the patients to ensure she gives them the best care they deserve. She focuses on the patients, establishing a vested interest in their care, advocating for their needs, and accommodating the plan of care to meet these needs. One of her postoperative patients was complaining of pain on the surgical site and was not relieved by the pain medications prescribed to him. Dima contacted the pain team and worked with them to start the patient on continuous pain medication through the “Patient Controlled Analgesia” (PCA) pump. Dima and the pain team educated the patient on how to use the PCA pump and what are the benefits and side effects of this modality. The patient’s pain improved tremendously, and he and his family kept on thanking Dima for her holistic care and for relieving him of his pain.

Dima is currently pursuing her Master’s degree in the Adult Gerontology-Clinical Nurse Specialist track. She is the chair of the Medical Surgical Clinical and Professional Advancement Council, a member of the Collaboration Council, a member of the Advanced Practice Registered Nurses Council, and a Magnet Champion. Dima has led many initiatives through these councils and has advocated for safe and high-quality patient care. Dima led a unit task force that worked on improved blood hemolysis rates. She worked with her colleagues and other disciplines to develop innovative initiatives to reduce blood hemolysis, especially those requiring redraws, and succeeded in decreasing the rates on her unit from 13% to less than 2%. These initiatives were disseminated across the hospital. Dima worked diligently on ensuring that her unit is CAUTI free. She rounded daily on all patients with an indwelling catheter and discussed the need to keep the catheter with the medical team and remove unnecessary catheters. The unit is CAUTI free for eight consecutive quarters.