Provide one example, with supporting evidence, of nurses incorporating specialty standards/guidelines into the delivery of care.
As discussed in OO8, FF Thompson Hospital's care delivery model is a blend of primary nursing and total patient care, emphasizing continuity of care across the patient's hospital stay. Our blended care delivery model is patient-centered, and the RN coordinates care and is accountable for all aspects of the nursing process for his/her assigned patients. The primary nurse communicates and interacts with multiple disciplines regarding the patient's specific health care concerns and develops a plan of care based off of the needs assessment. Incorporating the new CMS Core Measure Sepsis Resuscitation Protocol is a primary example of the RN's ability to coordinate and implement the plan of care based on the needs assessment and specialty standards and guidelines.
Implemented in the fall of 2013, the new Sepsis Resuscitation Protocol (the reinvigoration of the Surviving Sepsis Campaign) or what then became known as "Code 60" in FF Thompson Hospital, was presented to the Nursing Practice Council and introduced to the nursing staff in a hospital-wide education initiative using interactive online modules and unit-to-unit education sessions. Using nursing criteria developed by the World Federation of Critical Care Nurses* and the American Association of Critical Care Nurses (AACN) providing guidance to the nurse for care of the severely septic patient. Incorporating the use of the new Code 60 algorithm (Exhibit EP6.1) along with a standardized policy and procedure (Exhibit EP6.2) provided the primary nurse with the ability to integrate critical thinking and best practice into patient care.
Exhibit EP6.1 Exhibit EP6.1 FFTH Adult Sepsis Algorithm (2).pdf
Exhibit EP6.2 Exhibit EP6.2 Sepsis P&P.pdf
Clinical nursing staff and the Quality Improvement (QI) department identified that tracking and trending of Code 60 information needed to be included in the EMR to meet CMS standards. Nursing Informatics and clinical nurses on the Clinical Care Station (CCS) build team were highly involved in the creation of the tracking mechanism, and were able to create a tab within the electronic daily assessment of the patient (Exhibit EP6.3), along with creation of individualized nursing care order sets for each unit (Exhibit EP6.4).
Exhibit EP6.3 Documentation Screen for Code 60.png
Exhibit EP6.4 Daily Focus Assessment Sepsis Panel.png
The build team created the functionality page and discussed thru email changes and updates that needed to be addressed before incorporating it into the electronic medical record. This is depicted in the email below.
Tracking this information and providing clear pathways/algorithms has allowed the nursing staff to incorporate the specialty guidelines related to sepsis protocol into daily practice, and helps identify early stages of sepsis and provide preventative care.