Provide TWO examples, with supporting evidence, of workplace safety for nurses resulting from the safety strategy of the organization. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
Example one: Background/Problem Associate health and wellness are an integrate part of FF Thompson. In 2011, Deborah Weymouth, then COO, and several members of the Board of Directors, attended an Institute for Healthcare Improvement (IHI) seminar focused on hospital quality and safety. As a result of their findings, they initially developed an umbrella policy identified as the "Five Big Dots". The "Five Big Dots" were areas of concern within the hospital setting, and they were identified as: Reduction and Prevention of Mortality, Elimination of Patient Harm and Infections, Reduction of Preventable Readmissions, and Increase in Patient Satisfaction. In 2012, the "Five Big Dots" were renamed Strategic Aims, which became an integral part of the strategic plan of the organization. In 2013, a discussion arose during a 2nd quarter Quality and Safety Committee meeting, surrounding the safety of hospital associates and truly identifying and implementing strategic initiatives to decrease associate harm. The council was in agreement that the staff's safety needed to be included in the strategic plan, so that the highest possible care could be delivered to the patients. This decision led to the creation of Strategic Aim #6: Eliminate Associate Injury. For the department of nursing the two main areas of harm related to needle stick injuries and injuries associated with lifting and handling of patients.
Goal Statement
Eliminate RN needle stick injuries
Intervention The first area of concern related to workplace safety that was identified in the safety strategy of FF Thompson, was the amount of RN sharps exposures and how these could be eliminated. RN sharps exposures are tracked through Associate Health with detailed explanations of how the injuries occurred and what type of device was used. A review of the injuries reported identified that the most common sharps exposure for clinical nurses in the hospital was related to the use of the standard stocked insulin syringes. According to JSHQ, 1998, most needle stick injuries result from unsafe needle devices rather than carelessness by healthcare workers. After an evidence-based literature review, this issue was taken to our Nursing Practice Council in February of 2014, and subsequently with our Value Analysis Team (VAT). A trial of new insulin and TB syringes, both with built-in safety devices that retract the needle upon insertion was initiated. After two months of trials and presentations at VAT and Nursing Practice Council, the new syringes were selected. In May 2014, the process began to remove the old syringes from the entire hospital and replace with the new product. The Nurse Educator coordinated a week of training sessions with VanishPoint trainers, making sure the entire nursing staff within the hospital were trained in use of the new retractable needle devices. These sessions took place the first week of June, 2014. The May needle stick represented on the graph below took place before the implementation of the new syringes. All associates are required to complete an annual mandatory training session in January on our intranet regarding possible exposure to blood borne pathogens and how to protect themselves from injury. This interactive training component MUST be completed by all associates, and tracking is completed by each unit director (Exhibit EP18EO.1).
Exhibit EP18EO.1: Screenshot of FF Thompson Intranet Mandatory Education Page
Participants
Kiera Champlin-Kuhn, BSN, RN, MS-HQS, Director of Quality/Safety/Utilization and Clinical Documentation and Patient Safety Officer, Administration
Judy Habberfield, Materials Management Supervisor
Jan Lounsbury, RN, VanishPoint Clinical Educator
Adrian Hordon, MSN RN, Clinical Nurse Educator/Magnet Project Director, Patient Care Services
Elizabeth Alexander, MSN, RN, CN-E, Director of Medical Surgical Nursing, Patient Care Services
Hazel Robertshaw, PhD,RN CENP, Vice President of Patient Care Service/Chief Nursing Officer, Hospital Administration
Josh Kulp, BSN, RN, Director of Critical Care Nursing, Patient Care Services
Nursing Practice Council Members:
Cathy Crosby, MSN,RN, CNL, Clinical Nurse Leader, Diagnostic Imaging
Heather Forkum, BSN, RN, Clinical Nurse, Emergency Department, Department of Nursing
Kathy Wethington, RN, CMSRN, Clinical Nurse, 3 West Medical Surgical Nursing, Department of Nursing
Kyla Popielarczyk, BSN, RN, Clinical Nurse, Operating Room, Perioperative Services, Department of Nursing
Rebecca Dey, RN, Clinical Nurse, Ambulatory Procedures Unit, Perioperative Services, Department of Nursing
Tammy Giamei, RN, Clinical Nurse, 3 East, Medical Surgical Nursing, Department of Nursing
Data
Outcome
The goal for this intervention was to have an incident rate of zero for RN needle sticks, which mirrors the safety strategy of the hospital- to eliminate associate harm. Per the data table above, FF Thompson Hospital has achieved the goal for three consecutive months post Implementation of the new safety syringes decided on by the Clinical Practice Council.
Example Two:
Another example of workplace safety for Thompson nurses in conjunction with the strategic aims of the hospital, was the reduction of nurse-related injury related to patient lifting and handling. This information was reviewed through a Quality and Safety Management meeting, and then taken to the Quality Board of Directors. In 2013 FF Thompson Hospital adopted Strategic Aim #6: Eliminate Associate Injury. Goal Statement The Goal of Strategic Aim #6 was: Eliminate Associate Injury and this includes injuries related to patient lifting and handling. The improvement desired was to completely eliminate nurse-related injuries such as neck and back strain when assisting with the transfer and/or ambulation of a patient for the entire 2014 year. While the amount of nurse lifting/handling injuries are minimal within Thompson Hospital, there were still reported injuries in 2013, which was not meeting our goal of zero. The most recent data from the Bureau of Labor Statistics (BLS) show that nurses and nurse aides suffered the most lost-time cases of general musculoskeletal pain and back pain of all US jobs. The concerns regarding associate injury were raised at a Quality and Safety management group meeting, and then shared with the Board of Directors, who ratified the findings of the Quality team. Interventions
The concerns regarding safe patient lifting and handling were discussed at the Falls Committee meeting in November 2013, and the Policy and Procedure regarding patient lifting was reviewed. In line with the American Nurses Association publication on Safe Patient Handling the policy was revised. It was found that the policy did not capture the requirements that qualify a patient for a two person transfer, or identify patients who need extra support, such as a gait belt. Diana Ellison,MS, RN CNL, met with Curt DeWeese, Physical Therapist and Sharon Haefele, BSN, RN, WCC, Director of Clinical Compliance at the Continuing Care Center, and began the rewriting of the policy using evidence-based practice. Within the new hospital policy is an algorithm that helps guide the nurse in choosing the correct transfer style for the patient. This not only protects the patient, but the nurse as well. Curt Deweese created an online webinar that can be accessed through Thompson's intranet to provide the nursing staff with up-to-date information on safe patient transfers and body positioning to prevent injury (Exhibit EP18EO. 2). Curt also meets with all new clinical associates during New Associate Beginnings (NAB) to show proper moving and handling techniques across all aspects of the hospital. Nurses interested in reeducating themselves on proper moving technique are invited to attend a Safe Patient Handling/Back Safety course that is offered every two weeks during NAB (Exhibit EP18EO.3). Based on evidenced based research and discussion with the clinical nursing staff it was decided that beginning in 3rd Quarter 2013 all patients requiring assistance with transferring/ambulation would have a gait belt placed for their safety as well as the safety of the associate aiding in their transfer. Reusable gait belts are available in all patient rooms and are cleaned between patients to prevent the spread of infection. The new Policy and Procedure provides a detailed algorithm to guide the nurse in safe transfer of patients (Exhibit EP18EO.4).
Exhibit EP18EO.2 Screen shot from Intranet Education site
Exhibit EP18EO.3: Associate calendar accessible through FF Thompson intranet displaying Safe Patient Handling course
Exhibit EP18EO.4: Revised Lifting and Handling Policy
EP18EO.4 Lifting and Handling Policy.pdf
Participants Juanita Marshall,BSN, RN Associate Health Nurse, Associate Services Hazel Robertshaw, PhD, RN, CENP, Vice President of Patient Care Services/CNO, Hospital Administration Kiera Champlin-Kuhn, BSN, MS-HQS, RN Director of Quality\/Safety/Utilization and Clinical Documentation and Patient Safety Officer, Administration Curt Deweese, Physical Therapy, external consultant Sharon Haefele, BSN, RN, WCC Director of Clinical Compliance, Continuing Care Center, Senior Living Services
After implementation of gait belts, reeducation regarding the new patient lifting policy, and access to Curt Deweese for training opportunities to prevent injury, the goal of having zero nurse injuries related to patient lifting and handling has been met for the first three quarters of 2014.