Provide two examples, with supporting evidence, of an improvement that resulted from an innovation in nursing. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
Example 1 Innovation in nursing -elimination of CLABSI through the use of transparency data boards. Background/Problem Innovation in nursing practice comes from the open discussion and generation of new ways of thinking. At Thompson nurses at all levels strive to identify new ways of working that improve patient outcomes, improve efficiency and enhance the practice of nursing.
The Nursing quality plan sets forth lofty goals to eliminate hospital acquired infections and patient harm. Using visual management as a new strategy, nurses at FF Thompson have taken control over their quality data in a more proactive way. Monitoring progress against our goals of eliminating patient harm, eliminating hospital acquired infections and insuring compliance with core measures we have made significant progress over the past two years.
Our culture at FF Thompson is rich in empowerment of front line staff. Ideas are welcomed and embraced. One such idea set us on the pathway to embracing visual management as a tool to improve outcomes. Our Clinical Nurse Leader, Diana Ellison MS, RN, CNL is always looking for ways to improve outcomes. Diana identified that nurses were often overwhelmed with multiple competing priorities and that our best successes were achieved when we had a specific focus on an area of practice. Diana brought the idea of using visual management boards to the Nursing Practice Council to discuss how we could achieve this at Thompson.
Our Boards (see exhibit NK4EO.1) are prominently displayed in public areas on all our medical surgical areas as well as the intensive care unit. The boards have evolved over time, however the original boards were designed to remind nurses of "best practices" to prevent falls, pressure ulcers and infections. The boards list the "days since last.." by each category and nurses review this information on a daily basis. In 2012, there was an increase in the number of Central Line Associated Blood Stream Infections (CLABSI's) on our medical surgical units. A team came together to review our visual management strategy and identified an opportunity for the medical surgical units. Using multiple visual cues to identify central lines including signs in patient rooms, transparency boards, pink labels on the IV lines, and additions to the daily documentation tabs in Clinical Care Station (McKesson Paragon Electronic medical record documentation system) we were able to significantly impact our CLABSI rate across the hospital. Goal statement Eliminate Catheter Associated Blood Stream Infections Participants Diana Ellison, MS, RN, CNL. Clinical Nurse Leader, Nursing Administration, Patient Care Services Hazel Robertshaw, PhD, RN, CENP. Vice President of Patient Care Services/CNO, Hospital Administration Kiera Champlin-Kuhn, MS-HQS, RN. Director of Quality, Safety and Utilization Management, System Administration Elizabeth Alexander, MS, RN. CN-E. Director of Medical Surgical Nursing, Patient Care Services Gloria Karr, MS, RN-BC, CIC. Director of Infection Control/Emergency Preparedness, System Administration Adrian Hordon, MS, RN. Clinical Nurse Educator and Magnet Project Director, Nursing Administration, Patient Care Services Catherine Crosby, MS, RN, CNL. Clinical Nurse Leader, Diagnostic Imaging Kathleen Wethington, CMSRN, Clinical Nurse, 3 West, Medical Surgical Nursing, Department of Nursing
Interventions The first step was to conduct a Root Cause Analysis (RCA) of the 3 cases that had occurred. The Root Cause Analyses identified the following: a. All three patients' had peripherally inserted central lines (PICCs) b. One PICC had been in for 28 days c. Two of three patients with poor hygiene d. Identified a need to develop a tool to evaluate the continued need for PICC/Central Line (CL) in patients to ensure timely removal
Action items were identified following the RCA
a. The transparency boards on medical Surgical units were changed to include best practices for preventing CLABSI. This serves as a continual reminder to the nurses caring for patients
Exhibit NK4EO.1- New Visual Management Board
a. Better identification of patients with PICC/CL via signage to hang on Intravenous (IV) poles and labeling of the IV sites themselves with pink labels (Exhibit NK4EO.2)
Exhibit NK4EO.2
Central Line In Use.pdf
b. "Central Line" daily tab in Clinical Care Station developed to provide daily assessment tool for continued use of line (see Exhibit NK4EO.3). Information guides nurses to evaluate the continued need for central line access and if does not meet criteria, to ask MD for removal. The CLABSI prevention bundle serves as a daily reminder and documentation tool for key prevention strategies for CLABSI such as hand hygiene, chlorhexidine for site care, scrub the hub before access, and assessment of the site c. Daily Chlorhexidine Gluconate bath for all patients with a PICC/Central Line (CL) on the medical surgical units d. Purchase of a warmer for keeping baths warm for patient comfort e. Replace washing bucket every day to reduce the risk of infection as a result of wash bucket not being adequately dried. f. Daily huddle to include identification of all patients with PICC/CL g. Proactive bedside handoff education a. Throughout the month of May 2013, there were 4 opportunities for the RN staff at FF Thompson Hospital to come to the Nursing Skills Day and learn or reinforce their knowledge of the care and maintenance of Central Lines. Each participating RN had the chance to demonstrate the proper scrub the hub technique and be timed for 10-15 seconds as was referenced by the Central Line Associated Blood Stream Infection Prevention Education. Using simulation reinforced the correct technique. b. This education is now one of the annual nursing skills sessions enforcing the 15 second scrub the hub as a return demonstration. Exhibit NK4EO.3 Screen shot from Clinical Care Station Data Requirements:
Outcome Since the implementation of all the action items including the new white boards there have been no CLABSI's on any of our medical surgical units
Example 2 Innovation in nursing -development of online tools to streamline clinical placements process for students
Background/Problem
In August of 2013, Adrian Hordon, MSN RN and Angela Smith, Operations Supervisor of Associate Services, identified a process breakdown regarding onboarding local RN students into the hospital and found that the hours spent between calls, paperwork, contracts, uploading student access forms, and finding placement for all students was creating an average of 70.5 hrs of work for Adrian and Angela. A Do It Group (DIG) was formed and found that the Clinical Preceptors also had a difficult time gathering all the required paperwork for their students to complete and who to turn the appropriate documents in to. A DIG is an Associate work group (departmental or interdepartmental) that come together to solve a problem or explore an opportunity using the four-step DO-IT problem solving method.
D Define the problem/opportunity O Outline the problem/opportunity improvements I Implement your suggestions T Track your results
A DIG group consists of 5-7 Associates and an AQC sponsor to help them be successful. Ideally, the group meets once a week for four weeks and each meeting lasts for 50 minutes. However, a DIG may require fewer or more meetings to complete the process. Following completion, the recommendations of the DIG members are submitted to the Associate Quality Council for their approval. Pending approval, the DIG is implemented. The DIG is also tracked for 6 months to show results. Below is an example of one of the many in-depth spreadsheet tabs that help collect and analyze data as it is collected, and how many hours were spent by whom during the DIG process.
The group started in September of 2013, utilizing the help of Margaret Fowler, Corporate Communications Specialist, who helped create a website that would allow all required documentation and student information in one area, along with clinical placement schedules to provide transparency and prevent overbooking of floors, and also a contact list of who to contact for specific questions. Goal Statements The improvement that was desired from the creation of a school institution tab, was to provide the students and clinical instructors an internet portal that would provide all pertinent information regarding onboarding processes, required forms, important phone numbers and contacts, and scheduling information. Another goal was to decrease the number of physical hours spent processing and channeling incoming student and clinical instructor forms and questions. In September, the DIG team began developing the layout of the website, alongside Thompson clinical nurses, of which were also the clinical instructors for two of the local colleges. The nurses expertise and knowledge of deficiencies in current process helped guide the website build. Thompson Health > Career Opportunities > Career Opportunities > Student/Intern Placement information > Calendar Thompson Health > Career Opportunities > Career Opportunities > Student/Intern Placement information Thompson Health > Career Opportunities > Career Opportunities > Student/Intern Placement information > Forms Thompson Health > Career Opportunities > Career Opportunities > Student/Intern Placement information > Nursing Student Clinical Placement Portal
Outcome After the creation of the web portal and directions on use sent to all affiliated college coordinators on how to use it, the results noted for the Spring 2014 semester were astounding. The average number of hours spent on onboarding students plummeted from 70.5 to five hours per semester, and all required documents arrived on time and were processed before the start of the semester. Not only did this create a seamless process for the nursing students and clinical instructors, in the first quarter of 2014, Human Resources/Associate Services cut time spent on placement of ONE program by 60%, and Nursing Education cut time by 66%. This will be a time savings >160 hours per year and approximately $5000.00. Johnelle Keck, MSN, RN, and Patti VanAuker, MSN, RN, CEN, stated it was extremely easy to have students navigate the website, print off needed forms, and return them in a timely manner. All forms were into IT on time and there were no incomplete/lost pages during the process, which is a first