Provide two examples, with supporting evidence, of improvements in nursing practice that occurred because of clinical nurse involvement in a professional organization. Supporting evidence must be submitted in the form of a graph that clearly displays the data.
Example One:
Background Nurses at FF Thompson routinely scan the literature from their professional organizations and work to incorporate best practices into the workplace. This activity, supported by the Synergy Model of care, ensures that nurses are using clinical inquiry to evaluate and improve their practice. In 2012, the Infection Prevention (IP) nurses and the nurses from perioperative services came together to review current practice surrounding surgical site infection prevention. Using the Association of Perioperative Registered Nurses (AORN) and the Association for Professionals in Infection Control and Epidemiology (APIC) guidelines for reduction of surgical site infections they reviewed and revised the skin preparation guidelines within the hospital and reinforced surgical attire best practices (Exhibit SE2EO.1). AORN guides the practice for skin prep in the Operating Room (OR). Review of AORN guidelines for reduction of Surgical Site Infection (SSI) included: • Appropriate clothing (particularly hair coverage) • Skin preparation • Maintenance of the surgical sterile field • Reduction in interruptions in the rooms
Exhibit SE2EO.1 Evidence for practice changes
AORN_Evidence for Using CHG.pdf
Preoperative Chlorhexidine baths_showers_For or against.pdf
Example 1 2012 SSI Task Force.pdf
Goal Statement
Reduce Surgical Site Infection (SSI) rates by 30%
Interventions Reviewed current practice Reviewed AORN and APIC guidelines (Exhibit SE2EO.1) Re-education and monitoring of compliance with guidelines related to attire to OR staff, anesthesiologists and surgeons (Exhibit SE2EO.2)
Exhibit SE2EO.2
Exhibit SE2EO.2 Surgery attire.pdf
Reviewed proper skin prep and hand hygiene for surgeons, OR and Surgical Care Center (SCC) associates (Exhibit SE2EO.3)
Exhibit SE2EO.3
Exhibit SE2EO.3 Memo to OR Staff 5-12 IC.pdf
Careful monitoring of the air quality and barrier integrity in construction areas located in and around the OR suite Patient education brochure developed and distributed on or before admission. Memo sent out to hospital nursing in regards to CHG Baths (Exhibit SE2EO.4)
Exhibit SE2EO.4
Exhibit SE2Eo.4 Chlorhexidine Memo.pdf
CHG baths presented at the OR Committee Meeting and presented at Department of Surgery meeting with the following recommendation from the Infection Prevention and Control Committee: “The Infection Control Committee has the Department of Medicine’s support to implement the protocol in the ICU. Although it is strongly encouraged for implementation on the floors for all surgical patients, it will be left to the discretion of the attending physician."
CHG Baths implemented on 13 May, 2013. Monitored results/ongoing surveillance of recommended practices Monitored results
Participants
Gloria Karr, MS, RN-BC, CIC Director of Infection Control/Emergency Preparedness Donna Fulmer, MS, RN, CPAN, NE-BC Director, Perioperative Services Vickii Bement, BSN, RN, CNOR Charge Clinical Nurse Operating Room, Perioperative Services
Data
Outcome The graph demonstrates that that the goal of a 30% reduction in SSI’s was exceeded shortly after implementation of the new process. The new process continues to be an integral part in improving patient safety as well as ongoing surveillance of recommended surgical aseptic practices.
Example Two:
Background
Diabetes self-management education/support (DSME/S) provides patients the necessary tools to manage their diabetes. DSME/DSMS is a collaborative process through which people with or at risk for diabetes gain the knowledge and skills needed to modify behavior and successfully manage the disease and its related conditions.
To be recognized as a provider of DSME/S, a facility must adhere to the ten national standards for Diabetes Self-Management Education and Support outlined by the Task Force convened by the American Diabetes Association and American Association of Diabetes Educators. These standards are available for reference in EP13EO. Jane Hallstead, MSN, Diabetes Educator for FF Thompson Hospital is an active participant with the American Association of Diabetes Educators (AADE), and ensures that the above standards are addressed throughout the system with the use of evidence-based practice presented by AADE.
The Diabetes and Outpatient Medical Nutrition Therapy Center (the Center) at FF Thompson Hospital was established in 2007 and received its first American Diabetes Association recognition in 2008. The Center was recertified in 2011. Jane was appointed coordinator of the program in February, 2011. Standard #4 of AADE requires that there be a program coordinator designated to oversee the DSME program. The coordinator will have oversight responsibility for the planning, implementation, and evaluation of education services. The program coordinator has maintained the position since 2011. Standard #5 of the AADE states that one or more instructors will provide DSME and, when applicable, DSMS. At least one of the instructors responsible for designing and planning DSME and DSMS will be a registered nurse, registered dietitian, or pharmacist with training and experience pertinent to DSME, or another professional with certification in diabetes care and education.
DSME/S is provided on an individual basis or group setting. Medicare and insurance companies endorse group sessions, which provide opportunities for participants to share their personal successes and failures. The DSME program utilizes the American Diabetes Curriculum (ADA) and integrated the use of Conversation Map into the curriculum for the group classes. Conversation Map is a motivational, innovative and interactive education program, developed by Merck Pharmaceuticals in collaboration with the ADA program, that engages patients through patient-friendly support materials. The Center’s instructional staff serves as facilitators rather than lecturers.
In late 2011, Jane identified two areas for improvement:
Scheduling of patient appointments occurs in different ways, which has been problematic since the inception of the program. Some referrals for DSME/S are faxed to community wide scheduling and require the patient to call to make an appointment. Referrals that are sent directly to the Center are addressed on a timelier manner. Appointments may also be scheduled by the provider’s office directly, with or without patient’s knowledge, resulting in many patients missing these appointments. Group classes were set up based on the staff’s schedule, without consideration to the needs of the population the Center serves. Group classes were scheduled once a month on two separate days (3-hour sessions each), 3 days apart. The first class was facilitated by a registered dietitian and the second session was facilitated by a registered nurse. Attrition rate for the second session was high. As a consequence, many providers stopped sending referrals to the program both for individual consultations and group classes.
There also seemed to be a lack of knowledge among providers about the service the Center provides despite advertisement.
DSME/S Standard #3 states that the provider of DSME will determine how best to deliver diabetes education to that program, and what resources can provide ongoing support for that population. As identified in the Magnet 2014 manual, nursing practice is identified as, “…collaborative care of individuals of all ages, families, groups, and communities…advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles” (pp. 71). Following the Magnet model, it became apparent that a change in nursing practice in the role of education was needed to increase the participation of diabetic outpatients in classes to promote patient health. Jane evaluated the age of patients seen at the Center, and identified that most patients were actively working. This represented a significant barrier to their ability to attend classes during the day on weekdays. A one-day Saturday format would be more practical for this population. The 2-day format with shorter class times provides the older population the option of not having to sit in class for a full day, which can be difficult for those with back problems or those who can’t sit for a prolonged period of time. It may also make processing of information easier without getting overwhelmed with information. By giving participants different options, the Center would be able to bring the program to the population in need of diabetes education.
Practice managers were hired to by the hospital to help implement patient-centered medical home. These office practice managers serve as liaisons between the Center and program participants and patient support is carried on through this relationship.
Goal Statement: Increase total number of group class participants (minimum of 3 for each class) and group classes
Interventions:
Referrals: · Educated practice care managers about the program services and referral process · Monitor patient referrals on a bi-weekly basis for timely scheduling · Program coordinator reaches out to patients to assist them with scheduling appointment · Make reminder phone calls · Self-assessment forms mailed to group classes participants a week before appointment · Offices are notified when patient does not schedule appointment within three months from referral date.
Group class schedule revision: In 2012, the Center started offering two 3-hour group sessions in one day every third Thursday and full day classes every third Saturday of the month on an alternating basis. The registered dietitian facilitates the morning session.
More scheduling changes were implemented in 2014 in response to class attendance and feedback. Group classes were offered in two different formats 1. One-day class format (Saturday) in the months of March, June, and October 2. Two-day class format (Tuesday and Thursday, either 1-4 pm or 3-6 pm) in the months of January, February, April, May, August, September, and November. The topics for the classes were divided allowing both the RN and RD present the information on both days with the goal that participants will attend both sessions to obtain the most comprehensive education. Participants are also made aware that there will be separate co-pays for each visit.
Group class schedules are created three months prior to the next year based on the previous year’s performance
Marketing/Advertisement · Program advertised in Partners magazine which is a quarterly publication · Program advertised in the “Wellness Program” offerings monthly publication · Advertising program at community health fairs and activities (Day of Dance, Girls’ Night Out, Rose Walk and others) · Revised the Center’s brochure and distributed/mailed to providers along with class schedules · Updated/enhanced the Center’s website Participants · Anne Johnston, Corporate Communications · Elaine Jackson, Corporate Communications · Margaret Fowler, Corporate Communications · Linda Rowsick, RD-N, CDN · Jane Hallstead, RN, MSN, CDE · Wendy Blakemore, MT, ASCP · Ashley Randazzo, Community Wide Scheduling · Meghan Rutkowski, Community Wide Scheduling · Marie Ann Schlesing, Community Wide Scheduling · Joyce Hanselman, Community Wide Scheduling · Jannette Aruck,RN, RN Care Manager · Erin Nye, RN, RN Care Manager · Barbara Gerolomi, RN, RN Coordinator · Catherine Shannon, Director of Practice Management
Outcomes The above graph represents the changes in the number of participants from 2012-2014. There have been at least three participants in the majority of the classes. Classes are now offered multiple days throughout the week, with access to online learning as well.