Provide one example, with supporting evidence, of an initiative identified in the nursing strategic plan that resulted in an improvement in the nurse practice environment. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
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Provide one example, with supporting evidence, of an initiative identified in the nursing strategic plan that resulted in an improvement of clinical practice. Supporting evidence must be submitted in the form of a graph with data table that clearly displays the data.
Example One- Improvement in Nurse Practice Environment due to process redesign in the Perioperative Services Department for "clinical" patients
Background/Problem The nursing strategic plan outlines the goals and actions necessary to achieve the organizational objectives (see exhibit TL1EO.1). Improvements in the nurse practice environment are achieved when nurses are able to make autonomous decisions about the way they deliver care and about the environment in which they deliver care. In November 2012, a group of nurses from perioperative services came together to form a Do It Group (DIG). The DIG chair, Catherine Habberfield, RN, CNOR brought the proposal to the Associate Quality Council (AQC). She and her colleagues had identified a patient flow and patient safety opportunity with patients coming through the Operating Room (OR). Exhibit TL1EO.1 Excerpt from the Nursing Strategic Plan
Identify at least one core process to redesign
Establish teams in different nursing settings to review core processes
a. Patient flow
b. Patient safety
c. Patient Satisfaction
The operating room (OR) nurses identified that critical patient safety information (allergies, medications, vital signs and past medical history) was missing on a regular basis for a select group of patients coming to the OR. These patients were not being seen in pre-admission testing as they did not receive general anesthesia. Clinical (or clinic) patients are those patients that could be seen in a clinic setting for the procedure they need. There is no designated space for this at Thompson Hospital so patients are routinely admitted to the OR for these procedures. The OR nurses were responsible for their admission and discharge- as well as maintaining the normal flow of the OR and turnover of rooms. Goals Accurate and complete documentation of vital signs, medications, allergies and past medical history for 100% clinic patients. Description of interventions Thompson Health has a culture of safety and associate empowerment called the "Thompson Way". This program allows any associate to identify a problem and put together a group to fix it. There are a number of ways to do this. In this instance a "Do it Group (DIG)" was created in November 2012 to address this important patient safety and workflow issue. This interdisciplinary team included OR schedulers, pre-admission testing, OR, Surgical Care, and an informatics nurses. The first step was to identify the current process and a flow diagram was developed to visually describe the current steps (see Exhibit TL1EO.2). Exhibit TL1EO.2 Admission Process for Clinic Patients 2012
At the second meeting the interdisciplinary team developed a new "ideal state" process (see below). In addition the team created a form to track "key" issues including:
Exhibit TL1EO.3 2013 New Admission Process of Clinic Patients Having mapped out the new process (Exhibit TL1EO.3) the team presented the ideas to the key stakeholders; leadership, MD office staff, OR schedulers and nurses working in pre-admission testing, the surgical care center and the OR. All associates involved in the operationalization of the change received information and education with respect to their role in the smooth and safe transition of clinic patients using the new process. A new "bed type" was created within the Electronic Medical Record to ensure that patients were placed in the correct status prior to arrival. The new process was operationalized in January 2013 and the results were tracked from January through June 2013. Participants DIG Chair Catherine Habberfield RN, CNOR, Clinical Nurse, Operating Room, Perioperative Services, Department of Nursing DIG Member Vicki Bement, BSN, CNOR Clinical Nurse/Charge Nurse, Operating Room,Perioperative Services, Department of Nursing DIG Member Kathy Cooley, BSN, CNOR Informatics Nurse, Operating Room, Perioperative Services, Department of Nursing DIG Member Kim Hyde, LPN OR Scheduler, Operating Room, Perioperative Services, Department of Nursing DIG Member Tammy Jeffrey, RN Clinical Nurse, Operating Room, Perioperative Services, Department of Nursing DIG Member Kelly Hennessy, RN Clinical Nurse, Pre-Admission Testing Center, Perioperative Services, Department of Nursing DIG Member Louise McGuire, RN Clinical Nurse, Surgical Care Center, Perioperative Services, Department of Nursing DIG Sponsor Janet Kerr Director of Performance Improvement, Finance Department Data: Outcomes-Accuracy and compliant data 100% of patients Utilizing the DIG process, we were able to refine the process for admitting these "clinical" patients and improve patient flow and patient safety. The graph demonstrates that that the goal of 100% compliance with required data elements (vital signs, past medical history, home medications and allergies) was met from the second month of implementation of the new process. The new process is hardwired in the system and we have consistently achieved our goal of 100% compliance with required patient safety information in our electronic medical record. As evidenced by the description of Nursing Practice in the Magnet 2014 Manual, advocacy and promotion of a safe environment for all patients is observed through the new process, with accurate and timely documentation of these data elements and with improved throughput in the operating room. The results were shared with the organization during the "QTIPS" quality fair and this DIG was recognized during Associate Recognition month as the DIG of the Year for its contribution to patient safety in the OR. TL1E0.4 - OR Presentation at QTIPS Fair
Exhibit TL1EO.4 Q-Tips OR Dig of the Year Board.pdf Example Two- Initiative identified in the nursing strategic plan that resulted in an improvement of clinical practice. Background/Problem The strategic plan guides the development of programs to drive continuous improvements in care. Clinical nurses are empowered to change practice through the use of autonomous decision making. The Foley Catheter Removal Program, empowers clinical nurses to act autonomously within their scope of practice and aligns with the nursing strategic plan, "Sustain and advance a culture of safety, quality, and compliance throughout the system". Exhibit TL1EO.5 Excerpt from the Nursing Strategic Plan
Goal The goal that aligns with the nursing strategic plan is to develop department and unit-specific action plans to improve outcomes (Exhibit TL1EO.5). In the third quarter of 2012, the 3 East clinical nurses noted a spike in the rate of Catheter Associated Urinary Tract Infections (CAUTIs). They created a sub-committee led by the Clinical Nurse Leader, Diana Ellison MS, RN, CNL and Director of Medical Surgical Nursing, Elizabeth Alexander, MS, RN, C-NE. The team also included clinical nurses from the emergency department, patient care technicians, an infection control nurse, and the Clinical Educator. The team then formulated and implemented a plan to help drive the number of CAUTIs on the unit down. Description of Interventions
Exhibit TL1EO.6 Monthly Education Component showing Education regarding catheter associated UTI's
Used hands-on return demonstration for assessment of competence using simulation equipment. Implemented a practice to use a new (not just clean) wash basin and a clean cloth for perineal care every day. Bathing the perineal area prior to any catheter insertion was also implemented.
Exhibit TL1EO.7 Nurse driven Foley Catheter Removal Protocol
Exhibit TL1EO.8 Example of a unit based visual management board
Exhibit TL1EO.9 Excerpt from McKesson Paragon Clinical Care Station 'Foley tab'
Participants Elizabeth Alexander, MS, RN, CN-E Director of Medical Surgical Nursing, Patient Care Services Diana Ellison, MS, RN, CNL: Clinical Nurse Leader, Nursing Administration, Patient Care Services Vicki Erway, RN, CMSRN, Clinical Nurse, Float Pool, Department of Nursing Lisa Maier, RN Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing Adrian Hardens, MSN, RN, Clinical Nurse Educator and Magnet Program Director, Patient Care Services Cassandra Massa, BSN RN, Charge Nurse 3 East Medical Surgical Unit, Department of Nursing Kaitlyn Claeys, PCT, 3 East Medical Surgical Unit, Department of Nursing Lynette Ward, RN, Infection Control Nurse, Infection Control and Disaster Preparedness, System Administration Sarah Boyce, BSN ,RN, CEN, Clinical Nurse Emergency Department, Department of Nursing James Busch, Patient Care Technician, Emergency Department, Department of Nursing Outcomes The graph with data table below demonstrates the achievement of the goal set. Within the first quarter after implementation the raw number of CAUTI's reduced 75% from the baseline data in Q3 2012. With continued effort and reinforcement of the action plan we exceeded our original goal of outperforming the Magnet mean and eliminated CAUTI's. The graph demonstrates we have sustained this for a total of 2 quarters. Keeping our patients safe from harm is an important strategic goal. The reduction in Catheter Associated UTI's is one example of an improvement in patient safety. To remain compliant with this goal, rounding is completed on all patients with Foley catheters. The improvement in clinical practice aligns with the nursing strategic plan both in the area of re-engineering core processes and advancing a culture of safety, quality and compliance. Data