Sample Case Studies. Presented by: Collaborative Outcomes Council August 2016

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2 Sample Case Studies Presented by: Collaborative Outcomes Council August

3 Falls Nurse-Driven Indicators Pressure Ulcers CAUTI CLABSI Patient Satisfaction Throughput

4 Problem Statement: Scenario 1 - Falls Fall rate on Adult Surgical Unit is above the national benchmark 7 of the last 12 months. Current State: Review of data in the last 4 months reveals that there are 2.84 falls per 1,000 patient days on the unit. The NDNQI benchmark is 1.72 falls per 1,000 patient days for Adult Surgical Units. 38% of all falls on the unit occur when going to/from the bathroom. 77% of all falls were not observed by staff. The UPC consults with the SME and reviews literature for best practices in reducing falls. 4

5 Interventions Scenario 1 - Falls The UPC decides that Proactive Toileting and Patient Education are key interventions that need to be implemented. Proactive Toileting encourages patients to empty their bladders to reduce the need to go urgently. The unit decides to ask patients if they need assistance toileting every 4 hours. Patient Education is critical in helping patients understand the risk of toileting alone. The unit opts to use the Falls Tent Cards and Patient Falls Promise to facilitate patient education. What should this UPC measure for their interventions? 5

6 Scenario 2 - Pressure Ulcers Problem Statement Stage 2+ Pressure Ulcer rates have been trending upward in the last 2 years on an Adult Step Down unit. Current State Stage 2+ Pressure Ulcer rates are up to 3.8% in 2016 from 2.1% in NDNQI benchmark is 3.13% for Adult Step Down units. The unit performs a Root Cause Analysis and surveys staff to find a knowledge deficit in new graduates and new hires in properly assessing pressure ulcers. 6

7 Interventions Scenario 2 - Pressure Ulcers Integrate Pressure Ulcer education into orientation and annual skills lab Mandatory classes on a quarterly basis Consult with Wound/Ostomy team What should this UPC measure for their interventions? 7

8 Problem Statement Scenario 3 - CAUTI The CAUTI rate on an Adult Surgical Intensive Care unit has been consistently higher than the national benchmark. Current State The Standard Infection Ratio (SIR) on the unit is 1.86 over the past year. The IP Champions review each CAUTI case in the past year. They find the following: Foley catheter was left in the patient for longer than 6 days in each case. Catheter/Perineal Care compliance was only 48% in these cases. Staff report Perianal wipes are not readily available when needed. 8

9 Interventions Scenario 3 - CAUTI Lead Nurse actively monitors Foley Catheter days using Lead Nurse Quality Indicator Tool. Notifies RN and consults MD if Foley Catheter has been in for longer than 4 days. Daily assessment of necessity of Foley Catheter for each day beyond 4 days. Create a Foley Catheter care kit including Perianal wipes. What should this UPC measure for their interventions? 9

10 Problem Statement Scenario 4 - CLABSI The CLABSI rate on a Pediatric Critical Care Unit has underperformed the national benchmark 6 out of the last 8 quarters. Current State The CLABSI SIR on the unit is 1.46 over the past year. After reviewing Prevalence Day data the unit finds that both Curos Caps compliance and CHG bath compliance are below average on the unit. Curos Caps compliance of 60% A quick survey of the unit reveals that not all nurses know about the new policy requiring Curos Caps to be placed on all ports of all lines. CHG bath compliance of 76% 10

11 Interventions Scenario 4 - CLABSI Staff education on new policy. Huddle messages and fun rhyme. Test staff on remembering rhyme. Standard 9am CHG baths daily. What should this UPC measure for their interventions? 11

12 Scenario 5 Patient Satisfaction Problem Statement An Adult Medical Step Down Unit has underperformed the Nurse Communication HCAHPS Patient Satisfaction goal of the 82 nd percentile for 10 out of the last 12 months. Current State The unit is currently ranked in the 60 th percentile in the previous quarter. The unit hopes to integrate best practices of a script to introduce staff and narrate care. The UPC realizes that it would be a perfect tool to integrate with Teach Back during Commit to Sit (Take 5). 12

13 Scenario 5 Patient Satisfaction Interventions The UPC designates a Patient Satisfaction Champion to individually coach staff in developing a unique script that includes a personal introduction, discussion of the plan of care and patient s goal, and Teach Back. What should this UPC measure for their interventions? 13

14 Problem Statement Scenario 6 Throughput Delays in transporting patients from the Emergency Department to Inpatient Units is causing delays in patient care and overcrowding of the ED. Current State After a number of observations, the unit finds that the average transport time from the ED to the unit is nearly 1 hour after a bed has been assigned. On average, 10 minutes are spent trying to call the Charge Nurse on the inpatient unit to communicate that the patient is ready for transport and to confirm that the room on the unit is clean and ready. Another 10 minutes are spent locating the bedside nurse once the patient is on the unit. 14

15 Interventions Scenario 6 Throughput Bypass the phone call to the Charge Nurse and transport the nurse to Med-Surg units. Use CareConnect to communicate room status. Transporter uses call bell to notify unit that the patient is in the room. Unit monitors bed assignment to anticipate new patients. What should this UPC measure for their interventions? 15