NYDT - HCRA 2B ICU Breakthrough Project. Four Weeks to Success!

Transcription

1 NYDT - HCRA 2B ICU Breakthrough Project Four Weeks to Success!

2 Breakthrough Project Players SPONSORS Candido Anaya, MD Valry Anderson, 1199 Contract Administrator Barbara Boursiquot, RN, CWA Chief Steward Alison Corinotis, Human Resources Kevin Dwyer, Director of Food & Nutrition Adriana Fargelli, Director of Environmental Services Gary Moore, 1199 Organizer John Tsoi, Director of Patient Advocacy Majella S. Venturanza, Director of Nursing 1

3 Breakthrough Project Players TEAM LEADERS Epi Quimson, RN, CCRN Erna Clarke, RN, Nurse Educator TEAM MEMBERS Jasmine Allen, RN Joycelyn Badillo, Unit Clerk Lixia Cai, RN, CCRN Vilma Fe Dispo, Nurse Manager, MP Veronica (Twiggy) Gordon, Unit Clerk Siobhan Vereen, PCT, Nursing Student 2

4 Breakthrough Project Goals 1. To decrease the incidence of nosocomial pressure ulcers by 50% within 4 weeks. 2. Decrease 50% of the pressure ulcers in extended stay patients by 1 *stage (excluding stage 4) with 4 weeks. *Size, tissue, drainage Measures: 1. Weekly Prevalence and Incidence Pressure Ulcer and Risk Log 2. Pressure Ulcer Tracking Tool 3

5 Workplan: Key Components Created and implemented: A performance Performance Improvement Cross Shift Worksheet for nurses to ensure proper nutrition, turning, ulcer treatment and NPO guidelines. In-services to ICU nursing & medical staff on how to use worksheet and provide care to prevent/treat ulcers. PCT collaboration with nurses to ensure turning. Having Supplies We Need solutions. Collection of data by unit clerks - instrumental 4

6 Barriers and Innovations Barriers Regular turning, proper nutrition to stage of ulcer, rounding not consistent; NPO not specified by Doctor or followed. Validity of Performance Improvement Worksheet - are people just marking answers or really using it to change behavior? Innovations Created a Performance Improvement Cross Shift Worksheet (protocol) to ensure: Proper nutrition Rounding activity part of nurse daily patient round Special nutrition, vitamins for patients according to stage/ prevention of ulcers NPO Guidelines Created and administered a midpoint review questionnaire to check the knowledge, awareness and barriers experienced by nursing staff. 5

7 Barriers and Barriers Nurses not consistently participating in rounding with Doctors. Resistance to change and/or lack of information. Lack of staffing, turning is more difficult to do. Lack of supplies or run out especially on weekends; storage place a problem. Patient left too long on NPO. Different definitions of stage of ulcer. Innovations Innovations Nurses participate in daily rounds reinforced by Doctors and the Breakthrough Team. Provided multiple in-services and training for staff Each PCT came up with ideas on how to help nurses turn patients. Created communication board to note shortages; anticipate/address supply needs; create bins for storage of supplies (helps wkends). Created NPO sign with specified length of time for specific procedure. Reviewed definition of stage of ulcer with staff and standardized measurement of pressure ulcer. 6

8 Results - Goal One New Ulcer Rate/Pt Days 7% 6% 5% 4% 3% 2% 1% ICU: Pressure Ulcer Breakthr New Pressure Incidence and Rate/Patient d GOAL #1: To decrease the incidence of Hospital Acquired Pressure Ulcers in ICU by 50% in 4 weeks. 7 6 Number of New Ulcers % Week 1 (11/13-11/19) Week 2 (11/20-11/26) Week 3 (11/27-12/3) Week 4 (12/4-12/10) 0 Ulcer Rate Number of New 7

9 Results - Goal Two NEW YORK DOWNTOWN HOSPITAL ICU QUALITY IMPROVEMENT BREAKTHROUGH PROJECT: PRESSURE ULCER TRACKING TOOL GOAL #2. To decrease pressure ulcer stage in 50% of extended-stay patients (LOS >7 days) by one stage (excluding Stage 4) in 4 weeks (by 12/10/2006) PRESSURE ULCER ASSESSMENT TRACKING TOOL Monday Thursday Monday Thursday Monday Thursday Monday Thursday 11/13/06 11/16/06 11/20/06 11/23/06 11/27/06 11/30/06 12/04/06 12/07/06 Patient #1 MR# 4520 Adm. 7/11/06 Patient # 2 MR# Adm. 10/21/06 Patient # 3 MR# 7797 Adm. 10/31/06 Patient # 4 MR # 4876 Adm. 11/11/06 Patient # 5 MR # 0624 Adm. 10/31/06 Patient # 6 MR # 0046 Adm. 11/10/06 Patient # 7 MR # 2331 Adm. 11/16/06 Stage I 6 x 2 cm Stage 0 Stage 0 Stage 0 Transferred Stage 0 Died on 11/ x 1.5 cm 3 x 0.5 cm Coccyx 5 x 0.5 cm 2 x 0.5 cm 5 x 0.5 cm Coccyx 6 x 0.5 cm 3 x 1.5 cm 2 x 1.5 cm Coccyx 8 x 1 cm Stage I Stage I Rt. buttock I 3 x 4cm 4 x 1 cm Transferred off ICU Coccyx 5 x 0.5 cm Transferred off ICU Rt. buttock 3.5 x 1 cm I 4 x 6 cm Stage 0 Stage 0 Stage 0 Coccyx 6 x 0.5 cm Rt. buttock 3.5 x 1 cm Transferred off ICU Stage 0 Stage 0 Rt. Buttock 1.5 x 2.5 cm Died on 12/06 Week 1: 11/13 Š 11/19/06 Week 2: 11/20 Š 11/26/06 Week 3: 11/27 Š 12/03/06 Week 4: 12/04 Š 12/10/06 8

10 Results Goal Two (cont.) There were seven extended care patients. Two of these patients were transferred off the floor before the last measurement. Three of the five patients ulcers decreased by 1 stage and 1 patient s ulcer decreased in size. 9

11 Other Results We Observed Overall, Nurses are complying with and many say they like the new Performance Improvement Worksheet - some quick some slow to adapt. See a change in attitude in using equipment to prevent/heal ulcers (heel support, rectal tubes); more frequent turning and awareness of nutrition and length of NPO. NPO close to 95% compliance in use of NPO sign and 85% vitamin supplementation in patients with stage 2+. The satisfaction of nursing staff derived from a healed ulcer or improved skin in patients felt as personal success and reflected in reinforced good practice. To really see healing take place by their efforts is inspiring! 10

12 Other Results We Observed Nurses were reminded of nursing standards as they read the bundles for skin and nutrition every day. Staff are asking about the data: Are we improving? How did we do this week? As a result of the good work and model of this project other projects were initiated: Epi Quimson and Sonia Brown will lead PI on creating bundles for isolation of patients infected with resistant organisms. Respiratory Therapy has initiated a performance improvement project. Erna Clarke implemented a daily goal sheet for ICU Nurses. As awareness increased so has compliance, cooperation & understanding! 11

13 Recommendations for Continuation of Success Continued use and reinforcement of PI worksheet: Spot check inventories Monitored by rotating Volunteer Staff Teams Monthly meetings to remind nurses decrease prevalence and incidence of pressure ulcers Improve staffing! (50% nurses reported poor staffing as the #1 reason patients not turned optimally) Charge nurse: continue to use pressure ulcer & risk log daily 12

14 Recommendations for Continuation of Success (cont.) Conduct mini in-services on 4C & 5C on this project. Share results with Critical Care Committee, Unit Area Meeting, Physicians, Nurses and list in newsletter Actively participate in the plan of care discussion on daily rounds Do research on weaknesses in our nursing practice before starting a project and then appy evidenced based findings to resolve. 13

15 Insights and Learnings Awareness leads to action!!! Team work WORKS! We improved and learned as we went along When colleagues see results they want to take part! Everytime we create new tools we must reinforce for continued change When doctors are aware of what nurses can do they are more likely to seek their assistance in arriving at solutions Things can be done despite obstacles! 14

16 The Breakthrough Team 15

17 Remember Change is the only constant AND CHANGE IS GOOD! 16