Impacting quality outcomes: Utilizing an innovative unit-based nursing role. Kaitlin Lindner, BSN, RN, CCRN Stacey Trotman, MSN, RN, CMSRN, RN-BC

Transcription

1 Impacting quality outcomes: Utilizing an innovative unit-based nursing role Kaitlin Lindner, BSN, RN, CCRN Stacey Trotman, MSN, RN, CMSRN, RN-BC

2 Outcomes Identify opportunities for improving quality outcomes and patient safety through adopting a PSQN role Examine a specialized nursing roles impact on professional growth and development of direct care registered nurses

3 Safety & Quality at the Bedside To err is human Providing safe patient care Reporting processes Maintaining accreditation Healthcare competition

4 What is a PSQN Nurse? Dedicated nursing role with a specific focus Autonomous Interdisciplinary collaboration Quality team Infection control and prevention team Intensivist Stroke coordinator Unit educator

5 PSQN Role Evolution Driven by the 100,000 lives campaign Institute of Healthcare Improvement VAP reduction focus Developed in 2005 Shared educator and PSQN role PSQN 12 hours per week Interdisciplinary development of vent bundle

6 PSQN Role Evolution Successful VAP reduction Expanded focus on quality outcomes Delineated educator role from safety role Integrated with safety alerts AACN practice alerts Organizational safety alerts

7 PSQN 2016 Weekly patient safety rounds Stringent focus on quality outcomes Manager/PSQN weekly meetings Review of data Weekly successes Opportunities for improvement Professional growth and development

8 PSQN 2016 Staff resource Practice questions Clinical guidance Ethical challenges Interdisciplinary resourcing Accreditation unit representative Development of unit specific role description

9 Quality Outcomes Mercy Medical Center Critical Care Unit American Association of Critical Care Nurses 2012: Silver Beacon Award 2016: Gold Beacon Award

10 Safety Rounds

11 Safety Rounds Audit Tool

12 Ventilator Associated Pneumonia #of VAP 1,000 vent days Ventilator Associated Pneumonia FY9 FY10 FY11 FY12 FY13 FY14 FY15 FY16 Unit rate Total VAP Vent Days PSQN INTERVENTIONS: Multidisciplinary rounds Device sheet review Safety rounds HOB >30 degrees HiLo evacuation tube Yankauer Vent bundle

13 CAUTI #of CAUTI per 1,000 catheter days Catheter Associated Urinary Tract Infections FY12 FY13 FY14 FY15 FY16 Unit Rate Total CAUTI Catheter days PSQN INTERVENTIONS Multidisciplinary rounds Device sheet review Safety rounds Catheter necessity Securement CAUTI bundle CAUTI drill down

14 CLABSI #of CLABSI per 1,000 central line days Central Line Associated Blood Stream Infections FY12 FY13 FY14 FY15 FY16 Unit Rate Total CLABSI Central line days PSQN INTERVENTIONS Multidisciplinary rounds Device sheet review Safety rounds CVC necessity CLABSI bundle Biopatch assessment Documentation review Blood culture contaminant review CLABSI drill down

15 Medication Safety 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% Medication Reconciliation 94.6% 89.8% 87.4% 85.9% 85.3% FY12 FY13 FY14 FY15 FY16 PSQN INTERVENTIONS Monthly quality reporting Safety rounds: No unsecured medications present Medicated infusion dosage calculation Proper labeling of medicated infusions

16 HAPU Stage II & Above #of HAPUs per 1,000 patient days Hospital Acquired Pressure Ulcers Stage II & Above FY12 FY13 FY14 FY15 FY16 Unit Rate Total HAPU Patient Days PSQN INTERVENTIONS Braden score Safety rounds Correct bed surface Device review Floating heels Annual HAPU safety room

17 Hospital onset C.diff #of c.diff cases per 10,000 pt days Hospital Onset C. Diff PSQN INTERVENTIONS: CCU Infection Control & Prevention monthly meeting C.diff drill downs Specialized education Isolation audits 0.00 FY12 FY13 FY14 FY15 FY16 Unit Rate C.Diff cases Patient Days

18 Additional Safety Rounds 2016 Focused Assessments Alarm fatigue Progressive mobility DVT prophylaxis Communication with patients and family Chart review Unplanned extubations Restraints Delirium Falls Hand hygiene

19 Communication & Dissemination

20 Professional Growth & Development Certification Clinical Advancement & Mentoring

21 Certification Resource 2012: Led certification initiative

22 Clinical Advancement Mentoring Council support Poster/presentation development

23 Eliminating Silos: Role Dissemination Best practice sharing Organization level Nursing community level Removing barriers Staffing concerns and moral dilemmas Punitive perceptions Constructive conversations

24 Role Dissemination: NICU CCU PSQN presented at the MPSC VAP reduction Triggered by outcomes-based unit impacts NICU nurse manager collaboration Safety rounds spreadsheet Part-time employee 8 hours weekly

25 Role Dissemination B12 PCU Identify staff member with passion for safety and quality Part-time employee 4 hours weekly Collaborative meetings with CCU/B12 PSQN Safety rounds spreadsheet Integrated constructive staff conversations

26 Future plans PSQN collaboration between CCU/B12/NICU Streamline processes between PSQN s Future goal for all units to have a PSQN

27 Acknowledgements Christie Brown, BSN, RN, CCRN Lisa Baer, BSN, RN Theresa Bress, MSN, RN, CCRN, NE-BC Elizabeth Riley, BSN, MA, RN, NE-BC Joseph Costa, MD

28 Questions? Thank you!

29 References Kohn, L., Corrigan, J., Donaldson, M. (2002)) To Err is Human: Building a Safer Health System. Wadhington, D.C.: National Academy Press. Retrieved from =

30 Stacey Trotman MSN, RN, CMSRN, RN-BC Kaitlin Lindner BSN, RN, CCRN