OUTCOMES BASED CARE DRIVEN BY STAFF RN S: A PARTNERSHIP BETWEEN RN S, EDUCATORS AND NURSE MANAGERS P R E S E N T E D B Y R O S E M A R I E B AT T A G L I A, M S N, R N S O U T H C A R O L I N A N U R S E S A S S O C I AT I O N OBJECTIVES 1. Review resources and tools to assist registered nurses to identifying how their role as RN s can impact patient outcomes 2. Outline the education calendar to assist RN s in successful project completion 3. Discuss how an effective partnership between staff RN s, Educators and Nurse Managers can drive professional practice results WHY I GOT STARTED 1. Ambulatory Care was considering elimination of RN s in the clinic 2. Sigma Theta Tau International Leadership Conference 3. My role change from Educator to Manager: Article on my desk 4. National Invitational Conference: Ambulatory Care Registered Nurse Performance Measurement 1
Nurse Manager / Educator Partnership Advanced Practice RN restructuring.. Confusion on project expectations 25% RN III s withdrew from program Rational for Mentoring Program: To increase participation in the RN III program Emphasize outcomes-based, patient-centered care and the RN role in achieving success Nurse Manager / Educator Partnership RESOURCES AND TOOLS: Organizational Data / Past RN III projects AAACN or ANA Standards of Practice Quality Indicators (NQF, NDNQI, CMS, JCAHO) Red Cap survey: RN Knowledge PI/Research Knowledge & Skills Excel PowerPoint 2
RESOURCES AND TOOLS CMS: http://www.cms.gov/ JCAHO: http://www.jointcommission.org/standards_information/standards. aspx NDNQI: https://www.nursingquality.org/ NQF: http://www.nqf.org.za/ Any recent article regarding nursing practices changes, evidenced based care or improving patient care **Swan, Beth Ann. (2008) Making Nursing-Sensitive Quality Indicators Real in Ambulatory Care. Nursing Economic$, 26(3), 195-205. 3
EDUCATION OUTLINE Partnership Calendar RN 3 Timeline Toward Success Program Overview,Mandatory Meeting, Sign Attestation Form July Educational In-service #1: Literature search & How to Read a Research Article, Trip to Library Aug Sept Oct/Nov Project Proposals Due, Submit Top 5 Diagnoses for each clinic Educational In-service #2: How to design Patient Education Materials w/appropriate reading levels Mandatory mid-year Project Update meeting w/ns Mgr & Educ in December Jan/Feb/March Education In-service #3: Excel Basics Data collection Educational In-service #3: Presentation Tools & Tips April Projects Due 6/1 PERCENTAGE OF RN III S OUT OF TOTAL RN S 4
PROJECT CLASSIFICATION COMPARISON RESULTS Improving Quality Driving Outcomes REGISTERED NURSE OUTCOMES BASED CARE! L O C A L P R E S E N TAT I O N # S TAT E P R E S E N TAT I O N * N AT I O N A L P R E S E N TAT I O N IMPROVING RSV PROPHYLAXIS! # **** IRB APPROVED PROJECT PRIMARY CARE CLINIC, JOHN MARTINES, BSN, RN Increased compliance from 25% to >90% consistently *P value =.0007 5
GUIDELINES ADHERENCE FOR ASTHMA CARE IRB APPROVED PROJECT! *** PRIMARY CARE CLINIC, JOHN MARTINES, BSN, RN Reducing Seizure Emergency Room Visits! Bonnie Rab, RN Children s Neurology P<0.05 50 % reduction in total ED visits 58% reduction in non-admission visits 38% reduction in admission visits Average total # ED visits per patient dropped from 1.06 to.53 Table 2. Comparison of Frequency of ED Visits before and after Seizure Management Magnet Distribution Pre-Implementation Post-Implementation 5/1/201-4/30/2011 5/1/2012-4/30/2013 Total # ED visits 131 66 % (#) ED visits Admitted 36.6% (48) 45.5% (30) % (#) ED visits Not Admitted 63.4% (83) 53.0% (35) Average Total # ED visits/patient Average # ED visits Admitted/patient Average # ED visits Not Admitted/patient 1.06 0.53 p=0.0003* 0.67 0.28 p=0.0946 0.39 0.24 p<0.0001* Variation is statistically significant at the 95% level based on t-test 6
IMPROVING IMMUNIZATION RATES! PRIMARY CARE: NANCY SAMPSON, BSN, RN Pre-visit reminder call increased immunization compliance rates between ages 3months and 9 months at all ages REDUCING UNNECESSARY BACLOFEN PUMP ED ADMISSION AND INCREASING CHARGE CAPTURE! JAMIE NETTLES, RN CHILDREN S NEUROLOGY Unplanned emergency room visits dropped to zero and has continued at zero since the initiation of this project. Increased charges as a result of improved documentation were an unexpected outcome SURVEY TO DETERMINE REASON FOR NOT BREASTFEEDING! AMY ALLEN, RN CHILDREN S PRIMARY CARE 7
PRELIMINARY STUDY TO DETERMINE ACTUAL BREAST FEEDING RATES AMY ALLEN, RN CHILDREN S PRIMARY CARE Pre-data became part of MUSC Baby Friendly Initiative RETROSPECTIVE CHART REVIEW OF HGB A1C VALUES POST INSULIN PUMP! # IRB APPROVED PROJECT SHARON SCHWARZ, MSN, RN, APDE THANKS TO: Registered Nurses who work in Children s Ambulatory Care Center for Education & Best Practice, Nurse Alliance and Research & Practice Councils Inpatient & Ambulatory Care Educators Clinic Managers in Children s Ambulatory Care Children s Advance Practice Nurses Alicia Carvajal, MSN, RN: Former Educator Children s Ambulatory Care 8
QUESTIONS? Contact Information: battagl@musc.edu 9