Celebrating our Successes 214
Nurse Involvement in Decision Making Groups 5 CODE SEPSIS: Time from Antibiotic Order to Administration 45 4 Time in Minutes from order to administration 35 3 25 2 15 1 5 Education of Clinical Staff, Pharmacy, March 212 Code Sepsis implemented April 9, 212 Pharmacy review and follow up once Code Sepsis is activated on a patient, June 212 Goal time <6 minutes Emails to providers when met compliance Nov' Dec' Jan'12 Feb'12 Mar'12 Apr'12 May'12 Jun'12 Jul'12 Aug'12 Sep'12 Oct'12 Time from Order to Abx Administration 338 456 152 93 7 27 2 23 29 22 32 27 Pre-Code Sepsis Implementation Code Sepsis Implemented
Nurse Involvement in Decision Making Groups Average Door to Needle Time for tpa Administration 8 Average Minutes 75 7 65 6 55 5 45 No tpa given 1Q July, 2 Executive Committee discussion Aug, 2 ED Communication strategies Jan, 212 ED interdisciplinary team Feb, 212 pager for tpa 1Q 2Q 3Q 4Q 1Q12 2Q12 3Q12 4Q12 Door to Needle Time 73 56 58.8 57.9 52.6 6 57 Goal 6 6 6 6 6 6 6 6
Nurse Involvement in Professional Organizations Mortality 1 9 July1, 213: RRT/Sepsis Screening in Clinics # Deaths 8 7 April, 212: Develop, implement, monitor Sepsis Bundle Compliance/Improve utilization of Rapid Response July, 213: Enhance Antibiotic delivery processes (now obtaining delivery to hang at 15 minutes with goal of less than one hour) July 29, 213: CCU Code Sepsis Go Live 6 February 9, 213: Surgical ICU Pilot 5 April 29, 213: ED Code Sepsis Go Live August 26, 213: MICU Code Sepsis Go Live 4 July'12 Aug'12 Sept'12 Oct'12 Nov'12 Dec'12 Jan'13 Feb'13 Mar'13 Apr'13 May'13 June'13 July'13 Aug'13 Sept'13 Oct'13 Nov'13 Dec'13 Mortality 14 88 98 11 84 14 12 76 74 7 66 55 51 69 58 54 61 62
All Sepsis Mortality Index
Nurse Involvement in Professional Organizations 1 9 Healthy Work Environment Bullying 4A ICU % staff who feel bullied in the workplace 8 7 6 5 4 3 2 1 Implementation of THINK project Goal Baseline July 212 Mar-13 Oct-13 4A bullied 92 28 28 Goal 46 46 Goal indicates a 5% improvement from baseline score
Effective Education Programs Early Identification of Need for Foley Removal Reynolds 2 Education for Early Identification of Need for Foley Removal implemented Pilot implemented Total CAUTIs 1 Post Pilot Results Mar' Apr' May' Jun' July' Aug' Sep' Oct' Nov' Dec' Jan' 12 Feb' 12 Mar' 12 Apr' 12 May' Jun' 12 12 July' Aug' Sep' Oct' 12 12 12 12 Nov' Dec' Jan' 12 12 13 Feb' 13 Mar' 13 Apr' 13 May' Jun' 13 13 July' Aug' Sep' Oct' 13 13 13 13 # CAUTIs 2 1 1 1 1 1 1 1 1 1 1
Use of Internal Consultants Unit Acquired Pressure Ulcer Prevalence Rate 4A-Surgical ICU 3rd Quarter 213 45. 4. Percent of Patients with UAPU 35. 3. 25. 2. Began Mepilex Trial 15. 1. 5.. NDNQI Critical Care Benchmark 4Q 1Q12 2Q12 3Q12 4Q12 1Q13 2Q13 3Q13 64 44.44.. 1..... Wake Forest Baptist NDNQI Health Critical Care Benchmark 6.42 6.27 6.18 5.44 6.26 6.39 5.97 5.97
Use of External Consultants SCIP-Card-2: Perioperative Beta Blockers 1..98.96.94 Composite.92.9 Engagement of Wake Wings in Surgical Services Wake Wings Training.88 Kick-off and checklist trials.86 Wake Wings Go Live.84 Aug' 1 Sep' 1 Oct' 1 Nov' 1 Dec' 1 Jan' Feb' Mar' Apr' May' Jun' beta blockers.97.97.92.97.94 1..87 1..91.96.96 1. 1. 1. 1. 1. 1..96.96 1. 1. 1. 1. 1. Goal.97.97.97.97.97.97.97.97.97.97.97.97.97.97.97.97.97.97.97.97.97.97.97.97 Jul' Aug' Sep' Oct' Nov' Dec' Jan' 12 Feb' 12 Mar' 12 Apr' 12 May' 12 Jun' 12 Jul' 12
Workplace Safety Implementation of Chemotherapy Transfer Devices in the Hem/Onc Clinic 18 Residual Concentration (ng/ft²) on bedside tables 16 14 12 1 8 6 4 Pre-Implementation Post-Implementation 1 st Test Post-Implementation 2 nd Test Education Inpt Staff, Jan 12 Post-Implementation 3 rd Test Implementa tion in Inpt Units, Feb 12 2 Aug 12, 29 Feb 3, 21 Mar 4, 2 Mar 2, 212 Docetaxel Concentration (ng/ft2) 847.6... Paclitaxel Concentration (ng/ft2) 153.9 7.4..
Reallocation of Resources Hospice to Death Ratios with Implementation of Palliative Care Consult Team 2.5 Ratio 2 1.5 1 4 th Quarter FY 13: HIP Process Go Live Closing of Palliative Care Unit Implementation of Palliative Care Consult Team.5 New House Staff Training for HIP FY'12 FY'13 Jul'13 Aug'13 Sept'13 Oct'13 Nov'13 Dec'13 Jan'14 Hospice to Death Ratio.47.93 1.37 1.2 1.39 2.21 1.54 1.13 1.65 Goal 1. 1. 1. 1. 1. 1. 1. 1. 1.
Increasing Certification All RN Certification 6 5 Number of RN FTE Certifications 4 3 2 1 29 (starting point) 21 (1st year increase) 2 (2nd year increase) 212 (3rd year increase) 213 (4th year increase to date) RN FTE Completed 271 392 441 56 554 Goal 298 419 468 533
Nursing Strategic Plan: Efficiency Weekly % of Discharges by 1: p.m. 8 Reynolds Medicine 7.% 6.% % Discharges by 1 p.m. 5.% 4.% 3.% 2.% Week 3: Go Live 1.% Planning Phase: no data Week 35: Firm Up Target Time.% Week 18, Ending 3 Nov 212 Week 19, Ending 1 Nov 212 Week 2, Ending 17 Nov 212 Week 3, Ending 26 Jan 213 Week 31, Ending 2 Feb 213 Week 32, Ending 9 Feb 213 Week 33, Ending 16 Feb 213 Week 34, Ending 23 Feb 213 Week 35, Ending 2 Mar 213 Week 36, Ending 9 Mar 213 Week 37, Ending 16 Mar 213 8 Reynolds Medicine 25.% 18.4%.1% 6.7% 14.8% 36.4% 29.7% 42.9% 27.3% 54.8% 46.5% 58.3% Week 38, Ending 23 Mar 213
CNO Influenced Change: Organization 84 Overall Patient Satisfaction with Meals 83 Mean Press Ganey Satisfaction Score 82 81 8 79 78 77 76 Sticht Center AYR Pilot began Executive Food Tasting, August 1 Annual Goal Setting, Food & Nutrition, August Housewide AYR implemented 75 74 1Q1 2Q1 3Q1 4Q1 1Q 2Q 3Q 4Q 1Q12 2Q12 3Q12 4Q12 1Q13 2Q13 3Q13 4Q13 Overall Satisfaction with Meals 77.1 78.5 79 8.1 8.7 8.9 81.2 81.2 82 81.6 81 8.7 82.9 82 82.9 83.1 6+ Bed Group Mean Benchmark 78.8 79.5 79.7 79.3 79.1 79.6 79.8 79.7 79.6 8 79.9 79.8 79.5 8.2 79.8 79.8
Affiliations with Schools of Nursing Pre-Licensure Clinical Experiences 2 15 Number of Experiences 1 5 2 212 Clinical Experiences 147 196
Preceptorship / Practicum Experiences 12 1 8 Number of Experiences 6 4 2 AD BSN MSN/NP 2 5 91 12 212 15 22
Changes in Work Environment RN Response 9 8 7 6 5 4 3 2 1 Autonomy Goal: Increase Frequently/Always responses by 25% Never/Seldom/Sometimes Frequently/Always Pretest 8 2 PostTest1 43.75 56.25 PostTest2 22.22 77.78 RN Response 8 7 6 5 4 3 2 1 Active Team Member in Making Titration Decisions Goal: Increase Frequently/Always responses by 25% Never/Seldom/Sometimes Frequently/Always PreTest 7 3 PostTest1 56.25 43.75 PostTest2 33.33 66.64 RN Response 1 9 8 7 6 5 4 3 2 1 Never/Seldom/Sometimes Frequently/Always Pretest 55 45 PostTest1 31.25 68.75 PostTest2. 88.89 Orders Clear/Concise Goal: Increase Frequently/Always responses by 25% Duration Mean Drip Duration 12 1 9 8 7 6 5 Goal: Decrease time by 1% 4 3 2 1 Dopamine Dobutamine Hydrocortisone Pre 51.25 9.8 1.9 Post 37.55 6.7 75.5
Professional Practice Model Model of Care: Caritas Cafes Shared Governance: Advisory Council assessing communication/structure Care Delivery System: RT Partnership Model
Results of PPPM 3.94 Employee Engagement Survey Comparison Manager Domain 3.93 3.92 Leadership 3.91 3.9 3.89 3.88 3.87 3.86 3.85 Leadership 21 3.88 212 3.93 There has been an increase in the Leadership section of the Manager Domain of.5 from 21 to 212.
New Knowledge in Practice CAUTI Infections By Month 212 Change to to Medline Foley Tray, Initial Medline Education Modules Issues Identified with Medline Foley tray, Medline Re-Education 2 # Of Infections 18 16 14 12 Review EBP, CAUTI Bundle Education, CAUTI Audit Begins Foley Insertion Classes-All RN & NA II's Revised Foley Tray Housewide, Bundle Cards distributed to Staff 1 8 6 4 2 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec # 17 6 13 17 18 12 16 12 1 8 5
Neonatal Transport Nonemergent Intubation Success Rate 1% Intubation First Attempt 9% 8% 7% 6% 5% Premedication Protocol defined, education completed. New protocol implemented September 15, 213. Goal: Successful intubations on first attempt for 95% of all qualifying patients with use of appropriate premeds prior to intubation 4% 3% 2% Jan'1 to May'12 baseline (N=98) Sept'12 (N=) Oct'12 (N=1) Nov'12 (N=3) Dec'12 (N=7) Intubation First Attempt 34% 1% 1% 1%
629 9PHO 2. 1.8 1.6 CLABSI Rate 1.4 1.2 1..8.6 NDNQI Pediatric Medical Benchmark.4.2. 1Q 2Q 3Q 4Q 1Q12 2Q12 3Q12 629 9PHO 1.88...... NDNQI Pediatric Medical Benchmark.. 1..75.59.32.32 3Q12 ANALYSIS By Month Jul'12 Aug'12 Sept'12 3Q12 CLABSI Rate 629 9PHO # Infections. NDNQI Surgical Benchmark.32 The unit has outperformed the benchmark 6 of 7 quarters with infections in the last 6 quarters.
Improving Practice with Technology 91% 9% Target, 9% Alaris Guardrails Drug Library Compliance 89% Compliance with use of Guardrails 88% 87% 86% 85% 84% 83% 82% Aug- Sep- Oct- Nov- Dec- Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Overall 84% 85% 85% 87% 89% 89% 89% 9% 9% 89% 9% 9% 9% 89% 9% 9% 9% Target 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9% 9%