Impacting quality outcomes: Utilizing an innovative unit-based nursing role Kaitlin Lindner, BSN, RN, CCRN Stacey Trotman, MSN, RN, CMSRN, RN-BC
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
Safety & Quality at the Bedside To err is human Providing safe patient care Reporting processes Maintaining accreditation Healthcare competition
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
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
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
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
PSQN 2016 Staff resource Practice questions Clinical guidance Ethical challenges Interdisciplinary resourcing Accreditation unit representative Development of unit specific role description
Quality Outcomes Mercy Medical Center Critical Care Unit American Association of Critical Care Nurses 2012: Silver Beacon Award 2016: Gold Beacon Award
Safety Rounds
Safety Rounds Audit Tool
Ventilator Associated Pneumonia #of VAP 1,000 vent days Ventilator Associated Pneumonia 2.50 2.00 1.50 1.00 0.50 0.00 FY9 FY10 FY11 FY12 FY13 FY14 FY15 FY16 Unit rate 2.20 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total VAP 3 0 0 0 0 0 0 0 Vent Days 1361 1092 1027 911 963 781 949 854 PSQN INTERVENTIONS: Multidisciplinary rounds Device sheet review Safety rounds HOB >30 degrees HiLo evacuation tube Yankauer Vent bundle
CAUTI #of CAUTI per 1,000 catheter days Catheter Associated Urinary Tract Infections 2.00 1.50 1.00 0.50 0.00 FY12 FY13 FY14 FY15 FY16 Unit Rate 1.88 1.56 1.71 0.99 0.35 Total CAUTI 6 5 5 3 1 Catheter days 3197 3210 2916 3024 2887 PSQN INTERVENTIONS Multidisciplinary rounds Device sheet review Safety rounds Catheter necessity Securement CAUTI bundle CAUTI drill down
CLABSI #of CLABSI per 1,000 central line days Central Line Associated Blood Stream Infections 2.00 1.50 1.00 0.50 0.00 FY12 FY13 FY14 FY15 FY16 Unit Rate 1.91 1.70 1.53 0.50 1.15 Total CLABSI 5 4 3 1 2 Central line days 2621 2349 1964 1983 1742 PSQN INTERVENTIONS Multidisciplinary rounds Device sheet review Safety rounds CVC necessity CLABSI bundle Biopatch assessment Documentation review Blood culture contaminant review CLABSI drill down
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
HAPU Stage II & Above #of HAPUs per 1,000 patient days Hospital Acquired Pressure Ulcers Stage II & Above 10.00 8.00 6.00 4.00 2.00 0.00 FY12 FY13 FY14 FY15 FY16 Unit Rate 8.69 7.21 6.16 7.74 7.56 Total HAPU 47 38 34 34 32 Patient Days 5408 5269 5520 4395 4235 PSQN INTERVENTIONS Braden score Safety rounds Correct bed surface Device review Floating heels Annual HAPU safety room
Hospital onset C.diff #of c.diff cases per 10,000 pt days 35.00 30.00 25.00 20.00 15.00 10.00 5.00 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 22.19 26.57 19.93 13.65 30.70 C.Diff cases 12 14 11 6 13 Patient Days 5408 5269 5520 4395 4235
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
Communication & Dissemination
Professional Growth & Development Certification Clinical Advancement & Mentoring
Certification Resource 2012: Led certification initiative
Clinical Advancement Mentoring Council support Poster/presentation development
Eliminating Silos: Role Dissemination Best practice sharing Organization level Nursing community level Removing barriers Staffing concerns and moral dilemmas Punitive perceptions Constructive conversations
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
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
Future plans PSQN collaboration between CCU/B12/NICU Streamline processes between PSQN s Future goal for all units to have a PSQN
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
Questions? Thank you!
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 http://site.ebrary.com.ezp.waldenulibrary.org/lib/waldenu/docdetail.action?docid =10038653
Stacey Trotman MSN, RN, CMSRN, RN-BC strotman@mdmercy.com Kaitlin Lindner BSN, RN, CCRN kmarchi@mdmercy.com