There were many nursing-led initiatives focused on quality and safety and our journey to zero harm during fiscal year 2017. They incorporated quality process analyses, evidence-based practices and research leading to improved patient outcomes.
Our health system treats the most seriously ill patients with the most complex conditions. Our critical care patients frequently have 8-10 medications infusing and two to five vascular access sites. This means patients have more central lines, putting them at risk for a central line-associated bloodstream infection (CLABSI).
The hospital's eight adult critical care units are diligent in providing safe, high-quality care. Their efforts resulted in a major milestone: a CLABSI-free quarter for all adult critical care units, which includes more than 100 inpatient beds.
Our bedside nurses perform daily assessments on a patient's central line. They also ensure all components of our CLABSI prevention bundle, such as hub disinfection and dressing changes, are completed with high reliability. Daily huddles with staff also evaluate if the central lines are still needed for specific patients and discuss potential sources of CLABSI, such as peripheral arterial catheters.
Sharing lessons learned from patient safety events is a key component to our ongoing commitment to zero harm. Our Patient Safety Response Team (PSRT) helps to identify and to prevent reoccurrence of system contributors that may lead to a safety event. The team is comprised of nursing leadership, risk management and hospital executive team members.
This new program provides a framework for shared learning on enhanced patient safety practices. Staff are empowered to "stop the line" if they have any issues and then will contact the PSRT immediately to report the concern. The PSRT will review the issue and assist in developing an action plan to ensure our patients and staff are always safe.
The PSRT is enhancing our culture of safety by creating an environment where staff are encouraged to be proactive and to speak up if they have any questions or concerns. The PSRT is modeled after the hospital's many successful response teams, which have grown to include strokes, heart conditions, behavioral health, obstetrical emergencies and trauma activations.
With the increasing complexity of healthcare delivery and the need to operate efficiently, we use Lean, a continuous improvement approach supporting patient-centered healthcare. The exam clinic at The Richard and Annette Bloch Cancer Care Pavilion is improving processes and practices to enhance the patient experience.
The visibility wall is a Lean concept used by the exam clinic team. During daily huddles, they discuss quality and safety measures such as patient falls. During cancer treatment, patients may feel weak, which puts them at high risk for falls. Nurse leaders ask for the team's input on improvement. This generates discussion and problem-solving work among the frontline staff. Targeted education was created to help reduce patient falls. Staff also meet their patients at the main entrance to assist them to their appointment – always staying within an arm's reach.
For Sue Ellen Schmidt, having her admissions and postsurgical information collected in one binder made all the difference during her stay. The communication was right at her fingertips, helping her retain important patient education information. The bedside binder is a project led by nurse residents on Unit 53 (urology and surgical oncology). They created the project to organize admission handouts and other documents into one binder for their specific patient population. This has helped streamline information for both patients and nurses, ultimately giving them more time together at the bedside.
Our nurse residency program is a structured educational experience designed to develop competence in clinical practice and professional growth, and to support new graduate nurses in their first year of practice. The final component of the nurse residency curriculum includes completing an evidence-based practice project. Unit 53 nurse residents received positive feedback from their peers on their bedside binder project. Other inpatient units have taken notice and are creating their own bedside binders tailored to their patient population.