EP1EO
Professional Practice Model EP1EO
Two examples are required; one example must be from ambulatory setting, if applicable.
- Provide two examples, with supporting evidence, of an improved outcome associated with an evidence-based change made by clinical nurses in alignment with the organization’s professional practice model (PPM).
- Outcome data must be in the form of a graph and a data table
- Provide a schematic of the PPM
Example a: Implementing a Unit-Based Fall Committee to Decrease Patient Falls in the Emergency Department (ED)
Problem
There was an increase in patient falls in the Emergency Department in 2016. In 4th Quarter 2016, the fall rate was 0.60. Erika Setzer, BSN RN CEN CNML, nurse manager identified the need to engage clinical nurses and ancillary staff in fall prevention. She suggested a clinical nurse lead a unit-based Fall Committee to improve patient outcomes.
Goal statement
To decrease patient fall rates in the Emergency Department. Patient fall rates are measured as the total number of ED patient falls per 1,000 patient visits.
Participants
Emergency Department Fall Committee |
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Name/Credentials |
Discipline |
Title/Role |
Department |
Cindy Bailey, BSN, RN |
Nursing |
Clinical Nurse |
ED |
Sara Jones, BSN, RN |
Nursing |
Clinical Nurse |
ED |
Amanda Jagodzinski, BSN, RN |
Nursing |
Clinical Coordinator, Clinical Nurse |
ED |
Erika Setzer, BSN, RN, CEN, CNML |
Nursing |
Nurse Manager (at this time) |
ED |
Lynn Giacalone, MSN, RN |
Nursing |
Education Specialist |
Nursing Education |
Teresa Delpeschio |
Support Services |
Office Manager |
ED |
Edwin Medina |
Nursing |
ED Tech |
ED |
Greenwich Hospital’s Professional Practice Model
Greenwich Hospital’s Professional Practice Model (PPM) schematics include the patient and family at the center of nursing care while incorporating nursing theorist, Jean Watson’s Theory of Human Caring, and valuing nursing elements, such as Quality & Safety, Professional Development, Healing Environment and Practice Excellence which are the pillars of the PPM.
The PPM’s components contain a one sentence explanation:
- Professional Development: We develop as professionals and participate in peer review.
- Quality & Safety: We provide safe and quality care.
- Healing Environment: We support a patient and family-centered healing environment.
- Practice Excellence: We utilize Evidence-Based Practice, innovation and research.
Components of the PPM include Quality and Safety: providing safe and quality care, and Practice Excellence: using evidence-based practice, innovation and research. The ED Falls Committee aligned their work with these two components, understanding the importance of using evidence-based practices to improve the safety of patients. (Evidence EP1EOa-1, Greenwich Hospital Professional Practice Model)
Description of the Intervention
1st Quarter 2017
An inter-professional unit-based Fall Committee led by clinical nurse, Cindy Bailey BSN, RN, was created in January 2017. The membership included clinical nurses, a non-clinical business associate, an ED technician, a unit-based educator, and the nurse manager. The committee met monthly, conducted a literature review and learned about evidence-based strategies to reduce the patient fall rate in the Emergency Department. Based on the literature, the evidence-based strategies implemented included: increased communication on fall risk patients at unit huddles, furniture with safety features to assist with patient mobility and transfer, increased awareness and easy identification of fall-risk patients, recognition for staff when reaching a milestone of 100 days without a patient fall, education to increase utilization of bed, stretcher, and chair alarms and frequent rounding on patients identified as a fall risk by all members of the inter-professional team (Ashcraft S, Bordelon C, Fells S, George V, Thombley K, & Shirey MR, 2017) (Goldsack, Bergey, Mascioli, & Cunningham, 2015) (Meade, Kennedy, & Kaplan, 2010).
The committee gave positive reinforcement to staff directly and praised the efforts of the team during daily huddles in which the “number of days without a patient fall” was reported.
Outcomes
Clinical nurses in the ED implemented evidence-based changes, in alignment with the Greenwich Hospital Professional Practice Model, to reduce ED patient falls. As a result of their efforts, the post-implementation fall data revealed a rate of 0.31 in 2nd Quarter 2017, 0.31 in 3rd Quarter 2017, and 0.21 in 4th Quarter 2017.
Evidence EP1EOa-2, Greenwich Hospital Patient Fall Rate in the Emergency Department
Example b: Clinical Nurses Implement Nightshift Huddle in Alignment with the Quality & Safety and Practice Excellence Pillars of the PPM to Improve Communication
Problem
Greenwich Hospital (GH) is a high reliability organization (HRO), and one component of an HRO is a daily morning Safety Huddle. Evidence demonstrates that Safety Huddles can improve patient safety outcomes through enhanced team relationships, improved communication and a demonstrated commitment to a culture of safety (Provost et al., 2015). The GH Safety Huddle is held at 8:30 a.m. every day in the medical library (in person or by conference call). At this time, all hospital units are represented by nurses, physicians and leaders (directors and managers) to report out on good catches (near misses), issues, concerns, announcements and issues from the previous 24 hours and the next 24 hours to be shared system-wide. The Safety Huddle is led by the administrator on call.
The daily morning Safety Huddle began in September 2014. Unit Safety Huddles are conducted afterward at 9 a.m. on each unit to bring information to the unit-level nurses and clinical staff working that day. Nursing administrative coordinators are clinical nurses who are liaisons to nursing leadership on the off shifts. They round on units, address patient complaints, perform peripheral IVs, attend and run codes, and assist with orienting new nurses on units. At change of shift at 3 p.m., 7 p.m. and 7 a.m., they receive handoff from charge nurses and managers on the unit status for patient care and staffing and on the information shared at the morning Safety Huddle. The administrative coordinators are also on the email distribution list for the morning Safety Huddle so they are informed of the important topics discussed at that huddle. In addition, the administrative coordinators report any safety concerns from the nightshift at the morning Safety Huddle.
Clinical nurses on the nightshift reported to nursing administrative coordinators that they were not involved in the Safety Huddle and that important information was not being communicated to them. The nightshift clinical nurses verbalized a feeling of being disconnected and a concern for quality and safety because they were not included in the Safety Huddle.
Greenwich Hospital Professional Practice Model
Greenwich Hospital’s Professional Practice Model (PPM) includes the patient and family at the center of nursing care, incorporating nursing theorist Jean Watson’s Theory of Human Caring. The pillars of the PPM are the nursing elements of Quality & Safety, Professional Development, Healing Environment and Practice Excellence. (Evidence EP1EOb-1, Greenwich Hospital Professional Practice Model)
The PPM components include the following explanations:
- Professional Development: We develop as professionals and participate in peer review.
- Quality & Safety: We provide safe and quality care.
- Healing Environment: We support a patient and family-centered healing environment.
- Practice Excellence: We utilize evidence-based practice, innovation and research.
The initiative to improve communication and provide evidence-based, quality patient care on the nightshift focused on the PPM components of Quality & Safety (providing safe and quality care) and Practice Excellence (using evidence-based practice, innovation and research).
Eloisa Zano-Samuel, BSN, RN, Administrative Coordinator, Clinical Nurse, Nightshift council member; Normadene Devane, BSN, RN, Administrative Coordinator, Clinical Nurse, Nightshift council member; Jessica Elie, BSN, RN, Clinical Nurse, Chair Nightshift council; and Zach Harrison, BSN, RN, Co-chair Nightshift council, partnered with members of the Nightshift Council to develop and administer a survey of the nightshift clinical nurses. The Nightshift Council comprises clinical nurses from all nursing units. The purpose of the survey was identify the type and extent of communication issues experienced by nightshift clinical nurses. This project was approved by the Greenwich Hospital IRB.
In September 2019, surveys were completed by the nightshift clinical nurses and nursing staff members. A total of 60 surveys were completed and returned.
The survey questions asked about communication on the nightshift (7 p.m.-7:30 a.m.) using a Likert scale of strongly disagree, disagree, agree, and strongly agree. The survey questions were:
- Communication with the unit staff during the nightshift is good
- Communication with administrative coordinators during the nightshift is good
- Communication with other nursing units and department staff is good
The September 2019 survey results revealed that 40% of nightshift clinical nurses and nursing staff members agreed or strongly agreed that communication on the nightshift with unit colleagues was good; 30% agreed or strongly agreed that communication with administrative coordinators during the night shift was good; and 20% agreed or strongly agreed that communication with other nursing units was good. These results demonstrated that nightshift clinical nurses and nursing staff communication could be improved.
Goal Statement
Improve satisfaction with communication (%) for nightshift clinical nurses and nursing staff, as measured by a pre- and post-intervention survey with the questions:
- Communication with the unit staff during the nightshift is good
- Communication with administrative coordinators during the nightshift is good
- Communication with other nursing units and department staff is good
Participants
Nightshift Council Safety Huddle Taskforce
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Name/Credentials |
Discipline |
Title/Role |
Department |
Eloisa Zano-Samuel, BSN, RN |
Nursing |
Administrative Coordinator, Clinical Nurse, Nightshift Council Member |
Nursing Administration |
Normadene Devane, BSN, RN |
Nursing |
Administrative Coordinator, Clinical Nurse, Nightshift Council Member |
Nursing Administration |
Terry Azzarra, MSN, RN |
Nursing |
Administrative Coordinator, Clinical Nurse, Nightshift Council Member |
Nursing Administration |
Margaret Smith, BSN, RN |
Nursing |
Administrative Coordinator, Clinical Nurse, Nightshift Council Member |
Nursing Administration |
Gloria Gonzales, BSN, RN |
Nursing |
Administrative Coordinator, Clinical Nurse, Nightshift Council Member |
Nursing Administration |
Gladys Luz, BSN, RN |
Nursing |
Administrative Coordinator, Clinical Nurse, Nightshift Council Member |
Nursing Administration |
Lisa Micelli, MSN, RN |
Nursing |
Administrative Coordinator, Clinical Nurse, Nightshift Council Member |
Nursing Administration |
Sue Polaski, RN |
Nursing |
Administrative Coordinator, Clinical Nurse Nightshift council member |
Nursing Administration |
Vicky Yesko, MSN, RN, CCRN |
Nursing |
Clinical Nurse, Nightshift Council Member |
MSICU |
Zach Harrison, BSN, RN |
Nursing |
Clinical Nurse, Nightshift Council Co-chair |
Intermediate Care |
Vicky Costabile, BSN, RN, OCN |
Nursing |
Clinical Nurse, Nightshift Council Member |
Surgery |
Konul Mammadova, BSN, RN |
Nursing |
Clinical Nurse, Nightshift Council Member |
Medical Oncology |
Jessica Elie, BSN, RN |
Nursing |
Clinical Nurse, Nightshift Council Chair |
Maternity |
Rachel Jenner, MSN, RN, CEN, CPEN |
Nursing |
Clinical Nurse, Charge Nurse, Nightshift Council Member |
Emergency Department |
Dan Brown, RN, EFM-BC |
Nursing |
Clinical Nurse, Nightshift Council Member |
L&D |
Description of the Intervention
October 2019
The administrative coordinators, who are members of the Nightshift Unit Practice Council, discussed the survey results with the council. The administrative coordinators proposed instituting a Nightshift Safety Huddle for the nightshift clinical nurses and nursing staff members. The taskforce, a subset of council members created an agenda for the huddle that included the Greenwich Hospital morning Safety Huddle report out, good catches and near misses, and report out on census, bed assignment and staffing. The administrative coordinators met with managers to present the proposal for the Nightshift Safety Huddle and invited them to call in to the huddles.
The Nightshift Council members planned the Nightshift Safety Huddles to begin at 9pm, as this is after change of shift report and before 10 p.m. medications. They decided that the meeting would be held at the nurse’s station on each unit beginning at 9 p.m., with all nurses, secretaries and certified nursing assistants in attendance along with the administrative coordinators. The taskforce members developed the following schedule for the huddles: They would begin on the 3rd floor: Maternity, L&D and NICU, then Medicine unit, Medical Oncology, and then to the second floor: ICU and Telemetry, and then Surgery Unit and pediatrics. The Safety Huddle was intentionally kept brief, no more than 15 minutes to complete.
All interventions were fully implemented by the end of October 2019.
Outcomes
After the implementation of the Nightshift Safety Huddle, monthly post-surveys were administered to nightshift clinical nurses and nursing staff members from November 2019 to January 2020. Survey results revealed an increase in satisfaction with communication on the nightshift for clinical nurses and nursing staff members for all three questions.
The clinical nurses implemented an evidence-based change, the Nightshift Safety Huddle, in alignment with the Greenwich Hospital PPM to improve satisfaction with communication for nightshift clinical nurses and nursing staff members, as measured by a pre- and post-intervention survey with the questions:
- Communication with the unit staff during the night shift is good
- Communication with administrative coordinators during the night shift is good
- Communication with other nursing units and department staff is good
In addition to improved scores on the post-intervention surveys, the nightshift nurses anecdotally reported improved communication: increased collaboration, effective communication, cohesive team work, effective planning and improved flow of information.
Evidence EP1EO-2, Greenwich Hospital Improved Satisfaction (%) with Communication for Nightshift Clinical Nurses and Nursing Staff (NTSFT) as Measured by a Pre and Post Intervention Survey