SE1EO

 

Professional Development SE1EO

 

Two examples are required (one example MUST be from ambulatory setting, if applicable):

 

1. Provide two examples, with supporting evidence, of an improved patient outcome associated with the participation of clinical nurse(s) serving as a member of an organization-level interprofessional decision making group.
   • Patient outcome data MUST be submitted in the form of a graph with a data table.

 

 

Example a: Impact of a Sleep Menu on Reported Quietness of the Intermediate Care Unit

Problem
Patients are admitted to the 20-bed Intermediate Care Unit (ICA) for management of heart failure, dysrhythmias and acute cerebrovascular accidents. The ICA has in-room monitors, and all rooms have the capability for remote telemetry monitoring located at the nurses’ station. There is a significant amount of noise on the unit due to continuous cardiac monitoring, frequent assessments and the movement of patients from the unit to testing areas off the unit (CT, MRI, Interventional Radiology and Cardiology). In addition, multiple patient transfers on and off the unit lead to noise and disruptions.
 
The Intermediate Care Patient Satisfaction Committee is an organization-level, interprofessional decision-making group that is part of the larger interprofessional, organization-level decision-making Patient Satisfaction Steering Committee. The Patient Satisfaction Steering Committee, which meets weekly under the leadership of Norm Roth, President/Chief Executive Officer, and Diane Kelly, DNP, RN, Executive Vice President/Chief Operating Officer, reviews all patient complaints from the Press Ganey (PG) patient satisfaction surveys. In August 2019, The Patient Satisfaction Steering Committee noted that a number of negative PG reports for ICA related to noise. The ICA Patient Satisfaction Committee reviewed the PG data and determined a need to address the noise level on the ICA unit.

 

In August 2019, the ICA Press Ganey patient satisfaction score for the question, “Always quiet in and around the room” was 68.8%.  

 

Goal Statement
Increase the ICA Press Ganey patient satisfaction score for the Press Ganey question, “Always Quiet in and around the room.”

 

Participants

 

Intermediate Care Patient Satisfaction Committee
Name/Credentials	Discipline	Title/Role	Department
Ann Marie McGrory, BSN, RN	Nursing	Nurse Manager	ICA, MSICU, ED
Dawn Schupp, RN, CCRN	Nursing	Clinical Coordinator	ICA, MSICU
Christine Rae, BSN, RN	Nursing	Clinical Coordinator	ICA, MSICU
Elizabeth Purcell, BSN, RN	Nursing	Admission, Discharge, Transfer Clinical Nurse	ICA, MSICU
Alison Beam, BSN, RN	Nursing	Clinical Nurse	ICA
Elizabeth Narajan, BSN, RN	Nursing	Clinical Nurse	ICA
Debi D’Alba	Administration	Director	Patient Experience
Gerardo Laureano	Transportation	Transportation Coordinator	Materials Control
Edward Handel	Materials	Director of Environmental Services and Materials Management	Materials Control
Amy Ling, MSW	Social Work	Social Worker	Case Management
Maria Velez, CNA, NRA	Nursing	Nursing Resource Assistant	MSICU, IMCU
Stacey Green	Administration	Director of Volunteers	Volunteer Services
Jennifer Pascucci	Food and Nutrition	Director of Food and Nutrition	Sodexo Food Services
Nickolas Damiano	Coordinator	Supervisor of Environmental Services	Environmental Services
Omair Sheikh, MD	Medicine	Chief Resident, Physician	Medical Education
Amelia Somboonthum	Social Work	Lead Case Manager	Case Management
Michael Yaminsky	Food and Nutrition	Retail Manager	Sodexo Food Services

 

Description of the Intervention
September 2019
The Intermediate Care Patient Satisfaction Committee is an organization-level, interprofessional team of nurses, physicians, patient and guest relations staff, the director of Volunteer Services and representatives from Environmental services, Transportation, Materials Management, Food and Nutrition, and Social Services. The committee reviewed patient satisfaction scores on the ICA, conducting a six-week look back at the Press Ganey score for “Always quiet in and around the room.” Their purpose was to decrease noise to improve the patient experience and increase PG scores. The committee decided to empower patients through an innovative nurse-led education concept using a Sleep Menu. 

 

Dawn Schupp, RN, CCRN, Clinical Coordinator, Clinical Nurse, ICA MSICU; Christine Rae, BSN, RN, Clinical Coordinator, Clinical Nurse, ICA MSICU; Alison Beam, BSN, RN, Clinical Nurse, ICA; and Elizabeth Najarian, BSN RN, Clinical Nurse, ICA, developed a Sleep Menu to create a quiet environment and help patients sleep. The menu contains a list of items available on the unit for patients to select that support a quiet, healing environment, including ear plugs, eye masks, aromatherapy, music therapy, warm blankets, headphones and decaffeinated herbal tea. The clinical nurses presented the Sleep Menu to the interprofessional, organization-level decision-making Intermediate Care Patient Satisfaction Committee for approval. The committee redesigned the menu to include the updated hospital logo, font and pictures of the items. Copies were printed on cardstock by Greenwich Hospital Marketing department, and clinical nurses distributed the Sleep Menu to patients.

 

Members of the Intermediate Care Patient Satisfaction Committee educated ICA clinical nurses during daily Safety Huddles and staff meetings on the benefits of the Sleep Menu and how to use the available products. Clinical nurses began proactively distributing the Sleep Menu to patients. On admission, patients review the Sleep Menu, discuss it with their clinical nurse and choose the items they would like to use to decrease noise and increase sleep.

 

All interventions were fully implemented by the end of September 2019.

 

Outcomes

ICA clinical nurses serving as members of an organization-level, interprofessional decision-making group, the Intermediate Care Patient Satisfaction Committee, implemented interventions to increase patient satisfaction for the Press Ganey question, “Always quiet in and around the room.” The score increased from 68% in August 2019 to 85% in October 2019, 77.3% in November 2019 and 88.6% in December 2019.

 

 

Evidence SE1EOa-1, Greenwich Hospital Intermediate Care Unit Press Ganey Patient Satisfaction Question “Always quiet in and around the room”

 

 

Example b: Greenwich Hospital Clinical Nurses as Members of Organization-level Interprofessional Decision-making Group Reduce Patient Errors

Problem
During a hysteroscopy case in July 2018, a patient error related to fluid overload required transfer to a higher level of care post-operatively to the MSICU. Hysteroscopy procedures involve the surgeon using air or fluid to aid in visualization.

 

In July 2018, the percent of patient errors related to fluid overload for hysteroscopy patients was 33%. This is calculated as the number of patient errors related to fluid overload for hysteroscopy patients divided by the total number of hysteroscopy patients, multiplied by 100.

 

Goal Statement
Decrease the percent of patient errors related to fluid overload for hysteroscopy patients.

 

Participants

 

Greenwich Hospital/YNHHS Surgical Services Committee and Quality & Safety Taskforce
Name/Credentials	Discipline	Title/Role	Department
Marie Pham, BSN, RN, CNOR	Nursing	Nurse Manager, Taskforce Member	OR
Peggy Lennon, MSN, RN, NEA-BC	Nursing	Director, Surgical Services, Taskforce Member	Administration
Rhona Virtudes, RN, CNOR	Nursing	Clinical Nurse, Taskforce Member	OR
Leigh Shainwald, RN, CNOR	Nursing	Clinical Nurse, Taskforce Member	OR
Christal Rodenhiser, RN, CNOR	Nursing	Clinical Nurse, Taskforce Member	OR
Martha Cooper, BSN, RN, CNOR	Nursing	Clinical Nurse, Taskforce Member	OR
Madeline Abille, BSN, RN, CNOR	Nursing	Clinical Nurse, Taskforce Member	OR
Anna Giadana, BSN, RN, CNOR, RNFA	Nursing	Clinical Nurse, Taskforce Member	OR
Jane Nakashian, BSN, RN, CNOR	Nursing	Clinical Nurse, Clinical Coordinator, Taskforce Member	OR
Jane Ruf, MSN, RN, CNOR	Nursing	Clinical Nurse, Taskforce Member	OR
Doris Dubail, RN, CNOR, RNFA	Nursing	Clinical Nurse, Taskforce Member	OR
Ronnie Brock, CST	Nursing	Surgical Tech	OR
Margaret Towers, BSN, RN	Risk Management	Director, Taskforce Member	Risk Management
Jessie Riemer, BSN, RN, CHPQ	Performance management	Performance Specialist, Taskforce Member	Performance Improvement
Spike Lipschutz, MD	Physician	Chief Medical Officer, Taskforce Member	Administration
Gary Kalan, MD	Physician	Anesthesiologist, Taskforce Member	Anesthesia
Cathy Onorato, CRNA	Nursing	Certified Registered Nurse Anesthetist	Anesthesia
Paul Apostolides, MD	Physician	Surgeon-Chief	Neurosurgery
Catherine Alonzo, MD	Physician	Surgeon-Chief	Urology
Rich Brauer, MD	Physician	Surgeon	ENT
David Greenspun, MD	Physician	Surgeon-Chief	Plastic Surgery
Max Laureans, MD	Physician	VP YNHHS Surgical Services	Yale New Haven Health System
Paul Sygall, MD	Physician	Anesthesiologist	Anesthesia
Patricia Calyag, MD	Physician	Obstetrician	Obstetrics
Steve Hindman, MD	Physician	Surgeon-Chief	Orthopedics
Thomas Wilson, MD	Physician	Surgeon	ENT (Ear, Nose, Throat)
Herbert Facey	Manager	Manager	Sterile Supply Department
Diane Kelly	Administration	Chief Executive Officer, Taskforce Member	Administration
Helen Kimmons	Nursing	Nurse Manager	ASU/PACU
Kisha Mitchell-Richards, MD	Physician	Director	Laboratory
Suresh Mandava, MD	Physician	Surgeon-Chief	Ophthalmology
Alfonso Tagliavia, MD	Physician	Director-Chief Anesthesiologist	Anesthesia
Paul Waters, MD	Physician	Surgeon-Chief	Pulmonary

 

Description of the Intervention

August-September 2018
The Greenwich Hospital/Yale New Haven Health System (YNHHS) Surgical Services Committee is an organization-level, interprofessional decision-making group that meets locally at Greenwich Hospital (GH) and at the system level. The committee membership includes clinical nurses and other nursing members, surgeons, and representatives from administration, the Sterile Processing Department (SPD) and Laboratory Services. The committee reviewed the patient safety error related to fluid overload for the hysteroscopy patient and convened the interprofessional, organization-level Quality & Safety Taskforce to review the event and perform a root cause analysis.

 

The taskforce included nurses, physicians and representatives from Risk Management, Anesthesia and GH leadership. The Quality & Safety Taskforce performed a root cause analysis to review the event, determine how the error had occurred and identify strategies to prevent further patient errors.

 

The taskforce identified a lack of oversight of fluid management as the source of the error with the hysteroscopy fluid overload. The taskforce, including clinical nurse members, proposed the development of a nurse-driven protocol to enable nurses to execute nursing care decisions in a time-critical manner within the full scope of nursing practice.

 

Marie Pham, BSN, RN, CNOR, OR Nurse Manager, and Jayne Nakashian, BSN, RN, CNOR, Clinical Coordinator, followed up on the root cause analysis by conducting a literature review. They determined that the maximum absolute fluid volume deficit used in hysteroscopy procedures was 2500 mL, with a recommended limit of 1500 mL. The evidence demonstrated that the greater the fluid deficit, the greater the patient risk for fluid overload and potential for harm; if the amount of fluid being administered is not carefully calculated, the fluid deficit may lead to fluid overload.

 

Pham and Nakashian met with Clinical Nurses Rhona Virtudes, RN, CNOR; Madeline Abille, BSN, RN, CNOR; and Doris Dubail, RN, RNFA, CNOR to develop a nurse-driven set of interventions for the OR nurses to use during hysteroscopy cases to prevent patient errors related to fluid overload. The interventions included a Fluid Deficit Pause, which is similar to the time-out that is performed prior to the start of a procedure for safety measures during which the surgical team checks and double checks patient identification and procedure, and voices any concerns. The Fluid Deficit Pause is performed 20 minutes into the procedure, when the the surgeon administers fluid into the uterine cavity. The amount of fluid is measured and regulated, and when a 1000 mL deficit is reached, the procedure is paused for the OR team to stop, address patient status and determine fluid inputs and outputs for the case.The pause is conducted by the clinical nurse in the circulator role in the OR, who measures fluid in and fluid out during the case. Nurses are empowered to call a stop for clarification during the procedure if they have a question.

 

The taskforce clinical nurses developed audits for the new procedure and a new flow sheet in EPIC to document hysteroscopy fluid events.

 

The Quality & Safety Taskforce approved the change in practice of the Fluid Deficit Pause. The clinical nurse members of the Quality & Safety Taskforce developed education on the new Fluid Deficit Pause procedure and provided it to all OR clinical nurses and surgeons.

 

After a successful trial of the new procedure, the Fluid Deficit Pause was incorporated into a full secondary time-out during hysteroscopy procedures.

 

Outcomes
Clinical nurses, as members of the organization-level, interprofessional decision-making group, the Greenwich Hospital/YNHHS Surgical Services Committee and Quality & Safety Taskforce, decreased the percent of patient errors related to fluid overload for hysteroscopy patients. After the implementation of the new secondary time-out procedure, the Fluid Deficit Pause, the percent of patient errors related to fluid overload for hysteroscopy patients decreased to 0% in each of October 2018, November 2018 and December 2018.

 

 

Evidence SE1EOb-1, Greenwich Hospital Percent of Patient Errors Related to Fluid Overload for Hysteroscopy Patients