Hospital Story David Smith, MS, RN, ANP-BC Scottsdale Heathcare - - PowerPoint PPT Presentation

Hospital Story

David Smith, MS, RN, ANP-BC Scottsdale Heathcare Scottsdale, AZ

Objectives and About Us

• Scottsdale Healthcare is a community health

system located in Scottsdale, Arizona composed of 3 acute care hospitals and comprehensive ambulatory services.

• Magnet status as a system.
• Objectives

– List two factors used to determine the composition of the multidisciplinary team. – List a strategy used to overcome cultural barriers.

2

Team Formation

• Team leadership provided by three nurses

who were participating in our Clinical Scholars Program (an EBP training fellowship for RNs).

• Additional team members selected from the

ICU nursing staff, registered dietitian, materials management staff, nursing leadership, Quality Enhancement Services staff, and the Director of Nursing Research.

3

AIM and Measure Selection

• Goal: Reduce unit-acquired pressure ulcer

rate to below the NDNQI mean (based on unit type and hospital size).

• Measure was selected because NDNQI is the

primary database used at SHC to benchmark nurse-sensitive quality outcomes.

• This ICU had been above the mean for most

quarters for more than a year.

4

Tests of Change

• This practice improvement program was

developed as part of a evidence-based practice fellowship for RNs.

– Review of literature. – Comparison of evidence-based best practices with typical practice in the ICU at that time. – Staff initiated monthly prevalence studies (NDNQI is quarterly). – Interventions expanded as a deeper understanding of the pressure ulcer literature developed. – Eventually expanded to all ICUs in the system after successful tests of change in a single unit.

5

Barriers, and How We Resolved those Barriers

• Culture and resistance to change were the

biggest barriers.

– Project leaders worked to develop a strong sense

• f peer-to-peer responsibility.

– Use of “wound warriors” for all shifts. – Monthly feedback to staff at unit meetings, one

• n ones, and posters placed in break room.

– Making data real and adding the human factor.

6

Outcomes

Advice for Fellows

• It takes a team.
• Enthusiastic leadership is vital.
• Get staff personally involved – bad outcomes are

a reflection of our practice – Take Ownership.

• Even simple data requires translation.
• Celebrate victories no matter how small.
• Do not settle for less than what you had planned.
• A deep dive into the literature is vital in

determining best practices.

8

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Wrap Up and Next Steps

• Summary: Development and implementation of an

evidence-based pressure ulcer prevent protocol by a multidisciplinary team resulted in a statistically significant reduction in HAPU formation throughout

• ur system.
• Next steps: Examining the impact of increased use
• f technology to ensure a bundle of critical nursing

behaviors (including hourly rounding and bedside handoffs) on patient falls.

• Questions?