Patient / Staff Focus Health

Quality Improvement Project

🙠 🙢
Stephanie Brioux, Gabriela Chavez, Samantha Kerr, Sydney Mank, & Kaitlin Scruggs

November 20th, 2019

 Overview of Patient Care Delivery System

• Southern Arizona Veterans Affairs (VA)

Hospital
• Medical-Surgical Floor
• Focus:
• Patient/Staff focus related to dual RN skin
checks (“four-eyes on”) every shift for the
prevention of hospital-acquired pressure
injuries
 Microsystem Model:
Leadership
• “The ability to influence other people.”
• “Foster clear vision...create a culture of candor...acting with
integrity.”
• Democratic Leadership Style
• VA Medical-Surgical Floor:
• Effective communication
• Nurse manager/clinical nurse leader
• Case management
• Float-pool nurses
LaCroix, D. (2019) Leadership and management. [Powerpoint Slides]. Retrieved from: www. d2l.arizona.edu
 Microsystem Model:
Organizational Culture and Support
• “The total of an organization’s values, language, traditions,
customs... the values and behaviors that contribute to the unique
social and psychological environment of an organization.”
• VA Medical-Surgical Floor:
• Fulfillment of mission and values
• Volunteers and ambassadors
• Unit meeting/huddle daily
• Chaplain services
• Pet therapy
• Hospital organized events
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 305).
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model:
Patient Focus & Staff Focus
• Patient Focus: “Respect for patient’s preferences,
coordination and integration of care, proper information and
education, physical comfort, emotional support, involvement
of family, and incorporation of values and needs.”
• Bedside report should be incorporated
• Staff Focus: “Nurse satisfaction relies on overall job
satisfaction, quality measurement, and proper and fair
scheduling.
• Continuing Education/Career Development
• Inservices
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 365.
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model:
Interdependence of Care Team
“Enhanced teamwork with more effective communication
between varying levels of staff, leading to improved patient
& healthcare worker satisfaction”
• VA Medical-Surgical Floor:
• Daily interdisciplinary team rounding
• Strong interdisciplinary relationships
• Teaching hospital - rounds lead by residents,
students’ role in interdisciplinary team
• Communication - phones & pagers (no Voceras)
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 163).
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model:
Use of Information and Healthcare Technology
• “The use of technology allows for instant access and exchange of
sensitive patient information and staff utilization for further
education.”
• VA Medical-Surgical Floor:
• EHR’s aim to “transform health care into a safe, effective, and
more efficient system”
• Outdated and hard-to-use charting system
• Phone/pager use
• Not enough on every unit
• TMS online modules for training
• WOW/Mobile Medcarts
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 513).
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Microsystem Model:
Process for Healthcare Delivery Improvement
“Benchmarking is the process of measuring products,
practices, services against best performing organizations”:
tool used to identify desired standards of performance
• VA Medical-Surgical Floor:
• Established board to track falls and infections
(CLABSI’s/CAUTI’s)
• Badge cards that provide quick information to
assess and intervene for pressure ulcers, stroke,
and sepsis.
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 614).
 Microsystem Model:
Staff Performance Patterns
“Performance appraisals assess employee strengths and
development needs using different measurements and
evaluation methods”
• VA Medical-Surgical Floor:
• Annual performance appraisals
• Daily tracking of CAUTI’s, CLABSI’s, falls, hospital
acquired C-Diff, and incident reports
• Employee of the Month, Daisy Award
• High alert medication Dual-RN check offs
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.
p. 647). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Specific Aspect Targeted for Improvement

• Evidence Based: Introduction to pressure injuries:

Prevention across the acute-care continuum (2018)
• Improving patient focus
• Decreasing hospital-acquired pressure ulcers in
patients by evaluating the entire skin with two sets of
eyes every shift and upon transfers to any other unit
• Implementing a unit-based skin champion is key in
preventing pressure injuries
• Advocation and on-the-spot resource on the unit
Spader, C. (2018). Introduction to pressure injuries: Prevention across the acute-care continuum. American Nurse Today, (May 2018), pp. 17.
Retrieved from https://www.americannursetoday.com/wp-content/uploads/2018/05/DabirSupplement_May2018.pdf
 Specific Aspect Targeted for Improvement

Government of Western Australia Department of Health (2019) Comprehensive Skin Assessment Tool. [Powerpoint Slides]. Retrieved from:
https://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/safety/PDF/Skin-assessment-form.pdf
 Integrative Nursing Principle #5

• “Integrative nursing practice

is informed by evidence and
uses the full range of
therapeutic modalities to
support/augment the healing
process, moving from least
intensive/invasive to more,
depending on need and
context.”
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 305). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Leading the Plan for Healthcare Delivery
Improvement
• Set a goal: A 25% decrease in hospital-acquired pressure
injuries within 1 month
• Maintain steady decline in pressure injuries during 1st year
• Staff education regarding new policy of dual skin check
• In-service education
• On-going pre-shift huddle reminders
• Implement buddy system to ensure check off on dual skin
assessment & file tool in patients’ chart
• Unit manager visits with nurses daily to ensure complete
documentation & check paper chart
 Conclusion

1 Week 1 Month 1 Month 1 Year

Training Pre-Implementation Implementation Sustainment

- Inservicesduring - Develop - Daily nurse manager - Compare results with

huddle every day for a implementation action verification of dual skin other organizations /
week to ensure every plans check completion other VA’s
- Transition to new
staff member receives - RN buddy verification - Regularly analyze data
policy
information. - Develop unit goals for of dual skin check - Compare data to
- Information about implementation plan completion baseline data gathered
performing and in training period
documenting dual skin
checks
- Gather baseline data
for comparison
Questions?
 References

Government of Western Australia Department of Health (2019) Comprehensive Skin Assessment Tool.
[Powerpoint Slides]. Retrieved from:
https://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/safety/PDF/Skin-
assessment-form.pdf

LaCroix, D. (2019) Leadership and management. [Powerpoint Slides]. Retrieved from: www.
d2l.arizona.edu
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and
application (9th ed).. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Spader, C. (2018). Introduction to pressure injuries: Prevention across the acute-care continuum.
American Nurse Today, (May 2018), pp. 17. Retrieved from
https://www.americannursetoday.com/wp-content/uploads/2018/05/DabirSupplement_May2018.pdf