Patient Focus

Quality Improvement Project

🙠 🙢
Julia Binder, Kristin Cabatingan, Sage Charlee, Chloe DeWitt, & Bella Rahal

April 29th, 2020

 Overview of Patient Care Delivery System

Tucson Medical Center (TMC)

Adult Surgical Unit
o 34 bed surgical telemetry unit
o Pre & post-operative care
o 1:5 ratio
Focus-
o Patient focus related to RN
“bladder bundle” checks every
shift for the prevention of
hospital-acquired catheter-
associated urinary tract infection
(CAUTI’s)
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 Microsystem Model:
Leadership

Charge Nurse: Democratic Leadership Style

o “Less control... directed through suggestions and
guidance, communication flows up and down,
decision making involves others, emphasis is on
(we), constructive criticism”

TMC Adult Surgical Unit:

o Charge nurse empowers staff to promote a culture of
candor, be optimistic, mentor others, as well as
provide feedback to staff throughout the shift

LaCroix, D. (2020) Leadership and management [PowerPoint slides]. Retrieved from www.d2l.arizona.edu

3
 Microsystem Model
Organizational Culture and Support

“The values and behaviors that contribute to the

unique social and psychological environment of an
organization”
TMC Adult Surgical Unit:
o Hospital Chaplain always available
o Hospital mission statement is achieved
o Volunteer work is available
o Unit huddles are clear and concise
o RT/Pharmacy team
o Unit specialized trainings/events are frequent
Marquis, B. L., & Huston, C. J. (2017). Leadership and management functions in nursing: Theory and application (9th
ed. p. 306). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 4
 Microsystem Model:
Patient Focus & Staff Focus

Patient Focus: “That is Staff Focus: “Integrating

respectful of and leadership roles and
responsive to individual management functions
patient preferences, ensures that the type of
needs, and values, and patient care delivery model
ensuring that patient will provide quality care and
values guide all clinical staff satisfaction”
decisions” o New grad residency
o Timely care, program, staff-patient
incorporate patient in ratio, inservices
decisions, education,
hourly rounding
Marquis, B. L., & Huston, C. J. (2017). Leadership and management functions in nursing: Theory and
application (9th ed. p. 364-367). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
5
 Microsystem Model:
Interdependence of Care Team

Collaboration, Communication, Consideration

“Interdependence has been defined as more than one
entity working together to accomplish a common objective”
TMC Adult Surgical Unit:
o Interprofessional Collaboration
• RT, chaplain, social workers, case management,
house supervisor, PCTs
o Communication
• Phones, Vocera, Charting
o Consideration
• Teaching hospital, cultural competence

Huth, C., Kelly, B., & Van Sell, S. L. (2017) Interdependence: A concept analysis. International Journal of Nursing
and Clinical Practices, 4(225), 1-4. https://doi.org/10.15344/2394-4978/2017/225
6
 Microsystem Model:
Use of Information and Healthcare Technology

“Technology has given the potential for instant information

access and exchange”
TMC Adult Surgical Unit:
o EPIC
• Medication resource, patient charting, dual check offs
o Vocera
• Facility wide communication device
o Desktop/Laptops with scanners
• Present in every room to ensure adequate and correct
charting
• Proper documentation of medication administrations
Marquis, B. L., & Huston, C. J. (2017). Leadership and management functions in nursing: Theory and application (9th ed. p.
506). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

7
 Microsystem Model:
Process for Healthcare Delivery Improvement

Process Improvement
TMC Adult Surgical Unit -
Frequent assessments
o Hourly rounding
CAUTI checks
o During PCT & RN handoffs
Sepsis Protocol
o Charted & documented
Dual RN Skin Check for Pressure Ulcers
o 4 eyes on patient

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 Microsystem Model:
Staff Performance Patterns

Performance Pattern
TMC Adult Surgical Unit -
Daisy Award
Required inservices
o Continued education
Incident reports
o Hospital acquired injuries (unit focused)
Dual RN Med Check-offs
o Ensures medication administration is done
correctly
Unit manager monthly meetings
o More frequent for new hires
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 Specific Aspect Targeted for Improvement

Our Focus: Patient focus related to RN “bladder bundle” checks every shift for
the prevention of hospital-acquired catheter-associated urinary tract infection
(CAUTI’s)

Evidence Based Article: CAUTI Prevention Strategy Using Education

o We chose patient focus because based on the article, implementation
of patient-centered education resulted in a decreased rate of CAUTIs
o Provides an improvement in overall patient care by preventing CAUTIs
• CAUTI is a never event; 80% of infection rates are due to CAUTIs
• 113,000 deaths annually due to CAUTIs
• Increase staff awareness and patient advocacy
• Improve quality of patient care
• Reduce morbidity rates
• Decrease length of stay
• Lessen healthcare costs

Locke, L. M., Grissman, C. L., Crasta, R. D., Bazan, G. N., & Love, K. (2017). Catheter-associated urinary tract
infection prevention strategy using education in an intensive care unit. Retrieved from
https://digitalcommons.psjhealth.org/cgi/viewcontent.cgi?article=3688&context=publications
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 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

Kreitzer M. J. (2015). Integrative nursing: application of principles across clinical settings. Rambam
Maimonides medical journal, 6(2), e0016. doi: 10.5041/RMMJ.10200
11
 Leading the Plan for Healthcare Delivery
Improvement

TMC Adult Surgical Unit-

Set a unit/hospital wide goal
o Goal:
• The hospital unit will reach the desired goal of having 25%
less hospital-acquired CAUTIs by the end of the first year
• There will be a 50% decrease in hospital acquired
CAUTIs per month
Implement
o New policy development
• Bladder bundle checks every shift (day/night)
o Required inservices
o Buddy system
• Charting check offs, dual skin check, med sign offs
Evaluate
o Charge nurse observations every shift
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 Implementation Timeline

Goal: 50% decrease in hospital-acquired CAUTIs

Months:

0-1 1-3 3-4 4-8 8-12 12+

Planning Training Implementation Evaluation

Project Introduce new Determine Implement new Incorporate Evaluate

planning policy and buddy policy required outcomes.
and goal integrate system to development inservices. Incorporate
setting teaching of incorporate and required Charge nurse hospital-wide.
bladder dual check inservices and nurse
bundle checks offs manager
to staff. evaluation. 13
 Conclusion

TMC Adult Surgical Unit:

o After implementing the plan…
• The hospital unit will reach the desired goal of
having 25% less hospital-acquired CAUTIs by
the end of the first year
• There will be a 50% decrease in overall hospital
acquired CAUTIs per month
• Staff will be adequately trained on CAUTI
prevention after training
• The unit manager will evaluate the
implementation plan after the first year
• The charge nurse will successfully evaluate each
staff member every shift
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Questions?

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 References

Huth, C., Kelly, B., & Van Sell, S. L. (2017) Interdependence: A concept analysis. International Journal of
Nursing and Clinical Practices, 4(225), 1-4. https://doi.org/10.15344/2394-4978/2017/225

Kreitzer M. J. (2015). Integrative nursing: application of principles across clinical settings. Rambam
Maimonides medical journal, 6(2), e0016. doi: 10.5041/RMMJ.10200

LaCroix, D. (2020) Leadership and management [PowerPoint slides]. Retrieved from www.d2l.arizona.edu

Locke, L. M., Grissman, C. L., Crasta, R. D., Bazan, G. N., & Love, K. (2017). Catheter-associated urinary
tract infection prevention strategy using education in an intensive care unit. Retrieved from
https://digitalcommons.psjhealth.org/cgi/viewcontent.cgi?article=3688&context=publications

Marquis, B. L., & Huston, C. J. (2017). Leadership and management functions in nursing: Theory and
application (9th ed. p. 306). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

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