�Patient Focus

�Quality Improvement
Project
� Bella Rahal, Sage Char-Lee, Chloe DeWitt, Julia Binder & Kristin Cabatingan

� April 29, 2020

1
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
infections (CAUTI’s)
2
 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
• To provide exceptional health care with compassion
o Volunteer work is available
o Unit huddles are clear and concise
o RT/Pharmacy
o Unit specialized trainings/events
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.

TMC (2020). Mission statement. Retrieved from https://www.tmcaz.com/about-tmc/mission-vision-and-values

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
ensuring that patient model will provide quality
values guide all clinical care and staff
decisions” satisfaction”
o Timely care, o New grad residency
incorporate patient in program, staff-patient
decisions, education, ratio, inservices
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 6
and Clinical Practices, 4(225), 1-4. https://doi.org/10.15344/2394-4978/2017/225
 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

“Benchmarking - a tool for identifying desired standards of

organizational performance”

TMC Adult Surgical Unit -

Frequent assessments
o Hourly rounding
Sepsis Protocol
o Charted & documented
Dual RN Skin Check for Pressure Ulcers
o 4 eyes on patient

Marquis, B. L., & Huston, C. J. (2017). Leadership and management functions in nursing: Theory and application (9th
ed. p. 614). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

8
 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
Parmar, R. (2020) Performance appraisal [PowerPoint slides]. Retrieved from www.d2l.arizona.edu 9
 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
10
 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-specific 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
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 and nurse manager observations every shift and
evaluates unit outcomes by the end of the year
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 Implementation Timeline

Goal: The hospital unit will reach the desired goal of

having 25% less hospital-acquired CAUTIs by the end of
the first year.
Months:

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

Planning Training Implementation Evaluation

Project Introduce new Implement Implement new Incorporate Evaluate

planning policy and a buddy policy required outcomes.
and goal integrate system to development. inservices.
setting teaching of incorporate Charge nurse
bladder dual check 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
• 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?

15
 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.

Parmar, R. (2020) Performance appraisal [PowerPoint slides]. Retrieved from www.d2l.arizona.edu

Tucson Medical Center. (2020). Mission. Retrieved from

https://www.tmcaz.com/about-tmc/mission-vision-and-values
16