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Congratulations to the selected Spotlight posters! These featured posters are the top 10 scored posters.
Updated: 04/12/23
Updated: 04/12/23
Cardiac arrests are rare medical emergencies in the primary care setting, but prompt, coordinated intervention is essential. In a large health system in the Midwest, despite annual competency assessment, nurses reported feeling unsure of their role in a “code blue.” Annual medical emergency response competency assessments are held in conference rooms and nurses are evaluated individually. While this model promotes efficiency for the thousands of nurses who complete this competency, it does not increase the confidence of nurses to find the equipment on their unit or to learn their role as a code team member. The team of primary care nursing education specialists conducted a learning needs assessment in November 2021. The findings of the learning needs assessment supported our assumptions:
1) Nurses value hands-on in-situ practice.
2) There is anxiety about the preparation and ability of their colleagues to respond to emergencies.
3) There is anxiety about roles when managing a medical emergency.
4) There is uncertainty about how and where to obtain medical emergency supplies in their work settings.
A literature search revealed that the results of the learning needs assessment were not unique - uncertainty regarding roles and teamwork in a medical emergency is common among nurses. The literature search also found that in-situ simulations alleviated some of that anxiety and improved performance. In response to what was found with the learning needs assessment and the literature, conducting in-situ simulations was the necessary next step. The education team consists of seven nursing education specialists, who cover approximately 1,000 nurses in over 25 practice sites in 18 different cities in 3 states. A “champion” model was employed. Each work area recruited expert staff nurses to serve as “champions” to disseminate education to the rest of the unit, for a total of 38 champions across primary care. In Spring 2022, 4 hours of initial education were provided to the champions. The first class was held virtually for two hours explaining the champion role and providing education on principles of simulation education. The second class was held in person for hands-on practice of the code blue scenario and simulation equipment. Following the education, champions held mock codes on their units throughout the summer with a goal of 80% participation. An evaluation will be completed when the simulations conclude. Nurse managers and staff nurses have shared that the simulations have been well-received. The champions have enjoyed the leadership position, and this has offered a professional development opportunity for expert clinicians. One of the clinics had a code blue the day after the staff had simulations. The nurses were confident and handled the emergency smoothly. Next steps include simulation for other emergencies common in primary care, including anaphylaxis, hypoglycemia, and behavioral emergencies.
1) Nurses value hands-on in-situ practice.
2) There is anxiety about the preparation and ability of their colleagues to respond to emergencies.
3) There is anxiety about roles when managing a medical emergency.
4) There is uncertainty about how and where to obtain medical emergency supplies in their work settings.
A literature search revealed that the results of the learning needs assessment were not unique - uncertainty regarding roles and teamwork in a medical emergency is common among nurses. The literature search also found that in-situ simulations alleviated some of that anxiety and improved performance. In response to what was found with the learning needs assessment and the literature, conducting in-situ simulations was the necessary next step. The education team consists of seven nursing education specialists, who cover approximately 1,000 nurses in over 25 practice sites in 18 different cities in 3 states. A “champion” model was employed. Each work area recruited expert staff nurses to serve as “champions” to disseminate education to the rest of the unit, for a total of 38 champions across primary care. In Spring 2022, 4 hours of initial education were provided to the champions. The first class was held virtually for two hours explaining the champion role and providing education on principles of simulation education. The second class was held in person for hands-on practice of the code blue scenario and simulation equipment. Following the education, champions held mock codes on their units throughout the summer with a goal of 80% participation. An evaluation will be completed when the simulations conclude. Nurse managers and staff nurses have shared that the simulations have been well-received. The champions have enjoyed the leadership position, and this has offered a professional development opportunity for expert clinicians. One of the clinics had a code blue the day after the staff had simulations. The nurses were confident and handled the emergency smoothly. Next steps include simulation for other emergencies common in primary care, including anaphylaxis, hypoglycemia, and behavioral emergencies.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Maria Caldwell, MSN Ed, RN, HHP-BC | Sharon JJ Peacock, MSN Ed, RN, AMB-BC | Kimberly Sipos, BSN, RN, AMB-BC
Updated: 03/01/23
Updated: 03/01/23
Background: The ambulatory care services division is a multi-site organization offering primary and specialty care services to customers in Virginia and North Carolina. Due to a large geographical area of coverage, the clinical education team has met challenges distributing easily accessible educational material in a timely fashion. Quick response (QR) codes are widely used in the acute care and school settings to disseminate educational material; however, little research is available on the use of QR codes in the ambulatory care practice setting.
Research question: Will quick response (QR) codes positively impact participants’ perception regarding availability of clinical educational resources in the ambulatory care setting?
Purpose: The purpose of this research is to determine if QR codes utilized by participants for educational resources in a multi-site, multi-specialty ambulatory care setting will demonstrate increased self-efficacy in their ability to competently engage in tasks relevant to their job profile and scope of practice.
Methodology: The design is a pre-experimental one-group pre-test/post-test design. A review of QR code usage and location of usage will also be analyzed as part of the study. Study participants will be medical assistants (MA), licensed practical nurses (LPN), and registered nurses (RN) in the ambulatory care services division. This survey result combined with the data from QR code usage will determine if the implementation was beneficial.
Analysis: A modified general self-efficacy scale (GSES) was administered pre-intervention and will be administered post-intervention to measure participants perceived self-efficacy to access clinical educational resources. The post-intervention survey will also query participants use of specific QR codes. Additional data on patient demographics will also be collected.
Results: Research is ongoing with projected completion November 2022.
Research question: Will quick response (QR) codes positively impact participants’ perception regarding availability of clinical educational resources in the ambulatory care setting?
Purpose: The purpose of this research is to determine if QR codes utilized by participants for educational resources in a multi-site, multi-specialty ambulatory care setting will demonstrate increased self-efficacy in their ability to competently engage in tasks relevant to their job profile and scope of practice.
Methodology: The design is a pre-experimental one-group pre-test/post-test design. A review of QR code usage and location of usage will also be analyzed as part of the study. Study participants will be medical assistants (MA), licensed practical nurses (LPN), and registered nurses (RN) in the ambulatory care services division. This survey result combined with the data from QR code usage will determine if the implementation was beneficial.
Analysis: A modified general self-efficacy scale (GSES) was administered pre-intervention and will be administered post-intervention to measure participants perceived self-efficacy to access clinical educational resources. The post-intervention survey will also query participants use of specific QR codes. Additional data on patient demographics will also be collected.
Results: Research is ongoing with projected completion November 2022.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/22/23
Updated: 03/22/23
Purpose: It has been well documented that providing comprehensive and effective preoperative education to patients and families has reduced postoperative
complications. This poster aims to describe the development and implementation of a thorough, nursing-led preoperative education process for patients undergoing melanoma surgery and its impact on patient outcomes.
Description: In August 2021, the nurse navigator project lead and subject matter expert identified several gaps in patient care in the melanoma surgical oncology department. After prioritizing these gaps through the lens of both the patient experience and quality and safety, she set out to develop and implement a net new preoperative education process for all patients undergoing melanoma surgery. She first developed a reader-friendly patient education packet, which included information on critical topics such as incision and wound care, prevention and identification of potential complications, lifestyle and behavior modifications, resources, and instructions for contacting the care team. The surgeon and her clinical nurse educator reviewed and edited the packet and ultimately approved it for use by our central patient education committee in October 2021. Using a flipped classroom methodology, she established a collaborative workflow utilizing the practice coordinator to ensure each surgical patient was provided with the educational packet to review before the formal teaching session. During the 1:1 education with the patient, she reviewed and reinforced vital teaching points, answered questions, and validated the patient’s comprehension of the instruction.
Evaluation/outcomes: When comparing pre- vs. post-intervention results, we noted a 5.6% decrease in post-op surgical site infection cases within 30 days and a 12.6% decrease in seromas and incision dehiscence. Additionally, the nurses reported receiving fewer messages and phone calls with questions from melanoma surgery patients in the postoperative period. These encouraging results have inspired other teams within our cancer center, as they highlight the need to prioritize patient education in nursing.
References
1) Ariyo, P., et al. (2019). Implementation strategies to reduce surgical site infections: A systematic review. Infection Control & Hospital Epidemiology, 40(3). doi:10.1017/ice.2018.355
2) Eastwood, D. et al. (2019). Improving postoperative patient reported benefits and satisfaction following spinal fusion with a single preoperative patient education session. The Spine Journal, 19(5). https://doi.org/10.1016/j.spinee.2018.11.010
3) Klaiber, U. et al. (2018). Impact of preoperative patient education on the prevention of postoperative complications after major visceral surgery. Trials, 19. https://doi.org/10.1186/s13063-018-2676-6
4) Koivisto, J-M., et al. (2019). Patient education in relation to informational needs and postoperative complications in surgical patients. International Journal for Quality in Health Care, 32(1). https://doi.org/10.1093/intqhc/mzz032
complications. This poster aims to describe the development and implementation of a thorough, nursing-led preoperative education process for patients undergoing melanoma surgery and its impact on patient outcomes.
Description: In August 2021, the nurse navigator project lead and subject matter expert identified several gaps in patient care in the melanoma surgical oncology department. After prioritizing these gaps through the lens of both the patient experience and quality and safety, she set out to develop and implement a net new preoperative education process for all patients undergoing melanoma surgery. She first developed a reader-friendly patient education packet, which included information on critical topics such as incision and wound care, prevention and identification of potential complications, lifestyle and behavior modifications, resources, and instructions for contacting the care team. The surgeon and her clinical nurse educator reviewed and edited the packet and ultimately approved it for use by our central patient education committee in October 2021. Using a flipped classroom methodology, she established a collaborative workflow utilizing the practice coordinator to ensure each surgical patient was provided with the educational packet to review before the formal teaching session. During the 1:1 education with the patient, she reviewed and reinforced vital teaching points, answered questions, and validated the patient’s comprehension of the instruction.
Evaluation/outcomes: When comparing pre- vs. post-intervention results, we noted a 5.6% decrease in post-op surgical site infection cases within 30 days and a 12.6% decrease in seromas and incision dehiscence. Additionally, the nurses reported receiving fewer messages and phone calls with questions from melanoma surgery patients in the postoperative period. These encouraging results have inspired other teams within our cancer center, as they highlight the need to prioritize patient education in nursing.
References
1) Ariyo, P., et al. (2019). Implementation strategies to reduce surgical site infections: A systematic review. Infection Control & Hospital Epidemiology, 40(3). doi:10.1017/ice.2018.355
2) Eastwood, D. et al. (2019). Improving postoperative patient reported benefits and satisfaction following spinal fusion with a single preoperative patient education session. The Spine Journal, 19(5). https://doi.org/10.1016/j.spinee.2018.11.010
3) Klaiber, U. et al. (2018). Impact of preoperative patient education on the prevention of postoperative complications after major visceral surgery. Trials, 19. https://doi.org/10.1186/s13063-018-2676-6
4) Koivisto, J-M., et al. (2019). Patient education in relation to informational needs and postoperative complications in surgical patients. International Journal for Quality in Health Care, 32(1). https://doi.org/10.1093/intqhc/mzz032
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/22/23
Updated: 03/22/23
The university was awarded $2.8 million in July 2018 from HRSA. The four-year registered nurse in primary care (RNPC) training grant recruits and trains undergraduate nursing students and current RNs to practice to the full scope of their license in community-based primary care teams to increase access to care. Over the four years of this program, 96 undergraduate nursing students were trained in primary healthcare concepts and had clinical placements in underserved primary care settings. These clinical placements include both rural and urban communities. By incorporating primary healthcare in the education of students, this addresses health equity and population health and begins to break down the barriers for diverse populations when accessing healthcare (The Future of Nursing 2020-2030, 2021).
Purpose: The RNPC programs seeks to increase the number of students who are committed to practicing in rural and underserved areas, develop a replicable nursing curriculum providing training in primary healthcare, enhance RNs abilities to address population health outcomes and public health needs of underserved populations, and provide career support to students thus increasing the number of BSN-prepared nurses employed in primary care facilities located in various underserved areas.
Description: Primary healthcare training was provided in didactic and clinical instruction at two campuses in Nevada and Utah. This included information on community-based primary care initiatives, chronic disease prevention strategies, healthcare needs of underserved populations, rural healthcare, and the need for interprofessional healthcare collaboration. Practicing RNs receive training in achievement of health equity, population health, social determinates of health, current trends, and issues related to the access of care for underserved populations.
Evaluation/outcomes: The RNPC has enrolled a total of 96 students in 6 cohorts. 43 have graduated. 5 participated in immersive primary care senior practicums. 16 had primary healthcare certificates awarded. 150 hours of primary care training/student were provided. The RNPC grant has offered 8 primary care trainings to RNs in the overview of primary care, addiction, depression, STDs, adult immunizations, self-care for the provider during the pandemic, and pediatric health.
Reference: National Academies of Sciences, Engineering, and Medicine (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982.
Purpose: The RNPC programs seeks to increase the number of students who are committed to practicing in rural and underserved areas, develop a replicable nursing curriculum providing training in primary healthcare, enhance RNs abilities to address population health outcomes and public health needs of underserved populations, and provide career support to students thus increasing the number of BSN-prepared nurses employed in primary care facilities located in various underserved areas.
Description: Primary healthcare training was provided in didactic and clinical instruction at two campuses in Nevada and Utah. This included information on community-based primary care initiatives, chronic disease prevention strategies, healthcare needs of underserved populations, rural healthcare, and the need for interprofessional healthcare collaboration. Practicing RNs receive training in achievement of health equity, population health, social determinates of health, current trends, and issues related to the access of care for underserved populations.
Evaluation/outcomes: The RNPC has enrolled a total of 96 students in 6 cohorts. 43 have graduated. 5 participated in immersive primary care senior practicums. 16 had primary healthcare certificates awarded. 150 hours of primary care training/student were provided. The RNPC grant has offered 8 primary care trainings to RNs in the overview of primary care, addiction, depression, STDs, adult immunizations, self-care for the provider during the pandemic, and pediatric health.
Reference: National Academies of Sciences, Engineering, and Medicine (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Cara Hough, BSN, RN-BC | Amber Hearron, MSN Ed, RN, Telephone Triage Clinical Nurse Educator, UT Southwestern Medical Center
Updated: 03/22/23
Updated: 03/22/23
At a large expanding academic medical center with over 80 clinics, adult ambulatory care nurses are being expected to care for pediatric patients due to outpatient rapid expansion. These nurses did not have the pediatric emergency training needed for the ambulatory care setting. While the American Heart Association (AHA) pediatric advanced life support (PALS) and pediatric emergency assessment, recognition, and stabilization (PEARS) are options for training, they are costly, not specific to ambulatory care, and take time away from the nurse’s clinical role. With these needs discussed, the clinical education and professional development (CEPD) department created recognition of pediatric emergencies plus stabilization (ROPE+S). This course was implemented to develop pediatric emergency recognition and response training for ambulatory care nurses and is also a substantial cost saving initiative for the institution. This curriculum is online-based learning, with no current in-person didactic training required. The course takes an average of eight hours to complete. It includes pre-existing and institutional created evidence-based learning modules and associated skills with quizzes to assess knowledge, and it offers NCPD upon completion of all course requirements. The elements of ROPE+S include emergency primary and secondary assessment for pediatric patients, asthma, assessment of respirations, seizure precautions, recognition of various types of shock, and use of an AED in the pediatric population. The CEPD targeted members of the ambulatory care rapid response teams as well as nurses who might be assigned to care for pediatric patients in the clinic. This course has been assigned to over 150 nurses so far. With the development of ROPE+S, the need for pediatric training for the ambulatory care nurses is being met. The institution is also saving money. The average PALS class from the AHA costs $150 per learner, and a PEARS course cost $125. Currently, over 150 nurses have been assigned ROPE+S in lieu of an AHA course, saving the institution $18,750. The average daily rate for an ambulatory care nurse is $316. Additionally, the medical center would also need to pay a float pool nurse to cover the shift, equaling $94,800 per year. Added together, the ROPE+S course is saving the medical center approximately $113,550 annually. Since clinics can’t afford to allow their nurses to be away from patient care, scheduling and staffing were also a concern when registering employees for AHA classes. This can lead to a delay in the staff attending these courses, which could in turn cause safety concerns if the staff are not appropriately trained to care for the patients. A post-ROPE+S survey also showed that 77% of respondents would recommend this training to a co-worker. ROPE+S will be assigned to an estimated 150 nurses annually to reinforce the training. It will be adapted based on clinic needs and participant survey results. The goal is for continued cost savings and more efficient training for the staff, which will ultimately lead to safer patient care and better outcomes.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/22/23
Updated: 03/22/23
Peripheral neuropathy is a prevalent and complex complication of diabetes mellitus. Classically characterized by burning or tingling in the lower extremities, neuropathy can gradually lead to numbness and loss of sensation. Deprived of normal protective sensation, patients are unable to feel pain in the affected area. Minor insults such as cuts, burns, or foreign bodies can go unnoticed, resulting in ulcerative wounds or even amputation if left untreated. Systematic screenings, such as annual foot exams, are central to reducing diabetes-related complications. One key component of the foot exam, the 10-gram (g) monofilament test, specifically tests for loss of protective sensation.
At a large academic medical center, a family medicine clinic sought to increase the number of patients receiving timely diabetic foot exams. Historically, providers were responsible for initiating and completing the entire foot exam, including monofilament testing. This proved challenging within the time constraints of a short clinic visit. Additionally, the electronic medical record (EMR) did not alert staff when the annual exam was due. As a result, exams were not consistently performed. To address this care gap, a collaborative team developed a more efficient workflow. Utilizing the shared governance structure, this workflow was presented to and approved by the organization’s multidisciplinary ambulatory care practice council.
The primary workflow revision shifted the monofilament testing from the providers to the certified medical assistants. This was determined to be within the scope of non-licensed clinical staff because it involves data collection rather than clinical judgment. In addition to completing the monofilament test, medical assistants streamlined the exam process by removing patient footwear and initiating documentation prior to the provider entering the room. These efficiencies enabled providers to complete the foot exam within the timeframe of the office visit.
To ensure success, capabilities of the EMR were maximized. For example, to decrease the chance of inadvertent exam omission, a best practice alert was integrated into the EMR to prompt staff when a patient’s annual foot exam is due. After the medical assistant documented monofilament results on the flowsheet, the provider then received an alert prompting them to review the findings and complete the remaining components of the exam. Another EMR modification was a revision to the exam flowsheet, making it more comprehensive and user-friendly. Lastly, adding foot exams to the health maintenance record made previous exams more easily accessible for review.
In the three months prior to the workflow change, an average of 23 diabetic foot exams were completed monthly in the observed clinic. Since implementing the new workflow, the monthly exam average has skyrocketed to 105. These impressive results have spurred interest from other clinics to adopt the process and utilize medical assistants to their full scope. The results also showcase the immediate benefit of implementing best practice alerts for health maintenance items. Most importantly, by increasing the completion rate of annual comprehensive foot exams, fewer patients with diabetes will experience the devastating effects of undetected sensory loss that could lead to ulceration and amputation.
At a large academic medical center, a family medicine clinic sought to increase the number of patients receiving timely diabetic foot exams. Historically, providers were responsible for initiating and completing the entire foot exam, including monofilament testing. This proved challenging within the time constraints of a short clinic visit. Additionally, the electronic medical record (EMR) did not alert staff when the annual exam was due. As a result, exams were not consistently performed. To address this care gap, a collaborative team developed a more efficient workflow. Utilizing the shared governance structure, this workflow was presented to and approved by the organization’s multidisciplinary ambulatory care practice council.
The primary workflow revision shifted the monofilament testing from the providers to the certified medical assistants. This was determined to be within the scope of non-licensed clinical staff because it involves data collection rather than clinical judgment. In addition to completing the monofilament test, medical assistants streamlined the exam process by removing patient footwear and initiating documentation prior to the provider entering the room. These efficiencies enabled providers to complete the foot exam within the timeframe of the office visit.
To ensure success, capabilities of the EMR were maximized. For example, to decrease the chance of inadvertent exam omission, a best practice alert was integrated into the EMR to prompt staff when a patient’s annual foot exam is due. After the medical assistant documented monofilament results on the flowsheet, the provider then received an alert prompting them to review the findings and complete the remaining components of the exam. Another EMR modification was a revision to the exam flowsheet, making it more comprehensive and user-friendly. Lastly, adding foot exams to the health maintenance record made previous exams more easily accessible for review.
In the three months prior to the workflow change, an average of 23 diabetic foot exams were completed monthly in the observed clinic. Since implementing the new workflow, the monthly exam average has skyrocketed to 105. These impressive results have spurred interest from other clinics to adopt the process and utilize medical assistants to their full scope. The results also showcase the immediate benefit of implementing best practice alerts for health maintenance items. Most importantly, by increasing the completion rate of annual comprehensive foot exams, fewer patients with diabetes will experience the devastating effects of undetected sensory loss that could lead to ulceration and amputation.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Lindsay Miller, MSN, RN, NE-BC, Associate Nursing Officer, Vanderbilt University Medical Center
Updated: 03/22/23
Updated: 03/22/23
Health equity has been identified as a key focus in the Future of Nursing Report 2020-2030. Organizations across the nation are trying to understand how they can involve clinical nurses in health equity efforts. This project explains how one organization leveraged feedback from front-line staff to create a community-based health equity service projects. This project can be easily replicated by other organizations who are also working to engage front-line staff in health equity work.
Our organizational community health needs assessment (CHNA) explored community concerns related to health for historically marginalized populations; access to health care, housing, transportation, mental health resources, and prevention and education are the needs the community prioritized. To address these needs with institutional resources, the organization formed an implementation strategy with the goal of engaging leaders, staff, and community partners. One implementation strategy involved the engagement of clinical staff in the design of community-based health equity projects that improve outcomes for various minority patient populations.
With staffing shortages and limited resources, we were tasked to understand how we could engage nursing staff in work that advances health equity within our community. Through listening sessions and a staff survey, clinical staff were interviewed with a goal of understanding their interest and willingness to participate in this work. The outcome of listening sessions and staff survey identified that front-line nursing staff have significant interest in helping advance the organizational health equity mission. Listening sessions also identified perceived barriers to assisting with community projects, populations staff that are interested in serving, and ways the organization can support nursing staff in doing this work.
After data was collected from listening sessions and the staff survey, our team was able to design community-based service projects from the input of clinical nurses. The opportunities and partnerships were then distributed for staff participation. The outcome of this project has resulted in the engagement of clinical nursing staff in community partnerships, grant applications, and the community-based prevention and educational efforts. Examples include Spanish-speaking nurses educating elderly Hispanic adults on the importance of daily activity and the development of vital sign education and future distribution of blood pressure cuffs to elderly homebound patients.
Our organizational community health needs assessment (CHNA) explored community concerns related to health for historically marginalized populations; access to health care, housing, transportation, mental health resources, and prevention and education are the needs the community prioritized. To address these needs with institutional resources, the organization formed an implementation strategy with the goal of engaging leaders, staff, and community partners. One implementation strategy involved the engagement of clinical staff in the design of community-based health equity projects that improve outcomes for various minority patient populations.
With staffing shortages and limited resources, we were tasked to understand how we could engage nursing staff in work that advances health equity within our community. Through listening sessions and a staff survey, clinical staff were interviewed with a goal of understanding their interest and willingness to participate in this work. The outcome of listening sessions and staff survey identified that front-line nursing staff have significant interest in helping advance the organizational health equity mission. Listening sessions also identified perceived barriers to assisting with community projects, populations staff that are interested in serving, and ways the organization can support nursing staff in doing this work.
After data was collected from listening sessions and the staff survey, our team was able to design community-based service projects from the input of clinical nurses. The opportunities and partnerships were then distributed for staff participation. The outcome of this project has resulted in the engagement of clinical nursing staff in community partnerships, grant applications, and the community-based prevention and educational efforts. Examples include Spanish-speaking nurses educating elderly Hispanic adults on the importance of daily activity and the development of vital sign education and future distribution of blood pressure cuffs to elderly homebound patients.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/01/23
Background: A highly engaged and well-trained workforce is vital to safe and effective care. Our organization identified a concerning, downward trend in employee engagement scores and convened a cross-functional workgroup to identify contributing factors and develop solutions. One contributing factor was the lack of opportunity for professional development and advancement.
Method: A survey was developed to assess not only team member level of interest, but also the perceived value of professional development, certification, continuing education, and advanced degree opportunities. The survey was administered to all 386 clinical non-provider staff members, including registered nurses (RNs), licensed practical nurses (LPNs), and medical assistants (MAs). We achieved an excellent 78% response rate. 75% of all respondents reported that they would value receiving a non-credit certificate for completion of an internal professional development course. Additionally, we queried motivation associated with their choice. Specifically, our RNs indicated that their top three reasons for pursuing advanced degrees or certification were to 1) improve the quality of patient care, 2) increase job opportunities within the organization, and 3) advance personal commitment to professionalism. Allowance of free text comments resulted in additional information such as concerns related to cost and schedule challenges.
Intervention: This poster presentation will focus specifically on the development of internal certification programs that provide value to the participant and align with organizational goals. An advance care planning (ACP) course and an advanced electrocardiogram (ECG) course were developed and implemented. A return on investment analysis for the ACP course predicted positive results through increased completion of ACP conversations, which is often a reimbursed, but underutilized service, as well as employee engagement. Both courses included didactic instruction, simulation, case studies and a written final assessment. Expectations were established that, following certification, participants would commit to actively using these skills in the ambulatory care environment by completion of a targeted number of ACP visits or ECGs, respectively. Recertification is available following completion of a biennial refresher course. All courses are offered during work hours with manager approval at no cost to the employee.
Results: 84 clinical staff have completed ACP training. Between August 2020 and May 2021, the number of completed ACP visits increased by 4.8%. 13 support staff have successfully completed the ECG course since its inception in June 2022. Class evaluations confirmed the perceived value of professional development opportunities that was reported on the survey.
Discussion: Participation rate and evaluation results indicate that internal certification courses can be a cost-effective, multi-purpose solution to advance staff skills for top-of-license work and engage team members in their professional development. High-quality care and improved patient outcomes can help engage both patients and team members. The fast pace of change in health care necessitates the creation of time- and cost-effective methods to improve patient care as well as engage staff in their development.
Limitations: During the implementation of the courses, the organization changed engagement survey platforms, making a direct comparison of pre- and post-engagement challenging.
Method: A survey was developed to assess not only team member level of interest, but also the perceived value of professional development, certification, continuing education, and advanced degree opportunities. The survey was administered to all 386 clinical non-provider staff members, including registered nurses (RNs), licensed practical nurses (LPNs), and medical assistants (MAs). We achieved an excellent 78% response rate. 75% of all respondents reported that they would value receiving a non-credit certificate for completion of an internal professional development course. Additionally, we queried motivation associated with their choice. Specifically, our RNs indicated that their top three reasons for pursuing advanced degrees or certification were to 1) improve the quality of patient care, 2) increase job opportunities within the organization, and 3) advance personal commitment to professionalism. Allowance of free text comments resulted in additional information such as concerns related to cost and schedule challenges.
Intervention: This poster presentation will focus specifically on the development of internal certification programs that provide value to the participant and align with organizational goals. An advance care planning (ACP) course and an advanced electrocardiogram (ECG) course were developed and implemented. A return on investment analysis for the ACP course predicted positive results through increased completion of ACP conversations, which is often a reimbursed, but underutilized service, as well as employee engagement. Both courses included didactic instruction, simulation, case studies and a written final assessment. Expectations were established that, following certification, participants would commit to actively using these skills in the ambulatory care environment by completion of a targeted number of ACP visits or ECGs, respectively. Recertification is available following completion of a biennial refresher course. All courses are offered during work hours with manager approval at no cost to the employee.
Results: 84 clinical staff have completed ACP training. Between August 2020 and May 2021, the number of completed ACP visits increased by 4.8%. 13 support staff have successfully completed the ECG course since its inception in June 2022. Class evaluations confirmed the perceived value of professional development opportunities that was reported on the survey.
Discussion: Participation rate and evaluation results indicate that internal certification courses can be a cost-effective, multi-purpose solution to advance staff skills for top-of-license work and engage team members in their professional development. High-quality care and improved patient outcomes can help engage both patients and team members. The fast pace of change in health care necessitates the creation of time- and cost-effective methods to improve patient care as well as engage staff in their development.
Limitations: During the implementation of the courses, the organization changed engagement survey platforms, making a direct comparison of pre- and post-engagement challenging.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Quyen Hurlburt, MSN, RN, CCTC, Director of Nursing and Clinical Operations, Cedars-Sinai Medical Network | Isabelle Mishaw, MSN, RN, CMSRN
Updated: 03/23/23
Background: The clinical operations department in the medical network is responsible for validating clinical skills of new clinical staff working in direct patient care roles. This process is in place to ensure staff are competent to perform the essential duties according to their job descriptions. As of November 1, 2021, the list for new employees who require skills validation was 156. One contributing factor was the COVID-19 pandemic, which resulted in reduced room capacity, and employee availability/willingness to attend due to safety concerns. To reduce the number of new employees working without skills validation, the process was reviewed to identify areas of improvement to increase efficiency, attendance, and patient safety.
Purpose: To reduce the list of new employees who need skills validation to 6 months. Staff scoring >81% (national benchmark) were not required to attend skills lab.
Results: There were 156 new employees on the on the list for skills validation as of November 2021. Post-implementation in December 2021, the list decreased to 111. As of August 2022, there were 73. The median monthly attendance was 28 employees compared to 10 employees prior to implementation.
Conclusions: The interventions were successful in meeting the target of
Purpose: To reduce the list of new employees who need skills validation to 6 months. Staff scoring >81% (national benchmark) were not required to attend skills lab.
Results: There were 156 new employees on the on the list for skills validation as of November 2021. Post-implementation in December 2021, the list decreased to 111. As of August 2022, there were 73. The median monthly attendance was 28 employees compared to 10 employees prior to implementation.
Conclusions: The interventions were successful in meeting the target of
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Quyen Hurlburt, MSN, RN, CCTC, Director of Nursing and Clinical Operations, Cedars-Sinai Medical Network | Ashley Poe, MSN, RN, AMB-BC
Updated: 03/30/23
Updated: 03/22/23
Background: Ambulatory care clinic staffing model lacks registered nurses (RNs) and quite often include unlicensed personnel such as medical assistants (MAs) and licensed vocational nurses (LVNs). Due to the scope of practice, unlicensed personnel and LVNs are unable to triage and assess patient calls and messages, whereas it is within scope for RNs. As a result, mishandling of phone calls regarding the appropriate triaging of symptoms was a common occurrence. There is also a lack of guidelines to successfully triage patient calls resulting in potential patient care delays. Practice change was needed to improve the management of patient calls to provide safe patient care in a timely manner.
Purpose: To develop a standardized, evidence-based call team utilizing established resources.
Methods: Data collection and analysis were completed using Excel spreadsheet. The following interventions were performed in collaboration with and support from information technology (IT), clinical support (physician and nurse leads), and leadership teams: 1) Identified best practices through literature review for guidelines regarding triage call teams, 2) identified departments not staffed with RNs to assess needs, 3) identified common reasons for calls and messages, 4) developed 116 standardized algorithms for triaging symptoms, 5) prioritized top 12 reasons for patient calls to develop algorithms and smart phrases, 6) identified experienced staff to cover the call team and assist with training, 7) rotated training schedules to ensure each call member is exposed to all assigned departments, and 8) conducted weekly meetings to review action plans and pending actions.
Results: Data for 13 different specialties were reviewed between August 1, 2021, and July 31, 2022. A total of 116 reasons were identified for patient calls. There were 72 urgent and 44 non-urgent reasons identified. The top 12 reasons included male abdominal pain, female abdominal pain (menstrual cramps), anaphylaxis, anxiety and panic attack, back pain, breathing difficulty, chest pain, COVID-19, dizziness, headache, blood pressure, and leg edema.
Conclusions: The development of the call team utilizing established resources was cost-effective and contributed to the success of the implementation. The new standardized algorithms lead to improved management of patient calls, which resulted in appropriate escalation of urgent symptoms and appropriate triage. A barrier identified was the competing time between usual clinical duties and phone triage commitment. Time was allocated for each commitment to balance the employee’s responsibilities. This practice change can be applied to other ambulatory care areas that have limited RN staffing model.
Purpose: To develop a standardized, evidence-based call team utilizing established resources.
Methods: Data collection and analysis were completed using Excel spreadsheet. The following interventions were performed in collaboration with and support from information technology (IT), clinical support (physician and nurse leads), and leadership teams: 1) Identified best practices through literature review for guidelines regarding triage call teams, 2) identified departments not staffed with RNs to assess needs, 3) identified common reasons for calls and messages, 4) developed 116 standardized algorithms for triaging symptoms, 5) prioritized top 12 reasons for patient calls to develop algorithms and smart phrases, 6) identified experienced staff to cover the call team and assist with training, 7) rotated training schedules to ensure each call member is exposed to all assigned departments, and 8) conducted weekly meetings to review action plans and pending actions.
Results: Data for 13 different specialties were reviewed between August 1, 2021, and July 31, 2022. A total of 116 reasons were identified for patient calls. There were 72 urgent and 44 non-urgent reasons identified. The top 12 reasons included male abdominal pain, female abdominal pain (menstrual cramps), anaphylaxis, anxiety and panic attack, back pain, breathing difficulty, chest pain, COVID-19, dizziness, headache, blood pressure, and leg edema.
Conclusions: The development of the call team utilizing established resources was cost-effective and contributed to the success of the implementation. The new standardized algorithms lead to improved management of patient calls, which resulted in appropriate escalation of urgent symptoms and appropriate triage. A barrier identified was the competing time between usual clinical duties and phone triage commitment. Time was allocated for each commitment to balance the employee’s responsibilities. This practice change can be applied to other ambulatory care areas that have limited RN staffing model.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
