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Congratulations to the selected Spotlight posters! These featured posters are the top 10 scored posters.
Tags:
leadership
shared governance
Updated: 03/01/23
Updated: 03/01/23
Outcome: Participants will be able to illustrate how a multi-location health system utilized a central council structure in their ambulatory care shared governance model to facilitate communication and collaboration across all represented clinical practice areas and connect front-line staff to similar practice settings across the enterprise.
Purpose: Shared governance is a leadership model that facilitates shared decision-making and empowers front-line clinicians to determine, implement, and maintain practice standards in their clinical environment. An effective ambulatory care shared governance model enables front-line clinicians to communicate and collaborate to drive changes needed for delivery of quality patient care and outcomes.
Description: A large academic health system in Northern California expanded their shared governance structure to include ambulatory care in 2019. With 11 service lines, 37 clinical practice locations, and >600 nurses represented, engagement of all represented ambulatory care practice sites required a method to connect clinical staff across all practice locations, allow for collaborative work, and communicate outcomes. The action request form (ARF) platform, first developed in the organization’s inpatient shared governance structure, was utilized in the ambulatory care shared governance structure to connect staff at all practice areas to their respective council. Any staff member can submit requests and recommend solutions for improvements in their clinical practice area (Moreno et al., 2018). These requests are then routed to the associated service line council. ARFs are reviewed and discussed monthly at shared governance council meetings, with actions taken towards resolution documented within the ARF platform to communicate this information back to the submitter. Sustained utilization of the platform by front-line staff has been maintained through consistent communication and confidence that submissions to the platform will be acknowledged and addressed. The expected timeframe for closure of each request is
Purpose: Shared governance is a leadership model that facilitates shared decision-making and empowers front-line clinicians to determine, implement, and maintain practice standards in their clinical environment. An effective ambulatory care shared governance model enables front-line clinicians to communicate and collaborate to drive changes needed for delivery of quality patient care and outcomes.
Description: A large academic health system in Northern California expanded their shared governance structure to include ambulatory care in 2019. With 11 service lines, 37 clinical practice locations, and >600 nurses represented, engagement of all represented ambulatory care practice sites required a method to connect clinical staff across all practice locations, allow for collaborative work, and communicate outcomes. The action request form (ARF) platform, first developed in the organization’s inpatient shared governance structure, was utilized in the ambulatory care shared governance structure to connect staff at all practice areas to their respective council. Any staff member can submit requests and recommend solutions for improvements in their clinical practice area (Moreno et al., 2018). These requests are then routed to the associated service line council. ARFs are reviewed and discussed monthly at shared governance council meetings, with actions taken towards resolution documented within the ARF platform to communicate this information back to the submitter. Sustained utilization of the platform by front-line staff has been maintained through consistent communication and confidence that submissions to the platform will be acknowledged and addressed. The expected timeframe for closure of each request is
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.
This qualitative, phenomenological study described how nurse leaders in a large southwestern region of the United States perceived their lived experiences of structural empowerment and job satisfaction within an organization. Diverse nursing models of leadership have contributed to quality metrics and measurable positive outcomes, yet few have assessed the key role of front-line nurse leader. Front-line nurse leaders have been directly engaged in and leading through recent challenging times, which adversely contributes to diminished empowerment and less job satisfaction. Structural empowerment for nurses is fostered through supportive leadership, professional autonomy, and visible trust. Kanter's theory of structural empowerment and Herzberg’s two-factor theory of job satisfaction provided the study’s theoretical foundation. An older model was a modified version of van Kaam method analysis that assisted in answering the study’s three research questions: How do nurse leaders perceive their lived experiences of structural empowerment and job satisfaction? What perceived organizational factors contribute to structural empowerment and job satisfaction for the nurse leader? How does the nurse leader perceive leadership effectiveness as it relates to their experience of structural empowerment and job satisfaction in a large southwestern region of the United States? Approximately, 18 nurse leaders were recruited from a large southwestern region in the United States for the sample size. A descriptive, qualitative methodology aided in answering research questions while revealing emerging themes. The sources of data included a demographic questionnaire and semi-structured interviews completed with the nurse leaders. Meaningful themes emerged and were coded by NVivo qualitative software. The thematic analysis identified the following themes: autonomy communication, connection, experience, job satisfaction, influence, perception, structural empowerment, and work environment. The results of this study may assist leaders and workers in areas of empowerment and job satisfaction. Additionally, this study created an opportunity to further consider diverse generational nurse leaders, gender-led perceptions for front-line leaders, and influential drivers for sustained leadership satisfaction. Moreover, research is needed to make known additional factors to describe the lived experience while fostering new research considerations.
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.
P069 - Supporting Newly Licensed Practical Nurses: An Ambulatory Care Transition-to-Practice Program
Lynn D'Angelo, DNP, RN, NEA-BC, Director, Ambulatory Clinical Excellence, UMass Memorial Medical Center | Amy Moisan, RN
Updated: 03/14/23
Updated: 03/14/23
The fast-paced environment of ambulatory care nursing requires new hires to be equipped with powerful tools of knowledge, skill, and abilities to deliver high-quality safe care. An innovative licensed practical nurse (LPN) transition-to-practice program is an essential strategy to develop the confidence and competence of newly licensed practical nurses. The newly designed LPN transition-to-practice program provides recent graduates of practical nursing programs with a cohort model; evidence-based curriculum aligned with the Massachusetts Nurse of the Future Core Competencies for LPNs; and an experienced preceptor at the clinic level. During this nine-month program participants attend weekly interactive classes for the first two months and then monthly skills-based classes; provide patient care with an experienced preceptor; complete an evidence-based practice project; shadow caregivers in other disciplines; participate in simulation to further develop critical-thinking skills; build organization-wide relationships; and increase confidence in safe delivery of care. This transition-to-practice program was a creative solution to address increasing vacancies and patient volume, support workforce development, and increase retention. To measure outcomes related to LPN confidence and competence, participants complete a survey upon program start and again at three months, six months, and nine months after the program, as well as evaluations after each class to assess the program structure, including content and faculty. The feedback received from the inaugural class has been very positive. The participants appreciate the cohort model, the advocacy of the program facilitator in breaking down barriers for the new graduates, as well as the forum to build on skills and concepts acquired in school. This LPN transition-to-practice program has been a success!
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
Significance and background: Accurate patient identification continues to be at the top of The Joint Commissions (TJC) national patient safety goals to prevent wrong patient errors. TJC identifies two elements to meet this goal which includes using two patient identifiers when collecting specimens and labeling specimen containers in the presence of the patient. A review of ambulatory care specimen labeling errors from FY18-FY21 revealed the ambulatory care sites with the highest number of errors to focus our quality improvement efforts. Scope of work was identified, and lean methodology was utilized to determine the root causes of the errors. This revealed variations in specimen collection workflows, and standard work for specimen collection was developed and implemented in the ambulatory care setting with the highest number of errors.
Purpose: The purpose of the specimen labeling errors project was to reduce errors in the ambulatory care setting.
Intervention: The workgroup consisted of nursing leadership and nurse managers of the ambulatory care clinics with the highest number of errors. An analysis was completed and consisted of a fishbone diagram to identify contributing factors, five whys to determine root cause, development of counter measures into a PICK chart, and creation of standard work. Staff members of the clinic with the highest number of errors were educated to the standard work. The nurse manager and director tracked the five main process measures from the standard work at daily huddle, documenting any defects and their contributing factors. The five process measures included: 1) patient service representative (PSR) provides labels to patients at check-in, performs two identifiers, and communicates those labels stay with the patient for duration of their visit; 2) provider notifies RN/MA of specimen needed and order is entered as a clinic collect; 3) RN/MA utilizes the specimen collection in-basket workflow to print specimen requisition; 4) RN/MA completes specimen labeling process (initials, date, time) in front of patient; and 5) RN/MA perform two identifiers with the patient, checking specimen and requisition. If patient unavailable, complete with another staff member. After 60 days of no defects, leadership began weekly observations of the standard work with real-time corrections of any defects.
Evaluation: Implementation of the standard work for specimen collection was successful in reducing specimen labeling errors. Errors from FY18-FY21 in the implementation clinic totaled 26 errors, with an average of 6.5 errors per year. Standard work implementation began March 30, 2021, and the last specimen error to date occurred on April 14, 2021.
Discussion/lessons learned: During initial implementation, workflows impacted by the new standard work were discussed at huddle and required multiple PDCA cycles by clinic staff. Performing standard work elements out of order was still considered successful if each element of the collection process was met. Current focus is implementation in other ambulatory care clinics. Finding different levels of adaptability within manager team and successful implementation requires clinic leadership knowledge of workflows and front-line participation and observation.
Learning outcome: Reduce specimen labeling errors through lean methodology and implementation of standard work.
Purpose: The purpose of the specimen labeling errors project was to reduce errors in the ambulatory care setting.
Intervention: The workgroup consisted of nursing leadership and nurse managers of the ambulatory care clinics with the highest number of errors. An analysis was completed and consisted of a fishbone diagram to identify contributing factors, five whys to determine root cause, development of counter measures into a PICK chart, and creation of standard work. Staff members of the clinic with the highest number of errors were educated to the standard work. The nurse manager and director tracked the five main process measures from the standard work at daily huddle, documenting any defects and their contributing factors. The five process measures included: 1) patient service representative (PSR) provides labels to patients at check-in, performs two identifiers, and communicates those labels stay with the patient for duration of their visit; 2) provider notifies RN/MA of specimen needed and order is entered as a clinic collect; 3) RN/MA utilizes the specimen collection in-basket workflow to print specimen requisition; 4) RN/MA completes specimen labeling process (initials, date, time) in front of patient; and 5) RN/MA perform two identifiers with the patient, checking specimen and requisition. If patient unavailable, complete with another staff member. After 60 days of no defects, leadership began weekly observations of the standard work with real-time corrections of any defects.
Evaluation: Implementation of the standard work for specimen collection was successful in reducing specimen labeling errors. Errors from FY18-FY21 in the implementation clinic totaled 26 errors, with an average of 6.5 errors per year. Standard work implementation began March 30, 2021, and the last specimen error to date occurred on April 14, 2021.
Discussion/lessons learned: During initial implementation, workflows impacted by the new standard work were discussed at huddle and required multiple PDCA cycles by clinic staff. Performing standard work elements out of order was still considered successful if each element of the collection process was met. Current focus is implementation in other ambulatory care clinics. Finding different levels of adaptability within manager team and successful implementation requires clinic leadership knowledge of workflows and front-line participation and observation.
Learning outcome: Reduce specimen labeling errors through lean methodology and implementation of standard work.
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
It is well known that the nursing workforce shortage continues to worsen, and the COVID-19 pandemic has exacerbated the staffing gaps experienced in ambulatory care nursing. The impact of the “great resignation” has been felt throughout healthcare via increased workload and burnout experienced by staff and nurse leaders. Turnover rates for registered nurses (RN), licensed practical nurses (LPN), and unlicensed assistive personnel (UAP) such as medical assistants (MA) continue to rise, and with it a need to replace those that leave the occupation or workforce entirely (AACN, 2020; BLS, 2022; MGMA, 2021). The US Labor and Statistics Occupational Outlook Handbook (2022) notes MA employment growth alone is projected to increase 18% by 2030, double the average of other occupations. Additionally, the impact of staffing concerns on nurse leaders is significant, negatively impacting nurse leaders' emotional health, and as a result, their ability to lead their teams effectively and remain in leadership positions (AONL, 2021).
Healthcare organizations employ various roles to support ambulatory patient care in the clinic setting. From a nursing perspective, this may include RNs, LPNs, and UAPs to support delegated nursing tasks. Nurse leaders are accountable for maintaining a safe environment for patients and are aware of the knowledge, skill level, and limitations of licensed nurses and UAPs. This expertise positions nurse leaders to effectively lead workforce innovation, and this important work begins with the nursing process step of assessment.
A current state assessment completed by nurse leaders in our organization revealed tasks that do not require formal clinical expertise yet are important aspects of providing safe and quality patient care (i.e., escorting patients, cleaning and stocking supplies in exam rooms, and doing equipment checks). This presented an opportunity to develop a unique on-the-job trained UAP that can offload specific support tasks and allow our formally educated team to focus on direct patient care including medication administration, patient outreach, and provider support.
The purpose of this poster presentation is to share a process with nurse leaders that can be used to innovate and develop a new UAP role in their clinic setting and integrate it into the care model effectively. The poster will review our process from concept and assessment to pilot and spread. We plan to engage viewers by sharing a case study and providing examples of tools used and lessons learned from problem statement through implementation. We also plan to share the evaluation and outcomes of the project one-year post-conception, including how it has lessened the negative impact of staffing shortages and began to build a pipeline of individuals interested in the nursing profession. After completing this learning activity, the participant will be able to discuss practices and tactics to clearly delineate nursing scope of practice and UAP scope of work and demonstrate nurse leader competencies critical to the successful development and implementation of a new UAP role.
Healthcare organizations employ various roles to support ambulatory patient care in the clinic setting. From a nursing perspective, this may include RNs, LPNs, and UAPs to support delegated nursing tasks. Nurse leaders are accountable for maintaining a safe environment for patients and are aware of the knowledge, skill level, and limitations of licensed nurses and UAPs. This expertise positions nurse leaders to effectively lead workforce innovation, and this important work begins with the nursing process step of assessment.
A current state assessment completed by nurse leaders in our organization revealed tasks that do not require formal clinical expertise yet are important aspects of providing safe and quality patient care (i.e., escorting patients, cleaning and stocking supplies in exam rooms, and doing equipment checks). This presented an opportunity to develop a unique on-the-job trained UAP that can offload specific support tasks and allow our formally educated team to focus on direct patient care including medication administration, patient outreach, and provider support.
The purpose of this poster presentation is to share a process with nurse leaders that can be used to innovate and develop a new UAP role in their clinic setting and integrate it into the care model effectively. The poster will review our process from concept and assessment to pilot and spread. We plan to engage viewers by sharing a case study and providing examples of tools used and lessons learned from problem statement through implementation. We also plan to share the evaluation and outcomes of the project one-year post-conception, including how it has lessened the negative impact of staffing shortages and began to build a pipeline of individuals interested in the nursing profession. After completing this learning activity, the participant will be able to discuss practices and tactics to clearly delineate nursing scope of practice and UAP scope of work and demonstrate nurse leader competencies critical to the successful development and implementation of a new UAP role.
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
Background: Patients and families visiting our pediatric otolaryngology (ENT) clinic often call for clarification of plan of care, post-appointment questions, and post-surgical concerns that were previously reviewed. Additionally, there is frequent improper utilization of the emergency department due to lack of understanding of normal post-operative outcomes. Evidence suggests that implementation of health literacy strategies can increase patient understanding and decrease emergency department visits and re-hospitalizations. However, healthcare professionals often fail to employ health literacy techniques.
Purpose: This study sought to improve the effectiveness and retention of diagnoses and surgical education in a specialty clinic setting by implementing health literacy strategies.
Methodology: Baseline, six-month, and twelve-month post-implementation surveys were completed by staff to measure comfort, consistency, and perceived feasibility of health literacy strategies. Strategies were introduced to ENT staff through routine lessons from a health literacy liaison, role-play opportunities, in-clinic coaching, and debrief discussions. Additionally, two project champions were appointed to work with an external facilitator with expertise in health literacy to minimize staff resistance and promote comfort and consistency in utilization of strategies. Strategies included teachback, “chunking” information, and reducing medical jargon.
Results: Baseline data was collected from 36 ENT staff members. Follow-up surveys were conducted 6 months and 12 months after implementing strategies in the clinic. 33 staff members completed the six-month survey and 26 completed the twelve-month survey. The baseline survey found that only 40% of staff had used teachback within the past six months of practice, while the six-month post-implementation data showed an increase to 61%, then to 73% at twelve-month post-implementation. At the time of baseline data collection, 57% of staff felt highly confident (score of 7 or greater out of 10) utilizing teachback techniques, while the six-month post-implementation data showed an increase to 75%, which then slightly decreased to 65% at twelve-months post-implementation. After proper training, use of project champions, removal of identified barriers to implementation, and education on health literacy tools, staff reported feeling more comfortable utilizing the strategies and report doing so more consistently.
Implications: 15-59% percent of patients within the United States have limited health literacy, impacting patient understanding of medical needs, compliance with treatment, active participation in care, and escalating healthcare costs. Utilizing health literacy strategies can improve patient outcomes and increase understanding of care. Prior to implementing health literacy techniques, staff did not consistently or confidently use strategies such as teachback. Anecdotally, staff are working to overcome fears while more frequently integrating teachback strategies into their clinical interactions and workflow, leading to the dip in confidence data. Because of this, the decrease in staff confidence, correlating with an increase in utilization at the twelve-month mark, is understandable. Health literacy champions and project coordinators will continue to assess barriers to implementing health literacy strategies in the clinic, provide reassurance to staff as they work to change behaviors, and continue to adapt practices to improve provider and staff comfort and consistency in applying these strategies to patient care.
Purpose: This study sought to improve the effectiveness and retention of diagnoses and surgical education in a specialty clinic setting by implementing health literacy strategies.
Methodology: Baseline, six-month, and twelve-month post-implementation surveys were completed by staff to measure comfort, consistency, and perceived feasibility of health literacy strategies. Strategies were introduced to ENT staff through routine lessons from a health literacy liaison, role-play opportunities, in-clinic coaching, and debrief discussions. Additionally, two project champions were appointed to work with an external facilitator with expertise in health literacy to minimize staff resistance and promote comfort and consistency in utilization of strategies. Strategies included teachback, “chunking” information, and reducing medical jargon.
Results: Baseline data was collected from 36 ENT staff members. Follow-up surveys were conducted 6 months and 12 months after implementing strategies in the clinic. 33 staff members completed the six-month survey and 26 completed the twelve-month survey. The baseline survey found that only 40% of staff had used teachback within the past six months of practice, while the six-month post-implementation data showed an increase to 61%, then to 73% at twelve-month post-implementation. At the time of baseline data collection, 57% of staff felt highly confident (score of 7 or greater out of 10) utilizing teachback techniques, while the six-month post-implementation data showed an increase to 75%, which then slightly decreased to 65% at twelve-months post-implementation. After proper training, use of project champions, removal of identified barriers to implementation, and education on health literacy tools, staff reported feeling more comfortable utilizing the strategies and report doing so more consistently.
Implications: 15-59% percent of patients within the United States have limited health literacy, impacting patient understanding of medical needs, compliance with treatment, active participation in care, and escalating healthcare costs. Utilizing health literacy strategies can improve patient outcomes and increase understanding of care. Prior to implementing health literacy techniques, staff did not consistently or confidently use strategies such as teachback. Anecdotally, staff are working to overcome fears while more frequently integrating teachback strategies into their clinical interactions and workflow, leading to the dip in confidence data. Because of this, the decrease in staff confidence, correlating with an increase in utilization at the twelve-month mark, is understandable. Health literacy champions and project coordinators will continue to assess barriers to implementing health literacy strategies in the clinic, provide reassurance to staff as they work to change behaviors, and continue to adapt practices to improve provider and staff comfort and consistency in applying these strategies to patient care.
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
Problem statement: Scope technicians and clinical staff members are not adhering to the standards of endoscope reprocessing within the organization’s policy, instruction for use (IFU) equipment manuals, and current national standards and guidelines. There are variations in practices across multiple categories that influence endoscope reprocessing including people, processes, equipment, materials, environment, and management. The organization identified a need to develop a well-defined policy for managing high-level disinfection (HLD) specific to endoscope reprocessing.
Interventions: With the organization’s commitment to achieving zero patient harm, the nursing education department partnered with key stakeholders such as infection preventionist, sterile processing departments (SPD), scope technicians, environmental health and safety specialists, and regulatory departments to create standardized processes for endoscope reprocessing. After completion of a thorough root cause analysis, the following interventions were implemented to address system issues:
1) revision of the organization’s policy to establish a clear, step-by-step HLD process, standardizing HLD logs and incorporating the new 2022 AAMI National Standards; 2) development and implementation of the organization’s training for managers and staff, including an e-learning module, manager webinar, and HLD-specific endoscope competency; 3) creation of a new audit tool in an electronic reporting system, continuously monitoring department’s adherence, maintenance and identifying gaps and trends across the system; 4) development of the endoscope reprocessing committee, including key super users from each department where endoscope reprocessing occurs to disseminate information and assess adherence to the policy and IFUs; 5) development of a comprehensive multidisciplinary rounding plan by regulatory, infection prevention, nurse education, and managers; and standardization of equipment, purchasing, and expansion of HLD into new locations.
Outcome: Outcomes were evaluated over the course of 2022 and can be presented in the following categories:
People: 100% compliance with training through e-learning modules and competencies. Maintained greater than 90% endoscope reprocessing committee participation from May 2022-October 2022.
Process: At baseline (2021), only 20% of the departments completed the paper spot-check audits. After implementing the electronic audit tool in August 2022, compliance for department audits increased to 60%.
Equipment: Standardized endoscope cabinets and process for maintenance.
Environment: Standardized lighting, magnification, temperature and humidity monitoring, and HLD room cleaning.
Significance/implications for practice: Comprehensive multidisciplinary actions improve adherence to endoscope reprocessing standards. Utilizing multiple modalities to teach the staff the necessary skills increased staff repetition to successfully perform endoscope reprocessing. Additionally, physical rounding in departments and monthly committee meetings increase staff engagement and compliance to continually sustain zero patient harm.
References
1) Association of Perioperative Registered Nurses (AORN). (2019). Flexible endoscopes. In Guidelines for perioperative practice (pp. 199–388). Denver, CO: AORN, Inc.
2) Association for the Advancement of Medical Instrumentation. (2017). ANSI/AAMI ST79: Comprehensive guide to sterilization and sterility assurance in healthcare facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation.
3) Association for the Advancement of Medical Instrumentation. (2022). ANSI/AAMI ST91:2021 Flexible and semi-rigid endoscope reprocessing in healthcare facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation.
Interventions: With the organization’s commitment to achieving zero patient harm, the nursing education department partnered with key stakeholders such as infection preventionist, sterile processing departments (SPD), scope technicians, environmental health and safety specialists, and regulatory departments to create standardized processes for endoscope reprocessing. After completion of a thorough root cause analysis, the following interventions were implemented to address system issues:
1) revision of the organization’s policy to establish a clear, step-by-step HLD process, standardizing HLD logs and incorporating the new 2022 AAMI National Standards; 2) development and implementation of the organization’s training for managers and staff, including an e-learning module, manager webinar, and HLD-specific endoscope competency; 3) creation of a new audit tool in an electronic reporting system, continuously monitoring department’s adherence, maintenance and identifying gaps and trends across the system; 4) development of the endoscope reprocessing committee, including key super users from each department where endoscope reprocessing occurs to disseminate information and assess adherence to the policy and IFUs; 5) development of a comprehensive multidisciplinary rounding plan by regulatory, infection prevention, nurse education, and managers; and standardization of equipment, purchasing, and expansion of HLD into new locations.
Outcome: Outcomes were evaluated over the course of 2022 and can be presented in the following categories:
People: 100% compliance with training through e-learning modules and competencies. Maintained greater than 90% endoscope reprocessing committee participation from May 2022-October 2022.
Process: At baseline (2021), only 20% of the departments completed the paper spot-check audits. After implementing the electronic audit tool in August 2022, compliance for department audits increased to 60%.
Equipment: Standardized endoscope cabinets and process for maintenance.
Environment: Standardized lighting, magnification, temperature and humidity monitoring, and HLD room cleaning.
Significance/implications for practice: Comprehensive multidisciplinary actions improve adherence to endoscope reprocessing standards. Utilizing multiple modalities to teach the staff the necessary skills increased staff repetition to successfully perform endoscope reprocessing. Additionally, physical rounding in departments and monthly committee meetings increase staff engagement and compliance to continually sustain zero patient harm.
References
1) Association of Perioperative Registered Nurses (AORN). (2019). Flexible endoscopes. In Guidelines for perioperative practice (pp. 199–388). Denver, CO: AORN, Inc.
2) Association for the Advancement of Medical Instrumentation. (2017). ANSI/AAMI ST79: Comprehensive guide to sterilization and sterility assurance in healthcare facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation.
3) Association for the Advancement of Medical Instrumentation. (2022). ANSI/AAMI ST91:2021 Flexible and semi-rigid endoscope reprocessing in healthcare facilities. Arlington, VA: Association for the Advancement of Medical Instrumentation.
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.
Gina Foster, MBA, RN | Kristin Negley, MS, APRN, CNS, Primary Care Clinical Nurse Specialist, Mayo Clinic | Jeffrey Timm, MS, RN, PHN
Updated: 03/22/23
Updated: 03/22/23
Eighteen registered nurse (RN)-run anticoagulation clinics providing in-person patient care identified a need to standardize practice and implement innovative staffing models to assure provision of expert anticoagulation services continue. The nation is facing a nursing shortage and models of care utilizing nurses to their full scope of practice are essential. Rapid changes made during the pandemic demonstrated nurses could manage patients on warfarin virtually without impacting quality and safety.
Transitioning to a virtual model of care for nursing staff and integrating the teams provided many benefits to patients and staff. Patients can complete a point-of-care (POC) INR test anywhere within our health system, followed by a virtual visit with an anticoagulation nurse, resulting in increased access closer to their home or work. Patient appointment availability is no longer limited by nurse staffing. Confirmatory venous draws for POC INRs greater than five were often refused when nurses completed the POC test. Patients now receive their POC in a lab setting, resulting in almost 100% compliance with venous confirmatory draws. Virtual desk staff were implemented, assuring administrative work is completed by the right role. Seven nursing FTEs were converted to non-licensed roles of administrative and lab staff. Basic patient education was transitioned into an interactive class format. Facility use has decreased within the virtual model, reallocating 23 rooms to be utilized for revenue generating purposes by providers.
Assuring two nurse-led anticoagulation programs successfully integrated from rural and urban-based locations into one virtual program was a significant accomplishment. Use of a nursing leadership team was key to the success of the project. The nursing education specialist, clinical nurse specialist, and nurse manager each leveraged their expertise. Nursing staff workgroups were established to ensure that nursing voices were heard. A nurse-led unit council and an education committee were imperative to the success. Strategically timed mandatory education sessions provided small, consistent change and level setting for all staff. Nurses identified that the education sessions helped keep the focus on what is best for patients and started the transition from separate unit-based thinking to a team approach. The charge nurse team and strong interprofessional collaboration were also essential to a successful transition. Teambuilding and managing the stress of staff were identified as opportunities for improvement. A workgroup to help with team building was established before integration, but lack of staff interest led to deprioritization of this work. The group became very active a month after integration but could have been prioritized sooner. More proactively and effectively managing the emotional needs of staff and alleviating their fears may have led to decreased stress.
This anticoagulation program has demonstrated nurses providing warfarin dosing and INR management per protocol in a virtual environment results in patients with high time in therapeutic range and compliance. The efficiencies gained from transitioning to a virtual model of care, combined with assuring RN practice at the top of licensure, will provide sustainability of the anticoagulation program for the benefit of both staff and patients alike.
Transitioning to a virtual model of care for nursing staff and integrating the teams provided many benefits to patients and staff. Patients can complete a point-of-care (POC) INR test anywhere within our health system, followed by a virtual visit with an anticoagulation nurse, resulting in increased access closer to their home or work. Patient appointment availability is no longer limited by nurse staffing. Confirmatory venous draws for POC INRs greater than five were often refused when nurses completed the POC test. Patients now receive their POC in a lab setting, resulting in almost 100% compliance with venous confirmatory draws. Virtual desk staff were implemented, assuring administrative work is completed by the right role. Seven nursing FTEs were converted to non-licensed roles of administrative and lab staff. Basic patient education was transitioned into an interactive class format. Facility use has decreased within the virtual model, reallocating 23 rooms to be utilized for revenue generating purposes by providers.
Assuring two nurse-led anticoagulation programs successfully integrated from rural and urban-based locations into one virtual program was a significant accomplishment. Use of a nursing leadership team was key to the success of the project. The nursing education specialist, clinical nurse specialist, and nurse manager each leveraged their expertise. Nursing staff workgroups were established to ensure that nursing voices were heard. A nurse-led unit council and an education committee were imperative to the success. Strategically timed mandatory education sessions provided small, consistent change and level setting for all staff. Nurses identified that the education sessions helped keep the focus on what is best for patients and started the transition from separate unit-based thinking to a team approach. The charge nurse team and strong interprofessional collaboration were also essential to a successful transition. Teambuilding and managing the stress of staff were identified as opportunities for improvement. A workgroup to help with team building was established before integration, but lack of staff interest led to deprioritization of this work. The group became very active a month after integration but could have been prioritized sooner. More proactively and effectively managing the emotional needs of staff and alleviating their fears may have led to decreased stress.
This anticoagulation program has demonstrated nurses providing warfarin dosing and INR management per protocol in a virtual environment results in patients with high time in therapeutic range and compliance. The efficiencies gained from transitioning to a virtual model of care, combined with assuring RN practice at the top of licensure, will provide sustainability of the anticoagulation program for the benefit of both staff and patients alike.
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 COVID-19 pandemic provided the opportunity to explore and reimagine our organizations practice leadership model. We were seeing turnover in all roles which highlighted the need to make an effective and efficient leadership structure change as an important focus for our future success. The purpose of the structure evaluation and implementation was to provide the following: 1) provide effective and efficient leadership, direction and oversight of all practice activities; 2) drive increased employee and provider engagement through lean management; 3) drive excellent patient experience as the organization shifts to new care models and pathways; 4) simplify leadership “layers” at the practice level and apply a consistent model of practice leadership across all service lines; 5) define core accountabilities for leadership team members; and 6) ensure that the work of the practice leadership team is unencumbered with tasks that should be completed by centralized teams or existing organizational departments.
Therefore, in 2021, our organization reimagined our ambulatory care support structure for our clinical staff to align with our support structure we had in place for our administrative employees. In doing so, we implemented new roles within our leadership team that serve as senior directors of clinical operations and clinical managers (number of clinical managers is dependent upon number of practices in service line) for each of our service lines. The senior director of clinical operations works collaboratively in a team leadership model with other service line leadership to include our directors of operations, program directors, vice-president, and medical director to ensure patient access to services and quality of care. The clinical directors are responsible for cross-continuum oversight in their respective service line across the organization to ensure safe, efficient, evidence-based care is being provided while following regulatory requirements. In addition, the clinical director serves as a clinical leadership resource, coach, and mentor to clinical staff across the service line by encouraging professional growth and development. Modeling the behavior we wish to see in our clinical staff, the clinical director maintains professional affiliations to keep abreast of latest trends in field of expertise and are required to have a master's degree and obtain nurse executive certification when eligible. The clinical director, along with the clinical managers, ensures that appropriate clinical standards and practices are developed and implemented as a result of research and non-research findings.
In less than a year of implementation of the leadership structure change, the clinical directors have had a positive impact in identifying variations in clinical practice across the organization and implemented or refined standard work. Relationships established within the practices with the clinical staff have proven to be beneficial, and we look forward to our next employee engagement scores. The traditional leadership team has welcomed and embraced the new leadership team approach, identifying the value clinical leadership and oversight has provided thus far in reducing variation. We are excited for the opportunities and journey that this new, emerging model of leadership will take us.
Therefore, in 2021, our organization reimagined our ambulatory care support structure for our clinical staff to align with our support structure we had in place for our administrative employees. In doing so, we implemented new roles within our leadership team that serve as senior directors of clinical operations and clinical managers (number of clinical managers is dependent upon number of practices in service line) for each of our service lines. The senior director of clinical operations works collaboratively in a team leadership model with other service line leadership to include our directors of operations, program directors, vice-president, and medical director to ensure patient access to services and quality of care. The clinical directors are responsible for cross-continuum oversight in their respective service line across the organization to ensure safe, efficient, evidence-based care is being provided while following regulatory requirements. In addition, the clinical director serves as a clinical leadership resource, coach, and mentor to clinical staff across the service line by encouraging professional growth and development. Modeling the behavior we wish to see in our clinical staff, the clinical director maintains professional affiliations to keep abreast of latest trends in field of expertise and are required to have a master's degree and obtain nurse executive certification when eligible. The clinical director, along with the clinical managers, ensures that appropriate clinical standards and practices are developed and implemented as a result of research and non-research findings.
In less than a year of implementation of the leadership structure change, the clinical directors have had a positive impact in identifying variations in clinical practice across the organization and implemented or refined standard work. Relationships established within the practices with the clinical staff have proven to be beneficial, and we look forward to our next employee engagement scores. The traditional leadership team has welcomed and embraced the new leadership team approach, identifying the value clinical leadership and oversight has provided thus far in reducing variation. We are excited for the opportunities and journey that this new, emerging model of leadership will take us.
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 and background: Patients with end-stage liver disease are frequently admitted to the hospital due to the complex nature of the disease process. This places them at risk for hospital-acquired complications and injuries which include pressure injuries, deep vein thrombosis, and falls. Inadequate communication about fall risk factors between the nurses and the patient care associates (PCAs) can put the patients in harm's way and potentially lead to falls. Creating a communication tool that addresses specific fall risk factors can increase awareness and bridge the communication gap among the nursing team.
Project design/methods: The project team was led by the unit educator and consisted of shared governance council members. The plan, do, study, act (PDSA) methodology was utilized for this quality improvement initiative. The goal of this project was to reduce the number of falls from 1.58 to one or less per month. Lewis’ Change Theory and Roy’s Adaptation Model were used to identify interventions and drive change.
Thorough chart reviews and root cause analyses identified hemodynamic changes such as low blood pressure, hyponatremia, and ascites as predisposing risk factors for falls. These findings were incorporated into a new pre-liver transplant fall risk bundle which included an updated communication tool that incorporated predisposing fall risk factors. Education was provided to staff, and fall rates pre- and post-intervention were monitored. Due to the novel coronavirus (COVID-19) pandemic, several PDSA cycles were implemented to meet the challenges and restrictions posed by the pandemic, such as staffing, patient acuity, and patient volume.
Results and outcomes: The quality improvement initiative was piloted in December 2020. Education on the fall risk bundle and the communication tool was completed by 85% of the nursing staff. The total number of falls decreased from 19 in 2020 to 9 in 2021, showing a 53% reduction in falls. As of July 2022, there have been five falls.
Implications on practice: This communication tool, specifically addressing hemodynamic changes and fall risks, bridges the communication gap between the nurses and the PCAs. The tool can be redesigned to meet the needs of specific patient populations that experience hemodynamic changes and other factors to help prevent falls.
References
1) Yildirim, M. (2017). Falls in patients with liver cirrhosis. Gastroenterology Nursing, 40(4), 306-310.
Román, E., Córdoba, J., Torrens, M., Guarner, C., & Soriano, G. (2013). Falls and cognitive dysfunction impair health-related quality of life in patients with cirrhosis. 2) European Journal of Gastroenterology & Hepatology, 25(1), 77–84.
3) Soriano, G., Román, E., Córdoba, J., Torrens, M., Poca, M., Torras, X., Villanueva, C., Gich, I. J., Vargas, V., & Guarner, C. (2012). Cognitive dysfunction in cirrhosis is associated with falls: A prospective study. Hepatology, 55(6), 1922–1930.
4) Tapper, E. B., Nikirk, S., Parikh, N. D., & Zhao, L. (2021). Falls are common, morbid, and predictable in patients with cirrhosis. Journal of Hepatology, 75(3), 582–588.
Project design/methods: The project team was led by the unit educator and consisted of shared governance council members. The plan, do, study, act (PDSA) methodology was utilized for this quality improvement initiative. The goal of this project was to reduce the number of falls from 1.58 to one or less per month. Lewis’ Change Theory and Roy’s Adaptation Model were used to identify interventions and drive change.
Thorough chart reviews and root cause analyses identified hemodynamic changes such as low blood pressure, hyponatremia, and ascites as predisposing risk factors for falls. These findings were incorporated into a new pre-liver transplant fall risk bundle which included an updated communication tool that incorporated predisposing fall risk factors. Education was provided to staff, and fall rates pre- and post-intervention were monitored. Due to the novel coronavirus (COVID-19) pandemic, several PDSA cycles were implemented to meet the challenges and restrictions posed by the pandemic, such as staffing, patient acuity, and patient volume.
Results and outcomes: The quality improvement initiative was piloted in December 2020. Education on the fall risk bundle and the communication tool was completed by 85% of the nursing staff. The total number of falls decreased from 19 in 2020 to 9 in 2021, showing a 53% reduction in falls. As of July 2022, there have been five falls.
Implications on practice: This communication tool, specifically addressing hemodynamic changes and fall risks, bridges the communication gap between the nurses and the PCAs. The tool can be redesigned to meet the needs of specific patient populations that experience hemodynamic changes and other factors to help prevent falls.
References
1) Yildirim, M. (2017). Falls in patients with liver cirrhosis. Gastroenterology Nursing, 40(4), 306-310.
Román, E., Córdoba, J., Torrens, M., Guarner, C., & Soriano, G. (2013). Falls and cognitive dysfunction impair health-related quality of life in patients with cirrhosis. 2) European Journal of Gastroenterology & Hepatology, 25(1), 77–84.
3) Soriano, G., Román, E., Córdoba, J., Torrens, M., Poca, M., Torras, X., Villanueva, C., Gich, I. J., Vargas, V., & Guarner, C. (2012). Cognitive dysfunction in cirrhosis is associated with falls: A prospective study. Hepatology, 55(6), 1922–1930.
4) Tapper, E. B., Nikirk, S., Parikh, N. D., & Zhao, L. (2021). Falls are common, morbid, and predictable in patients with cirrhosis. Journal of Hepatology, 75(3), 582–588.
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.
