Nurse-driven safety initiatives
Summa Health System’s goal was to reduce safety events by 80% within the first 2 years of our comprehensive focus on a culture of safety. Summa has defined a serious safety event as any deviation in care that causes moderate to severe harm to a patient. We are proud to report an 82% reduction of serious safety events within 18 months.
Here are a few of our nurse-driven safety initiatives that have been implemented within Summa Health:Improved care of critical care patients requiring insulin drips. Lisa Ray, BSN, RN, staff nurse on one of Summa’s intensive care unit (ICU) floors recognized the need for better glucose control of patients in the ICU. She reviewed current literature on insulin drip procedures and identified the need for incorporating a new target blood glucose level for ICU patients. With stakeholder support of Summa physicians, pharmacists, administration and nursing, Lisa received approval to conduct a trial in her 26-bed trauma surgical ICU. Because of the success of the trial, it was extended to all ICU units. Six months prior to the trial, 9 out of 12 ICU patients on insulin drip experienced hypoglycemic episodes. Following the 6-month trial, 28 patients were without hypoglycemic episodes because of the new target blood glucose level.
Simulations offer real-life scenarios. Simulations are a safe and effective way to learn from both successes and mistakes. When faced with similar circumstances on a patient, practicing on a manikin allows nurses to know what to do, as well as to perform appropriately. Carol Kridler, MSN, RN, CCRN, a staff development instructor in critical care, is a co-leader in developing a program where nurses face real-life situations in a simulated environment. Working with Scott Atkinson, coordinator of the Virtual Care Simulation Lab, Carol provides simulations of clinical situations based on computer learning modules from The American Association of Critical Care Nurses Essentials of Critical Care Orientation (ECCO).
The focal point is several manikins, which talk, blink and breathe; have a pulse;
and can mimic a real patient. Nurses can learn to assist with the insertion of a
breathing tube or chest tube; practice inserting an IV or bladder catheter; change
a dressing; or assist with a birth. Carol and Scott have worked with several of
the manikin manufacturer’s programs to ensure nurses have the most realistic
simulations incorporating Summa’s policies and practices.
One critical care scenario coaches nurses to recognize when a Code STEMI (ST-Elevation Myocardial Infarction) should be called. In another, nurses learn how to assist with placing an artificial airway or rapidly assess symptoms of a trauma patient. The work of Carol and Scott was recognized by the National Nursing Staff Development Organization (currently the Association for Nursing Professional Development) with an award for Excellence in the use of Educational Technology.
Safer labor and delivery for mother and baby. Pitocin is often administered to induce labor by speeding up contractions. However, overusing the drug can be harmful to mother and child. Too many contractions can cause the blood flow to be cut off to babies and can cause mothers to bleed too much after delivery. Summa Health System – Akron Campus' perinatal safety team has implemented practices to improve the safe administration of pitocin, which has led to improved outcomes in labor and delivery. As a result, Summa has earned the 21012 Ohio Patient Safety institute Best Practice Award for improving the safety of labor augmentation and induction.
The policy on pitocin is part of an overall effort at Summa to improve the safety of deliveries by implementing the “bundle” criteria for the induction and augmentation of labor. Implementing the bundle criteria at Summa is a nurse-driven initiative and has resulted in better care, as well as healthier mothers and babies.
The implementation of bundling includes:
Reducing hospital-associated infections. Nurses at Summa Health System – Akron and St. Thomas Campuses implemented evidence-based measures – or bundles – to prevent hospital-associated infections (HAIs). Caregivers washing their hands as they enter and exit a patient’s room is the first and most important step to prevent HAIs. Catheter Associated Urinary Tract Infections (CAUTI) and Central-Line Associated Bloodstream Infections (CLABSI) are two of the most common HAIs.
A team of Summa nurses met to address The Joint Commission’s National Patient Safety Goal of Prevention of CAUTIs. A nurse-driven protocol for CAUTI prevention was developed to remove a catheter as soon as possible. The nurse protocol included criteria for continuing to use a catheter, criteria for removal by a nurse and post-catheter assessment. Nurses also developed criteria to justify the placement of a catheter if ordered by a doctor within the electronic medical record. Nurses receive online education as well as practical pointers developed by the CAUTI Prevention Committee.
Quality care goes beyond the spoken word. Quality healthcare depends on communication. That is a challenge for Summa’s Family Medicine Center and Labor and Delivery as both units care for a number of patients of Limited English Proficiency (LEP) who don’t speak or understand the English language. An example is the refugee populations of Burmese and Nepalese communities that have been resettled to Akron, Ohio, where Summa Health System’s main campuses are located.
A lack of communication can potentially compromise safety and quality of care. In Women’s Health, for example, there are challenges when an LEP patient arrives in labor and delivery in an emergency situation. Critical information is needed before an interpreter can be contacted.
Some issues that arise when treating a LEP patient include:
Plans are underway for additional notebooks to address Arabic- and Congo-speaking refugee populations that will soon arrive in the Akron area. The goal is to create an atmosphere where expectant mothers can deliver in a safe and comfortable environment despite the language barrier, making sure LEP populations have a good care experience. As a result, these patients will likely continue to come back for treatment.
Technology strengthens patient care. Knowledge-Based Charting
(KBC) done on portable computers (workstations on wheels or WOWs) outside each patient
room at Summa Health System – Akron Campus means no more paper charting for nurses.
The benefits of KBC, compared with the paper-based system, include:
In 2012, training and implementation of new equipment began, including: seven pupilometers to provide objective pupilary assessments; a hypothermia device; and bispectral index monitor to assess the condition of a sedated patient. This technology has allowed critical care nurses to receive more objective information about the condition of a TBI patient, leading to better informed care.
Breastfeeding initiative. In 2009, nurses at Summa Health System – Akron Campus' maternity unit decided to stop providing kits for new mothers that included baby formula packets. Instead, the nurses concentrated on teaching new mothers to breastfeed their newborns.
By encouraging and supporting new mothers to meet their breastfeeding goals, Summa is helping to keep babies safer and healthier. Formula-fed babies have been found to be at an increased risk of obesity, sudden infant death syndrome and other conditions. Nurses teach new mothers on how to properly breastfeed; lactation consultants are available for additional guidance.
As a result, Summa Health System – Akron Campus has become a leader among hospitals in Ohio with its breastfeeding initiative, winning a maternity care best practices award from the Ohio Lactation Consultant Conference. Only hospitals that don’t distribute formula packets can earn this award. In addition, Summa Health System – Akron Campus received a grant from National Initiative for Children's Healthcare Quality (NICHQ) – 1 of 90 in the country and 6 in Ohio – to help improve breastfeeding practices.
Summa Health System – Akron Campus has obtained a "Baby Friendly Hospital" designation. This is an international award from the World Health Organization, given to hospitals that achieve the Ten Steps to Successful Breastfeeding, which include the elimination of formula packets. Read more about this initiative.
Continuing the tradition of helping overcome substance abuse. Summa Health System – St. Thomas Campus has a tradition of helping patients overcome substance abuse. In 1939, Sister Mary Ignatia, hospital registrar, and Robert Smith, M.D. (Dr. Bob), collaborated to admit to the hospital patients who were suffering from alcoholism in order to receive treatment. At that time, alcohol was not yet classified as a disease.
The tradition continues today at Summa Health System – St. Thomas Campus' Ignatia Hall, a 14-bed, specialized detoxification unit. Patients come to the detoxification unit on a voluntary basis. Nurses receive ongoing education about how to assess and treat patients by two attending physicians. Nurses are educated on how to screen new patients.