Must Haves
Incorporate evidence based practice
Barbera, M. (1994, September). Giving report: How to Sidestep Common Pitfalls. Nursing, 24(9), 41.
Crane, N. (2009,January), Fall Prevention. MedSurg Nursing, 18(1), 58.
Groah, L. (2006, January). Hand off-A link to Improving Patient Safety. AORN Journal, 83(1), 227-230.
Meade, C., Kennedy, J., Kaplan, J. (2008). The effects of emergency department staff
Rounding on patient safety and satisfaction. The Journal of Emergency Medicine,
Corrected proof.
Meade, C. (2007, Spring2007). ROUND Bounty. Marketing Health Services, 27(1), 23-
27. Retrieved July 19, 2009, from Business Source Premier Database.
Meade, C. (2006). Effects of nursing rounds: on patient’s call light use, satisfaction, and
safety. The American Journal of Nursing 106(9), 58-70.
Odom-Forren, J. (2007, August). Accurate Patient Hand Offs: Imperative for Patient Safety. Journal of Perianesthesia Nursing, 22 (4), 233-234.
Orr, N., Tranum, K., & Kupperschmidt, B. (2006, December). Hourly rounding for positive patient and staff outcomes: fairy tale or success story?. Oklahoma Nurse, 51(4), 11-11. Retrieved September 26, 2009, from CINAHL database.
Roberts, D. (2007, January). Clear Communication-Accept Nothing Less. Medsurg Nursing, 16(3), 142-148.
Sandlin, D. (2007, August). Improving Patient Safety by Implementing a Standardized and Consistent Approach to Hand-Off Communication. Journal of Perianesthsia Nursing. 22 (4), 289-292.
Steiner, Jeanne. (2006, March). Managing Risk: Systems Approach Versus Personal Responsibility for Hospital Incidents. Journal of the American Academy of Psychiatry and the Law, 34, 96-98.
Flow Chart Process
Identify metrics for evaluation: Overhead paging audit, PRC data, NDNQI RN Satisfaction Data, nurse driven patient outcomes; falls, pressure ulcers, patient satisfaction, nurse retention rates.
Identify who needs education on initiative:
Patients
Families
ED staff
ED leadership team
Nurse champions
ED faculty
Assign accountability and clear timeline:
Action / Person Assigned / Timeline / StatusCreate video role modeling NMTs / Kory Knipp, Amanda, Liz, Anthony, Valerie Riebli / September 22
Communication to CSRC regarding expectations for staff who float into unit / Janice Sisco / August 14 / Completed
Assign nurse champions (2 to 3 per shift) Qualities include positive change agent, role model and resource, knowledgeable about NMTs, energetic, strong work ethic, and accountable. Group suggested the champions participate in filming the video. / Kristi Bare /,Gayle Kilts, Valerie Riebli
(Anna Mlodzik, Carolyn Van, Sally Dye, Christy Hart) / September 14 / Completed
Set up meeting with nurse champions to educate them on the components of NMTs. / Valerie Riebli / October 1, 2009
Present information at staff meetings:
Copies of EBP
Laminated clock
Details of initiative / Gayle Kilts, Janice Sisco, Valerie Riebli / Oct. 12th-7:15pm
14th-2:15
16th 5:15 /7:15am
Collect Baseline data / Valerie Riebli / September 10th -14th / Completed
NMT goes live. / October 16th
Debrief daily during first week of initiative then weekly for 1 month. / Janice Sisco, Anna Mlodzik, Carolyn Van, Sally Dye, Christy Hart, / October 23rd
October 30th
November 6th
November 13th
Add information about NMTs to orientation pathway / ED educator/Janice Sisco / August 21 / completed
Utilize ED website to post information about initiative / Brent Lemonds / August 21
Provide laminated clock face for hourly rounding / Gary / July 31 / completed
Friday communication / Janice Sisco / Each Friday / completed
Standardize rounding forms / Gayle and Tonya / August 7 / completed
Order clipboards for hall beds / Janice Sisco / July 24 / completed
Nominations from steering group (retreat participants) due / All team members at retreat / Due July 17, 2009 / completed
Define leader rounding for outcomes and set expectations / Brent and leadership team / August 21 / completed
Change white marker boards in patient rooms to add permanent marker to prompt info: Date, Tech, RN, paramedic, and goals / Tonya / July 31 / completed
Provide signal for hall bed patients to use in lieu of call light / Gayle / August 28 / completed
Communicate initiative to Ian Jones / Brent / July 20 / completed
Bulletin board / Valerie Riebli / October 5, 2009
Develop plan for sustained success: sustained success will be achieved through ongoing leader rounding for outcomes, incorporation of education into orientation pathway, at least yearly education to staff, sharing of outcomes data with staff linking them to the initiative, and repeat overhead paging audits.
Identify Methods of Content Delivery: See figure 1
Metrics for evaluation: Baseline data:
Overhead paging audit
PRC data
NDNQI RN satisfaction Data
Nurse driven patient outcomes: pt falls
Pressure ulcers
Patient satisfaction
PDSA
What are we trying to accomplish? Achieve 100% compliance rate of nursing model tactics.
How will we know that a change is an improvement? Is system performing as planned?
Bedside report: standardized
Individualized Plan of Care: Patient is involved with goal-#patients meeting their goals
Hourly Rounding: decrease in call lights, patient falls, pressure ulcers, increase in patient and staff satisfaction,
Leadership Rounding: success of NMT,s, increase in staff satisfaction
What changes can we make that will result in an improvement?
Bedside report: modeling on video what bedside report look like (tool to standardize process)
Individualized Plan of Care: Put on white boards for a visual reminder in the patient’s room
Hourly Rounding: making clocks for a visual reminder, modeling what hourly rounding looks like on video.
Leadership Rounding: set times for rounding, therefore these times can be enforced.
Change Theory: Stetler Model Theory-
This theory integrates EBP with research.
There are five phases: 1) Preparation
2) Validation
3) Comparative evaluation and decision making
4) Translation and Application
5) Evaluation
courseweb.edteched.uottawa.ca/nsg6133/.../Stetler-Marram.pdf
OR
http://74.6.239.67/search/cache?ei=UTF-8&p=Stetler+Model+Theory&fr=yfp-t-152&u=courseweb.edteched.uottawa.ca/nsg6133/Course_Modules/Module_PDFs/Stetler-Marram.pdf&w=stetler+model+theory+theories&d=DwzyEd29TeE2&icp=1&.intl=us&sig=gArTsgbpYybXu1qZMKbNfw--
Knowledge Translation-provides a framework that may be helpful in considering the challenges that clinicians are likely to face when attempting to implement evidence based practice.
Knowledge Translation- exchange, synthesis, and ethically sound application of knowledge within a complex system of interactions among researchers and users to accelerate capture of the benefits of research.
Rogers Diffusion of Innovations- Behavioral theory that describes the process the user goes through in the adaptation/rejection of new ideas, practices, and technology.