Engaging the Front Line: A Case Study on Implementing Lean Methodology to Improve Central Line-Associated Bloodstream Infections.

Employee engagement is a key driver in achieving successful quality improvement initiatives. An important aspect of engagement is enabling the nursing staff to have a role in problem solving at the front line, thus improving productivity. Finding an appropriate methodology that resonates with the frontline staff can be challenging. This article discusses the use of the Lean Methodology to prevent central line-associated bloodstream infections in a large urban hospital. The case study provided will review an initial attempt at frontline problem solving using the Lean Methodology and a more successful strategy with the development of a nurse champion program.

Emergency Department Initiative to Improve Sepsis Core Measure Compliance: A Hospital Network Approach.

The topic of sepsis has been realized among the last 20 years. A majority of patients with sepsis enter the health system through the emergency department, and health professionals need to provide evidence-based care. Within the health system, interdepartmental teams were formed with the purpose to set a system-wide standard to meet the evidence-based practice standards for sepsis. Participants were recruited from every department that was involved with the care delivery of emergency department patients with sepsis. The team developed a team charter to state the group objectives. A gap analysis was completed to set group priorities. The first priority was to develop a system-wide sepsis alert process. The Operational Excellence coach conducted direct observations and interviews at each system facility and then a sepsis alert plan was developed. Two hospitals volunteered to pilot the sepsis alert within their emergency departments, and education was completed at each hospital. Informatics nurses developed electronic medical record workflow and outcome elements to help the team with the process. The pilot process showed an increase in compliance for core measures and laid the groundwork for each hospital to develop an individualized process.

Utilization of Institute for Health Care Improvement Tools to Develop a Mortality Review Process.

Mortality rates have emerged as one of the main metrics determining quality of care within a hospital. In an effort to evaluate cases, this article illustrates the use of the Institute of Healthcare Improvement Global Trigger Tool as well as the implementation of a 3-prong review process in a large, urban teaching facility. In addition, the findings of the evaluation process are shared.

Determining Nursing Education Needs During a Rapidly Changing COVID-19 Environment.

COVID-19 created an environment that required rapid implementation of procedures and processes to minimize transmission. This led to an urgent response from the Department of Professional Practice and Education to implement education to a large number of personnel. This article describes strategies and methods employed to meet the training demands at a time when resources and supplies were limited. This study aims at developing and implementing education on infection prevention and management of patients with suspected or known COVID-19 for the nursing staff providing care. Following guidelines from the hospital's COVID-19 oversight committee, the Department of Professional Practice and Education rapidly initiated education on several key topics. This was accomplished by teamwork within the department to quickly identify priorities and suspend noncritical programs. Multiple training methods were deployed while a smaller group of educators developed additional training. Sixty to seventy percent of 1015 staff were trained within 6 days. Soon after, several additional educational topics were identified and training was concluded over a 3-week period. Training can be provided on an urgent basis with the use of multiple educational methods, suspension of noncritical programs, and teamwork. A smaller committee within the department allows for concentrated efforts in the design of additional training.

Trends in central line-associated bloodstream infections in a trauma-surgical intensive care unit.

OBJECTIVE: To report the impact of hospital-wide interventions on central line-associated bloodstream infection (CLABSI) rates in a 24-bed trauma-surgical intensive care unit. DESIGN: Data were gathered retrospectively from January 1, 2001, through June 30, 2009. Interventions to reduce CLABSI rates during this period included standardization of line insertion and maintenance processes, development of a mandatory education program incorporating practical line insertion simulation sessions, frequent audits, and intensive care unit staffing modifications. We used the χ(2) test and analysis of variance to analyze the data where appropriate. SETTING: Urban tertiary referral center providing level I trauma services. PATIENTS: Eight thousand four hundred eighty-one trauma-surgical intensive care unit admissions, of which 76% were owing to trauma. RESULTS: During this period, the incidence of CLABSI declined from 6.1 to 0.3 per 1000 line-days. No CLABSIs occurred for 8 of the last 10 quarters (January 2007 to June 2009). Internal jugular sites were associated with a higher CLABSI rate than subclavian sites (P = .03). The central line utilization ratio remained high for most of the study period. When compared with the 2006-2007 Centers for Disease Control and Prevention data, the trauma-surgical intensive care unit was at the 10th percentile in CLABSIs and at the 75th to 90th percentile in central line utilization ratios. CONCLUSIONS: The significant decline in the incidence of CLABSIs, which reflected the national trend, could be attributed to multiple interventions. The high central line utilization ratio compared with nationally available data represents a potential target for further improvement.

Trauma VAP SWAT team: a rapid response to infection prevention.

The prevention of ventilator-associated pneumonia (VAP) has been a challenge within many healthcare organizations. The initial efforts for VAP prevention focused on compliance with "ventilator bundles." VAP rates initially improved with implementation of the bundles but then reached a plateau. The trauma surgical intensive care unit (ICU) was interested in investigating measures to further improve the prevention of VAP after bundle implementation. A multidisciplinary team was formed to investigate innovative strategies to prevent VAP. The group identified their initial focus as head of bed (HOB) elevation intervention within and outside of the ICU through HOB audits and a transport checklist. Through these efforts, the VAP rate within the trauma surgical ICU dropped to the lowest level in 4 years.

Use of prone positioning in a patient with acute respiratory distress syndrome: a case review.

The care of a patient with acute respiratory distress syndrome is complex. The nurse must not only concentrate on the physical demands of the patient but also on the emotional demands of the patient and family. Understanding the disease process can aid the nurse in understanding the treatment options including the use of prone positioning for this patient population.

Decreasing ventilator-associated pneumonia: getting on board.

The prevention of ventilator-associated pneumonia (VAP) has been a quality effort that many organizations across the country have undertaken. Through a multidisciplinary approach, the best practices to prevent VAP for our organization were established. Through the interventions of securing the patient resuscitation bag in one location, maintaining the patient's head-of-bed elevation to more than 30 degrees if not contraindicated, Yankauer suction tip care, and the use of chlorhexidine mouth rinse, the incidence of VAP decreased by 43% within a 6-month time frame. Additional ventilator-associated prevention efforts such as sedation and weaning protocols have been established to further enhance preventive efforts.