| |
The Quality Councils develop and implement performance improvement initiatives that assure quality patient outcomes. Here are some highlights of their work in FY 2008.
Click on the links below for additional information on specific Crozer-Keystone hospitals.
Crozer-Chester Medical Center
Delaware County Memorial Hospital
Taylor Hospital
Crozer-Chester Medical Center/Springfield Hospital
Blood Transfusion Slip Redesign Improves Compliance
Cathy Petrucci, RN, BSN, OCN, and Kate Eppehimer, RN, BSN, CCRN.
Crozer’s Quality Council designed and implemented a new blood transfusion slip to improve compliance to at least 90 percent with the standard of taking vital signs every 15 minutes after the start of a transfusion. This initiative began after a 2007 audit showed deficiencies in this practice.
Council members Cathy Petrucci, RN, BSN, OCN, data support specialist in Quality Monitoring & Improvement at Crozer, and Katherine Eppehimer, RN, BSN, CCRN, a nurse in Crozer’s Shock Trauma Unit, collaborated with Anne McCartney from the Blood Bank to redesign the blood transfusion slip. Previously, the slip had lines for nurses to record only pre- and post-transfusion vital signs. The new slip, which was implemented in August 2008, includes enough lines for nurses to record vital signs every 15 minutes for the first, second and third hours after the transfusion begins, in addition to pre- and post-transfusion. “We are confident that this will lead to improvement without adding another form for nurses to complete – just a modification of the existing form,” notes Petrucci. Early data on the effectiveness of the new form show improvement in nursing documentation of vital signs before, during, and after blood transfusion.
Back to top>
Delaware County Memorial Hospital
Skin Care Initiative Reduces Incidence of Pressure Ulcers
From left to right: Eileen Young, RN, MSN, Kathleen McLaughlin, RN, CWOCN, Maureen Ingram, RN, BC, MSN, CWOCN, and Janet Slaven, RN, CWOCN.
In 2007, the national KCI study indicated that the prevalence of pressure ulcers at DCMH was 14 percent, twice the national average of 7 percent. Maureen Ingram, RN, BC, MSN, CWOCN (Certified Wound Ostomy Continence Nurse), chair of the DCMH Quality Council’s Skin Care Committee, researched best practices for preventing pressure ulcers and implemented new mechanisms for patient care in collaboration with her Crozer-Keystone counterparts, Janet Slaven, RN, CWOCN at Crozer, and Kathleen McLaughlin, RN, CWOCN at Taylor.
Best practices included the purchase of new mattresses for all DCMH non-critical care beds and 30-degree wedge pillows to assist with positioning patients side to side. Elevation of patient’s heels off the bed with pillows and the use of Prevalon boots greatly reduced the incidence of heel breakdown, which often leads to pressure ulcers. Best practices also include daily interdisciplinary collaboration for patient care with physical therapists, nutritionists, social services and case management. Members of the Skin Care Committee conducted educational sessions for bedside nurses, and consistent rounding by the nurse educator/CWOCN nurse has enhanced the educational process.
As a result of these efforts, the overall prevalence of pressure ulcers at DCMH dropped significantly to 4.62 percent, according to the quarterly prevalence study for DCMH completed in September 2008.
Back to top>
Taylor Hospital
Assessing and Treating Stroke in Post Cardiac Catheterization Patients
John Harper, MSN, RN-BC, and Lisa Bambach, RN.
Taylor’s Quality Council holds a Mortality and Morbidity (M&M) Conference to review any adverse events brought to the council by a staff nurse, nurse manager, nurse executive or another department within the hospital. In 2007, the Council held an M&M Conference to review a case in which a post cardiac catheterization patient suffered a stroke. After review and research of current best practices, the Council recommended that stroke care be added to the standard of care (SOC) for such patients.
The revised SOC includes assessing for signs and symptoms of stroke, and immediately activating the hospital’s Rapid Response Team (RRT) if a patient shows these signs. As soon as the RRT arrives, the nurse activates the stroke beeper for a neurologist while sending the patient for a CAT scan of the head. When a neurologist arrives, he/she determines whether the patient is a candidate for treatment with tissue plasminogen activator (TPA), a blood clot dissolver. If so, the patient is transferred to the ICU where TPA is administered.
The Quality Council, chaired by Lisa Bambach, RN, recommended that education on the revised standard of care be provided to every unit in the hospital. In addition, the council developed a stroke self-learning packet with a post-test for units specifically designated to care for stroke patients.
The Quality Council, chaired by Lisa Bambach, RN, recommended that education on the revised standard of care be provided to every unit in the hospital. In addition, the council developed a stroke self-learning packet with a post-test for units specifically designated to care for stroke patients.
“Strokes post cardiac catheterization are very rare,” notes John Harper, MSN, RN-BC, Quality at Taylor. “However, after this event, we had another patient who suffered a stroke post cardiac catheterization. Nurses promptly followed the new standard of care with a positive outcome.”
To ensure continuous performance improvement, Harper reviews every patient chart after a cardiac catheterization for compliance with the new standard of care.
Back to top> |
|