By Debra Wood, RN, contributor
May 9, 2013 - Always seeking solutions to problems and ways to improve care, nurses draw on their knowledge and experience to enhance patient outcomes.
Laura Beth Brown, RN, MSN, developed a predictive model to identify at-risk patients in need of additional interventions to improve outcomes.
“Nurses innovate every day,” said Laura Beth Brown, RN, MSN, vice president of Vanderbilt Health Services in Nashville. “Nurses are innovating because they have more evidence-based practice information, they have experience and they see what works when you apply it.”
Here are just a few of the things today’s innovative nurses have been able to accomplish:
Predictive care models. Brown came up with the idea for a predictive model, using information from the electronic medical record, to determine patients likely to need home health services. With success in correctly identifying those patients, the health system now uses the data to predict patients at risk for pressure ulcers, falls and readmissions, and then takes action to specifically address those issues.
“Hopefully, the model will [help us achieve] the triple aim: better care, better health, and at a reduced cost,” Brown said. “We are starting to realize there are a lot of things we don’t know that we think we know.”
The project has found that for every additional medication, there is a 1 percent increased risk of readmission. Red cell distribution, grip strength and other functional variables contribute more to risk than a diagnosis.
Inspired infant wear. “Nurses are highly creative and adaptable,” agreed OB nurse Jonelle Krier, RN, BSN, MS, founder and chief clinical officer of Assessables in Duluth, Minn. “They have the ability and chance to make a difference in the lives of patients by putting that creativity to use.”
Krier came up with the idea for an infant body suit with an opening that provides umbilical exposure, after becoming frustrated with parents’ struggles with air drying the cord. The one-piece garments also are now used in some hospital nurseries. Krier won a Huggies® MomInspired™ grant, which has helped her expand into colors and another outfit.
“Nurses can provide better care and even change the industry standard, by listening to their patients and thinking of ideas and products to help them,” Krier said.
Caregiver connections. At the other end of the lifecycle, nursing professor Kristen Mauk, PhD, DNP, RN, CRRN, GCNS-BC, GNP-BC, FAAN, president of Senior Care Central in Valparaiso, Ind., addressed two needs with her innovative solution to help older adults “age in place” while giving nursing students and nursing assistants (CNAs) more experience working with people. She connects care seekers with potential caregivers online, and the care arrangements are made directly between the two entities.
“By linking to students and CNAs who are more skilled providers, the client gets better care, is matched by a checklist of needs and wants, and can negotiate an individualized schedule and hourly payment,” Mauk said.
Ingrid Venezia, RN, tries to make a personal connection with every oncology patient.
Personalized patient care. Individual nurses make a difference one-on-one with patients. Ingrid Venezia, RN, a nurse at the New Jersey/Metro New York ProCure Proton Therapy Center, has set a goal to identify at least one personal “like” or comfort factor for each patient, which she knows will put them at ease and help foster conversation and an emotional connection. For instance, with one little boy who liked trucks, she keeps a monster truck handy and brings it out during his treatment.
“Being healed is different than being medically treated,” Venezia said. “As long as I am able to create a personal connection, I know that I am aiding their care beyond the proton therapy that they are receiving.”
Safety campaigns for healthcare professionals. Mary Foley, PhD, RN, chairperson of the Safe in Common campaign to prevent needlestick injuries, has reached out to student nurses and clinicians in practice outside of hospitals and is using online petitions and social media as well as traditional media to call attention to the continuing problem of needlesticks and the need for safer products. She called safer work environments a critical link to patient safety.
“Nurses who can work with a peace of mind and with a sense of support by leaders that their safety is considered can practice at a higher level and focus on the patient and families,” Foley said.
Collaborative care clinics. Academic nurses innovate, too. Nurses at the Ila Faye Miller School of Nursing and Health Professions at the University of the Incarnate Word (UIW) in San Antonio, Texas, came up with an idea for an inter-professional and collaborative model health care clinic and received federal funds for a demonstration project to develop the clinic on the city’s east side, which has a population of primarily lower-income, African-American residents.
The initiative aims to develop a model of care coordination for high risk patients with diabetes using high functioning professionals who communicate effectively about patient needs to achieve high quality patient outcomes, said Mary Elaine Jones, PhD, RN, project director.
Research initiatives with bedside solutions. Nurses also innovate within the acute-care setting. Some changes become transformational and change the delivery of care, while other interventions are smaller but directly affect patients.
Jane O’Rourke, RN, DNP, said leadership support is critical to inspiring nurse innovation.
“It’s important to keep innovating, because we have to keep improving the care we give and the outcomes,” said Jane O’Rourke, RN, DNP, director of evidence-based practice at Montefiore Medical Center in Bronx, N.Y.
Montefiore has launched a research committee and encourages nurses to investigate new solutions. Its leaders mentor staff and have started a Scholars at the Bedside program, hyperlinking library databases to bedside computers and dispatching clinicians to help the nurses develop clinical questions, such as new ways to move patients, and find the evidence-based answers.
“The nurses love it, and it’s inspiring to them,” O’Rourke said. “In order for staff to be inspired to be innovative, they have to have tools. And that’s what we are doing, but paramount to that is leadership being infectious with that motivation.”
Hospital innovation units with new nurse roles. Massachusetts General Hospital in Boston has taken the concept of innovation to another level, creating initially 12 Innovation Units that evaluate the patient journey, make care safer, increase continuity and interdisciplinary care, and boost time nurses spend with patients.
“All of us in health care are challenged to bend the cost curve and bring better value to patients and families,” said Jeanette Ives Erickson, RN, DNP, FAAN, chief nurse and senior vice president for patient care at Massachusetts General Hospital, which has created 15 interventions to streamline care or address gaps in the delivery system. One was the creation of the attending nurse role--experienced and respected nurses who have improved workflow, introduced technology, and addressed over-use, under-use and misuse of services.
“The outcomes are spectacular [on the Innovation Units],” said Erickson, explaining that patient satisfaction has improved, patients spend less time in the hospital and are not being readmitted as often as on traditional units. Costs came down on the Innovation Units by 3 percent.
“The attending nurse role is the heart of the model, high functioning nurses advancing care delivery,” Erickson said. “I’m thrilled it places a nurse in the center of the care team.”
Heidi Kraemer, BSN, MSN, created an environment comfortable for patients with dementia.
Dedicated units for dementia patients. Heidi Kraemer, BSN, MSN, a nurse at Alexian Brothers Medical Center in Elk Grove Village, Ill., developed an Acute Care for the Elderly inpatient unit for dementia patients hospitalized for medical reasons. Family members with the disease made her keenly aware of the population’s special needs, and walking through the hospital seeing such patients restrained or sedated convinced her there must be a better way to care for them.
Staff, who receive additional training in dementia care, strive to maintain each patient’s routine as much as possible to promote calm. Techs are available to sit with patients and assist with feeding.
“We try to live in their world, we don’t make them live in ours,” she said, adding such a policy is only feasible on such a dedicated unit.
Patricia Gessner, DNP, ACNP, helped develop protocols that have reduced delirium in the ICU.
Delirium-reducing protocols. Another Alexian Brothers nurse, Patricia Gessner, DNP, ACNP, critical care nurse practitioner, worked closely with an ICU intensivist and colleagues to implement strategies to reduce delirium in ICU patients, by recognizing it earlier, lighting the unit to re-establish circadian rhythms, not waking patients during the night for a bath, and reducing the use of benzodiazepines. The initiative has realized an average savings of $12,000 per patient.
“It took a lot of effort to change the culture, but the strategies were simple and low-cost,” said Gessner, adding, “our hope is to prevent delirium altogether.”
Motivational tools. Aiming to find a deliberate means of encouraging a discouraged patient, Michelle Leslie, RN, an inpatient nurse at Cancer Treatment Centers of America in Philadelphia, came up with a goal-setting and reward system, using large, poster-sized Post-Its to brighten up the patient’s room. She helped the patient fill the Post-Its with statements and positive affirmations like, “I will walk through the hall today during physical therapy.” Once a page became full, Leslie would organize a “dance party” where the nurses, family and friends celebrated joyfully. Now the unit has another tool for motivating patients.
Cheryl Bailey, RN, MBA, said technology can help spur innovation.
Mobile discharge instructions. Cheryl Bailey, RN, MBA, chief nursing officer and vice president of patient care services at Cullman Regional Medical Center in Cullman, Ala., embraces technology as a way to innovate and improve patient care.
“We want to be trailblazers,” Bailey said. Cullman uses Lean Six Sigma to reduce waste and improve efficiency. “Technology can make us more efficient, and that gives us more time with the patient.”
Bailey decided to let the hospital serve as a beta site to help develop Good to Go, a mobile health platform, during which nurses record on an iPod discharge instructions. Those self-care directions and educational videos, created in house, are available by phone or Internet to the patients and their family caregivers and have improved communication on inpatient and other units. Bailey randomly listens to the recordings, creating an accountability factor.
On the pilot unit, readmissions declined in the first six months by 15 percent and patient-reported Hospital Consumer Assessment of Healthcare Providers and Systems scores improved, in some cases by more than 60 percent.
“That directly affects our bottom line in a positive way,” Bailey said. “And it gives patients a safety net and a sense of peace.”
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