By Debra Wood, RN, contributor
April 5, 2013 - Critical care nurses at seven Pennsylvania hospitals have begun their journey into learning about managing quality improvement initiatives from conception through sharing findings while tackling their own project as participants in the American Association of Critical-Care Nurses (AACN) Clinical Scene Investigator (CSI) Academy.
Chris Huot, BA, RN, called the academy an opportunity to put positive change in the hands of nurses.
“We saw it as an opportunity to grow nursing practice in the critical care area and put the ability to make a positive change in the hands of staff nurses at the front line,” said Chris Huot, BA, RN, nurse manager, critical care, at Penn Medicine-Pennsylvania Hospital in Philadelphia.
Mary Del Guidice, RN, MSN, BS, CENP, chief nursing officer at Pennsylvania Hospital, called the chance to participate in the academy too good to pass up as nurses adapt to an ever challenging and evolving practice environment.
AACN describes the CSI Academy as a nursing excellence and leadership training program designed to leverage the staff nurse's expertise to enhance patient care and improve fiscal outcomes. The program is designed to help staff nurses guide their peers in creating unit-based change that is easily scaled hospital-wide.
Tonya Johnson, MSN, RN, CCRN, said the CSI Academy helps empower nurses.
“Nurses can be empowered to own a project from beginning to end,” said Tonya Johnson, MSN, RN, CCRN, clinical director at Pennsylvania Hospital, which will work to reduce sedation and increase early mobility in the ICU. “They can make a difference in a big way, if you give them the time and skills to do it.”
Lehigh Valley Health Network in Allentown, Penn., also is participating in the academy. For its Quiet ICU project, the nurses will implement measures to make the ICU more conducive to sleeping at night. Three of the four participating nurses work the night shift.
“[The academy] was an opportunity to help nurses at the bedside learn skills to be good change agents,” said Denise Davis-Maludy, RN, director of the ICU at Lehigh Valley. She anticipates the nurses attending the academy will bring those skills back and teach them to fellow nurses in critical care and other units throughout the network.
Del Guidice agreed, saying, “The learning staff bring back will translate into other areas--how to approach problems, solve problems, how to bring the right people around the table--skills they will carry to other venues, improving care in their practice.”
Karen Trinidad, MSN, RN, a clinical level 2 nurse at Pennsylvania Hospital, and four nurses from each of the other participating hospitals have attended the first all-day educational coursework to prepare them for carrying out their projects.
“It was very valuable,” Trinidad said. “We discussed concerns and fears about the upcoming year and our projects.”
At the end of the 16-month academy, the teams will present to project leads and chief nursing officers the results of their efforts. In addition, Huot hopes the Pennsylvania Hospital nurses will put together an abstract and present their work at a national conference or professional organizational conference.
The other participating Pennsylvania hospitals are Abington Memorial, Fox Chase Cancer Center, the Hospital of the University of Pennsylvania, Lankenau Medical Center, and Penn Presbyterian Medical Center. All of the hospitals will receive a $10,000 implementation grant from AACN, which plans to invest $1.25 million in the program during the next three years.
The AACN CSI Academy expands a successful pilot program developed by the Bi-State Nursing Innovation Center, Kansas City, Mo., with funding from the Robert Wood Johnson Foundation. Those nurse-led projects in seven hospitals saved a total of $2.6 million.
Hospitals in other regions also are participating: eight in Texas began in January, seven in Massachusetts began in November 2012, and seven in North Carolina began in October 2012.
Nurses on the surgical intensive care unit at UNC Hospitals in Chapel Hill, N.C., are building on a randomized clinical trial conducted in 2011 about patient mobility. The nurses have incorporated early mobilization in the standard of care, said Darla K. Topley, RN, MSN, CCNS, a clinical nurse 4 in the surgical trauma ICU at UNC.
UNC has put a slightly different spin on its project by including nurses and patients on an acute care floor. That began with the idea of carrying through with the early mobility started in the ICU as the patient progresses.
“We are excited in the intensive care unit, because we believe as soon as they come into the unit, we start moving them,” Topley said. “Patients are excited, and we want to get families involved as well.”
(L) Keri O’Brien, RN, clinical nursing director of the Neuroscience ICU at Tufts Medical Center and (R) Diane Gillis, MS, RN, director of clinical education at Tufts.
At Tufts Medical Center in Boston, nurses are building on a prior quality initiative and are taking aim at eliminating device-related pressure ulcers in the adult ICU. Diane M. Gillis, MS, RN, director of clinical education at Tufts, appreciates that the academy enables staff nurses to direct the initiative while learning more about project management, data collection and analysis, and strategic communication.
“In addition to them working together as a foursome, they are learning and benchmarking and networking with the other 29 participants,” Gillis said. “It’s wonderful and a tremendous opportunity for professional development perspective.”
Gillis added that the academy creates a model that can be used for other projects as health care organizations continue to focus on improving safety and quality.
Cardiac intensive care nurses at Massachusetts General Hospital in Boston are focusing on reducing ventilator-associated pneumonia by implementing the Awakening and Breathing Coordination, Delirium Monitoring and Management and Early Mobility (ABCDE) bundle, after learning more about it at an AACN conference.
Colleen Snydeman, RN, MSN, NE-BC, expects nurses will share what they have learned and expand their project to other areas in the organization.
Working on the bundle will likely decrease patients time on the ventilator, which would lead, hopefully, to less ventilator-associated pneumonia and delirium and decreased patient length of stay, said Colleen Snydeman, RN, MSN, NE-BC, director of patient care services at Mass General.
At Newton-Wellesley Hospital in Newton, Mass., nurses also are tackling early mobility, particularly of ventilator-dependent patients. The academy has taught them how to break down the project into manageable components.
“We wanted to get nurses involved in the project and keep it going,” said Colleen Ryan, RN, nurse educator at Newton-Wellesley. “The best part is hearing about other people’s projects and how they are moving forward.”
Nurses at Beth Israel Deaconess Medical Center in Boston are working to prevent delirium. Jane Foley, RN, BSN, MHCA, associate chief nurse for the critical care and medical–surgical inpatient units, called it an exciting program that will “empower and develop staff nurses at the bedside to influence improvements that affect patient outcomes.”
Foley finds “being part of a larger team of other critical care nurses also has intangible rewards. Being able to share knowledge and network allows for long-lasting collaboration, which is hugely important today in a very complex health care environment.”
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