RSSArchive for September, 2011

Visiting hours

How do you feel about unrestricted visiting hours? More and more organizations are moving toward removing restrictions and allowing family and friends to visit at any time.

Sixty-two percent of respondents to our StrategiesForNurseManagers.com poll said they have unrestricted visiting hours.

Thirty-eight percent said they have visiting hours that allow patients time to rest and helps staff organize their work.

Joint Commission releases R3 report looking at CAUTI

The Joint Commission has just released a new R3 report examining the 2012 National Patient Safety Goal (NPSG) related to catheter-associated urinary tract infections, or CAUTI.

CAUTI is the leading healthcare-associated infection, with roughly 450,000 cases reported in hospitals every year. The Joint Commission added a new NPSG, going into effect January 1, 2012, to require hospitals to minimize the risks for CAUTI through better processes and practices.

For more information on the R3 report, visit The Joint Commission’s website.

Winner of HCPro’s nurse leader best practices contest

Editor’s note: This best practice was submitted by Anjie Vickers, RN, BSN, NE-BC, Carolinas Medical Center, Charlotte, NC. Anjie won a free book. Congratulations Anjie and thanks to everyone who submitted a best practice!

I am the nurse manager of a 19-bed progressive care unit, which I have managed for almost 11 years. The culture has dramatically changed from that of the one I started with. That was one in which the nurses exhibited horizontal violence, resisted change, and lacked shared ownership. How I changed it to one that is now a healthy work environment that embraces shared decision making, learning, and engagement involved a combination of the following.

I created an expectation of peer accountability. If the employee came to me with a complaint about someone else, I set clear expectations asking if they had spoke to their peer first and foremost. Peer review and accountability has evolved over time and continues to improve even more. We have most recently adopted the practice of bedside report and have expectations that peers will communicate, mentor, and develop each other with peer-to-peer feedback and expectations of each other.

We created our unit-based council (UBC), which has grown over time to now include each of the following:

  • Quality unit-based council
  • Professional development unit-based council
  • Coordinating unit-based council

We have sub-committees off these councils that include our Sunshine Committee, Peer Interviewing team and Self-Scheduling committee. We also empower our staff to be the champions of different goals and areas, such as restraint champion, skin care liaison, and falls champion. This helps to create an engaged workforce where everyone is part of our success.

Our community liaison assists with coordinating and organizing our volunteer events such as volunteering at a men’s homeless shelter.

Areas that we have been successful include:

  • Falls champion-Quality UBC: Reduced our falls from a total of 25 in 2010 to eight in first quarter 2011, one in second quarter, and zero in third quarter
  • Skin care champion-Quality UBC: Reduced unit-based pressure ulcers from 18 and 20 in last two quarters respectively of 2009 to zero in first half of 2010
  • Professional Development Council achieved recognition of Hallmarks of a Healthy Work Environment in 2010

The feedback from patients and families speaks highly of the engagement of this department and includes many compliments.

Rewarding near-miss reporting

By now, most of us involved in patient safety understand the importance of reporting, collecting, and analyzing near misses. More and more, healthcare providers are beginning to understand that more often than not, a systematic problem—not an individual—is behind potentially dangerous errors.

But how do you get staff to report them? No really—actually report them? Including physicians? Many healthcare providers have been working in the field for decades, and for many of those decades, mistakes were swept under the rug—especially mistakes that luckily did not reach the patient. No harm, no foul, no reporting—this was a common way of thinking for many years. When providers have learned and worked in an environment where reporting errors often meant severe individual punishment, how do get them to trust you that reporting is okay?

It’s critical to show staff the positive effects of near miss reporting. It’s also a good idea to publicly and consistently reward those who “see/experience something and say something.” A good example is one surgical suite in Johns Hopkins Hospital in Baltimore that implemented its Good Catch Awards. After 24 months, the health center provided a table of 27 good catches that shows how systems were changed in response to the catch, including one that led to a national recall of an improperly labeled drug that lead to look-alike medication errors.

Clinicians honored with an award receive public recognition with wall boards on the surgical suite. The system is not yet implemented hospital-wide, but continues at the Weinberg OR Suite at Johns Hopkins Hospital.

Do you have a near-miss reporting system? Is it used? Do staff receive public recognition for their efforts? Have you had trouble getting staff to trust that reporting is benefits all? Post your comments below.

Reference: Anesthesiology News

Source: Tami Swartz, Patient Safety Monitor Blog

Learning patient satisfaction from the Ritz

Yet another company outside the field of healthcare has offered its services to teach hospitals something about customer service and excellence. Of course, the customers in healthcare are patients, and taking care of them is different than taking care of customers.

Still, we’ve seen Disney offering lessons to healthcare institutions, and now the Ritz-Carlton. Erlanger Health System in Chattanooga, TN, signed a $388,000 contract with the Ritz to help the hospital change its culture to service excellence.

What do you think? Is this a passing fad? Or is this the beginning to really focusing on patient satisfaction and service excellence in healthcare?

Source: Tami Swartz, Patient Safety Monitor Blog

Should visiting hours be restricted?

At many hospitals around the country, visiting hours are a thing of the past. Patients’ families are free to come and go as they please without restriction.

The issue provokes much debate among nurses, particularly when visiting hours are in place in high-tech, high-acuity areas such as the ICU.

A recent article in the periodical Briefings on The Joint Commission highlighted the issue because The Joint Commission is evaluating its compliance with CMS requirements in the area of visiting rights, specifically in the Patient Rights chapter and other areas of Joint Commission standards.

Elizabeth Di Giacomo-Geffers, RN, MPH, CSHA, a healthcare consultant in Trabuco Canyon, CA, and former Joint Commission surveyor, discussed research findings about visiting hours.

Di Giacomo-Geffers writes:

“Emotion is certainly a factor in the exploration of visitation hours, but nothing can turn the tide of medicine the way cold hard numbers can.

A physician in Milan whose work I’ve admired, Alberto Giannini, presented a fascinating report in 2008 to the 3rd EfCCNa Congress and 27th Aniarti Congress in Florence entitled “Should we open or close the ICU to family members?” Dr. Giannini used information gathered from a number of polls regarding ICU patients’ perception.

He led off with a discussion about what patients ranked as their most immediate perceptions during treatment in the ICU. Many of the items listed were logical due to their relation to physical comfort-being thirsty, for example, was most highly reported at 63%, and sleep deprivation, temperature issues (feeling too hot or too cold), and even hunger made the list. But an overwhelming 62% reported being afraid or anxious, and 46% felt lonely or isolated during their time in the ICU. [more]

Patient safety and agency nurses

Medication errors are twice as likely to occur with agency and temporary emergency room (ER) nurses than with permanent staff, according to a new study from Johns Hopkins University School of Medicine.

There are many reasons for such findings, including the fact that temporary nurses are unfamiliar with their surroundings. They do not know the nurses, physicians, and multidisciplinary personnel they are working with, which can lead to communication problems and poor teamwork. They may be less comfortable speaking up if they have questions or concerns.

Bringing in agency staff is often the only way to ensure adequate staffing and they are a valuable resource for most organizations. So what should nurse managers do to mitigate the effects and improve patient safety?

1. Advocate for thorough orientation for new agency staff.
Organizations should have competency-based orientation programs designed for temporary staff so they can quickly and easily learn what you need them to know.

2. When on the unit, assess for competency. Once the agency staff are on the unit, don’t just assume they can handle anything. Charge nurses should be involved in assessing them for competency and how they deal with situations. Don’t give them more than they can handle right off the bat. Assign more challenging situations to experienced staff until you know the agency staff member can handle more and you are confident in his or her decisions. [more]