Quality Improvement


First in the U.S. to Implement ERAS® for Heart Surgery

First in the U.S. to Implement ERAS® for Heart Surgery

What began as a goal for a solitary nurse became an interprofessional success of national importance. WakeMed is the first hospital in the United States to introduce early recovery after surgery (ERAS) for heart surgery patients – a value-based, single, standardized pathway approach to surgery. Gina McConnell, BSN, RN, CCRN, WakeMed Cardiothoracic Intensive Care, and her physician partner heart surgeon Judson Williams, MD, have been sharing their expertise and results of their efforts at conferences throughout the United States.

The team’s work was also the cover story for the magazine Nursing 2018. McConnell and Williams, along with Patricia Woltz, PhD, RN, William Bradford, MD, and Erin Ledford, PharmD, authored the article which is titled “Rationale, design and implementation of an enhanced recovery after cardiac surgery (ERAS-Cardiac) program to improve healthcare quality.”

Unadjusted Clinical Outcomes on First 9 Months of ERA

 


Proper SEND off

Providing the Proper SEND off

SEND Off – Structured Engaged Nursing Discharge – the new structured discharge process in 5A Medical Intermediate Care, continues to positively impact patient satisfaction scores for the unit. A clinical nurse from the unit brought the basic concept to WakeMed after learning about it at a national nursing conference. The 5A Unit Council then adapted the concept for their patients. It’s success has made it a standard of practice for the unit. It is also an important reminder of how simply sitting and talking with a patient can dramatically impact communication and the entire care experience.

PRC% Excellent - Patient Satisfaction with Nurses' Communication

 


Life-saving CPR for Coaches

Life-saving CPR for Coaches

By its mission, WakeMed is committed to improving the health and well-being of our community with outstanding and compassionate care to all. WakeMed nurses embrace our community-minded mission by educating the public about health care topics and performing screenings throughout the area.

WakeMed Nursing Education is doing their part by coordinating SportFit, an event to provide Wake County Public School System athletic directors (ADs) and coaches with Heartsaver® CPR and AED training. The program is fully funded through the WakeMed Foundation, which means the education is free for attendees – many of whom are volunteers. Approximately 300 coaches and ADs have received this life-saving training since SportFit began in 2017. SportFit also increases the rate of bystander CPR and AED preparedness for the entire community in keeping with Healthy People 2020 goals.

 


ChasingZero

WakeMed began the system-wide Chasing Zero initiative to eliminate all preventable harm, including Hospital acquired infections (CAUTI, CLABSI, C. difficile, etc.), surgical site infections, falls with injury, preventable sepsis, wrong site/wrong patient/wrong procedure surgeries, retained objects, medication errors, pressure ulcers and preventable blood clots. WakeMed Cary Hospital received the first-ever Chasing Zero Hero award for being CLABSI free for 15 months.

Administrative champions for the Chasing Zero campaign are WakeMed Senior Vice President & CNO Cindy Boily, RN, MSN, and WakeMed Senior Vice President & Chief Quality & Medical Staff Officer, West Paul, MD, PhD.

 


Stopping Sepsis, Saving Lives

Treatment guided by the use of evidencebased care bundles from the Surviving Sepsis Campaign guidelines is directly linked to improved mortality and quality outcomes. WakeMed has an interprofessional team continually working on improving care for our patients with sepsis through education new screening tools, ordersets and protocols, metric tracking and monthly case reviews with feedback.

The eICU, ED and Rounding Nurse Program are instrumental in expediting identification and care of this patient population.

System SEP-1


Decreasing Device Days

Decreasing Device Days

WakeMed Nursing’s innovation, teaching and leadership have led to continued decreases in device days for patients with catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs).

Nursing’s focus is on care, access and maintenance of central and arterial lines. The Ultrasound Guided Peripheral IV (UGPIV) training program continues to improve the IV placement experience for patients with difficult venous access. More than 260 nurses throughout the health system are certified to use the technique. Experienced practitioners of this skill consistently achieve greater than 90 percent first-stick success in our most challenging IV access patients.

Because everyone can benefit from a skills refresher, 2,700 nurses were directly observed practicing four central line procedures to ensure competency of best-practice use during the past year. In addition, care for intensive care patients with arterial and central lines is now standardized in accordance with updated best practices.

We attribute the decrease in device days to several Nursing initiatives. During the past year, Nursing introduced several alternatives to Foley catheters, resulting in a 16 percent decrease in their use. An interprofessional task force continues to reinforce the importance of proper urine culture practices, reducing unnecessary cultures to determine the necessity of a Foley catheter and its timely removal.

Chasing Zero