Quality Improvement

2013 nursing Quality Improvement

Structured Interdisciplinary Bedside Rounds (SIBRs)

Decreases in length of stay, 30-day readmissions and mortality rates are prevalent in the WakeMed nursing units that practice SIBRs – an initiative spearheaded by nurses and hospitalists.

Every attempt is made to place all of a hospitalist’s patients on the same unit. Then, SIBRs bring all of the members of the care team – patient, family, hospitalist, charge nurse, case manager, clinical nurse and pharmacist – together at the same time each day to discuss the patient’s progress and care and to understand the patient and family’s goals for care and discharge.

2014 nursing QI SIBRs

Feed-and-Sleep Interdisciplinary Collaborative

In 2011, 50 percent of infants younger than 3 months who received anesthesia before an MRI experienced respiratory complications. Today, none of them do, thanks to the MRI Feed-and-Sleep Program.

Several WakeMed Imaging Services clinical nurses worked with their Imaging Services, Information Services and scheduling colleagues to implement the practice of feeding and swaddling an infant before an MRI to alleviate the need for anesthesia. After 33 months and 42 infant Feed-and-Sleep studies, the team has achieved a 97.6 percent success rate with no respiratory complications.

2014 nursing QI MRI's 3 Month old

Hunting Down HAPUs

Again, this year WakeMed far outpaced other like U.S. hospitals in reducing HAPUs.

WakeMed’s certified Wound Ostomy Continence Nurse team led the system-wide initiative to reduce device-related, hospital acquired pressure ulcers (HAPUs). Through collaboration with respiratory therapists, and Surgical Trauma Intensive Care Unit (STICU) nurses and evaluation using evidence based criteria and education, clinical nurses successfully met the goal of one or zero device-related HAPUs after the four-month intervention implementation period.

2014 nursing QI HAPUs 1

2014 nursing QI HAPUs 2

Nurse-designed Technology & Partnerships Save Lives2014 nursing QI Tech Partner

Two WakeMed Emergency Department (ED) nurses improved the care of stroke patients by creating a smart timer to help nurses and physicians meet the multiple timed goals for steps in the process of preparing to administer vital medication to dissolve blood clots. They partnered with a friend in software development and created an iPhone application (app) called Acute Stroke Timer. The gold standard for ischemic stroke care is administration of tissue plasminogen activator (tPA) within 60 minutes of arrival. That requires carefully choreographed steps along the way, each with their own target between 10 and 45 minutes. The app serves as a visual and audible reminder of each step, the target time, and the time left to complete the action.

Instances of tPA administration greater than 60 minutes after arrival with delays attributed to nursing or to the system (labs, support services) were reduced to zero in the four months following formal implementation of the Acute Stroke Timer in the Raleigh AED. The final version was released via the Apple App Store April 9, 2013 and is available there.

A Patient Satisfier

A group of nurses formed the Ultrasound Guided Peripheral IV insertion team (UGPIV) to improve the patient experience during the placement of IVs by training nurses to use existing equipment to decrease the number of unsuccessful attempts in patients with challenging venous access.

In 2014, over 100 nurses were trained in this skill and performed more than 2,500 UGPIV insertions with an 85 percent first-stick success rate. Pediatric nurses began training in May 2014. Patient survey results reveal increased patient satisfaction with the IV experience, a reduction of median attempts for successful placement, increased perception of nurse technical skills, and decreased pain. Now, 10 to 14 nurses are certified each month in this skill.

2014 nursing QI Satisfaction IV

2014 nursing QI Median Attempts Success

Practical, Replicable Strategies to Reduce CLABSIs

A 38-bed complex intermediate care unit served as the pilot site for a clinical nurse study on the efficacy of a central venous catheter (CVC) care bundle to reduce central line associated blood stream infections (CLABSIs). By implementing practical bundle strategies such as dressing surveillance on every shift, designating a day of the week for dressing changes and daily assessments of the need for a central line, nurses proved that the bundle and the reduction of device days reduces CLABSI rates. The CVC care bundle is being adopted in appropriate nursing units at WakeMed Raleigh Campus and WakeMed Cary Hospital.

2014 nursing QI CLABSI Rates