New Knowledge, Innovations and Improvement
Evidence-based practice and research enable Rochester General Hospital to explore the safest practices for nursing care.
Improving access for long-term IV therapy
Our PICC team RNs provide an important service to patients who need long-term or repeated IV drip antibiotics or multiple IV chemotherapy treatments. Prior to June 2013, patients had to have a chest X-ray after placement of the PICC line to determine the tip location. Sometimes, they would need more than one x-ray to make a final determination. Because the PICC line could not be used until the radiologic read was completed, patients experienced delays in the start of therapies.
In 2012, the FDA approved technology that uses the patient’s heart rhythm to confirm the IV port tip location, eliminating the need for x-rays. Our PICC team nurses reviewed the research on ECG technology and we were convinced that this could significantly improve patient safety and satisfaction. In collaboration with our Education and Infection Prevention teams as well as Dr. Sterns, we began the process of implementing this technology. The effort was led by Suzanne Colayori, RN and Susan Williams, RN, BSN. Their vision, clinical knowledge and determination, along with the support of peers and leadership, made this goal a reality.
Today, chest x-rays are no longer required in approximately 90% of patients, which allows for immediate use of their PICC lines. Patients who need extended IV therapy can come to the hospital as an outpatient to have the PICC line placed, reducing their stay to four hours or less and eliminating the need to occupy a bed. Inpatients have their therapy initiated more quickly, which can reduce their time to discharge. We’ve also eliminated x-ray radiation exposure without sacrificing care quality. We educate patients and families on the process and the therapy goals prior to each procedure. Patient feedback has indicated a better understanding of the procedure and increased satisfaction.
The team takes pride in educating bedside nurses and providers on the advantages of this new technology. They have extended this outreach to other facilities in our system. Delays in care for patients with no other IV access have been reduced significantly. The discharge process has been expedited for inpatients needing PICC placement prior to discharge. The technology and our team’s skills have shortened the lengths of stay for both inpatients and outpatients requiring this service. By eliminating the need for x-rays, we estimate the hospital will save over $100,000 per year.
The simulation lab
The Simulation Lab improves patient care, patient outcomes and general patient safety throughout Rochester General Hospital through a program of professional development that allows both new and experienced healthcare professionals to participate in a non-threatening, interactive, simulation learning environment that improves technical skills, enhances critical decision-making and communication skills, and builds teams.
We opened our first Simulation Lab in November 2013 with five simulators; and in 2014 we launched interprofessional training programs for residents, physicians, nurses, patient care technicians, pharmacists and respiratory therapists. We created simulation programs for the Women’s Center, the Internal Medicine Residency program, the Operating Room staff, Pediatric Emergency Department, Rochester General Pediatric Association and many acute care units.
Our programs improve patient safety and care based on resuscitation data. Code modules help us bridge the knowledge and skill gap in resuscitation skills for staff members who do not care for critically ill patients.
The “First Five Minutes” program helps staff build their resuscitation skills and improve communication skills during high stress events. The unit’s CNS or educator sets up the equipment and facilitates the simulation debriefing. This provides an opportunity to assess staff knowledge and skills, and helps build stronger teams. Staff members have noted an increase in their confidence level during a resuscitation event after completion.
“Boot Camp” is a pilot program developed with St. John Fisher College’s Wegmans School of Nursing in 2014 to help new internal residents prepare for residency. During the six-week rotations, teams trained together in the simulated scenarios. In addition to providing the residents with a foundation, the program’s goal was to improve communication among healthcare providers and to promote a better understanding of the importance of each member of the healthcare team.
Department of Nursing research & evidence-based practice
Our Department of Nursing Research & Evidence-Based Practice (DNR & EBP) provides mentorship and support to RNs on nursing research and evidence-based practice projects, and presentation and publication development. We currently oversee 28 nursing research studies and projects involving more than 35 RNs.
Our nurses bring the latest evidence to the bedside. Under our department’s leadership, the Evidence-Based Practice Liaison (EBPL) committee achieved the first of 13 EBP competencies to enable them to fulfill their vision. During Nurses’ Week 2014, over 80 nurses and EBPLs displayed 41 posters highlighting insightful clinical questions and reviews of related literature. The DNR & EBP also reviewed and approved nine EBP reviews, many of which resulted in practice changes designed to enhance patient outcomes.
Each year, our RNs are required to review a current nursing research article, summarize it and apply it to the clinical setting. In 2014, the DNR & EBP launched the electronic Clinical Research Utilization form to streamline this process, make the review process more meaningful and improve the tracking and reporting of submissions. As of November 2014, more than 800 submissions had been received on a wide variety of topics, including the influence of sedation strategies on unplanned extubations in the ICU, staff nurses’ perceptions regarding palliative care for hospitalized older adults and transitioning the premature infant from non-supine to supine position prior to hospital discharge.
Also in November, the DNR & EBP sponsored the 14th Annual Nursing Research Conference, in which 175 nurses and nursing students were able to boost their EBP knowledge. Keynote speaker Jeanne Grace, PhD, RN, Chair, Research Subjects Review Board and Emeritus Professor of Clinical Nursing at the University of Rochester School of Nursing, covered EBP basics and methods for appraising and applying clinical practice guidelines, systematic reviews and qualitative research to nursing practice.
Proning MICU patients using rotoprone
When patients with Acute Respiratory Distress Syndrome (ARDS) are no longer oxygenating well enough despite our interventions, we use a practice called proning. Traditionally, this involved gathering the MICU staff and collaboratively turning the patient 180 degrees onto their stomach. But in July 2014, our ICU team began using a specialty bed called the Rotoprone, a high-tech bed that could accomplish the exact same goal mechanically, with minimal team intervention.
The MICU staff wanted to be a part of the initiation process – we were all looking forward to the relief it would provide our patients with ARDS. Our patient arrived on the unit, and because there had been little specialized training for using the bed the MICU team called the company for assistance. Thanks to the nurses’ initiative, we were able to successfully place the patient in Rotoprone.
Evidenced-based practice shows that using the Rotoprone bed for specialized ARDS treatment reduces morbidity, mortality and even length of ICU stay. Our MICU has pioneered this high-tech system by creating a protocol that will be used in the ICUs throughout our organization.
SICU: The journey to zero
In fall 2014, the Rochester General Surgical Intensive Care Unit celebrated the passing of four full years without a central line associated blood stream infection (CLABSI) – a feat that continues today, thanks to an engaged and collaborative multidisciplinary team. All team members – from the medical director, nurses and PAs to our support staff – have been key stakeholders in the development and execution of the mission, which has become a shared goal.
Our strategy has been to implement the bundling of evidence-based interventions and team empowerment. This gives everyone a voice to discuss issues in real time, and we all are committed and passionate about the outcomes. Staff education is paramount and ongoing as new team members join the unit. The outcomes are shared at huddles, with challenges identified and solutions found.
With the perseverance, vigilance and professionalism of our committed team, we are keeping our patients safe every day as we continue on our Journey to Zero.
The 2000 short-stay unit
In February 2014 a new surgical short stay unit opened at Rochester General Hospital, giving patients an extraordinary healing environment that complements our teams’ nationally recognized care and creates an even more positive patient experience.
The unit is now designed for patients who need to say in the hospital for 23 hours or less after surgery. It’s the latest example of our family-centered approach to care; each of the 12 state-of-the-art private rooms features:
- A private bathroom and shower
- Family-friendly furniture that allows loved ones to remain comfortable when staying with patients
- Telehealth capabilities
Development of the Unit began by our building a “mock” patient room in the hospital’s Medical Office Building so that nurses and physicians could make suggestions on best practices for caring for these patients. For example, we moved the placement of gloves and gowns, changed the height of workstations and offered different lights for assessments and documentation based on their recommendations.