Team Redesigns Workflow in Medical Surgical Nursing Units

Time Frame: October 2007 – December 2008

Project Description: Over the past several years the nursing care model for the hospital’s adult Medical Surgical units has not provided an efficient and effective approach for the delivery of patient care services. The model lacks clarity in structure, order, role definition and adequate staffing plans, and fails to meet unit-based quality and safety goals. The nursing staff has repeatedly expressed frustration with working in a chaotic, stress-filled environment. Data from the National Database for Nursing Quality Indicators from 4Q ’05 to 3Q ’07 indicates that:

• The average percent of all falls with moderate or greater injury severity for 2 West is 6.37 as compared to the national comparative mean of 4.23;
• The combined average percent of patients with unit acquired pressure ulcers is 4.91 as compared to the national comparative mean of 3.45;
• The combined average total patient care hours per day is 11.46 as compared to the national comparative mean of 9.23.
Project Goals:
• Reduce total patient care hours from 11.46 to 9.23;
• Create a new patient care delivery model;
• Reduce patient falls on 2 West with moderate or greater severity from 6.37 to 4.23;
• Reduce combined unit acquired pressure ulcers from 4.91 to 3.45;

Interventions: The team broke into subgroups to develop final design features for implementation of the redesigned care delivery model. Those features consisted of four primary improvement interventions: Falls Prevention, Skin Ulcer Prevention, Multidisciplinary Care Planning and Resource Planning. Both the Falls and Skin Ulcer prevention programs were built on hourly patient rounds/safety checks, toileting schedules, outcomes reporting, enhanced acuity risk identification and patient/staff education.

The Multidisciplinary Care Planning process was modeled on daily multidisciplinary rounds with physicians, case managers and other caregivers, verbal walking rounds and goal setting with the patients, scheduled discharge appointments and care team huddles. The Resource Plan included a new bed placement system, implementation of team nursing (RN paired with LPN), an enhanced staffing plan and a new RN designee role.

Project Results:

• New patient care delivery model fully implemented.
• Total patient care hours reduced from 11.46 to 10 as of the end of 2008 (full implementation still in progress at that time, 2009 data not yet available)
• Falls and skin breakdown data not yet available for calendar year 2009