St. Francis Critical Care: Nursing Unit Assessment

1. St. Francis Critical Care: Nursing Unit Assessment Kayla Hopper, Kerri Jo McDaniel, Alex Rodriguez, Baylee Stephens, KaileySweatman, & Sam Trupp

2. St. Francis • Located in Columbus, Georgia • Nursing Manager: Kelli Koelsch • Intensive care unit (ICU)- 13 beds • Critical care unit (CCU)- 10 beds • Overflow care unit (OCU)- 4 beds

3. Who is Kelli Koelsch? • Nursing manager for both the CCU and ICU units at St. Francis hospital • Worked bedside for 12 years • Has been a nurse manager for 2 years • Advice: • Know how to multi-task • Always identify communication as a problem • People skills are a must • Have to be able to admit that you are wrong

4. Mission St. Francis, a community-owned, Catholic healing ministry exists to provide exceptional health care services, in partnership with physicians, for all those in need.

5. Vision St. Francis will be the preeminent health care delivery system in the Chattahoochee Valley and surrounding communities- the first choice of patients, physicians, associates and payers for health, wellness and life.

6. Core Values/Goals • Excellence • Professionalism • Courage • Compassion • Creativity • Open Communication • Mutual Respect • Ethical Behavior

7. Unit Culture • Good interpersonal relationships • Friendly with peers, patients, and families • Teamwork • Good orientation for new nurses

8. Conflict Resolution Strategy • Open communication • Hear both sides of the story before a decision is made • Address the problem with each person individually • Have a meeting with all individuals involved

9. National Patient Safety Goals • Pressure ulcer prevention • NPSG.14.01.01: Assess and periodically reassess each resident’s risk for developing a pressure ulcer and take action to address any identified risks. • Central line-associated bloodstream infection prevention (CLABI) • NPSG.07.04.01: Implement evidence-based practices to prevent central line-associated bloodstream infections. • Catheter-associated urinary tract infections (CAUTI) prevention • NPSG.07.06.01: Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections.

10. Pressure Ulcer Prevention • Nationwide: • 2.5 million patients per year acquire a pressure ulcer • Pressure ulcers cost $9.1-$11.6 billion per year in the U.S. • About 60,000 patients die as a direct result of a pressure ulcer each year • St. Francis Critical Care Unit: • In the beginning of 2012, the ICU had 2 pressure ulcers and the CCU had 2 pressure ulcers • As a result, they reevaluated the policies and procedures • Purchased new critical care beds • Set up turn teams on ICU and CCU • Designate 2 nurses per shift to remind all the other nurses about positioning • Chart position every 2 hours

11. Financial Issues on the Unit • Core measures and reimbursement complications • Performance based • Must score well to be reimbursed for care • Performance is tracked throughout the year by submitting data. • If they don’t submit data/score well, they don’t get reimbursed. • Sample data that is graded • Post-operative patients have to have their Foley catheter removed by post-op day 1 • Have a blood sugar less than 200 post-op

12. Need for Change on the Unit • Change needed: Reporting at the bedside • It is a standard of nursing practice that report be given at the bedside. • Driving force: • The unit implemented a policy that nurses give report at bedside (except for some personal patient information). • Restraining force: • It is difficult to shift from reporting in the nursing station because it is a habit.

13. Patient-centered Care • Open visitation policy • Except for the quiet time at night or during certain procedures • Visitors can’t stay on the unit over night, but the waiting room is always open • Physician explanation • Physician should make the decision of whether to discuss patient-care and interventions with the family or another group of doctors if the patient is unable to make their own decision

14. Continuous Quality Improvement Measures • Hospital-wide measures that are more focused on this unit • Acute coronary syndrome policy • Goal: 90 minutes to cath lab • Stroke • CT within 3 hours • TPA if indicated • CABG • Prevention of sternal infection • Ventilator-associated pneumonia • CAUTIs and CLABIs

15. Leadership Skills • Focus on interpersonal relationships • Facilitates feedback to ensure that communication remains open • 3 staff meetings offered per month for the sake of communication • Power of motivation • Team building • Consistent feedback • Discipline policy • 1st offense: documented, but education on the error is the focus • 2nd offense: verbal warning • 3rd offense: write-up

16. Current Recruitment and Retention on the Unit • Recruitment: • They do not have any bonuses, referral bonuses, or any huge effort in place in the CCU • Recruit within the hospital using the clinical ladder • Retention/Attrition Rate: • They do have a retention problem because people go back to school (nurse practitioner and CRNA schools) • Average years worked is 5 • Big turnover every 2 years for people going back to school

17. Staffing Process • Normally a 2:1 ratio • Exceptions to the 2:1 ratio: • Open heart, balloon pump, induced hypothermia, or if the patient has coded or is at risk for coding • All of these would be a 1:1 ratio • Floating • Try to avoid calling in other unit nurses because CCU/ICU is so specialized • If it is a necessity, they prefer to call nurses from telemetry

18. QUESTIONS?

19. References • http://www.ahrq.gov/research/ltc/pressureulcertoolkit/putool1.htm • http://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFaqId=163&ProgramId=1