EP2
Shared-Decision Making EP2
Provide one example, with supporting evidence, of clinical nurses using shared decision-making to change the nurse practice environment.
Example: Crash Cart Step Stools
Need for Change
During patient resuscitations at Catholic Health Initiatives (CHI) St. Vincent Hot Springs
(SVHS), it had become second nature for clinical nurses and other staff members to place their knees on the patient’s bed while doing chest compressions. However, this nursing practice increases the risk of needlestick injuries, exposure to bodily fluids, and other work-related injuries.
Clinical nurses from the ICU (combined Medical Intensive Care Unit and Surgical Intensive Care Unit) came up with the solution of purchasing step stools and conducting a pilot in the ICUs in February 2022 to determine whether this would be an effective change in nursing practice. While the step stools were effective, they were easily lost. This led to staff members being taken away from emergent situations to search for a stool to use. The ICU clinical nurses continued the pilot to develop an effective way to keep the crash cart stools readily available.
Clinical Nurses Use Shared Decision Making
On March 3, 2022, Clinical Nurse Logan Jenkins, BSN, RN, CCRN shared with the CHI SVHS Shared Governance Interprofessional Practice Council (IPC) that the ICU nurses had been trialing small, collapsible step stools to hang on the crash carts for over a month and that it was going well. The purpose of the step stools was to assist clinical nurses and other staff members in doing chest compressions without having to put their knees on the patient’s bed and to prevent nurses from searching for an available step stool. Jenkins told the IPC there was still some more work to do with the ICU Unit Based Council (UBC) to determine where to place the step stools on the crash carts. Vicky Sanders, MSN, BS, RN, CNML, Clinical Director Nursing Administration, also advised the ICU UBC to collaborate with Infection Prevention to determine how to clean the step stools. (Evidence EP2-1, IPC Minutes and Roster March 2022)
On March 23, 2022, the ICU UBC determined that it was best to hang the step stools by the ambu bag. Jenkins wrote an SBAR and shared it with the ICU UBC, which approved it to be taken to the next IPC meeting to present the recommendation. (Evidence EP2-2, UBC Minutes and Roster) (Evidence EP2-3, SBAR) Jenkins spoke with Marcie Hermann, BSN, RN, Infection Control, about disinfecting the step stools. Hermann recommended they be cleaned when the crash carts go to Central Supply after they are used, with Central Supply following their established procedures for cleaning the rest of the crash carts.
Change in Nurse Practice Environment
In April 2022, Jenkins presented to the IPC the SBAR for the crash cart stools to be implemented for the hospital. Jenkins shared that Infection Prevention had approved the step stools being disinfected with the rest of the crash cart when brought to Central Supply after use. The IPC voted unanimously to approve the recommendation. (Evidence EP2-4, IPC Minutes and Roster April 2022)
Step stools were ordered for all the crash carts in the hospital in May 2022. The change in the nursing practice environment to add a step stool to each crash cart was implemented in June 2022. The addition of the crash cart stools ensures one is readily available to all clinical nurses and other staff members when needed. This change in the nurse practice environment mitigates the risk of needlestick injuries, exposure to bodily fluids, and other work-related injuries, and it ensures adequate resources are available to care for the patient. (Evidence EP2-5, Step Stool Purchase Order)