EP5EO

 

Expert Recommendations EP5EO

 

Using the required empirical outcomes (EO) format, provide one example of an improved patient outcome associated with one or more experts’ recommended change in nursing practice.

 

 

Example: Four Eyes in Four Hours

Problem

The Medical Intensive Care Unit (MICU) at Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) had an increase in hospital acquired pressure injuries (HAPI) stage 2 and above in fall 2021.

 

Pre-Intervention

CommonSpirit Health (CSH), the overarching organization for CHI SVHS, has a national HAPI team consisting of expert wound cares nurses from across the nation.

 

In 2nd and 3rd Quarters 2021, the CSH HAPI team was in the process of developing the use of the Core Nursing Standards of Practice (CNSOP), which would heighten awareness of skin assessments. Lyssa Edwards, BSN, RN, WCON, Enterostomal RN, CHI SVHS Wound Care Expert, represented CHI SVHS on the CSH HAPI team. Edwards developed wound care expertise through her work experiences and obtaining board certification.

 

Edwards identified that many SVHS hospital acquired injuries were attributed to the hospital due to a lack of documentation on admission. Edwards also identified that CHI SVHS MICU had an increase in the incidence of HAPIs stage 2 and above in 3rd Quarter 2021 (July-September), which measured 21.43%.

 

Goal Statement

Decrease the percent of CHI SVHS MICU HAPIs stages 2 and above.

 

Participants

 

 

CHI SVHS HAPI Team

 

Name/Credentials

Discipline

Title/Role

Department

Lyssa Edwards, BSN, RN, WCON

Nursing

Enterostomal RN, HAPI Team Chair

4E Medical/ Surgical

Angie Pike, BSN, RN

Nursing

Patient Care Coordinator

2W
Oncology/Renal

Kaitlyn Atkins, MSN,
RN, CPN

Nursing

Clinical Director of
Nursing

Nursing
Administration

Charity Hixon, MSN, BSN, RN, CPHQ, CIC

Nursing

Director Infection Prevention

Infection Prevention

Cynthia Hughes, RD

Dietician

Registered
Dietician

Dietary

Megan Savage, MS, OT/L

Occupational Therapy

Manager Rehabilitation Services

Rehabilitation Services

Trish Nicholas, BSN, RN

Nursing

Nurse Manager Surgical ICU

Surgical ICU

Vicky Sanders MSN,
RN, CNML

Nursing

Market Director
Nursing Excellence

Administration

 

Description of the Intervention
4th Quarter 2021 (October-December)
In October 2021, the CHI SVHS HAPI Team, led by Edwards, reviewed and discussed the information from the CSH HAPI team. The CHI SVHS HAPI Team included Angie Pike, BSN, RN, Patient Care Coordinator 2W Oncology/Renal ; Kaitlyn Atkins, MSN, RN, CPN, Clinical Director of Nursing, Nursing Administration; Charity Hixon, MSN, BSN, RN, CPHQ, CIC, Director Infection Prevention; Cynthia Hughes, RD, Dietary; Megan Savage, MS, OT/L, Manager Rehabilitation Services; Trish Nicholas, BSN, RN, Nurse Manager Surgical ICU; and Vicky Sanders, MSN, RN, CNML, Market Director Nursing Excellence.

 

The HAPI Team developed a plan to initiate the measures needed to ensure the policy for the Core Nursing Standards of Practice (CNSOP) was completed. The action plan included conducting two-RN skin assessments within four hours, along with wound photography. The CNSOP outlined the recommended change in nursing practice to have two licensed nurses complete a skin assessment within four hours of patient admission, upon discovery of a suspected pressure injury, and when patients are transferred from another unit/department. This change in nursing practice became known as “Four Eyes in Four Hours.”

 

Another change in nursing practice in alignment with the CNSOP was to ensure the assessment and documentation of wounds on admission, upon discovery, every shift, and with any change in wound status, as well as photography of all wounds and pressure injuries on admission and weekly thereafter. The changes in alignment with the CNSOP apply to all admitted inpatients.

 

To support the implementation of the changes in nursing practice:

  • iPads were ordered for each unit to use for wound photography.
  • Nicholas collaborated with Information Technology to outline the process that would be used to ensure each clinical nurse has access to an iPad to upload their photographs in the electronic health record.
  • The HAPI team met to develop the Skin Wound Action Team (SWAT). The SWAT was developed to designate skin champions on each unit to educate others on the expectations of the CNSOP related to wound assessments, documentation and photography.
  • Edwards, the wound care expert, led one-hour education sessions for the SWAT members.
  • All RNs were given access to take wound photos using the iPad.
  • In December 2021, SWAT members shared education on all units during shift huddles (held every 12 hours at the change of shift) and unit meetings.

 

The interventions were fully implemented by December 31, 2021.

 

Collaboration resulted in education being provided to ensure compliance with the new CNSOP policy, which went into effect on January 1, 2022.

 

Wound Care Expert Edwards’ recommendations led to changes in nursing practice including Four Eyes, Four Hours and wound photography. These changes were associated with an improvement in the percent of HAPIs stage 2 and above in the CHI SVHS MICU.

 

References:

Nursing: Scope and standards of practice 3rd ed | ana. Nursingworld.org. (2015). https://www.nursingworld.org/nurses-books/nursing-scope-and-standards-of-prac tice-3rd-ed/

 

Scope and Standards of Medical-Surgical Nursing Practice. Docslib. (2018). https://docslib.org/doc/5998429/scope-and-standards-of-medical-surgical

 

Outcome