EP8EOa

 

Interprofessional Care EP8EO

 

Using the required empirical outcomes (EO) presentation format, provide one example of an improved outcome associated with an interprofessional quality initiative led or co-led by a nurse (exclusive of the CNO). 

 

 

Example a: Nurse-led Interprofessional Quality Initiative Decreases the Patient Fall Rate

Problem
There was an increase in patient falls related to delirium on the Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) 5E Orthopedics/Neurosurgery (5E) unit.

 

Pre-Intervention

In March 2022, Kaitlyn Atkins, MSN, RN, CPN, Clinical Director of Nursing, attended leadership meetings during which physicians shared concerns about an increase in surgeries related to patient falls. They noted that the falls were often related to patient delirium. Atkins recognized that patients at risk for delirium are typically 65 years or older, which make up a significant percentage of the 5E patient population. The patients on 5E also have an increased use of narcotics to control pain for fractures and/or post-surgical pain, along with other comorbidities, which could contribute to delirium.

 

Atkins developed an interprofessional Delirium Task Force to address the identified opportunity of reducing the 5E fall rate. As Atkins understood the benefit of including frontline nurses in this work, she requested Angie Pike, BSN, RN, Clinical Nurse/Patient Care Coordinator, to co-lead the task force.

 

Atkins and Pike recognized that the success of the initiative would require interprofessional collaboration; they therefore brought in colleagues including nurse leaders, clinical nurses, pharmacists, therapists, and a physician. Atkins and Pike requested that this interprofessional task force focus the quality initiative on the risk factors, prevention, and management of delirium to improve the fall rate.

 

The 5E fall rate for patients 65 years and older was 2.50 per 1000 patient days for February-March 2022.

 

Goal Statement

Decrease the CHI SVHS 5E patient fall rate for patients aged 65 years or older.

 

Participants

 

Delirium Task Force
Name/Credentials	Discipline	Title/Role	Department
Kaitlyn Atkins, MSN, RN, CPN	Nursing	Clinical Director of Nursing/Lead	Nursing Administration
Angie Pike, BSN, RN	Nursing	Clinical Nurse/Patient Care Coordinator/Co-Lead	2 West Oncology/ Renal
Chae Brewer, BSN, RN	Nursing	Nurse Manager	2 West Oncology/ Renal
Barbara Ellis- Erby, BSN, RN	Nursing	Nurse Manager	5 East Orthopedics/ Neurosurgery
Christi Amerson, PharmD	Pharmacy	Manager of Pharmacy	Pharmacy
Delia de los Reyes, BSN, RN	Nursing	Nurse Manager	4 East Medical/Surgical
John Pabona, MD	Physician	Hospitalist	Hospitalist
Megan Savage, MS, OT/L, CBIS	Therapy	Manager Therapy Services	Therapy
Teresa Lambert, MBA, BSN, RN	Nursing	Vice President Patient Care Services/Assistant Chief Nursing Officer (role of CNO)	Administration
Savannah Candau, BSN, RN	Nursing	Clinical Nurse	Medical Intensive Care Unit
Sheila Clemons, BSN, RN	Nursing	Nurse Manager	Medical Intensive Care Unit
Trish Nicholas, BSN, RN	Nursing	Nurse Manager	Surgical Intensive Care Unit

 

Description of the Intervention
April 2022

• During the Delirium Task Force meetings, Atkins and Pike led the quality improvement discussions about root causes of delirium. The task force noted that while all patients’ home routines are disrupted when admitted to the hospital, this disruption can be a primary factor contributing to episodes of delirium in patients 65 years or older. The interprofessional task force also identified that the hypnotics that many patients were ordered as a sleep aid are linked to delirium. Finally, the team identified the opportunity to better educate frontline workers on the risk factors, prevention, and management of delirium. The team then worked on developing and implementing interventions to address these root causes.
• Pike facilitated the development of a questionnaire that would be administered upon admission for all patients to better understand their home routine. Frontline staff members could then incorporate aspects of the patient’s home routine into their hospital care. The nursing team was educated on the rationale for the questionnaire and how to incorporate it into patients’ care to prevent falls. It consisted of the following questions:
  • How many hours do you usually sleep each night?
  • What time do you get up in the morning?
  • What time do you usually go to bed?
  • Do you prefer to bathe/shower in the morning or at night?
  • What time do you normally eat breakfast, lunch, and dinner?
• Pike also presented to the Delirium Task Force the concept of a “badge buddy,” which staff members would wear with their badges as reminders for morning and bedtime best practices to prevent delirium:
  • Ensuring the clock in the patient’s room is visible and correct.
  • Ensuring patients wear their glasses and hearing devices during the day.
  • Adjusting the volume of medical equipment in the patient room to a normal range during the day and reducing the volume of alarms at night.
  • Encouraging family members to visit during the day and stay with the patient overnight.
  • Turning on the lights and television during the day and turning them off at night.
• The task force approved the implementation of the badge buddies, which were made by a local print shop and distributed to the nurse manager to pass out to team members during daily shift huddles.
• Christi Emerson, Pharmacy Manager, discussed with the Pharmacy and Therapeutics (P&T) Committee the use of hypnotics based on the Delirium Task Force’s concerns. The committee voted to add melatonin as a sleep aid to the formulary, as some patients take melatonin as part of their bedtime routine. For all new orders of a hypnotic, the task force members encouraged the pharmacists to contact the MD responsible for the patient to recommend melatonin as a first-line sleep aid medication. Nurse managers ensured compliance with nurses completing the questionnaire by checking the nurse servers before rounding on patients, as this is where the completed forms were kept.

 

The interventions were fully implemented by the end of April 2022.

 

An interprofessional quality initiative focused on preventing delirium, co-led by Clinical Nurse Pike, was associated with a decrease in the fall rate on 5E for patients aged 65 years or older.

 

References:

Marcantonio, E. R. (2017). Delirium in hospitalized older adults. New England Journal of Medicine, 377(15), 1456–1466. https://doi.org/10.1056/nejmcp1605501

 

Martinez, F., Tobar, C., & Hill, N. (2014). Preventing delirium: Should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature. Age and Ageing, 44(2), 196–204. https://doi.org/10.1093/ageing/afu173

 

Outcome

(Evidence EP8EOa-1, CHI SVHS 5E Patient Falls Rate Graph)