NK9EOb

 

Innovation NK9EO

 

Using the required empirical outcomes (EO) presentation format, provide one example of an improved outcome associated with clinical nurse involvement with the design or redesign of workflow. 

 

 

Example b: Clinical Nurse Involved with the Workflow Redesign of 2 West to Protect Hospice Patients from Falling

Problem
Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) 2W Oncology/Renal Unit (2 West) experienced an unexpected patient fall. All hospice patients are admitted to this unit as of September 2022, as the dedicated hospice unit at CHI SVHS is closed.

 

Pre-Intervention

A hospice patient fell during the shift of Clinical Nurse Katee Fendley, RN, 2 West. In response, Fendley collaborated with Nurse Manager Angie Pike, MSN, RN, 2 West, to determine how clinical nurses could redesign the workflow in caring for hospice patients to prevent falls on 2 West. Workflow is defined as:

 

    “The set of tasks, grouped chronologically into processes, and the set of people or resources needed for those tasks, that are necessary to accomplish a given goal. An organization’s workflow is comprised of the set of processes it needs to accomplish, the set of people or other resources available to perform those processes, and the interactions among them.” (Cain& Haque, 2008, pg. 1)

 

Pike recommended that Fendley perform an evidence-based practice (EBP) literature search on falls among hospice patients.

 

Fendley found EBP literature on terminal restlessness in hospice patients. Terminal restlessness, also called terminal agitation or terminal delirium, occurs in the days leading to death. Patients may be anxious, agitated, or show signs of cognitive decline. The EBP literature provided insights on promoting safety and comfort for patients during their final days, including immediately placing an internal urinary catheter, immediately placing bed alarms, and increasing the frequency of rounding. Fendley knew this EBP could assist with the 2 West work environment redesign to prevent future hospice patients from falling.

 

The rate of hospice patient falls on 2 West was 7.14 in February 2024. This rate is calculated by dividing the number of falls by the number of hospice patients during the same period and multiplying by 100.

 

Goal Statement

Decrease the hospice patient fall rate on CHI SVHS 2 West unit.

 

Participants

 

 

2W Hospice Patient Fall Group

 

Name/Credentials

Discipline

Title/Role

Department

Katee Fendley, RN

Nursing

Clinical Nurse/Lead

2 West

Angie Pike, MSN, RN, CMSRN

Nursing

Nurse Manager

2 West

 

Description of the Intervention
March 2024

  • Fendley created a PowerPoint presentation on the EBP changes to 2 West’s workflow to educate the staff. The objectives for clinical nurses and patient care technicians (PCT) included being able to:
    • Define terminal restlessness for hospice patients and list signs and symptoms, which include angry or emotional outbursts, agitation, confusion, lack of attention, and fidgeting.
    • Describe the interventions used to manage patients with terminal restlessness. Interventions to manage these patients included changes to the workflow on 2 West to prevent patients from falling. These interventions included:
      • Immediately placing an internal urinary catheter upon admission to assist with toileting needs. Clinical nurses and PCTs used to place pads/briefs/external urinary catheters for hospice patients as they needed them; the workflow was changed to place an internal urinary catheter on every hospice patient immediately upon admission, as toileting is the leading cause for these patients getting out of bed.
      • Immediately placing a bed alarm to alert the staff if the patient is getting up. Before the workflow change, clinical nurses and PCTs did not place a bed alarm on hospice patients’ beds.
      • Rounding hourly on hospice patients to take care of their needs and prevent them from getting up. Clinical nurses and PCTs previously rounded on hospice patients every two to four hours.

 

Fendley reviewed the PowerPoint presentation with Pike, who approved it. Fendley used this presentation to educate the 2 West staff on the EBP workflow changes during a staff meeting, and she answered questions. Fendley provided 1:1 education to staff members who were unable to attend the staff meeting.

 

Hospice Patient Workflow Before Change

Hospice Patient Workflow After Change

Placing an external catheter, pad, or brief when needed

Immediately placing an internal urinary catheter upon admission to the unit

No bed alarm

Immediately placing a bed alarm on the bed upon patient’s admission to the unit

Rounding every 2-4 hours

Rounding every hour

 

The interventions to redesign the workflow on 2 West were fully implemented by the end of March 2024.

 

Clinical Nurse Fendley’s involvement with the redesign of workflow for hospice patients on 2 West was associated with an improvement in the hospice patient fall rate. The workflow redesign included immediately placing an internal urinary catheter upon admission to assist with toileting needs, immediately placing a bed alarm to alert the staff if the patient is getting up, and rounding every hour to take care of patients’ needs to prevent them from getting up.

 

References

Morrow, A. (2023). Recognizing terminal restlessness at the end of life. Verywell Health. https://www.verywellhealth.com/terminal-restlessness-1132271

 

Srakocic, S. (2022). Why people experience terminal restlessness when their dying. Healthline. https://www.healthline.com/health/terminal-restlessness

 

Outcome

(Evidence NK9EOb-1, 2W Hospice Patient Fall Rate Graph)