3,520 research outputs found

    Innovation through an Academic Practice Partnership: A New Clinical Nurse Leader (CNL) Implementation Model

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    Problem The IOM reports (1999, 2001) were catalysts for development of a new nursing role - the Clinical Nurse Leader (CNL). Academic practice partnership models are needed to integrate the CNL role in health care systems. Context A large integrated health care system in Northern California and a university Clinical Nurse Leader (CNL) program initiated a formal academic practice partnership, establishing a hospital based MSN CNL program. Intervention A CNL implementation model was developed that includes (a) academic practice partnership advisory charter; (b) academic practice partnership roles (MSN CNL program director, MSN CNL faculty liaison, and hospital-based CNL preceptor/mentor); (c) CNL preceptor/mentor educational module; and (d) electronic CNL program implementation toolkit. Measures Likert-type scale questionnaires were developed to assess the perception of the value of the CNL program from nursing leaders and CNL students participating in the pilot site hospital model. Results Results from the nursing leaders indicate that nursing leaders are now familiar with the competencies of the CNL, and perceive that graduates with these competencies bring value to the organization. Results from students indicate that CNL students value the hospital -based model, apply theory from the courses in their current leadership roles, and can articulate improved patient and system outcomes they hope to achieve as CNL graduates. Conclusions Academic practice partnerships support the integration of CNL education and new models of CNL practice within organizations. The CNL program implementation model is a strategic tool to develop long-term, sustainable academic practice partnerships that improve health care outcomes

    Implementation of a Pediatric Post-Operative Hand-Off Tool: A Patient Safety Project

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    Abstract Problem: The clinical nurse leader (CNL) performed a microsystem assessment using the Dartmouth assessment tool to evaluate the microsystem’s readiness to provide safe care for pediatric post-operative cardiovascular patients. The microsystem is a 12-bed unit caring for critically ill pediatric patients requiring intensive monitoring and therapy. The microsystem’s interdisciplinary team is comprised of medical doctors, nurses, respiratory therapists, social workers, nutritionists, child life specialists, and pharmacists. During assessment and gap analysis, the CNL identified gaps in nursing knowledge and skills to deliver safe care for this patient population during the immediate post-operative phase of recovery. There is a concern for patient safety and poor quality outcomes due to these gaps. Since it is a new patient population for the microsystem, there are no protocols nor tools in place for nurses to feel confident in their ability to safely and effectively care for these patients. Context: As part of the organization’s integration efforts, the pediatric cardiovascular surgical service will be offered to its members beginning August 2018. This service will be piloted in a 12-bed microsystem, where the care of the patients post-operatively will occur. The microsystem interdisciplinary team has never cared for these patients in their immediate post-operative phase of recovery. Approximately 40% of the nurses in the microsystem are master’s prepared, and 85% of the nurses in the microsystem have over 5 years of experience in the pediatric intensive care unit (PICU). Because this is a new patient population for the microsystem, a nursing knowledge and skills gap was identified. Nurses are not confident and competent to care for these patients in the current state. To address this, prior to the first surgical date of August 15, 2018, the organization partnered with a neighboring organization with extensive experience in caring for congenital heart disease patients for training and education. Thirty-five out of 70 nurses in the microsystem, who volunteered to be part of the core group of cardiothoracic (CT) surgery trained nurses, were sent to that organization for training and education. Each nurse received 32 hours of didactic classes and 36 hours of hands-on precepted training in the other organization. The microsystem also provided 8 hours of further education and training of equipment and simulation. After training and education, the CNL collaborated with the nurse manager and frontline interdisciplinary team to create a hand-off tool and to define nurse roles during post-operative take back to ensure safety and quality outcomes during the most critical phase of the patient’s recovery. Intervention: The interdisciplinary team created a post-operative hand-off tool for a safe hand off at the PICU. The tool includes basic patient information, weight, diagnosis, surgical procedure, intraoperative information such as anesthesia and sedation used, blood products and medications administered during the procedure, and events such as arrhythmia and bleeding. The tool also has information pertinent to post-operative care, such as vital signs parameters, pain and sedation plan, medications, laboratory monitoring, and other details important for the nurse to monitor. The frontline nurses also created defined nursing roles during the post-operative take back to help ensure that all necessary care and tasks are safely accomplished in a timely and effective manner. Measures: Direct observation was done during the hand-off process to evaluate completion of all items in the hand-off tool at the PICU during hand off. Direct observation was done on the execution of the RN1 and RN2 roles. The goal is 100% utilization of the tool and the defined RN roles every post-operative take back. Results: Four surgical cases were performed since August 15, 2018. The hand-off tool and RN1 and RN2 roles have been utilized 100%, with no variances and barriers. Conclusion: The immediate post-operative phase of recovery for a pediatric cardiovascular patient is the most critical and intense period. Attention to detail and timely delivery of care are very important; hence, clear communication is vital during the hand-off process. In an effort to achieve a safe hand-off process and meet the patient’s care demands, the interdisciplinary team created the tool and the roles. Based on the results to date, these tools are effective interventions to ensure delivery of safe quality care to acutely ill pediatric patients after CT surgery in the immediate post-operative period

    Process Improvement Manual: Front and Back Office

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    The global aim of this project is to decrease variations and improve efficiency in the tasks assigned to the support staff at an outpatient breast clinic. The breast center has a five-person administrative team who rotate through four positions monthly. The specific aim is by May 1, 2017, 100% of the five employees will have a comprehensive knowledge of their role, and adhere to a standardized way of completing tasks. The CNL Leadership themes used were Educator, Team Leader Manager, and Outcomes Manager. Informative interviews were conducted with the staff to gauge the unique needs of the team. 100% of the staff indicated that a standardized protocol for their job functions and procedures was a needed resource. After the implementation of the manual, the post-survey proved 100% of the employees indicated a thorough knowledge of their job roles. The effectiveness of this manual will be sustained because a member of the staff has volunteered to update the manual on a quarterly basis. A recommendation for future improvements is a new employee on-boarding program; the manual will be a strong tool to get new staff oriented to the microsystem

    The Role of the Clinical Nurse Leader in Reintroducing and Sustaining a Successful Cancer Risk Assessment Program in a Community Hospital Setting

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    Abstract The goal of implementing a comprehensive cancer risk assessment (CRA) program prompted the evaluation of a community-based breast center microsystem and previous CRA program for feasibility and sustainability. The development of a value proposition by the Clinical Nurse Leader student highlights the role in the advancement of the nursing profession as an interdisciplinary leader. Review of current literature facilitated development of program structure and identification of downstream revenue sources. Data analysis includes historical patient volume, screening and procedural reimbursement rates, population statistics and organization market share, and program financial impacts. Data synthesis reveals a CRA program demonstrates potential revenue generation of 283,996.20bythesecondyearofimplementation.Theassociatedcostsrelatedtostaffingandstartupcapitaltotal283,996.20 by the second year of implementation. The associated costs related to staffing and start up capital total 231,988.00, determining an estimated break-even point to be within the first 18 months of the program. With evidence demonstrating improvements in patient outcomes related to early disease detection, the recommendation to the institution is therefore to invest in implementing a comprehensive cancer risk assessment program

    Quality Improvement Project on Patient Falls in a Medical-Telemetry Unit

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    This paper will summarize the quality improvement falls prevention project conducted by a group of University of San Francisco Clinical Nurse Leader (CNL) students. Falls in the acute care setting are a major issue in the current health care system and are a main topic of interest for CNL students to address in order to demonstrate their competency in risk reduction, health promotion, and evidence-based practice. A large, metropolitan hospital uses the Morse Fall Scale to assess patients for fall risk factors. On a medical-telemetry floor, fall incidence rates are increasing from the previous fiscal year. Due to the negative impact of falls on patient outcomes, the CNL students conducted a systematic analysis of the problem. The results were used to design, implement, and evaluate an evidence-based practice intervention to address the root cause of falls on the unit. The systems theories used in this quality improvement project are Chaos Theory and Kotter’s Eight Step Change Model

    Building the Business Case for Clinical Nurse Leader Integration into a Hospital Staffing Model

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    The Clinical Nurse Leader (CNL) is a newer role in the nursing profession. This generalist Registered Nurse (RN) role was designed to help address fragmented healthcare delivery and care coordination, emphasize and facilitate evidence-based practice, and improve patient quality outcomes at the microsystem level (AACN, 2011). This paper describes a Doctor of Nursing Practice (DNP) project that took place from January through December 2017 focused on making the business case to incorporate CNLs into a hospital staffing model. The CNLs focused on reducing hospital acquired infections (HAIs). The CNLs’ work reduced HAIs by 48% in 2017 as compared to 2016 thereby saving the hospital nearly $385,000 in unreimbursed clinical care. Based on this project’s outcomes, four full-time CNL positions were approved for 2018

    Improving Communication in a Virtual Team: A Quality Improvement Project

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    Problem: Data analysis based on two surveys revealed team communication, interdependence, technology interfaces, and integration as the quality gaps in the Virtual Surveillance Team. When compared with traditional in-person teams, a virtual working team faces different types of communication challenges. Context: The virtual surveillance team in the regional quality department at Oakland monitors both Advance Alert Monitor (AAM), a statistical model developed by the Kaiser Permanente (KP) Division of Research (DOR) that is used to predict an individual’s likelihood of deterioration, and eHospital care gaps for Kaiser Foundation Hospitals in Northern California (KFH, NCAL). The latest evaluation from DOR of the AAM intervention in the pilot site from August 2016-February 2017 showed mean 35.5 hour reduction in hospital length of stay (LOS), and mean 19.1 hour reduction in Intensive Care Unit (ICU) LOS (Kaiser Permanente, 2017). As a result of the AAM implementation, the KP NCAL region planned to implement AAM intervention in all 21 facilities of KFH. To achieve this goal, the virtual surveillance team which includes the Clinical Nurse Leader (CNL) student has expanded rapidly. Communication failures have been frequently attributed to harmful events in healthcare for nearly two decades (Clarke, 2016). For this reason, better communication strategies, knowledge sharing among the team members, and collaborative technologies are critical for the CNL student’s team, where patient safety is the primary goal. Interventions: The quality improvement project aims at two interventions with the purpose of streamlining the workflow, and improving communication among the team. One intervention is to create a SharePoint team communication platform. A second is to develop an online training module of the SharePoint site for the team. Measures: The outcome measures are to improve the percentage of interdependence responses, and the percentage of integration of technology used to support the work of the virtual team. The outcome measures are analyzed through pre, intermediate, and post implementation surveys. Results: Trust and collaboration among team members increased from 58% to 72%. Integration of information and technology used to support the work of the team increased from 47% to 60%. With the implementation of SharePoint communication platform an increase in staff productivity is expected, due to decrease in time spent at the start of the shift to 15 mins per team member. The cost avoidance accrued through increase in staff productivity is estimated to be 21,040.ThelongtermcostsavingsattributabletothisprojectthroughenhancedcommunicationandwithAAMimplementationisanestimated4.5hourmeanreductioninhospitallengthofstayanda0.9meanhourreductioninICUlengthofstay.Thiswouldgenerateanannualcostsavingsof21,040. The long term cost savings attributable to this project through enhanced communication and with AAM implementation is an estimated 4.5 hour mean reduction in hospital length of stay and a 0.9 mean hour reduction in ICU length of stay. This would generate an annual cost savings of 14,160 per facility in 2018 with an estimated annual savings of $142,000 for the healthcare organization. The team effectiveness, and the ease of use of technology is expected to improve once the SharePoint site has been implemented. Conclusions: The implications for practice are pending based on feedback from team members after using the site. Enhanced team communication with this project implementation is predicted to improve quality outcomes and increase cost savings

    Improving Vaccination Uptake in the Latinx Community Through Standardized Outreach

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    In the United States, Latinx communities have experienced a disproportionately high burden of COVID-19 infections and hospitalizations throughout the pandemic. The focus of this quality improvement project is to standardize the patient outreach process and education to increase COVID-19 vaccine uptake. The ambulatory community clinic in the city of Oakland, California serves a majority of underserved Latinx patients that have demonstrated distrust of the healthcare system and their disbelief in the positive outcomes of the COVID-19 vaccine. The high burden of COVID-19 infections among the Latinx community has led to misinformation and fear. In order to overcome this issue, Clinical Nurse Leader (CNL) skills have been used to analyze, educate, and manage future outcomes. Using these skills would have measured the number of vaccine appointments made after the implementation of standardization of outreach and education compared to the number vaccine appointments made prior to the implementation of the intervention. Due to COVID restrictions and difficulty in communication, the quality improvement project will be limited to establishing a clear purpose and intervention for future use to increase vaccination rates among the Latinx community. The recommendations provided will help staff members from the community clinic adapt and modify the interventions that will apply the needs of the community

    Optimizing Sepsis Care in a Medical Surgical Telemetry Unit

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    Problem: Sepsis is a potentially fatal condition that must be identified and treated immediately. Sepsis is a significant concern at Hospital X in California, as it is in many healthcare facilities worldwide. Sepsis is a life-threatening condition that occurs when the body\u27s response to infection becomes dysregulated, leading to widespread inflammation and organ dysfunction. At Hospital X, efforts are made to identify and treat sepsis promptly and effectively. The hospital employs various strategies, such as implementing early recognition protocols, educating healthcare providers on sepsis identification, and utilizing evidence-based interventions to improve patient outcomes. By enhancing sepsis awareness, providing timely interventions, and fostering a culture of continuous improvement, Hospital X aims to address the sepsis problem and to improve patient safety and care within its facility. Context: Clinical Nurse Leader (CNL)students from the University of San Francisco led this quality improvement project. The students started constructing a comprehensive and long-lasting plan of transformation that would benefit the patients and employees through a microsystem evaluation and strengths, weaknesses, opportunities, and threats (SWOT) analysis. The interdisciplinary team collaborated to form a unit-based and facility-wide sepsis committee that convened daily to discuss any challenging patients and monthly to discuss the ongoing management of patients suffering from sepsis. It\u27s important to note that the specific individuals involved in a clinical study on sepsis can vary depending on the study\u27s objectives, design, and the resources available within the hospital or research institution. key stakeholders involved in this project include, Unit Manager, data analyst, and Registered Nurses. Intervention: This intervention involved multiple components aimed at improving sepsis bundle compliance within the microsystem. Firstly, active and passive observational data were collected, allowing for a comprehensive understanding of the current practices and challenges related to sepsis management. Additionally, anonymous questionnaires were administered to the nurses, with participation incentivized to encourage engagement and gather valuable feedback on sepsis bundle adherence. The healthcare providers received sepsis bundle training, which aimed to enhance their knowledge and skills in sepsis prevention and management. The effectiveness of the training method was assessed to determine its impact on improving bundle compliance. Furthermore, the accessibility of the electronic cardiac arrest risk triage (eCART) system was evaluated, considering its role in facilitating efficient and accurate risk assessment for sepsis. Identified barriers to sepsis bundle adherence were examined to understand the factors hindering compliance and develop targeted interventions. The significance of the rapid response process in managing sepsis cases was also explored, highlighting its role in timely interventions. Based on the findings, recommendations were formulated to improve bundle compliance, addressing identified barriers and optimizing the rapid response process. This multifaceted intervention aimed to enhance sepsis bundle adherence and ultimately improve patient outcomes in the medical-surgical unit. Measures: Collaborated with Hospital X leadership team regarding sepsis among multiple medical-surgical units. Developed a specific aim statement on the unit of choice. Generated a PICOT question. Produced a proposal for Hospital X leadership approval. Created data collection questionnaires. Assessed the microsystem using the %ps. Conducted a SWOT analysis. Ran a root cause analysis. Collected data on the Medical-surgical unit: Passive and active observational data in the microsystem, administered questionnaires to the nurses. Analyzed data from observations and questionnaires. Reviewed the results from the gathered data. Developed recommendations based on the study’s findings. Presented the recommendation plan to Hospital X leadership on April 17, 202

    Reducing the No-show Rate of Breast Cancer Screenings: A Quality Improvement Project

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    Clinical nurse leaders (CNLs) are change agents who “improve quality, cost, or efficiency of healthcare delivery” (Noles, Barber, James, & Wingo, 2019, p. 307). The CNL of a breast cancer clinic recognized the significant impact the high no-show rate of breast cancer screening appointments had on patient outcomes and staff productivity. After conducting a microsystem assessment, the CNL organized a meeting with key stakeholders to identify potential interventions to address this issue. Concerns regarding the efficiency and effectiveness of the current telephone reminder system were raised, indicating an area for improvement. The CNL facilitated the team in researching evidence-based practices to identify a better method to remind patients of their appointments. After conducting the literature review, a text-based reminder system proved to be the most effective, efficient, and economical (Vidal, Garcia, Benito, Binefa, & Moreno, 2014). The aim of this quality improvement project is to reduce the breast cancer screening no-show rate by 2% to enhance the quality of life of patients, decreasing cancer mortality through early detection of breast cancer. During this time, the Covid-19 pandemic hit, preventing the progression and changing the scope of the project where implementation and evaluation of the intervention could not be accomplished. However, the CNL continued communicating and collaborating with staff members remotely to develop a detailed plan with the hopes of the team utilizing components that will work for them. The CNL was driven by professional values and core competencies to engage staff, cultivating an environment that supports change
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