Keane, Patrick, RN

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Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingImproving Patient Outcomes through BedsideNeurological ExaminationsPatrick Keane RNLehigh Valley Health Network, Patrick_C.Keane@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtKeane, P. (2014, December, 3). Improving Patient Outcomes through Bedside Neurological Examinations. Poster session presented at theCooper University Nursing Research Conference, Camden, NJ.   © 2014 Lehigh Valley Health Network Facts GoalBarriersImprove bedside change of shift communication of neurological assessments based on evidence and best practices  Pre-Implementation SurveyReeducation: Lunch-n-Learns by neurology experts	 	 	 –	 	differentiating	levels	of	consciousness	 	 	 –	 	muscle	strengths	 	 	 –	 	charting	discrepanciesTools: Pen lights and pupil size charts Standard work: neurological examinations conducted at the bedside•  Paucity of current research•  Nurse skepticism•  Hand-off report time constraints Nurse residents of a 14-bed neuroscience intensive care unit (NSICU) identified a ‘disconnect’ in the interpretation of neurological assessments during change of shift report. These discrepancies resulted in unnecessary calls to physicians and avoidable tests for patients. This presentation describes how practice changes were implemented to alter existing communication handoff at the bedside to improve the validity of neurological exams during change of shift. •  The ability to accurately assess a patient’s neurological status is crucial to the provision of safe and efficient care.•  Acuity assessments vary due to the subjectivity of the person completing the evaluation more often than an actual change in the patient.Problem Focused Triggers 1. Risk Management Data 2. Process Improvement Data 3. Internal/External Benchmarking Data 4. Financial Data 5. Identification of Clinical Problem Knowledge Focus Triggers 1. New Research or Other Literature 2. National Agencies or Organizational Standards and Guidelines 3. Philosophies of Care 4. Questions from Institution Standards Committee Consider Other Triggers NO Form a Team Assemble Relevant Research & Related Literature Critique & Synthesize Research for Use in Practice Is there A Sufficient Research Base? NO YES Pilot the Change in Practice 1. Select Outcomes to be Achieved 2. Collect Baseline Data 3. Design Evidence-Based Practice (EBP) Guideline(s) 4. Implement EBP on Pilot Units 5. Evaluate Process and Outcomes 6. Modify the Practice Guideline Conduct Research Base Practice on Other Types of Evidence 1. Case Reports 2. Expert Opinion 3. Scientific Principles 4. Theory Institute the Change in Practice Continue to Evaluate Quality Of Care and New Knowledge Is Change Appropriate For Adoption in Practice NO YES YES Disseminate Results Monitor and Analyze Structure, Process, and Outcome Data • Environment • Staff • Cost • Patient and Family Is this Topic A Priority For the Organization Reprinted with permission from Marita G. Titler, PhD; RN, FAAN, University of Iowa Hospitals and Clinics. Copyright © 2008. Source: Pediatr Nurs 2010 Jannetti Publications, Inc. The Iowa Model of Evidence-Based Practice to Promote Quality Care  Outcomes•  Early catches in patient neurological changes•  Increased peer accountability•  Timely communication with physicians•  Decreased calls to providers•  Medication reconciliation •  “Never-events” prevented“Conducting bedside exams together at change of shift ensures patients’ findings are documented according to clinical condition, not clinical opinion.”~Clinical Nurse, NSICU Next Steps•  Monitor for compliance•  Audit charts for charting discrepancies•  Conduct post-implementation survey•  Provide ongoing education References:1.	 	Communicating	to	Improve	Quality	Implementation	Handbook.	Agency for Healthcare Research and Quality.	Jiffs,	L.,	&	Beswick,	S.	(2013).	Patients’	Views	on	Bedside	Nursing	Handover.	Journal of Nursing Care Quality, 10,	1-6.	2.	 	Maxton,	P.,	Derby,	K.,	Wrobleski,	D.,	&	Foss,	D.	(2012).	Bedside	nurse-to-nurse	handoff	promotes	patient	safety.	MedSurg Nursing,	21(3),	140-144.3.	 	The	Agency	for	Healthcare	Research	and	Quality,	(2013).	Nurse bedside shift report: Implementation handbook.	Richard,	J.	(1988).	Congruence	between	intershift	reports	and	patients’	actual	conditions.	Image: Journal Of Nursing Scholarship,	20(1),	4-6.	4.	 	Wakefield,	D.,	Ragan,	R.,	Brandt,	J.,	&	Tregnago,	M.	(2012).	Making	the	transition	to	nursing	bedside	shift	reports.	The	Joint	Commission Journal on Quality and Patient Safety,	38(6),	243-253.(N=30,	71%	response	rate)Implementation Strategies PICO QuestionQ. Does change of shift nurse-to-nurse neurological examination at the bedside versus verbal neurological examination report affect identification of early neurological changes?•  Identify Problem•  Develop PICO question•  Complete literature search•  Build evidence table•  Disseminate findingsThe Iowa Model of Evidence-Based Practice to Promote Quality CareLehigh Valley Health Network, Allentown, PAImproving Patient Outcomes through Bedside Neurological Examinations   1. Bedside neurological shift report holds people accountable.  Strongly agree Agree Neither Agree or Disagree Disagree Strongly Disagree50% 33% 13% 3% 0%2. Bedside neurological shift report helps me prioritize my workload.Strongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree23% 60% 13% 3% 0%3. Bedside neurological shift report also allows me to perform medication reconcil iation.Strongly Agree Agree Neither Agree or Disagree Disagree Srongly Disagree13% 57% 17% 10% 3%4 . Immediately after bedside neurological shift report, I am able to communicate with    providers regarding patient care.Strongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree23% 47% 17% 13% 0%5. Approximately how many times have you picked up a neurological change at change of shift?5 Times or > 4 Times 3 Times 2 Times Never30% 27% 30% 13% 0%

Improving Patient Outcomes through Bedside Neurological Examinations

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Improving Patient Outcomes through Bedside Neurological Examinations

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