improved safety through an acuity driven tool · 2016-03-23 · page 4 of 16 translate scores in to...

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Organization: Suburban Hospital Johns Hopkins Medicine. Solution Title: Improved Patient Safety Through An Acuity Driven Tool For Equitable

Geographic Assignments on the Progressive Care Unit (PCU). Program/Project Description: Develop a unit‐specific acuity tool to efficiently staff a 20‐Bed Progressive Care

Unit (PCU). Problem to be solved: Our 20‐Bed Progressive Care Unit (PCU) staffing levels and practices – unit was

running significantly over our standard for nursing hours and unit was running over its nursing budget. Adding more staff was not a viable option.

Problem Identified by: Progressive Care Unit’s (PCU) CUSP Team ‐ CUSP Team Champion Existing baseline data: Our pre and post data included the following:

1. Surveys of the nursing staff about the effectiveness of the Acuity‐Driven Nursing Assignments.

2. Patient Falls Data. 3. HCAHPS results for Nursing Communication and Staff Responsiveness. 4. Incremental staff overtime levels.

Goals/Success Criteria: 1. Make acuity‐balanced geographic patient assignments for the oncoming shift.

2. Use the acuity scores to create equitable patient assignments. 3. Reduce patient falls. 4. Reduce staff overtime. 5. Allocate nurses per patient acuity:

a. Allow for focused care on patient and family. b. Reduce medical and medication errors. c. Decrease patient complications. d. Improve patient satisfaction. e. Reduce nurse fatigue. f. Decrease nurse burnout. g. Improve nurse retention and job satisfaction.

Process to develop Solution: Conducted a thorough assessment of our staffing practices on February 1st, 2015 PCU staff and ancillary staff were given a CUSP tool: Staff Safety Assessment Form. The purpose of this was to tap into staff knowledge and experiences at the frontlines of

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patient care to find out what risks were present in the PCU that had or could have jeopardized patient safety. Initial 2‐question safety survey:

1. How you think the next patient in your unit will be harmed? 2. What you think can be done to prevent or minimize this harm?

Solution: Acuity tool and Geographic Assignments ACUITY TOOL : ( 1= LOWEST, 4 = HIGHEST ACUITY) SCORES TO BE COLLECTED BY CHARGE NURSE AT 5 P.M FROM NURSE

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Translate Scores In to Patient Assignments

1. To translate acuity scores into equitable patient assignments the charge nurse will collect the acuity tool from direct care nurses once completed for each patient and calculate total acuity scores near the end of each shift.

2. Keep scores balanced across nurses. Charge nurse will consider geographic location of rooms, need for continuity of care, congruency between nurse expertise and patient needs.

What To Consider for Staff Assignments:

1. Acuity Score: Assess complexity of patient care needs. 2. Unit Geography. 3. Continuity of Care. 4. Competency and Experience of Staff.

Solution Implementation: CUSP Strategy 1. Implementing an acuity tool: 1. Allocate nurses per patient acuity:

A. Allows for focused care on patient and family. B. Reduces medical and medication errors. C. Decreases patient complications. D. Improves patient satisfaction. E. Reduces nurse fatigue. F. Decreases nurse burnout. G. Improves nurse retention and job satisfaction.

2. Before roll out of the geographic assignment and acuity tool we educated the staff by: 1. Presenting case studies so nurses could practice using the tool. 2. Stimulating discussion of the benefits of the geographic assignment and the tool:

A. The benefits of empowerment. B. Assurance of quality care. C. Patient safety and satisfaction.

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D. Nurse Retention. E. Equitable assignments.

3. Needs for staff are determined by several factors that include but are NOT limited to: 1. Age of Patient. 2. Complexity of patient care, frequency of assessments and interventions, tests required. 3. Education needs of patient and their family. 4. Special cultural needs of patient and family/significant other. 5. Need for infection protocols, specialized equipment. 6. Psychosocial needs.

Measurable Outcomes: 1. Nurse Communication and Staff Responsiveness. 2. Incremental Staff Overtime Levels. 3. Patient Falls data.

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Fall Data: Nearly 3 months without a fall from August 14, 2015 to present.

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Sustainability: 1. Senior Management has endorsed the tool and made it mandatory practice.

2. Staff sees value of tool and has fully bought into using it daily. 3. CUSP team continues to monitor tool use and attain staff feedback. 4. CUSP team analyzes measurable outcomes to see if they align with

success criteria. Role of Collaboration and Leadership: Mission Statement: CUSP’S mission for the 3200 PCU unit is to provide

exceptional patient and family centered health care in a safe environment that meets and exceeds the expectations of those we serve and educate. 1. CUSP meets monthly to monitor the Acuity Tool Program. 2. CUSP team created for program oversite with the following staff (order not

relevant): 1. Chief nursing officer 2. PCU Director 3. PCU Manager 4. ICU physician 5. Hospitalist 6. Nurse Practitioner 7. Case Manager 8. Pharmacist 9. PCU Unit RNs 10. Patient Care Tech 11. Patient Family Representative

Innovation: The Acuity tool is innovative because: 1. It is simple to implement. 2. It can be quickly tailored to any type of Medical unit with a few

modifications to meet specific patient needs. 3. Tool implementation will generate a cost savings gained via efficient

allocation of staff and reduced staff incremental overtime.

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Response of Hospital Staff

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Incremental Overtime

235

200.7

175.5167.8

175.5

118.2

0

50

100

150

200

250

April May June July Aug Sept

Hours

Months

Incremental Overtime ‐ 2015

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CUSP SURVEY

1. Do you find the acuity tool has helped with nurse assignments?

2. Do you find the score is reflecting the workload required for the patient and the assignments are equally distributed on the unit?

3. Has geographic assignments helped with efficiency of your care for the patients?

4. Do you find you are able to leave your work shift on time, and are not staying overtime to chart on your patients?

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Do you find the acuity tool has helped with nurse assignments?

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Do you find the score is reflecting the workload required for the patient and the assignments are equally distributed on the unit?

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Has geographic assignments helped with efficiency of your care for the patients?

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Do you find you are able to leave your work shift on time, and are not staying overtime to chart on your patients?

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CUSP Timeline

PCU CUSP Champion: Melissa Shively RN, BSN Email: mshivel2@@jhmi.edu Phone: 301.896.2810

PCU Unit Manager: Cora Abundo, RN, BSN Email: [email protected] Phone: 301.896.2810

improved safety through an acuity driven tool · 2016-03-23 · page 4 of 16 translate scores in to...

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