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St. Francis Critical Care: Nursing Unit AssessmentKayla Hopper, Kerri Jo McDaniel, Alex Rodriguez, Baylee
Stephens, Kailey Sweatman, & Sam Trupp
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St. Francis
• Located in Columbus, Georgia
• Nursing Manager: Kelli Koelsch
• Intensive care unit (ICU)- 13 beds
• Critical care unit (CCU)- 10 beds
• Overflow care unit (OCU)- 4 beds
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Who is Kelli Koelsch?• Nursing manager for both the CCU and ICU units
at St. Francis hospital
• Worked bedside for 12 years
• Has been a nurse manager for 2 years
• Advice:• Know how to multi-task• Always identify communication as a problem• People skills are a must• Have to be able to admit that you are wrong
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Mission
St. Francis, a community-owned, Catholic healing ministry exists to provide exceptional health care
services, in partnership with physicians, for all those in need.
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Vision
St. Francis will be the preeminent health care delivery system in the Chattahoochee Valley and
surrounding communities- the first choice of patients, physicians, associates and payers for
health, wellness and life.
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Core Values/Goals• Excellence
• Professionalism
• Courage
• Compassion
• Creativity
• Open Communication
• Mutual Respect
• Ethical Behavior
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Unit Culture• Good interpersonal relationships
• Friendly with peers, patients, and families
• Teamwork
• Good orientation for new nurses
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Conflict Resolution Strategy
• Open communication
• Hear both sides of the story before a decision is made
• Address the problem with each person individually
• Have a meeting with all individuals involved
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National Patient Safety Goals
• Pressure ulcer prevention• NPSG.14.01.01: Assess and periodically reassess
each resident’s risk for developing a pressure ulcer and take action to address any identified risks.
• Central line-associated bloodstream infection prevention (CLABI)• NPSG.07.04.01: Implement evidence-based practices
to prevent central line-associated bloodstream infections.
• Catheter-associated urinary tract infections (CAUTI) prevention• NPSG.07.06.01: Implement evidence-based practices
to prevent indwelling catheter-associated urinary tract infections.
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Pressure Ulcer Prevention• Nationwide:
• 2.5 million patients per year acquire a pressure ulcer• Pressure ulcers cost $9.1-$11.6 billion per year in the
U.S.• About 60,000 patients die as a direct result of a pressure
ulcer each year
• St. Francis Critical Care Unit:• In the beginning of 2012, the ICU had 2 pressure ulcers
and the CCU had 2 pressure ulcers• As a result, they reevaluated the policies and procedures
• Purchased new critical care beds• Set up turn teams on ICU and CCU• Designate 2 nurses per shift to remind all the other nurses
about positioning• Chart position every 2 hours
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Financial Issues on the Unit
• Core measures and reimbursement complications• Performance based
• Must score well to be reimbursed for care• Performance is tracked throughout the year by
submitting data.• If they don’t submit data/score well, they don’t get
reimbursed.
• Sample data that is graded• Post-operative patients have to have their Foley
catheter removed by post-op day 1 • Have a blood sugar less than 200 post-op
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Need for Change on the Unit
• Change needed: Reporting at the bedside• It is a standard of nursing practice that report be
given at the bedside.
• Driving force:• The unit implemented a policy that nurses give
report at bedside (except for some personal patient information).
• Restraining force:• It is difficult to shift from reporting in the nursing
station because it is a habit.
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Patient-centered Care• Open visitation policy
• Except for the quiet time at night or during certain procedures
• Visitors can’t stay on the unit over night, but the waiting room is always open
• Physician explanation• Physician should make the decision of whether to
discuss patient-care and interventions with the family or another group of doctors if the patient is unable to make their own decision
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Continuous Quality Improvement Measures
• Hospital-wide measures that are more focused on this unit
• Acute coronary syndrome policy• Goal: 90 minutes to cath lab
• Stroke• CT within 3 hours• TPA if indicated
• CABG• Prevention of sternal infection
• Ventilator-associated pneumonia
• CAUTIs and CLABIs
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Leadership Skills• Focus on interpersonal relationships
• Facilitates feedback to ensure that communication remains open
• 3 staff meetings offered per month for the sake of communication
• Power of motivation• Team building• Consistent feedback
• Discipline policy• 1st offense: documented, but education on the error is
the focus• 2nd offense: verbal warning• 3rd offense: write-up
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Current Recruitment and Retention on the Unit
• Recruitment:• They do not have any bonuses, referral bonuses, or
any huge effort in place in the CCU • Recruit within the hospital using the clinical ladder
• Retention/Attrition Rate:• They do have a retention problem because people
go back to school (nurse practitioner and CRNA schools)
• Average years worked is 5• Big turnover every 2 years for people going back to
school
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Staffing Process• Normally a 2:1 ratio
• Exceptions to the 2:1 ratio:• Open heart, balloon pump, induced hypothermia, or
if the patient has coded or is at risk for coding• All of these would be a 1:1 ratio
• Floating• Try to avoid calling in other unit nurses because
CCU/ICU is so specialized• If it is a necessity, they prefer to call nurses from
telemetry
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QUESTIONS?
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References
• http://www.ahrq.gov/research/ltc/pressureulcertoolkit/putool1.htm
• http://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFaqId=163&ProgramId=1