intro critical care nursing ex med ed
TRANSCRIPT
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Med-Ed, Inc * 1911 Charlotte Drive * Charlotte * North Carolina * 28203 * p (704) 333-1090 * f (704) 333-5020 * www.mededseminars.net
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Nursing EXcellence TrainingOnline Orientation Program
Introduction to Critical Care Nursing Module Presented by: Cammy House-Fancher, ACNP, MSN, CCRN-CSC, PCCN
Topic DescriptionThis introduction begins a comprehensive review of the core concepts required by the bedside critica
care nurse. The focus of this module is to prepare the novice critical care nurse to provide patient-centered, quality care in the complex environment of the intensive care unit. Presentations correlate
evidence-based practice guidelines, the “Institute of Health’s Improvement” Initiatives to “Save 100,000
Lives” and “Do No Harm”, and AACN’s concepts of a healthy work environment.
Chapters1. Evidence Based-Practice2. Healthy Work Environment
3.
Daily Goal Checklist4.
Save 100,000 Lives5. Do No Harm
Objectives At the completion of this topic, the participant will be able to:
1. Incorporate principles of critical care nursing, the synergy model and evidence-based practice to
provide a healthy work environment and improve patient outcomes.2.
Analyze common critical care health problems and their treatment modalities.3. List, discuss and utilize treatment modalities to prevent complications of critical illness.
4. Improve communication and collaboration with peers and colleagues responsible for patient care.
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Introduction toCritical Care Nursing
Med Ed
2009
Objectives
1. Discuss and define the hospital’s
mission of care for the critically ill
adult. 2. Incorporate principles of critical
care nursing, the synergy model and
evidence based practice (EBP) to
provide a healthy work environment
and improve patient outcomes.
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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Objectives
3. Analyze common critical carehealth problems and their treatment
modalities.
4. List, discuss and utilize treatment
modalities to prevent complications of
critical illness.
Objectives
5. Improve communication and
collaboration with peers and
colleagues responsible for patient
care.
Critical Care
Major changes have occurred in every
aspect of health care delivery
Focus of the nurse has expanded from
direct patient care to organizing anddelivering EBP patient-centered care
with multiprofessional collaboration to
optimize patient outcomes within a
managed care environment…….
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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Focus
Integrating sophisticated technologywith psychosocial challenges and
ethical conflicts associated with
critical illness.
Patient and Family Centered
“Humanized’ Care
Changes
Pt acuity
Safety risks
Reduced stay
New technology
Nurse shortage
Cost reduction
Total qualitymanagement
Managed care
New devices
New regulations
EBP
Emphasis on outcomes, cost-
effectiveness, and consumer
satisfaction
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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EBP
“improving the quality of healthcarerequires a commitment to delivering
healthcare based on sound scientific
evidence and continuously innovating
new, effective healthcare practices
and preventive approaches..” President’sAdvisory Commission on Consumer Protection and
Quality in Healthcare
Steps to EBP Critical Care
Nursing Accept change
Exam pt outcomes
Causes of
dissatisfaction
Frame a clinical
question and searchliterature
Scientific merit
Conduct comparisonof current practiceand current
research
Implement change
Measure progress
Measure progress
Measure progress
Critical Thinking
Panel of experts: 10 affective habits of the
mind and 7 cognitive skills, components of
critical thinking 10 habits
Confidence, Contextual Perspective,
Creativity, Flexibility, Inquisitiveness,Intellectual Ability, Intuition, Open-
Mindedness, Perseverance, and Reflection
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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7 Cognitive Skills
Analyzing, Applying Standards,
Discriminating, Information Seeking,
Logical Reasoning, Predicting, and
Transforming Knowledge
Critical Thinking 101
Traditional teaching--Does Not Work
Strategies
Case Study Format, simulation,
videotaped vignettes, role playing,
clinical questioning
Mentors, Role Model
“Tinciture of Time”
Novice To Expert
Clinical Experience and Time
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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Synergy Model
AACN’s Model
1999
Link certified practice to clinical
outcomes.
Working Together
Common Goal
Patient - Nurse Link ??
What Drives the System
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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Transform Your Practice
Daily
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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Patient SafetyBest Bedside Practice
Cammy House-Fancher, ACNP,MSN, CCRN-CSC, PCCN
University of Florida
Patient Safety
• BEST Practice
• Bring Up the Bar
• Kick It Up a Notch
• Make It Happen
• Culture of Excellence
CULTURE OF EXCELLENCE
• AACN’s promotes creation of HWE
• HWE supports and fosters excellence in
patient care• Committed to promoting excellence in
patient care
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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COMPONENTS OFEXCELLENCE
• EDUCATION
• COMMITMENT
• ENVIRONMENT
EVIDENCE BASEDPRACTICE
• “Conscientious application of scientifically bestpractice by clinician in concert with patientunderstanding and valves”
• “Science of Medicine”
• “The integration of individual clinical expertise withthe best available external clinical evidence fromsystematic research” “ Art ofMedicine”
CDC: RATING THEEVIDENCE
• Category IA: strongly recommended forimplementation based on well-designed
clinical studies• Category IB: strongly recommended for
implementation based on clinicalstudies or theoretical rationale
• Category IC: required by state orregulatory agencies
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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CDC
• Category II: suggested for implementationbased on clinical studies or theoreticalrationale
• Unresolved issue: evidence is insufficient orno consensus regarding efficacy
» CDC 2003 Guidelines for Prevention of Healthcare Associated Pneumonia: MMWR;2004:53(no RR-3)
BEST CARE PRACTICES
• Build value into the structure
• Build value into the practice ofevidence-based practice--Medical andNursing
• Can Not change behaviors without“owning” the practice
• The value is inherent in evidence
BUILDING A PRACTICE OFEXCELLENCE
THROUGHKNOWLEDGE
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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EXCELLENCE
• Building Environment• Decreasing errors
• Increasing Patient Safety
• Checklists
10 TIPS TO IMPROVE CAREIN YOUR ICU
1. Conversation: www.sccm.org/tips
2. Improve Nursing Through Certification
3. Improve Skills of the Non-ICUSpecialist: FCCSCourse
4. Standardize ICU Practice: Evidence BasedGuidelines
5. Reduce Medication Errors
10 TIPS TO IMPROVE CAREIN YOUR ICU
6. Improve the Physical Environment
7. Measure Your Progress
8. Be More Visible
9. Advocate for Better Care
10. Implement a MultiprofessionalTeam Approach
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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WHAT ARE WE TALKING ABOUT
• Creating the case for HWE• Overview of the AACN Standards
• “Painting a picture” of HWE using theStandards and critical elements
HWE
• Mounting evidence that unhealthy work environmentscontribute to medical errors, ineffective delivery ofcare, and conflict and stress among healthprofessionals.
• Create healthy work environment to ensure patientsafety, enhance staff recruitment and retention, andmaintain an organization’s financial viability.
HWE: TWO STRATEGICPLATFORMS
• 1. Work and care environments mustbe safe, healing and humane, respectful
of the rights, responsibilities, needs andcontributions of patients, their families,nurses and all health professionals.
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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• 2. Excellence in acute and critical carenursing practice is driven by the needsof patients and their families and isachieved when nurses’ competenciesare matched to those needs.
MY GOALS
• IMPROVEMENT OF PATIENTOUTCOMES: WHERE IS THE EDGE
• Challenge your thinking
• Make you uneasy
• Move you to action
ASSERTION # 1
• There is a direct link between workenvironment and patient safety
• Ergo, if you are not addressing yourwork environment, you are not
addressing patient safety…
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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• “The mistakes are all there, waitingto be made”
– Chess master S. Tartakower (1887-1956)
ASSERTION # 2
• Healthy work environments do not justhappen
• Ergo, if you do not have a formalprogram in place addressing work
environment issues, little will change
• “Organizations learn and evolve throughconscious, deliberate action. Deliberate
action is ethical. When the time to acthas come, it is unethical not to dosomething.”
» David Thomas
» Ethics of Choice
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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ASSERTION #3
• Creating healthy work environments requireschanging long-standing cultures, traditionsand hierarchies
• Ergo, while everyone must be involved in thecreation of healthy work environments, theonus is onorganizational/departmental/unit leadersto assure that it happens
• “To do more than the minimum inanything takes leadership…”
» Robert Wachter
» 2004
THE ASSERTIONS
• HWE’s are directly linked to patientsafety
• HWE’s require a formal program
• Leaders must drive HWE’s
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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AACN’S STANDARDS
• The standards represent evidence-based and relationship-centeredprinciples of professional performance.
• Align directly with core competenciesIOM.
STANDARDS
• NEW WORDS
• Outcomes, Evidence-Based Practice,RCT, Patient Centered Care, E ICU,Informatics
• Patient Driven Care
• Daily Goal Sheets
AACN’s STANDARDS
• MEANINGFUL RECOGNITION
• Nurses must be recognized and mustrecognize others for the value eachbrings to the work of the organization
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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AACN’s STANDARDS
• AUTHENTIC LEADERSHIP
• Nurse leaders must fully embrace theimperative of a healthy workenvironment, authentically live it andengage others in its achievement
CREATING THE CASE FORHWE’s
WHAT DO WE KNOW????
STANDARDS
• Skilledcommunication
• TrueCollaboration
• Effective decisionmaking
• AppropriateStaffing
• MeaningfulRecognition
• AuthenticLeadership
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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• Communication issues arepresent in 65% of all sentinelevents reported to JCAHO
COMMUNICATION ISSUES
• Are present in more than 75% of wrongsite surgeries and delays in treatments
• And they are present in more than 60%of medication errors and ventilator“events”
SKILLED COMMUNICATION
• Focus on finding solutions
• Protect relationships
• Hear all perspectives
• Good will and mutual respect• Congruence between words
& actions
• Zero-tolerance
• Formal structures
for communication• Access totechnology
• Evaluation
• Part of performanceappraisal
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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Skilled Communication
• “Stories vs Facts”
• Collaboration • More than 90% havewitnessed disruptivebehavior by MDs
• Aware of actual adverseconsequences
• 17-30% nurses leave
• High prevalence of disruptivebehavior among nurses
TRUE COLLABORATION
• Nurse managers and medical directorsare equal partners in modeling and
fostering true collaboration.• Unresponsive bureaucracy generates
organizational stress=nurse burnout
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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CREATING THE CASE
Are There Challenges???
CHALLENGES TO THECASE
• Links to patient safety are notuniversally recognized
• Relationship issues seen as “soft”
• Hierarchy and power structures
• Hard to measure improvements
• Tradition
• Not a “sexy” issue
In the $1.5 trillion US health caresystem
• “Hospitals, like any other business, need tobe accountable for providing services thatdon’t harm the people they serve”
» R. Bison and Singh, 2003
» Wall of Science
• “We spend $25,000 for pills, procedures, andbedpans for every one dollar on patientsafety.”
» Wachter & Shojania, 2004
» Internal Bleeding
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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HWE’s
• This is being demanded by:• The Public
• Policy Makers
• Regulators
• Health Care Professionals
• Common Sense and Doing the RightThing
AACN’S HWE
• Common Threads
• Organizational responsibilities
• Individual responsibilities
• Support for & access to educationalprograms related to each
• Leadership/administration support
TRUE COLLABORATION
• Accountabilitydefined
• Decision makingauthority
• Resources fordispute resolution
• Embrace “culture” ofcollaboration
• Ethical lim its
• Respect each voice
• Personal integrity
• Skilledcommunication
• Competence of allteam members
• Nurse and MD equalpartners in care
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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TRUE COLLABORATION
• Patient and family satisfaction, patientsafety and outcomes, professional staffsatisfaction, nurse retention and cost.
• All related to collaboration !!!
EFFECTIVE DECISIONMAKING
• Organizationalvalues clear
• Structures assurepatients and familiesare heard
• Sharedaccountability fordecision making
• Respect for right ofall
• Incorporate all keyperspectives
• Evaluate results ofdecisions
• Cammy: hard data
EFFECTIVE DECISIONMAKING
• Responsibility=Accountability
• Authority
• National programs such as AACNBeacon Award for Critical CareExcellence, Magnet Nursing ServicesRecognition Program and the BaldrigeNational Quality Program.
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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APPROPRIATE STAFFING
• Staffing policiessolidly grounded
• Nurses participate inentire staffingprocess
• Staffing decisionsare evaluated
• Most Harmful
• Cammy: turn over
• Access to staffingdata
• Support servicesavailable to ensurenurses focus onnursing work
• Technologiesadopted that ⇑effectiveness ofnursing caredelivery
STAFFING
• Medication Error: Reporting Error inPatient Care
• Will not do the variance reporting???
• Why not????
• A way to track and tell the system of aproblem
STAFFING
• Evidence suggests that better patientoutcomes result when a higher proportion ofcare hours is provided by registered nurses.
– Needleman J, N Engl J Med 2002:346:1715-1720
• Further research supports a relationshipbetween specialty certification and clinicalnursing expertise
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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MEANINGFULRECOGNITION
• Comprehensiveprogram in placefor all
• Process forknowing how toparticipate
• Bedside to boardtable
• Includes process todetermine thatrecognition ismeaningful
• Recognition systemis regularlyevaluated
• Everyone isresponsible
RECOGNITION
Tweeners
Positrons Negatrons
RECOGNITION
• Establishing a Work Culture
• Role Modeling
• Mentorship• Fun
• Three L Philosophy
• Love it: Learn to love it:
• Leave it
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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AUTHENTIC LEADERSHIP• LEADERS:
• Understandrequirements/
• dynamics at point ofcare
• Generate visibleenthusiasm
• Role model
• Evaluate their impact &progress toward HWE
• ORGANIZATION:
• Assure leaders are wellpositioned andsupported
• Provide time, financialand human resources
• Include leader’s role inHWE into performanceappraisal
LEADERSHIP
• MENTORING
• MOVING THE STAFF FORWARD
• ROLE MODEL
“Our days begin to end theday we become silent about
things that matter.”
Martin Luther King, Jr.
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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HWE
• Call to action from AACN• National focus that becomes Patient
Centered Care with the Nurse as the“owner” and “driver” of excellence.
ALL ABOUTPLAYING IN THE SAND BOX
TOGETHER
DAILY GOAL CHECKLIST
THIS is patient Safety
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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TOP THREE PRIORITIES TOD/C PT
• Greatest pt safety risk from the Unit• Review med; can any be discontinued?
• Review tests, procedures, scheduledlabs, X-rays; can any be discontinued?
• Review catheters and tubes; can anybe discontinued?
• Adequate comfort/pain management?
TOP THREE
• Activity/PT/OT/Rehab consults?
• Sedation indicated? Can it be weaned?Changed to oral?
• Respiratory/Ventilator goals
• Neurological-ICP/psychological issuesand goals?
• Renal, fluid balance goals, electrolytereplacement-oral?
TOP THREE
GI/Nutritional goals
Liver/Pancreas
Hematology/Coagulation=blood productinfusion criteria
ID: cultures, drug levels-appropriateagents and doses?
Reviewed consultations: new?
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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TOP THREE
• Surgical Plans
• Communication with referring MD
• Family communication/social issues/code status
• Discharge planning--write transfer orders?
• Implement care protocols? Ventilator-weaningorders, sedation-weaning orders, glucose control,DVT & PUD prophylaxis?
TOP THREE
• HOB at 30 degrees
• Research protocol candidate? Glucosecontrol, extubation, bronchiolitis, etc.
GOALS
• Every Nurse, rounding MD, RespiratoryTherapist, PT, and all team members
should have same goals for patient andfamily
• Use Goal Checklist!!!!!
• Keep on Track for patient safety andHWE
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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SAVE 100,000 LIVES
THE CAMPAIGN
HOW IT WORKS
HOW TO START
100,000 Lives Campaign Objectives(December 2004 – June 2006)
• Save 100,000 lives
• Enroll more than 2,000 hospitals in theinitiative
• Build a reusable national infrastructurefor change
• Raise the profile of the problem(variability in the quality of Americanhealth care) - and our proactive response
100,000 Lives
• Is an initiative to engage US hospitals in acommitment to implement changes in careproven to improve patient care and preventavoidable deaths. End date is June 2006.
• IOM est 98,000 pts die secondary to medicalerrors
• CDC est 2 million pts have Hospital acquiredinfections.
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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Delivery of Evidenced-BasedCare
• Deployment of Rapid Response Team• Prevention of Adverse Drug Events
• Prevention of Central Line Infections
• Prevention of Surgical Site Infections
• Prevention of Ventilator-AssociatedPneumonia (VAP)
• Comprehensive Care of AMI
SAVE 100,000 LIVES
• HOB elevated! HOB elevated!
• No Nasal Tubes
• Sterile Technique
• Appropriate Sedation
• Glucose < 110 mg/dl
• Oral Care: Chlorhexidine
SAVE 100,000 LIVES
• Assessment of ability to extubate: venttraining protocols
• PUD prophylaxis• DVT prophylaxis
• HOB elevation > 30 degrees
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
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STRATEGIES
• Conventional Infection Control• Strategies Related to GI Tract
• Strategies Related to Patient Placement
• Strategies Related to Artificial Airways
• Conventional DVT Prophylaxis
Bundles• What is a "bundle"?
• A "bundle" is a group of interventions related toa disease process that, when executed together,result in better outcomes than whenimplemented individually.
• Examples of bundles include:
• * Ventilator Bundle
• * Central Line Bundle
• * Severe Sepsis Bundles
• * Ventilator Bundle
• * Central Line Bundle
• * Rapid Response Teams• * Multidisciplinary Rounds
• * Daily Goals Assessment
• * Intensivist Model
• * Effective Glucose Control
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
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1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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BUNDLES
• Development of Bundles of CareVentilator Bundles
Sepsis Bundles
DVT Prophylaxis
PUD Prophylaxis
Central Line Bundles
Bathing/Mouth Care/Turning Bundles
An Introduction to the5 Million Lives Campaign
December 12, 2006
100,000 Lives Campaign Objectives(December 2004 – June 2006)
• Save 100,000 lives
• Enroll more than 2,000 hospitals in the
initiative• Build a reusable national infrastructurefor change
• Raise the profile of the problem(variability in the quality of Americanhealth care) - and our proactive response
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
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1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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The Next Campaign
WE’RE GOING AFTER HARM…
Our Definition of Medical Harm
Unintended physical injury resulting from orcontributed to by medical care (including theabsence of indicated medical treatment), thatrequires additional monitoring, treatment orhospitalization, or that results in death.
Such injury is considered harm whether or not it isconsidered preventable, whether or not itresulted from a medical error, and whether ornot it occurred within a hospital.
For more information, please reference detailed FAQs at www.ihi.org/campaign.
The Next Campaign
WE’RE GOING AFTER HARM…
but what do we mean by “harm”?
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
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The Next Campaign
WE’RE GOING AFTER HARM…
but how much harm will we
reduce?
Logic Chain: Step 1
How Many Admissions perYear?
37 Mill ion Admissions
Source: The AHA National Hospital Survey for 2005
Logic Chain: Step 2
40 to 50 Patient Injuries per 100
Hospital Admissions
Source: IHI “Global Trigger Tool” Guiding Record Reviews
How Often Are Patients
Injured by Care?
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
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Logic Chain: Step 3
37 Million Admissions
X
40 Injuries per 100 Admissions
=
15 Milli on Injur ies per Year
How Many Injuries in the US?
The 5 Mill ion LivesCampaign
We are asking hospitals participating in theCampaign to prevent five million incidents ofmedical harm over the next two years.
Given the performance IHI has observed inhighly successful hospitals, and given all thatthe industry is investing in improving thequality of care nationally, we believe we can –and must – find a way to achieve such resultsin this period.
The 5 Mill ion LivesCampaign
• Campaign Objectives:
– Avoid five million incidents of harm over the next 24 months;
– Enroll more than 4,000 hospitals and their communities in
this work; – Strengthen the Campaign’s national infrastructure for
change and transform it into a national asset;
– Raise the profile of the problem – and hospitals’ proactiveresponse – with a larger, public audience.
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
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The six interventions from th e 100,000 Lives Campaign:
• Deploy Rapid Response Teams…at the first sign of patient decline
• Deliver Reliable, Evidence-Based Care for Acute MyocardialInfarction…to prevent deaths from heart attack
• Prevent Adverse Drug Events (ADEs)…by implementingmedication reconciliation
• Prevent Central Lin e Infections…by implementing a series ofinterdependent, scientifically grounded steps
• Prevent Surgi cal Site Infections…by reliably delivering the correctperioperative antibiotics at the proper time
• Prevent Ventilator-Associated Pneumonia…by implementing aseries of interdependent, scientifically grounded steps
The Platform• Prevent Pressure Ulcers... by reliably using science-based
guidelines for their prevention• Reduce Methicillin -Resistant Staphylococcus aureus (MRSA)
Infection…by reliably implementing scientifically proven infectioncontrol practices
• Prevent Harm from High-Alert Medications... starting with a focuson anticoagulants, sedatives, narcotics, and insulin
• Reduce Surgical Complications... by reliably implementing all ofthe changes in care recommended by the Surgical CareImprovement Project (SCIP)
• Deliver Reliable, Evidence-Based Care for Congestive HeartFailure…to reduce readmissions
• Get Boards on Board….Defining and spreading the best-knownleveraged processes for hospital Boards of Directors, so that theycan become far more effective in accelerating organizationalprogress toward safe care
www.ihi.org/campaign
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Introduction to Critical Care Nursing Module Sample Test Questions
1. What is the best level of evidence available for practice according to CDC?A. Level 3
B. Level 1a
C.
Level 2aD. Level 1b
2. Evidence-Based practice includes the art of medicine and the science of medicine.
A. TrueB. False
3. The Synergy model advocated that:A. The patient and family are the center of the universe
B. The health care team is the center of the universe
C. The administration is the center of the universe
D.
Government control should be the focus of health care policy
4. SCCM has tips to improve care in the critical care unit, this includes:
A. Nursing that is certifiedB. Standardizing practice
C. Improved physical environment
D. All the above
5. List four of the 10 effective habits that improve critical thinking skills:
A. Confidence, creativity, flexibility, open-mindednessB. Confidence, inflexibility, rigidness, discriminatory thinking
C. Confidence, creativity, discriminatory thinking, stubbornness
D.
Confidence, rigid thinking, unforgiving behavior, one-minded
6. Healthy work environment has an emphasis on patient outcomes, cost-effectiveness,
and consumer satisfaction.
A. TrueB. False
7. AACN’s Healthy Work Environment includes the following standards: skilledcommunication, true collaboration, effective decision-making, appropriate staffing,
meaningful recognition, and authentic leadership.
A. TrueB.
False
8. Communications problems do not represent the most common cause of sentinel
events.A. True
B. False
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
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1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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Introduction to Critical Care Nursing Module Sample Test Questions
9. The focus of AACN’s Healthy Work Environment includes a:A. Patient and family centered plan of care
B. Reduction of cost plan of care
C.
Communication care planD. All the above
10. Save 100,000 Lives was a campaign initiated by the Institute of Health Improvement
(IHI) for the development of a profile to improve patient care and prevent avoidabledeaths.
A. True
B. False
11. The resultant strategies developed from the profiles from the IHI Save 100,000 have
now been instituted nation wide and include the use of “bundles of care.”
A.
TrueB.
False
12. One of the most developed “bundles” in the Save 100,000 Lives was the:A. VAP Bundle
B. Communication Bundle
C. Sepsis BundleD. UTI Bundle
13. Other aspects of the Save 100,000 Lives Campaign provided information on manareas of patient care, including:
A. No nasal tubes
B.
Appropriate sedationC. Glucose control
D. All of the above
14. The definition of “bundle” includes a group of interventions related to a disease process, that, when executed together, result in better outcomes than when
implemented individually.
A. TrueB. False
15. In the platform for the six interventions for Save 100,000 Lives, the deployment of arapid response team:
A. Has shown to improve patient outcomes
B. Has shown to improve nurse/physician communication
C. Has shown to improve bedside assessmentsD. All the above
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
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1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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Introduction to Critical Care Nursing Module Sample Test Questions
16. The presence of a surgical site infection depends primarily on:A. Reliably delivering the correct perioperative antibiotic at the proper time
B. Continuing antibiotic therapy for one week post operatively
C.
Admitting the patient to the hospital two days before the surgery dateD. Use of betadine as a preoperative wash
17. The next national initiative by the IHI is still underway and is know as “Do No
Harm”. The goal of this campaign is to reduce the number of errors that result in patient injury.
A. True
B. False
18. How often are patients injured during their hospital stay?
A. 5 per 100 admissions
B.
10 per 100 admissionsC.
20 per 100 admissions
D. 40-50 per 100 admissions
19. The goal of the “Do No Harm” campaign is to reduce patient injury that results in
death by 5 million lives.
A. TrueB. False
20. In the Do NO Harm Initiative, prevention form harm from high alert medicationsincluded:
A. Anticoagulants
B.
Narcotics and sedativesC. Insulin
D. All the above
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN
1911 Charlotte Drive Charlotte, North Carolina 28203T 704-333-1090 * F 704-333-5020 * www.MedEdSeminars.net * [email protected]
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Introduction to Critical Care Nursing Module Sample Test Questions
Answers:
1.
B2. A
3. A
4. D
5. A6. A
7. A
8. B9. D
10. A
11. A
12.
A13.
D
14. A
15. D16. A
17. A
18. D19. A
20. D
Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module
Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN