Strategies for Success in Regulatory Readiness.

This article describes the formation of a Regulatory Advisory Council to address regulatory preparedness. The council used quality improvement methods to address data and findings from previous mock surveys and created 2 categories of work, an environment of care and clinical standards group, with checklists and work streams to improve organizational success with regulatory readiness.

KIDS CARE: A Behavioral Model To Strengthen Patient and Family Partnerships.

Patient- and Family-Centered Care is a core value of The Children's Hospital of Philadelphia (CHOP). Satisfaction/ experience data are closely tracked to assist in determining if hospital staff are partnering effectively with patients and families. When opportunities for improvement were identified within the Nursing Department, an existing institutional model, KIDS CARE, was used to promote change. KIDS CARE was developed to teach and reinforce respectful behaviors for nurses initiating partnerships with patients and families. The Patient Satisfaction Committee partnered with the Family Advisory Council and Shared Governance Council to revise this model to help achieve the goals of improving quality of care. Next steps involved educating patients, families, and staff using innovative multimodal strategies. By engaging in this renewed commitment to Patient- and Family-Centered Care, systems and structures were developed to keep KIDS CARE relevant and make strides toward improved outcomes for patients and families.

Using four-phased unit-based patient safety walkrounds to uncover correctable system flaws.

BACKGROUND: A unit-based Patient Safety Leadership Walkrounds (PSWR) model was deployed in six medical/surgical units at The Children's Hospital of Philadelphia to identify patient safety issues in the clinical microsystem. Specific objectives of PSWR were to (1) provide a forum for frontline staff to freely report and discuss patient safety problems with unit local leaders, (2) improve teamwork and communication within and across units, and (3) develop a supportive environment in which staff and leaders brainstorm on potential solutions. METHODS: Baseline data collection and discussion with leaders and staff from the pilot units were used to create a standard set of safety tools and questions. Through multiple Plan-Do-Study-Act cycles, safety tools and questions were refined, while the process of walkrounds in each of the six pilot units was customized. RESULTS: Leaders in all six pilot units indicated that PSWR helped them to uncover previously unidentified safety concerns. Top-impact areas included nurse-medical team relationship, work-flow flaws, equipment defects, staff education, and medication safety. The project engaged 149 individuals across all disciplines, including 33 physicians, and entailed 34 PSWR in its first year. Information from these pilot units initiated safety changes that spread across multiple units, with identification of hospital-wide quality and patient safety issues. CONCLUSIONS: For participating units, the PSWR process is a situational awareness tool that helps management periodically assess new or unresolved vulnerabilities that may affect safety and care quality on the unit. Unit-based PSWR help identify safety concerns at the microsystem level while improving communication about safety events across units and to hospital leaders in the macrosystem.

Time changes for scheduled nursing assessments: impact on clinical decisions and patient discharge.

Using a shared governance model, a clinical nursing practice change was implemented to increase collaborative decision making among health care providers at morning rounds. The goal of this project was to improve nursing workflow at the beginning of the shift and improve patient flow by discharging patients earlier. By changing the time of morning vital signs and nursing assessments from 0800 to 0600, staff reported increased collaboration among the multidisciplinary team and improved nursing workflow.

Supporting newly hired nurses: a program to increase knowledge and confidence while fostering relationships among the team.

BACKGROUND: It is important for newly hired nurses to be supported throughout their first year of employment by nurse leaders on their team. Newly hired nurses struggle with application of new clinical skills and critical thinking skills as well as integrating into unit culture. PROGRAM DESIGN: The Post Orientation Education Program (POEP) provided 18 newly hired nurses with clinical knowledge and support through one-on-one meetings with the nurse leaders on their unit. The nurse leaders discussed common diagnoses, laboratory tests, and medications in addition to providing support to the newly hired nurses as they adapted to the newness of nursing. Early in their career the newly hired nurses developed relationships with the leadership team that may have taken longer if not for the POEP. The program gave the newly hired nurses an opportunity to experience different teaching styles of the nurse leaders and offered them the chance to engage in conversations about both clinical and nonclinical information. OUTCOMES: The program was evaluated through pre/post tests and written evaluations. Evaluations revealed increased knowledge about common diagnoses, increased confidence in role, and the development of trusting relationships with the leadership team. CONCLUSION: The newly hired nurses valued the time that they spent with the leadership team as it helped them to integrate into the unit and feel comfortable using the leaders as resources for patient care. The POEP proved to be a program that impacted not only relationships among the team, but it increased retention and quality of patient care as the nurses felt supported by the team, knowledgeable about the care they were delivering and confident in their ability to seek out resources. A program like the POEP could be adapted to various healthcare settings based on individual needs of the team.