EP - Exemplary Professional Practice

EP33: Quality Care Monitoring and Improvement-Describe and demonstrate the structure(s) and process(es) used by the organization to allocate and/or reallocate resources to monitor and improve the quality of nursing and total patient care. The nurse has responsibility for ensuring the coordination of care among other disciplines and support staff.

One important process that the organization has in place to allocate/and or reallocate resources in Rita Smiths participation as Chief Nursing Officer and Senior Vice President in key organizational committees. For example, weekly Senior Leadership meetings which are conducted by Joe Scott, Chief Executive Officer, and attended by all Vice Presidents, the Value Analysis Committee; and organizational Strategic Planning Committee which establishes goals for the coming year and plans upcoming initiatives. Furthermore, her participation and voting membership on the Board of Trustees ensures that nursings interests are represented. Ms. Smiths role on these and other committees has been delineated in TL4 of the Transformational Leadership segment of this document. Her participation on these committees ensures that resources are allocated for capital projects, quality initiatives and strategic initiatives.

Another important structure and process to allocate/reallocate resources for nursing is our annual budget process, as described in EP12. Allocation of nursing resources is determined annually by the collaboration of the Chief Nursing Officer, Directors of Nursing and the Nursing Management Team. The leadership team performs a comprehensive evaluation of the resources that will be needed for the upcoming year. During this process input is gathered from direct care nurses, physicians and other members of the interdisciplinary patient care team. Information is shared regarding the addition of service lines and new programs or changing programs which may require the reallocation of nursing resources. Historic financial data is also taken into consideration in order to finalize this process.

Another process of allocating/reallocating resources is the process that occurs between the Nursing Directors and Nurse Managers at the Divisional level and on the individual units. Decisions are made on a daily/weekly basis to allocate and reallocate budgeted nursing resources in order to achieve divisional and departmental goals and to provide appropriate RNs to coordinate patient case. For example, recently an increased census of low birth weight infants was being admitted into the Newborn Intensive Care Unit (NICU) which required the need for additional nursing staff. The NICU Nurse Manager, Tara Mazzone MSN, RN, NEA-NIC and Lillian Reyes BS, RN Nurse Manager of Labor and Delivery (L&D), Post Partum (PP) and Newborn Nursery (NN) collaborated in order to provide adequate staff. The staff nurses from the Newborn Nursery, based on current competencies, were reallocated to help in the NICU. This assessment of the nursing staff needs was performed on a daily basis until the census was reduced. Another example of collaboration between leadership occurs in the Post Anesthesia Care Unit (PACU) and the Intensive Care Unit (ICU). Larissa Semenoff BSN, RN, CNOR Nurse Manager of the PACU and Cristina Simeone BSN, RN, Nurse Manager of Critical Care allocate/reallocate nursing resources based on need. When there are no surgical cases to be performed in an evening, the PACU direct care nurses are reallocated to the ICU to assist with transport of Critical Care patients and/or perform admissions/assessments.

Another example of allocating/reallocating nursing resources occurs at night. A huddle among the charge nurses of Post Anesthesia Care Unit (PACU), Intensive Care Unit (ICU) and the Emergency Department (ED) make a determination as to needed resources for the night shift. Issues such as the need for a transport nurse to take critical patients for diagnostic testing, types of patients holding in the ED awaiting inpatient beds and bed availability, as well as staffing issues. These nurses collaborate and decide and determine all staffing issues for the night.

Another important structure for the allocation/reallocation of resources is the nursing Quality and Safety Council (OO25). They participate annually in the hospital-wide quality and safety Expo and resources are provided to this group in order that they may purchase materials to initiate projects and poster presentations. This team is an important component in the quality and safety process.

The Division of Nursing has allocated an additional resource to the provision of wound care. Elizabeth Vocaturo MSN, RN, WCN is currently a staff nurse on 7 East, Medical- Surgical Unit. Rita Smith DNP, RN, NEA-BC, CNO has allocated her, on a part-time basis, as a resource nurse to work with Peggy Petrucelli BSN, RN, Wound and Falls Program Coordinator. Ms. Vocatura works closely with Ms. Petrucelli and assesses and organizes treatment plans for all types of wounds to include ostomies, dehiscence, venous, diabetic, traumatic and sickle-cell. She develops strategies with Ms. Petrucelli on unique treatment plans when needed and teaches the patients and families on how to care for wounds once discharged.

Rachele Dalalian RN, CLNC, and Bonnie Rosenzweig BSN, RN, CRRN, both Quality Outcomes Managers have been reallocated (Ms. Dalalian) and allocated (Ms. Rosenzweig to the Quality and Safety Department. Ms. Dalalian formerly was a staff nurse on the Labor and delivery Unit and Ms. Rosenzweig was transferred from a sister hospital. Both Ms. Dalalian and Ms. Rosenzweig work very closely with the nursing staff on all quality issues. Ms. Dalalian utilizes her knowledge of obstetrics to perform quality assessments on all obstetric initiatives. They both educate nursing staff when necessary on quality issues.

The morning interdisciplinary Bed Huddle is an important process where resources are allocated and reallocated. Housekeeping, facilities, critical care, emergency department and cardiac catheterization laboratory and telemetry participate in this process. Issues are discussed such as, census data, bed availability, number of anticipated discharges, and issues related to the availability of linen and other issues relating to patient care.

Nursing Resources were reallocated from a variety of departments to form a Nursing Informatics Team to implement the new EMR project. This team came from a variety of units and was essential in developing and implementing this system. They established a team of staff nurses, PCTs and Clerks in order to use their input to develop electronic processes. As a result they incorporated the John Hopkins Falls Risk and the Braden Skin Assessment, as well as the Early Warning Scoring System Tool. (See Appendix EP33-A and EP33-B for screen shots of the John Hopkins Fall Risk and Braden Skin Assessment tools).

Screen Shot of the Early Warning Scoring System

Screen Shot of the Early Warning Scoring System

Below is a table depicting where team members were reallocated from:

EP33-Table 1

A nursing position was recently allocated as a Patient Engagement Coordinator. (See Appendix EP33-C for Patient Engagement Coordinator job description). Yvonne Selleroli BSN, RN is currently rounding on all the units in collaboration with the Patient Advocate and addresses patient problems when they arise. She also functions as Chairperson of the Patient Engagement Council which serves as a forum to review Patient Satisfaction Results and develop strategies to address issues. All the units are represented during this meeting.