EP - Exemplary Professional Practice

EP1EO. Describe and Demonstrate the Result(s) of Applying the Professional Practice Model. Include Two (2) Examples Related to Nursing Practice, Collaboration, Communication, or Professional Development Activities.

Results of applying the Patient Centered Family Focused (PCFF) Model in Critical Care

The Critical Care Division has embraced the Patient Centered Family Focused (PCFF) Model. Nurses regularly participate in strategies such as, interdisciplinary rounding, safety huddles, bedside handoff, and white board communication to create an environment that promotes quality of care and enhanced patient safety. These strategies promote collaboration and communication amongst the patient, family and the healthcare team placing the patient and family at the center of care delivery

In January of 2011, the model was used to reduce Catheter Associated Urinary Tract Infections (CAUTI) in the Critical Care Division. An increase in the number of CAUTI in the ICU unit, led the critical care leadership team to spear head this initiative.

EP1EO-Table 1

A review of best practices and an evaluation of the process in place revealed an opportunity to reinvigorate the use of the CAUTI bundles by the nursing staff. The PCFF model uses evidence-based methods to assist nurses in making decisions essential to the care of the patient. Keeping in line with this model, an interdisciplinary rounding/handoff tool (Reference EP1E0-A) was developed by Claudia Garzon-Rivera MSN, RN, CCRN, CNL. This tool is used during interdisciplinary rounding to assist team members to contribute to the patients’ plan of care. The plan of care is formulated and documented on the tool. It is then used during handoff to enhance communication between nurses. This tool specifically highlights all ICU collaborative bundles including CAUTI.

The tool reinforces and reminds the interdisciplinary team to assess daily for necessity in patients with indwelling urinary catheter. This information is discussed during interdisciplinary rounds ensuring that urinary catheters are removed promptly. If the catheter is not discontinued for medical reasons the reason for the continuation of the catheter is documented in the medical record. Family members are always encouraged to participate in interdisciplinary rounds as they are an integral part of the team.

This tool enhances the bedside handoff process because it assists nursing staff to maintain and reinforce the established plan of care During bedside rounding the urinary catheter is visualized to ensure that the bag is maintained lower than the level of the bladder and the tubing above the level of the bag. This sets the stage for frequent monitoring by Nurses and Patient Care Technicians (PCT) during the shift.

In June 2011, a guideline (Appendix EP1EO-A) was developed and distributed to the nurses and physicians working in the critical care division. Erin Salmond BSN, RN, Charge Nurse, Alana Kearney BSN, RN, Staff Nurse, and Melissa Massa BSN, RN, Staff Nurse were instrumental in championing the new tool. This new tool, in addition to the ongoing use of the CAUTI bundles, was beneficial in maintaining CAUTI rates below the National Mean in both the ICU and CCCU units.

Catheter Associated Urinary Tract Infections - ICU

Catheter Associated Urinary Tract Infections - CCCU

Results of Applying Patient Centered Family Focused Model in the Neonatal Intensive Care Unit

The Neonatal intensive Care Unit (NICU) has always placed patients and family members at the center of their delivery of care. During the first quarter of 2011, an increase in the number of Peripheral Intravenous (PIV) infiltrations occurred. Neonates are especially vulnerable to injury from infiltrations. However these injuries are preventable if a hyper-vigilant approach to monitoring intravenous access is adopted. Using the concepts of accountability, autonomy, communication, excellence, and team work, Michelle Dickerson MSN, RN-C NEA-NIC Clinical Educator for the NICU took the lead in adopting the PCFF model to address this issue. She established a culture of safety by reinforcing rigorous and continuous monitoring of intravenous access sites by all members of the healthcare team.

Using the PCFF model, the following interventions were implemented to minimize the risk of and provide treatment of IV infiltration:

EP1EO-Table 1

Michelle Dickerson MSN, RN NEA-NIC Clinical Educator for the NICU continues the momentum by offering ongoing education and support regarding PIV infiltration. Just recently in 2012 an education session was presented on the management of IV infiltrations (Reference EP1EO-B). Since the third quarter of 20ll there have been no further infiltrates reported.

Level III Neonatal - Critical Care % of PIV Sites for Infiltrations