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Nursing EXcellence Training

Online Orientation Program

Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher, ACNP, MSN, CCRN-CSC, PCCN
Topic Description
This introduction begins a comprehensive review of the core concepts required by the bedside critical
care nurse. The focus of this module is to prepare the novice critical care nurse to provide patientcentered, quality care in the complex environment of the intensive care unit. Presentations correlate
evidence-based practice guidelines, the Institute of Healths Improvement Initiatives to Save 100,000
Lives and Do No Harm, and AACNs concepts of a healthy work environment.

Chapters
1.
2.
3.
4.
5.

Evidence Based-Practice
Healthy Work Environment
Daily Goal Checklist
Save 100,000 Lives
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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Copyrighted Materials, All Rights Reserved

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Introduction to
Critical Care Nursing
Med Ed
2009

Objectives
* 1. Discuss and define the hospitals

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.

1911 Charlotte Drive Charlotte, North Carolina 28203


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Copyrighted by Med-Ed, Inc., All Rights Reserved

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Objectives
* 3. Analyze common critical care

health 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 and


delivering EBP patient-centered care
with multiprofessional collaboration to
optimize patient outcomes within a
managed care environment.

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Focus
* Integrating sophisticated technology

with 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 quality
management
* Managed care
* New devices
* New regulations

EBP
* Emphasis on outcomes, cost-

effectiveness, and consumer


satisfaction

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

EBP
* improving the quality of healthcare

requires a commitment to delivering


healthcare based on sound scientific
evidence and continuously innovating
new, effective healthcare practices
and preventive approaches.. Presidents
Advisory 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 search
literature
* Scientific merit

* Conduct comparison
of current practice
and 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, OpenMindedness, Perseverance, and Reflection

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

* 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

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Synergy Model
AACNs Model
1999

* Link certified practice to clinical

outcomes.
* Working Together
* Common Goal
* Patient - Nurse Link ??
* What Drives the System

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Transform Your Practice


Daily

1911 Charlotte Drive Charlotte, North Carolina 28203


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Copyrighted by Med-Ed, Inc., All Rights Reserved

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Patient Safety
Best 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
AACNs promotes creation of HWE
HWE supports and fosters excellence in
patient care
Committed to promoting excellence in
patient care

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

COMPONENTS OF
EXCELLENCE
EDUCATION
COMMITMENT
ENVIRONMENT

EVIDENCE BASED
PRACTICE
Conscientious application of scientifically best
practice by clinician in concert with patient
understanding and valves

Science of Medicine
The integration of individual clinical expertise with
the best available external clinical evidence from
systematic research
Art of
Medicine

CDC: RATING THE


EVIDENCE
Category IA: strongly recommended for
implementation based on well-designed
clinical studies
Category IB: strongly recommended for
implementation based on clinical
studies or theoretical rationale
Category IC: required by state or
regulatory agencies

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

CDC
Category II: suggested for implementation
based on clinical studies or theoretical
rationale
Unresolved issue: evidence is insufficient or
no 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 of
evidence-based practice--Medical and
Nursing
Can Not change behaviors without
owning the practice
The value is inherent in evidence

BUILDING A PRACTICE OF
EXCELLENCE
THROUGH
KNOWLEDGE

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

EXCELLENCE
Building Environment
Decreasing errors
Increasing Patient Safety
Checklists

10 TIPS TO IMPROVE CARE


IN YOUR ICU
1. Conversation: www.sccm.org/tips
2. Improve Nursing Through Certification
3. Improve Skills of the Non-ICU
Specialist: FCCS
Course
4. Standardize ICU Practice: Evidence Based
Guidelines
5. Reduce Medication Errors

10 TIPS TO IMPROVE CARE


IN YOUR ICU
6. Improve the Physical Environment
7. Measure Your Progress
8. Be More Visible
9. Advocate for Better Care
10. Implement a Multiprofessional
Team Approach

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

WHAT ARE WE TALKING


ABOUT
Creating the case for HWE
Overview of the AACN Standards
Painting a picture of HWE using the
Standards and critical elements

HWE
Mounting evidence that unhealthy work environments
contribute to medical errors, ineffective delivery of
care, and conflict and stress among health
professionals.
Create healthy work environment to ensure patient
safety, enhance staff recruitment and retention, and
maintain an organizations financial viability.

HWE: TWO STRATEGIC


PLATFORMS
1. Work and care environments must
be safe, healing and humane, respectful
of the rights, responsibilities, needs and
contributions of patients, their families,
nurses and all health professionals.

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

2. Excellence in acute and critical care


nursing practice is driven by the needs
of patients and their families and is
achieved when nurses competencies
are matched to those needs.

MY GOALS
IMPROVEMENT OF PATIENT
OUTCOMES: WHERE IS THE EDGE
Challenge your thinking
Make you uneasy
Move you to action

ASSERTION # 1
There is a direct link between work
environment and patient safety
Ergo, if you are not addressing your
work environment, you are not
addressing patient safety

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

The mistakes are all there, waiting


to be made
Chess master S. Tartakower (1887-1956)

ASSERTION # 2
Healthy work environments do not just
happen
Ergo, if you do not have a formal
program in place addressing work
environment issues, little will change

Organizations learn and evolve through


conscious, deliberate action. Deliberate
action is ethical. When the time to act
has come, it is unethical not to do
something.
David Thomas
Ethics of Choice

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

ASSERTION #3
Creating healthy work environments requires
changing long-standing cultures, traditions
and hierarchies
Ergo, while everyone must be involved in the
creation of healthy work environments, the
onus is on
organizational/departmental/unit leaders
to assure that it happens

To do more than the minimum in


anything takes leadership

Robert Wachter
2004

THE ASSERTIONS
HWEs are directly linked to patient
safety
HWEs require a formal program
Leaders must drive HWEs

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

AACNS STANDARDS
The standards represent evidencebased and relationship-centered
principles of professional performance.
Align directly with core competencies
IOM.

STANDARDS
NEW WORDS
Outcomes, Evidence-Based Practice,
RCT, Patient Centered Care, E ICU,
Informatics
Patient Driven Care
Daily Goal Sheets

AACNs STANDARDS
MEANINGFUL RECOGNITION
Nurses must be recognized and must
recognize others for the value each
brings to the work of the organization

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

AACNs STANDARDS
AUTHENTIC LEADERSHIP
Nurse leaders must fully embrace the
imperative of a healthy work
environment, authentically live it and
engage others in its achievement

CREATING THE CASE FOR


HWEs
WHAT DO WE KNOW????

STANDARDS
Skilled
communication
True
Collaboration
Effective decision
making

Appropriate
Staffing
Meaningful
Recognition
Authentic
Leadership

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Communication issues are


present in 65% of all sentinel
events reported to JCAHO

COMMUNICATION ISSUES
Are present in more than 75% of wrong
site 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 to
technology
Evaluation
Part of performance
appraisal

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18

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Skilled Communication

Stories vs Facts

Collaboration

More than 90% have


witnessed disruptive
behavior by MDs
Aware of actual adverse
consequences
17-30% nurses leave
High prevalence of disruptive
behavior among nurses

TRUE COLLABORATION
Nurse managers and medical directors
are equal partners in modeling and
fostering true collaboration.
Unresponsive bureaucracy generates
organizational stress=nurse burnout

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

CREATING THE CASE


Are There Challenges???

CHALLENGES TO THE
CASE
Links to patient safety are not
universally 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 care


system
Hospitals, like any other business, need to
be accountable for providing services that
dont harm the people they serve
R. Bison and Singh, 2003
Wall of Science

We spend $25,000 for pills, procedures, and


bedpans for every one dollar on patient
safety.
Wachter & Shojania, 2004
Internal Bleeding

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

HWEs
This is being demanded by:
The Public
Policy Makers
Regulators
Health Care Professionals
Common Sense and Doing the Right
Thing

AACNS HWE
Common Threads
Organizational responsibilities
Individual responsibilities
Support for & access to educational
programs related to each
Leadership/administration support

TRUE COLLABORATION
Accountability
defined
Decision making
authority
Resources for
dispute resolution
Embrace culture of
collaboration
Ethical limits

Respect each voice


Personal integrity
Skilled
communication
Competence of all
team members
Nurse and MD equal
partners in care

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21

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

TRUE COLLABORATION
Patient and family satisfaction, patient
safety and outcomes, professional staff
satisfaction, nurse retention and cost.
All related to collaboration !!!

EFFECTIVE DECISION
MAKING
Organizational
values clear
Structures assure
patients and families
are heard
Shared
accountability for
decision making

Respect for right of


all
Incorporate all key
perspectives
Evaluate results of
decisions
Cammy: hard data

EFFECTIVE DECISION
MAKING
Responsibility=Accountability
Authority
National programs such as AACN
Beacon Award for Critical Care
Excellence, Magnet Nursing Services
Recognition Program and the Baldrige
National Quality Program.

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22

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

APPROPRIATE STAFFING
Staffing policies
solidly grounded
Nurses participate in
entire staffing
process
Staffing decisions
are evaluated
Most Harmful
Cammy: turn over

Access to staffing
data
Support services
available to ensure
nurses focus on
nursing work
Technologies
adopted that
effectiveness of
nursing care
delivery

STAFFING
Medication Error: Reporting Error in
Patient Care
Will not do the variance reporting???
Why not????
A way to track and tell the system of a
problem

STAFFING
Evidence suggests that better patient
outcomes result when a higher proportion of
care hours is provided by registered nurses.
Needleman J, N Engl J Med 2002:346:1715-1720

Further research supports a relationship


between specialty certification and clinical
nursing expertise

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23

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

MEANINGFUL
RECOGNITION
Comprehensive
program in place
for all
Process for
knowing how to
participate
Bedside to board
table

Includes process to
determine that
recognition is
meaningful
Recognition system
is regularly
evaluated
Everyone is
responsible

RECOGNITION
Tweeners

Positrons

Negatrons

RECOGNITION
Establishing a Work Culture
Role Modeling
Mentorship
Fun
Three L Philosophy
Love it: Learn to love it:
Leave it

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24

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

AUTHENTIC LEADERSHIP
LEADERS:
Understand
requirements/
dynamics at point of
care
Generate visible
enthusiasm
Role model
Evaluate their impact &
progress toward HWE

ORGANIZATION:

Assure leaders are well


positioned and
supported
Provide time, financial
and human resources
Include leaders role in
HWE into performance
appraisal

LEADERSHIP
MENTORING
MOVING THE STAFF FORWARD
ROLE MODEL

Our days begin to end the


day we become silent about
things that matter.
Martin Luther King, Jr.

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25

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

HWE
Call to action from AACN
National focus that becomes Patient
Centered Care with the Nurse as the
owner and driver of excellence.

ALL ABOUT
PLAYING IN THE SAND BOX
TOGETHER

DAILY GOAL CHECKLIST


THIS is patient Safety

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26

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

TOP THREE PRIORITIES TO


D/C PT
Greatest pt safety risk from the Unit
Review med; can any be discontinued?
Review tests, procedures, scheduled
labs, X-rays; can any be discontinued?
Review catheters and tubes; can any
be 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 issues
and goals?
Renal, fluid balance goals, electrolyte
replacement-oral?

TOP THREE
GI/Nutritional goals
Liver/Pancreas
Hematology/Coagulation=blood product
infusion criteria
ID: cultures, drug levels-appropriate
agents and doses?
Reviewed consultations: new?

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Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

TOP THREE

Surgical Plans
Communication with referring MD
Family communication/social issues/code status
Discharge planning--write transfer orders?
Implement care protocols? Ventilator-weaning
orders, sedation-weaning orders, glucose control,
DVT & PUD prophylaxis?

TOP THREE
HOB at 30 degrees
Research protocol candidate? Glucose
control, extubation, bronchiolitis, etc.

GOALS
Every Nurse, rounding MD, Respiratory
Therapist, PT, and all team members
should have same goals for patient and
family
Use Goal Checklist!!!!!
Keep on Track for patient safety and
HWE

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28

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

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 the
initiative
Build a reusable national infrastructure
for change
Raise the profile of the problem
(variability in the quality of American
health care) - and our proactive response

100,000 Lives
Is an initiative to engage US hospitals in a
commitment to implement changes in care
proven to improve patient care and prevent
avoidable deaths. End date is June 2006.
IOM est 98,000 pts die secondary to medical
errors
CDC est 2 million pts have Hospital acquired
infections.

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29

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Delivery of Evidenced-Based
Care

Deployment of Rapid Response Team


Prevention of Adverse Drug Events
Prevention of Central Line Infections
Prevention of Surgical Site Infections
Prevention of Ventilator-Associated
Pneumonia (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: vent
training protocols
PUD prophylaxis
DVT prophylaxis
HOB elevation > 30 degrees

1911 Charlotte Drive Charlotte, North Carolina 28203


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30

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

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 to
a disease process that, when executed together,
result in better outcomes than when
implemented 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

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31

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

BUNDLES
Development of Bundles of Care
Ventilator Bundles
Sepsis Bundles
DVT Prophylaxis
PUD Prophylaxis
Central Line Bundles
Bathing/Mouth Care/Turning Bundles

An Introduction to the
5 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 infrastructure
for change
Raise the profile of the problem
(variability in the quality of American
health care) - and our proactive response

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32

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

The Next Campaign

WERE GOING AFTER HARM

Our Definition of Medical Harm


Unintended physical injury resulting from or
contributed to by medical care (including the
absence of indicated medical treatment), that
requires additional monitoring, treatment or
hospitalization, or that results in death.
Such injury is considered harm whether or not it is
considered preventable, whether or not it
resulted from a medical error, and whether or
not it occurred within a hospital.
For more information, please reference detailed FAQs at www.ihi.org/campaign.

The Next Campaign


WERE GOING AFTER HARM
but what do we mean by harm?

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33

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

The Next Campaign


WERE GOING AFTER HARM
but how much harm will we
reduce?

Logic Chain: Step 1


How Many Admissions per
Year?

37 Million Admissions

Source: The AHA National Hospital Survey for 2005

Logic Chain: Step 2


How Often Are Patients
Injured by Care?
40 to 50 Patient Injuries per 100
Hospital Admissions

Source: IHI Global Trigger Tool Guiding Record Reviews

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34

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Logic Chain: Step 3


How Many Injuries in the US?
37 Million Admissions
X
40 Injuries per 100 Admissions
=
15 Million Injuries per Year

The 5 Million Lives


Campaign
We are asking hospitals participating in the
Campaign to prevent five million incidents of
medical harm over the next two years.
Given the performance IHI has observed in
highly successful hospitals, and given all that
the industry is investing in improving the
quality of care nationally, we believe we can
and must find a way to achieve such results
in this period.

The 5 Million Lives


Campaign
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 Campaigns national infrastructure for
change and transform it into a national asset;
Raise the profile of the problem and hospitals proactive
response with a larger, public audience.

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35

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

The six interventions from the 100,000 Lives Campaign:


Deploy Rapid Response Teamsat the first sign of patient decline
Deliver Reliable, Evidence-Based Care for Acute Myocardial
Infarctionto prevent deaths from heart attack
Prevent Adverse Drug Events (ADEs)by implementing
medication reconciliation
Prevent Central Line Infectionsby implementing a series of
interdependent, scientifically grounded steps
Prevent Surgical Site Infectionsby reliably delivering the correct
perioperative antibiotics at the proper time
Prevent Ventilator-Associated Pneumoniaby implementing a
series 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)
Infectionby reliably implementing scientifically proven infection
control practices
Prevent Harm from High-Alert Medications... starting with a focus
on anticoagulants, sedatives, narcotics, and insulin
Reduce Surgical Complications... by reliably implementing all of
the changes in care recommended by the Surgical Care
Improvement Project (SCIP)
Deliver Reliable, Evidence-Based Care for Congestive Heart
Failureto reduce readmissions
Get Boards on Board.Defining and spreading the best-known
leveraged processes for hospital Boards of Directors, so that they
can become far more effective in accelerating organizational
progress toward safe care

www.ihi.org/campaign

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36

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

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 2a
D. Level 1b
2. Evidence-Based practice includes the art of medicine and the science of medicine.
A. True
B. 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 certified
B. 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-mindedness
B. 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. True
B. False
7. AACNs Healthy Work Environment includes the following standards: skilled
communication, true collaboration, effective decision-making, appropriate staffing,
meaningful recognition, and authentic leadership.
A. True
B. False
8. Communications problems do not represent the most common cause of sentinel
events.
A. True
B. False

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37

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Introduction to Critical Care Nursing Module Sample Test Questions


9. The focus of AACNs Healthy Work Environment includes a:
A. Patient and family centered plan of care
B. Reduction of cost plan of care
C. Communication care plan
D. 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 avoidable
deaths.
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. True
B. False
12. One of the most developed bundles in the Save 100,000 Lives was the:
A. VAP Bundle
B. Communication Bundle
C. Sepsis Bundle
D. UTI Bundle
13. Other aspects of the Save 100,000 Lives Campaign provided information on man
areas of patient care, including:
A. No nasal tubes
B. Appropriate sedation
C. 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. True
B. False
15. In the platform for the six interventions for Save 100,000 Lives, the deployment of a
rapid response team:
A. Has shown to improve patient outcomes
B. Has shown to improve nurse/physician communication
C. Has shown to improve bedside assessments
D. All the above

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38

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

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 date
D. 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 admissions
C. 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. True
B. False
20. In the Do NO Harm Initiative, prevention form harm from high alert medications
included:
A. Anticoagulants
B. Narcotics and sedatives
C. Insulin
D. All the above

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39

Nursing EXcellence Training (NEXT) - Introduction to Critical Care Nursing Module


Presented by: Cammy House-Fancher ACNP, MSN, CCRN-CSC, PCCN

Introduction to Critical Care Nursing Module Sample Test Questions

Answers:
1. B
2. A
3. A
4. D
5. A
6. A
7. A
8. B
9. D
10. A
11. A
12. A
13. D
14. A
15. D
16. A
17. A
18. D
19. A
20. D

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40