Process Improvement

St. Joseph’s Medical-Trauma Unit

April, 29th 2020

Holly Arana, Dana Griffin, Carla Hernandez, and

Stephanie Martinez, Allie Paskitti
 Overview of Patient Care Delivery
System
Carondelet St. Joseph's Hospital - Tucson
● Medical-Trauma Intensive Care Unit, 21 beds
○ ICU East and ICU West
○ Core nurses, traveler nurses, physicians, respiratory
therapists, lift-team, pharmacists
● Process improvement focus: inadequate central line care
related to inconsistent care, short staffing, and lack of
training
○ Central line infections can cost 56,000 per case
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from Barsuk., et al (2015) Simulation-based mastery learning improved central
http://clinicalmicrosys tem.org/uploads/documents/microsystem_assessment.pdf line maintenance skills of ICU nurses. The Journal
of Nursing Administration. Walter Kluwer Health, Inc., 45(10), 511-517
 Microsystem Model: Leadership

Unit Charge RNs

● Most held a democratic leadership style
○ Empower staff to make decisions to promote
organizational productivity
○ Charge nurses were supportive of staff and gave
examples of how to achieve goals/expectations
Johnson, J. K. (2001). Clinical microsystem assessment. Marquis, B. L., & Huston, C. J. (2017). Leadership roles and
Retrieved from management functions in nursing: theory and application (9th ed,
http://clinicalmicrosystem.org/uploads/documents/microsyste pg. 46). Philadelphia: Wolters Kluwer Health.
m_assessment.pdf
 Microsystem Model: Organizational
Culture and Support
Unit Management
● House Supervisor & Nurse Manager = democratic
leadership style
○ “Directed through suggestions and guidance,
communication flows up and down, decision
making involves others, emphasis is on (we)”
● ICU team responded to trauma cases and
codes/emergencies in the hospital
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from Marquis, B. L., & Huston, C. J. (2017). Leadership roles and
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment. management functions in nursing: theory and application (9th ed,
pdf pg. 46). Philadelphia: Wolters Kluwer Health.
 Microsystem Model: Patient Focus &
Staff Focus
Patient Focus Staff Focus
● Total patient care ● Core nurses vs. traveler
● Teamwork oriented nurses
● Advocacy ● High burnout rates
● Emphasis on clustered ● Staff ratio 2:1 or 1:1
care, hygiene care,
positional changes
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
 Microsystem Model: Interdependence of
Care Team
● Purpose: patient-focused care
● Collaboration: interdisciplinary rounds
○ PCTs limited
○ Codes: chaotic without pre-designated roles
● Willingness to help: traveling RNs vs staff
● Trust and Respect: staff distrust of travel RNs
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
 Microsystem Model: Use of Information and
Healthcare Technology
● Cerner EHR
● Vocera’s for staff, phones at nurses station, limited directory
● Computers: limited WOWs, computers in each room,
computers at nurse’s station
● Security/visitation: RN responsibility
● Alarms/monitors: updated and functional
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
 Microsystem Model: Process for
Healthcare Delivery Improvement What is being
measured in terms of
Activities
Outcome Data
Collection
quality of care?

Performance Communication and

Improvement Activities
Health Care Delivery

staffing issues
Results
Limited Training and Limited Orientation
Support for Learning

Differentiation in Task
Empowerment to Performance
Innovate
Process Decreased Quality of
Care
Improvement
Implementing a Training for a Change
Change
Simulation-Based
Johnson, J. K. (2001). Clinical microsystem assessment. Barsuk., et al (2015) Simulation-based mastery learning improved central line Learning
Retrieved from maintenance skills of ICU nurses. The Journal
http://clinicalmicrosystem.org/uploads/documents/micr
osystem_assessment.pdf of Nursing Administration. Walter Kluwer Health, Inc., 45(10), 511-517
 Microsystem Model: Staff
Performance Patterns
Staff Focus
Staff Education 01
Staff members are valued
and Training High Expectations
Limited Knowledge Staff
Staff Poor Educational
of Expectations and Performance
Performance Support /Training of Staff
Patterns
Patterns
Responsibility 02 03
Staff Interdependence
Teamwork
Collaboration
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Recognition of Duties
 Specific Aspect Targeted for
Improvement
Process Improvement
Decrease the number of central line acquired blood infections
in the MICU
● Rationale ● Benefits of making a change
○ Patient safety at risk ○ Proper central line
○ Unclear protocol and lacking management lessens risk
outcome measurements for CLABSI
○ RNs wasting time, effort, ○ Improved data gathering
and supplies to redo ○ Less stress on RNs
dressings that are not dated Johnson,
from
J. K. (2001). Clinical microsystem assessment. Retrieved

http://clinicalmicrosystem.org/uploads/documents/microsystem_assess
ment.pdf
 Integrative Nursing Principle
Integrative nursing principle #4
“Integrative nursing is patient-centered and
relationship-based”

● Unifying staff to collaborate on quality and

safety goals builds relationships and focuses
on how each member of the team can
improve patient care
Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam Maimonides
Medical Journal, 6(2). doi: 10.5041/RMMJ.10200
 Jones, C. M., Stewart, C., Roszell, S. S. (2015) Beyond best practice

Timeline for Implementation implementing a unit-based CLABSI project. Journal of Nursing

Care Quality, 30(1), 24-30. doi: 10.1097/NCQ.0000000000000076

Plan Do Study Act

Months 1-2 Months 3-6 Months 7-8 Months 9-12

● Staff assessment ● RN training on ● Unit audits ● Implement CLM

on CLM CLM bundle
● Staff meeting held
● Charge RN ● Standardization of to facilitate ● Continue to
reviews test dressing change discussion and measure
results times allow for input outcomes for unit

● Unit begins ● Extra set of ● Data analysis of ● Compare unit

measuring days supplies kept at CLABSI rates statistics to
since last CLABSI bedside since new policy hospital-wide
benchmark
 References
Barsuk, J. H., Cohen, E. R., Mikolajczak, A., Seburn, S., Slade, M. & Wayne, S. D. (2015) Simulation-based mastery

learning improved central line maintenance skills of ICU nurses. The Journal of Nursing Administration.

Walter Kluwer Health, Inc., 45(10), 511-517

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from

http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf

Jones, C. M., Stewart, C., Roszell, S. S. (2015) Beyond best practice implementing a unit-based CLABSI project.

Journal of Nursing Care Quality, 30(1), 24-30. doi: 10.1097/NCQ.0000000000000076

Kreitzer, M. J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam Maimonides

Medical Journal, 6(2). doi: 10.5041/RMMJ.10200