Applying the PDSA Framework to Examine the Use of the Clinical Nurse Leader to Evaluate Pressure Ulcer Reporting

Polancich, Shea; Coiner, Sarah; Barber, Rebekah; Poe, Terri; Roussel, Linda; Williams, Kelley; Cumbest, Heather Tarquinio; Noles, Kristen M.; Herrero, Ashlea; Graham, Shannon; Miltner, Rebecca S.

doi:10.1097/ncq.0000000000000251

Cited by 6 publications

(9 citation statements)

References 8 publications

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“…There was a 70% reduction in total, all-stage HAPIs from the initial month of this study to the most recent month. A 6-year effort to improve HAPIs began in 2016, including a 16-member wound, ostomy, and continence team (Polancich, Coiner, et al, 2017;Polancich et al, 2019Polancich et al, , 2022. Continuous improvement efforts have been sustained despite fluctuations in RN staffing, particularly with lower numbers of permanent RN staff.…”

Section: Frommentioning

confidence: 99%

Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes

Polancich¹,

Miltner²,

Montgomery³

et al. 2023

Journal of Healthcare Management

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Goal: The purpose of this study was to examine nurse staffing while describing the relationships that exist in staffing and quality associated with nursing care during the COVID-19 pandemic, a significantly challenging time for nurse staffing. We examined the relationship between permanent registered nurse (RN) and travel RN staffing during the pandemic and the nursing-sensitive outcomes of catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), falls, and hospital-acquired pressure injuries (HAPIs) and length of stay and compared the cost of CAUTIs, CLABSIs, falls, and HAPIs in fiscal years 2021 and 2022. Methods: We used a descriptive, observational design to retrospectively examine permanent nurse staffing volume and CAUTI, CLABSI, HAPI, and fall counts from October 1, 2019, to February 28, 2022, and travel nurse volume for the most current 12 months, April 1, 2021, to March 31, 2022. Descriptive statistics, Pearson correlation, and statistical process control analyses were completed. Principal Findings: Pearson correlation showed a statistically significant, moderately strong negative correlation (r = −0.568, p = .001) between the active registered nurse full-time equivalents (RN FTEs) and average length of stay (ALOS), and a moderately strong positive correlation (r = 0.688, p = .013) between the travel RN FTEs and ALOS. Pearson correlations were not statistically significant, with low to moderate negative correlations for CAUTIs (r = −0.052, p = .786), CLABSIs (r = −0.207, p = .273), and falls (r = −0.056, p = .769). Pearson correlation for active RN and HAPI showed a moderately strong, statistically significant positive correlation (r = 0.499, p = .003). We observed common cause variation in CAUTIs and CLABSIs, with HAPIs and falls showing special cause variation via statistical process control. Practical Applications: Despite the challenges associated with the lack of available nurse staffing accompanied by increasing responsibilities including unlicensed tasks, positive clinical outcomes can be maintained by staff adherence to evidence-based quality improvement.

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Section: Frommentioning

confidence: 99%

Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes

Polancich¹,

Miltner²,

Montgomery³

et al. 2023

Journal of Healthcare Management

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“…4 A clinical nurse leader (CNL) project conducted within the organization confirmed suspicions by unit leaders that internally reported HAPI data was inaccurate. 5 Guided by the clinical question, "how does the use of a CNL role in an intensive care unit (ICU) and a medical surgical unit affect the identification and reporting of pressure injuries within 90 days," two CNLs evaluated each patient on the units daily, performing skin assessments and evaluating pressure injury prevention (PIP) and care practices. 5 Comparisons were made between bedside nursing staff and CNL skin assessments and resulting documentation data captured.…”

Section: Introductionmentioning

confidence: 99%

“…This led to the conclusion that there were "gaps in the validity and reliability of pressure injury reporting." 5 In 2016, the WOC nurses' senior director developed a business plan to increase the number of WOC nurses from four to 12. Using the EHR consult list for the WOC nurses, she was able to show they had an average of 60 wound consults a day and over 300 new ostomy teachings per year.…”

Section: Introductionmentioning

confidence: 99%

“…5 Guided by the clinical question, “how does the use of a CNL role in an intensive care unit (ICU) and a medical surgical unit affect the identification and reporting of pressure injuries within 90 days,” two CNLs evaluated each patient on the units daily, performing skin assessments and evaluating pressure injury prevention (PIP) and care practices. 5 Comparisons were made between bedside nursing staff and CNL skin assessments and resulting documentation data captured. The CNLs identified present on admission (POA) pressure injuries initially missed or mislabeled by staff as other wounds or skin conditions.…”

Section: Introductionmentioning

confidence: 99%

“…When wounds were identified as HAPIs, they were sometimes counted twice in the data collection system, once from nursing documentation, and once from Wound, Ostomy, Continence (WOC) Nurse documentation. This led to the conclusion that there were “gaps in the validity and reliability of pressure injury reporting.” 5…”

Section: Introductionmentioning

confidence: 99%

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Implementing an Electronic Root Cause Analysis Reporting System to Decrease Hospital-Acquired Pressure Injuries

Armstrong

2023

J Healthc Qual

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Hospital-acquired pressure injuries (HAPIs) continue to increase in comparison to other hospital-acquired conditions, despite advancements in prevention and wound care practices. In 2017, an interprofessional skin team (IST) was formed at an academic medical center to improve patient care and reduce HAPIs. Intentional wound, ostomy, continence (WOC) nurse rounding coupled with IST efforts steadily decreased HAPIs in the organization by 39%. In an effort to continue to improve care, a root cause analysis (RCA) of HAPIs was initiated in two intensive care units (ICUs) in October 2019. Using the Plan-Do-Study-Act model, two WOC nurses and a nursing professional development specialist from the IST developed the HAPIs RCA process. Rapid cycle process improvement demonstrated the need to transition from a paper form to an electronic process to increase accessibility for all nursing units and patients to benefit. In May 2020, an electronic reporting system for RCAs for HAPIs began. After implementation, there has been a 53.5% reduction in HAPIs over 2 years. The standardized, electronic RCA process has resulted in improvement, dissemination of best practices, and fostering nonpunitive accountability for each unit's HAPIs.

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Reducing hospital acquired pressure injury in a learning health center: Making the case for quality

Polancich

Patrician

Miltner

et al. 2022

Learning Health Systems

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Introduction:The purpose of this descriptive study is to examine a learning health system (LHS) continuous improvement and learning approach as a case for increased quality, standardized processes, redesigned workflows, and better resource utilization. Hospital acquired pressure injuries (HAPI) commonly occur in the hospitalized patient and are costly and preventable. This study examines the effect of a LHS approach to reducing HAPI within a large academic medical center.Methods: Our learning health center implemented a 6-year series of iterative improvements that included both process and technology changes, with robust data and analytical reforms. In this descriptive, observational study, we retrospectively examined longitudinal data from April 1, 2018 to March 31, 2022, examining the variables of total number of all-stage HAPI counts and average length of stay (ALOS).We also analyzed patient characteristics observed/expected mortality ratios, as well as total patient days, and the case-mix index to determine whether these factors varied over the study period. We used the Agency for Healthcare Research and Quality cost estimates to identify the estimated financial benefit of HAPI reductions on an annualized basis.

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Applying the PDSA Framework to Examine the Use of the Clinical Nurse Leader to Evaluate Pressure Ulcer Reporting

Cited by 6 publications

References 8 publications

Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes

Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes

Implementing an Electronic Root Cause Analysis Reporting System to Decrease Hospital-Acquired Pressure Injuries

Reducing hospital acquired pressure injury in a learning health center: Making the case for quality

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