b.      Describe how unit leaders guarantee joint accountability between medical, nursing and other leaders.

c.       Describe how this group works together to ensure integration of patient care within and outside of the unit.

Notes: Unit leaders are defined as anyone who has daily responsibility for unit function and may include managers, supervisors, charge nurses or directors. This may also include physicians and other non-nursing personnel. Some examples of accountability may include formal processes such as peer review, performance evaluation and/or performance against measurements and goals; it may also include informal feedback mechanisms or surveys. Integration of patient care includes the processes and systems used to ensure sustained quality of care between your unit and supporting units (such as dialysis or radiology) and/or outpatient care settings (such as clinics, offices and rehabilitation facilities).

Staff and director work collaboratively to attain all goals and maintain patient safety. Every shift has a charge nurse that is assigned by the staff on the unit. An ICU unit Chair present at hospital leadership council meetings brings information back to the unit and shares it with staff from all shifts. Director also presents information at staff meeting where ideas are introduced and decisions are often made. Evidence-based practice recommendations are provided via several forums to include: interdisciplinary patient rounds, staff meetings or informally as the need arises based on patient and staff needs. Every hospital inpatient department has a chair. Each department/unit chair meets quarterly. During these meetings the chairs discuss patient care issues, staff concerns and generate suggestions or processes that the staff nurses would like to incorporate into daily practice.

An example is hand-off of communication. The staff in the Intensive Care Unit (ICU) felt that hand-off communication should be verbal where they are afforded the opportunity to ask questions. The staff brought the concern to the director who then collaborated with the director in the medical surgical unit. The joint commission standards on handoff of communication where reviewed collaboratively between the different departments and based on the recommendations from the staff and the evidence-based research from Joint commission; all reports between ICU and medical surgical units are provided verbally staff to staff.

ICU’s medical director is a board certified pulmonary intensivist. The medical director is active in meeting with the units nursing director and the hospital CEO. The director maintains an open door policy, and together with the medical director, promotes collaboration among the various disciplines. The directors provide all staff with their personal phone numbers maintaining themselves highly accessible. Residents play an active role in the collaborative process. Patient care decisions are made as a team.

b.      Encourage/ensure frank, two-way communication throughout the unit.

c.       Share key hospital decisions and information.

Notes: Your response may include the frequency of interactions and modes of communication, both formal and informal.

Patients plan of care and unit plans are evaluated three times a week during interdisciplinary rounds. Various departments collaborate on a plan of care for each patient on the unit and goals are set, continued or modified as a result of interdisciplinary collaboration. The interdisciplinary team consists of nursing director, staff nurses, dietary, pharmacy, infection control, patient family members if present, unit secretary, case manager, residents from various disciplines, respiratory therapy, laboratory at least once a week and wound care nurse and physical therapy as needed.

Communication boards also keep all staff and unit visitors informed of unit activities and quality outcomes. The use of emails and monthly staff meetings is yet another form of communication between staff and leadership. All staff meeting minutes are posted so that staff who is unable to attend can read and signoffthat they read minutes. Many times staff will follow-up by calling director to obtain information directly from her.

Quality improvement measures are a continuous process for ICU staff. Improvement measures derived from informal staff meetings are brought to director who then collaborates with other department leaders and the practice council so that improvements or suggestions are considered for change and implementation in efforts to consistently provide optimal patient care and obtain the highest quality outcomes.

director is open and creative in adopting the new idea. The pulse is kept during staff meetings when the agenda is opened for staff feedback. The staff verbalizes the type of recognition that they want to receive. This is how the free Holiday of choice off came about. One staff proposed the idea during a staff meeting and it was adopted by all including the unit leader. This collaboration meant that for every holiday an extra nurse would need to be assigned to cover the nurse whose turn it may have been to work and yet won the opportunity to have the holiday off.

Patient safety and performance improvement committee meets monthly. During this meeting every unit’s data is presented, unit staff is present to discuss unit specific data and performance.

The ICU is a locked unit with exit only access via stairwell and a ring in system where one can see via use of camera who is requesting to come in. Voice communication is also available between the person requesting to enter unit and staff inside unit.

Staff meetings provide a venue for staff to express any concerns or suggestions. There are many applicants that apply to work on the unit. At present within the last 3 months over 20 applications have been received for the ICU alone. Several Medical-Surgical nurses have expressed interest in transferring to ICU however only two new positions were created one which was offered to an ICU working nights who wanted days and the other two were night positions. The ICU is proud to uphold its current reputation. The staff and director work closely as maintain the reputation they have worked towards

creating. No results avail to report on Category 5 specific to staff. The NDNQI survey results will be avail in October 2014.

Interdisciplinary rounds are conducted three times per week with representatives from various disciplines. During said rounds everyone is provided with an opportunity to speak without limitation to topic. Topics range from education, to patient treatment to patient safety. An excellent example involves having negative pressure rooms. The hospital is old, the unit used to use portable devices that would blow air out through the window to maintain negative pressure when indicated. Being that the hospital is in an old building the ICU rooms are tight for space. The portable machines took up most of the space in one of the corners. The staff brought this up during interdisciplinary rounds when presenting a case. This was excellent because the nursing director medical director and infectious disease nurse met afterwards to come up with a plan to see if a different system existed that would not occupy same amount of space. Today the unit has witnessed the fruit of effectively communicating patient, family and staff needs. Negative pressure machines are installed on the roof. No floor space is occupied provided the needed space for patient and family to enjoy.

nurse has cared for patient before or if family request specific nurse. This is an important part of creating

daily assignments and meeting patient needs.

solidified between nurse and case manager if the patient is being discharged out of the facility. Director to director collaboration is often witnessed as directors in the organization work closely together.

from being disrespectful.

The hospital promotes and encourages all staff to continue education and to become certified in area of specialty. The organization is committed to provide the resources and materials needed for the staff to study and successfully attain certification. Specialty area certification books and online courses have been purchased for any interested staff to use. The organization also reimburses staffs who successfully obtain certification.

There is also a section in the nurses’ yearly evaluation where one can indicate learning wishes and another area where the nursing director provides feedback to the staff in reference to education needs or continued education assigned to staff. The nurse and director agree on a date by which recommended education should be completed.

The ICU staff holds each other accountable and come together as a group to ensure that they always provide patients with the best care. The senior most staff enjoys educating the younger staff. This enhances  the culture of continuous learning and education that one enjoys in the ICU here at Larkin.

As the organization continues to grow there will be more opportunities for the staff to attend conferences. The CNO is working on creating a foundation where in-kind donations can be used to support nursing education for the bedside nurse.

b.      How new knowledge is translated from evidence-based research into bedside/unit practice.

c.       How new knowledge is shared with others.

Notes: Examples of processes to support a culture of inquiry may include unit research and nursing accountability for research as exemplified by data collection, primary investigator or performance improvement activities.

Once admitted it is the nurse’s responsibility to update medication reconciliation form. If a patient is transferred between different units in the hospital the nurses on respective units most complete medication reconciliation form. Compliance is being tracked to attain 100% compliance.

b.      How does the unit ensure pain scale inter-rater reliability among care givers.

Notes: Examples of ensuring consistent pain management may include policies, procedures or protocols, measurement tools appropriate to your unit patient population, or training to ensure inter-rater reliability for pain management tools.

Training and education of pain management ensure that Inter-rater reliability among care givers is maintained. Many times staff will consult with each other in the ICU when a patient’s pain is not relieved with the prescribed regimen. Residents will also be consulted to ensure that all patients receive the proper pain management when pain is not relieved by prescribed regime. Alternative measures are also initiated to promote pain relief. Examples practiced in the ICU include: closing blinds to allow enough light as per patient request, the glass doors are closed to diminish sound to patient’s room, for patient’s that require bed baths, the RN’s will employ a soft body rub with appropriate hospital lotions as per patient comfort level

There is no formal system or established questionnaire that guides the caller. Staff and leadership conduct round on patients and families and their perception of care received is gathered during these rounds. Larkin Community Hospital maintains a patient relations coordinator who addresses any patient or family concerns. If any issues arise they are addressed at the moment so that no one patient leaves without knowing that their concerns were addressed. Patient and family members are provided with an anonymous complaint line in the event that they choose this method of communication.