The Online Newsletter for Children's Nurses
e-Edition, Issue 12
Exemplary Care: A Reflection of Professional Practice
According to the American Nurses Credentialing Center, “The true essence of a Magnet® organization stems from exemplary professional practice within Nursing.” 1
Children’s Hospital Nursing Professional Practice Model (NPPM) is a dynamic framework comprised of twelve elements that encompass the attributes, systems, structures and processes that support the clinical practice of nurses and promote a professional practice environment.2
The practice of nursing at Children’s Hospital is continually evolving. As such, structure and processes that comprise the Nursing Professional Practice Model are constantly developed and revised.
The following two performance improvement projects demonstrate empirical outcomes resulting from the application of the systems, structures and processes of the Professional Practice Model
Prevention of Surgical Site Infection (SSI)
Highlighted structures and processes within the Professional Practice Model applied and/or modified to prevent SSI include:
Theoretical Framework: Concepts of participatory governance were applied in the formation of the interdisciplinary task force representing a variety of nursing professionals within the organization (i.e., Staff Nurse, Clinical Educator, Supervisor and Director).
Governance: The SSI Task Force was established to develop and implement the SSI bundle practices. The Perioperative Infection Control Committee provided leadership for Phase II of infection prevention strategies during construction. They continue as an active part of the Perioperative Governance Structure.
Professional Practice: Policy and Procedure for the prevention of SSI was established that incorporated SSI Bundle practices based on the collaborative with the Child Health Corporation of American (CHCA).
Care Delivery: Patient family education included elements of the SSI Bundle especially regarding skin/hand hygiene and the use of antibiotics.
Research/Evidence-Based Practice: The Pediatric Affinity Group developed the “How-to-Guide Pediatric Supplement” that provided evidence-based regimens to meet the prescriptive needs of pediatric patients. These were incorporated into the new practice policies and procedures.
Collaborative Partnerships: External collaborative partnerships were established between Perioperative Services and CHCA. Internal collaborative partnerships were demonstrated between Nurses, Physicians, Infection Control Specialists, Pharmacists and Administrators.
Outcomes: SSI outcome measures are monitored. Surveillance of post-operative infections includes compliance data referenced in the bundle as well as the composite of data reported to the California Department of Public Health (CDPH) each month.
Communication: A number of communications strategies were supported during the process including the promotion of daily reporting of concerns; communication between the Perioperative Practice Council Chair, Perioperative Practice Council members and the Perioperative Leadership Team; and reminders routinely provided by Leadership in daily huddles.
Operations: A number of operational processes were revised and/or newly established to support prevention of SSI; e.g., modifications to patient scheduling, documentation revisions, inspections and purchase of warming devices.
Focused improvements were initiated in two phases by an interdisciplinary team.
- Phase I involved development and implementation of the SSI Bundle.
- Phase II involved mitigating the risk of SSI while under construction.
The vigilance of the entire team resulted in finding no statistically significant increase in SSI during or immediately following the construction and renovation projects.
Prevention of Central Line-Associated Blood Stream Infection (CLABSI)
Highlighted structures and processes within the Professional Practice Model applied and/or modified to reduce CLABSI include:
Theoretical Framework: The Performance Improvement framework, Plan Do Check Act (PDCA), was utilized to guide the process. Concepts of participatory governance were applied in the formation of the interdisciplinary task force representing a variety of nursing professionals within the organization; (i.e., Staff Nurse, Clinical Nurse Specialist, Clinical Educator, Supervisor, Manager and Director).
Governance: The CLABSI Task Force was established and continues to provide oversight for compliance and outcomes associated with CLASBI.
Professional Practice: Clinical Policy and Procedure was modified through the Practice Council to incorporate insertion and maintenance bundles based on professional standards from the National Association of Children’s Hospitals and Related Institutions (NACHRI), California Perinatal Quality Care Collaborative (CPQCC) and California Department of Health Services (CDPH).
Collaborative Partnerships: External collaborative partnerships were established between the Neonatal Intensive Care Unit (NICU) and Child Health Corporation of America (CHCA) in association with the California Perinatal Quality Care Collaborative (CPQCC). The Pediatric Intensive Care Unit (PICU) established a partnership with the NACHRI collaborative with a focus on critically ill pediatric patients. Internal collaborative partnerships between Nurses, Physicians, Infection Control Specialists, Pharmacists and Administrators promoted standardization of care throughout the organization.
Care Delivery: Involving families in the Plan of Care is supported with use of several documents. Patient family education occurs with initial insertion of the central line, throughout the hospitalization and during ongoing maintenance to include home care if needed.
Outcomes: Weekly quality compliance audits by staff champions were established to provide support. Outcome measures are monitored.
Communication: Monthly and quarterly updates and outcomes are shared using a quality scorecard during unit-based Huddles and staff meetings. Monthly outcomes are posted on the PICU Wall of Data for staff review. The board indicating the number of days between infections is updated weekly to keep staff-awareness elevated.
Operations: Standardized supply kits were established to support the new care processes.
Practice insertion and maintenance bundles were initiated based on national standards. Standardized supply kits for the care of central venous catheters including dressing changes, cap changes and blood draws were implemented. An interdisciplinary organizational CLABSI Task Force was formed to provide ongoing oversight and support for standardizing care throughout the organization for patients with central venous lines; this included patients in outpatient and home care settings. The ongoing efforts of the task force have ensured continued focus and performance in the prevention of CLABSI. Through the performance improvement efforts, Children’s Hospital has been able to outperform the benchmark in eight out of ten reporting periods over the last three years.
Children’s Hospital has a rich history of interdisciplinary collaboration across the continuum of care and interdepartmentally promoting quality care. Several interdisciplinary team members have expressed their perception of collaboration with nursing.
“We feel very fortunate to have the kind of positive and engaging relationship between our nursing and social work.”
Anthony Yamamoto, LCSW, Director Social Work Services and Child Development
“Respiratory Care Practitioners (RCPs) team with the nursing staff to plan for and deliver the care needed by the patient, under the order of a physician.”
Daniel Englehaupt, RCP, Director Respiratory Care Services
“Our effective and successful collaboration between Nursing and Pharmacy has enabled us to provide the best care for our patients.”
Richard Sakai, Pharm.D., FASHP, FCSHP, Director Pharmacy Services
“Thank you for allowing me to share my thoughts and support of the amazing work provided by our magnanimous team of professionals who care for patients, families and each other here at Children’s Hospital Central California”
Susan Lea, MS, CTRS, PPS, Director Spiritual Support, Child Life and Interpreter Services
“There are nursing representatives that participate in all Medical Staff committees collaborating with physicians to ensure the safe, effective care of patients.”
Elizabeth Searles, MBA, BSN, BSM, RN, NE-BC, Director Medical Affairs and Quality
”Nursing is a vital component to the successful delivery of care at Children’s Hospital Central California across all of our 21 physician-based disciplines and 13 different testing and therapy services.”
David Hodge, Jr., Executive Director Ambulatory Services
“Home Care and Hospital-based clinical staff have made great advancements in the quality of collaboration and coordination of patient care services…”
Denise Russo, RN, Manager Clinical Services
“We are blessed at Children’s Hospital Central California with having highly skilled, educated and trained nurses to work with all aspects of care that we, as physicians, provide …”
Marvin Ament, MD
Structures that support interdisciplinary collaboration include interdisciplinary rounds and conferences, discharge huddles and collaboration with external stakeholders. These systems and forums provide an opportunity for all providers of nursing/patient care to collaborate in the management of the patient to ensure continuity of care.
Patient and Family Satisfaction
Consistent with its mission, vision, values and strategic goals, the organization thrives on providing care and service that exceeds the patients’ and their families’ expectations. Press Ganey patient and family satisfaction surveys provide the tools in order to measure the organization’s success toward that end. Specifically, the survey elicits feedback regarding the patients’ and their families’ overall assessment and satisfaction with their inpatient or outpatient experiences. This critical indicator, reflective of the organization meeting expectations, incorporates the following questions as part of the inpatient survey:
- Cheerfulness of the hospital
- How well staff worked together
- The care given at this hospital
- The likelihood of recommending this hospital
The organization’s performance on “overall assessment” has outperformed the
comparative database means for each six-month period over the last two calendar years.
Patient and family comments include:
Inpatient Acute Care
“The Nursing Staff in Craycroft is very helpful and just plain awesome. Nurse Sean was
fabulous and did everything and showed me everything so that we could go home.”
“Everyone was so nice, Billy was my favorite nurse.”
“Lisa was our nurse and she was great. Very helpful and friendly. Kept us informed of
what was going on. She was awesome.”
“I would like to thank Chris for being friendly and smiling.”
Neonatal Intensive Care
“Grant was very attentive; he made me feel like he cared about my child’s wellbeing.
When they drew her blood he put me in the quiet room. I was exhausted and having my
baby cry made me cry too. Our nurse was constantly checking in on us and even
brought me a soda so I could stay awake.”
Pediatric Intensive Care
“We are very grateful for all of the services we received. Thanks to the staff,
especially Gina. Thank you very much.”
Clinical outcomes, patient and family satisfaction and interdisciplinary collaboration
reflect the exemplary care provided through the professional practice of nursing.
1 2012 American Nurses Credentialing Center, Magnet Recognition Program® Retrieved from http://ancc.nursecredentialing.org
2 Adapted from Vermeltfoort, D., Dragomanovich, M, and Mountcastle, K. Common Components of Current Nursing Professional Practice Models in the Hospital Setting in the United States of America – A Qualitative Study.
In This Issue
Leadership That Transforms
Innovations In Nursing
The Magnet Culture
Meditech Scanning and Archiving