The Online Newsletter for Children's Nurses
e-Edition, Issue 5
PICU Beacon Award
Beacon Award Process Shines
Light On PICU Outcomes
By Diane Civiello, MS, BSN, RN, NE-BC
The Pediatric Intensive Care Unit (PICU) has been on a journey of excellence for the past year and a half. The Beacon Award for Critical Care Excellence, awarded by the American Association of Critical Care Nurses, highlights and recognizes the links between the quality of the work environment, excellence in nursing practice and patient care outcomes. There are approximately 6,000 critical care units in the U.S. and only 186 of these units have achieved this award. In May 2008, a PICU specific Beacon Award was created to provide measures specific to the pediatric critical care population. To date approximately 10 PICUs in the nation have achieved this award, three of which are in California.
Forty-two standards are used to measure achievement towards this award, representing evidence-based and relationship-centered principles of professional performance. Studies have demonstrated that effective and sustainable outcomes emerge when these standards are met. At the same time there is evidence that medical errors, poor care delivery, stress and conflict are all indicators of unhealthy work environments.
Six categories are evaluated comprised of 42 questions divided among these categories and each of the questions has a required standard. The categories include:
- Recruitment and Retention questions were designed to measure the unit’s ability to retain, recruit, recognize and promote from within.
- Education/Training/Mentoring measures type and frequency of educational offerings, staff meetings, incentives and outcomes of national certifications as well as how mentoring is continued beyond orientation.
- Evidence-based research measures policy and procedure practices, the extent of research and literature review to support practice and of course, participation in clinical research.
- Patient Outcomes evaluates Ventilator Associated Pneumonia (VAP), Central Line Associated Bloodstream Infection (CLABSI), Catheter Associated Urinary Tract Infection (CAUTI), pressure ulcer and fall data.
- Healing Environment, the largest section, looks at medication error rate, plans of care, interdisciplinary practice, referral practices, palliative and end of life care, debrief/stress relief opportunities, ability to meet family needs, collaborative communication, physical environment, and the commitment of all staff to support this work.
- Leadership/Organizational Ethics looks at relationships with the Unit’s medical group, professional organization participation and accountability for process improvement and the like.
Eighteen months ago, the PICU’s multidisciplinary Professional Development Council engaged in the process to become a Beacon unit. As the name implies, a beacon is a guiding light that gives direction to a destination. To keep us on track and serve as a visual reminder, a six-foot ‘Beacon-like’ poster was created with questions in red serving as the body of the beacon poster. We measured our progress of completion of the application by replacing the red question with a gray (stone colored) question to signify the response to the question was written. When all the red questions had been replaced with gray ones we all knew the application was nearly complete. A banner “Keep Your Eye on the Goal” was draped across the beacon and it served as our icon. It has served us well as not only a great visual reminder, but a photograph backdrop to catalogue the memories of the process. The poster lives on and will remain in the unit until it is replaced with the award plaque.
The process began with a goal and a set of staff meetings in which council members shared the meaning and process of the award. An Intensive Care Technician (ICT) council member created a Powerpoint to share in these meetings and as a group, tested the waters of staff engagement in the idea. Then, 100 percent of the staff signed the “Bold Voices Statement,” on a commitment to excellence and to the process of becoming a Beacon Award winning unit. The 42 questions were assigned among the council and others. Stacy Hamilton, BSN, RN, PICU Charge Nurse, past chair of the council, led the process with her team.
The designation was awarded to the PICU in January 2010. The PICU staff has improved outcomes in many of the standards simply by choosing to shine the light of the Beacon upon themselves and their practice. Some examples of initiatives that have been developed through this journey are:
- A decrease in CAUTI. Prior to this journey there was no measurement of CAUTI in place. A team was formed and a literature review was done. Policies were reviewed and a process was created to measure catheter days, necessary to calculate rates of infection. Initial rates were 9/1000 in February 2009. Huddle topics and education ensued and by fiscal year-end, the average rate was decreased by 50 percent with a stretch of no UTIs for three months. Currently a team is attending a research academy and their project is the creation of a CAUTI “bundle” which does not currently exist in literature.
- “PICU Pals” mentorship process. No mentoring program existed at the beginning of this journey and today there is a formalization of a voluntary program of experienced staff to mentor new staff. An “ASK ME” button campaign serves as a visual reminder of a safe and confidential “pal” to go to with any question or concern.
- A significant increase in certified nurses. In spring 2007, there were six nationally certified CCRNs in the PICU. Through focused efforts we have achieved a significant increase resulting in 38 CCRNs in the PICU.
- A decrease in our VAP and CLABSI rates.
These are only a few of the many positive outcomes that have been achieved for which the staff can take professional pride. Achieving the Beacon Award creates a new opportunity for ways to continue to improve and re-evaluate how we care for kids, their families and each other.
The PICU staff is a group of amazing people, providing incredible care who are truly deserving of the Beacon light shining upon them and I am proud to be their part of their team.
 AACN Standards for Establishing and Sustaining Healthy Work Environments, 2005
In This Issue
Nursing Rights and Responsibilities
Nurse of the Year 2010
PICU Beacon Award
Critical Care Transport Excellence
A Culture of Inquiry
Nursing Governance Outcomes
Parents As Partners In Care
Contributions to Practice
Contributions to New Knowledge - Nursing Research
Leadership In Professional Nursing Organizations