• A Call for Help: Hourly Rounding to Reduce Alarm Fatigue

      Birdsong, Amy E.; Gourley, Bridgitte (2019-05)
      BACKGROUND/LOCAL PROBLEM: Frequent call lights and alarm fatigue were identified by nursing staff and leadership as a quality concern on a Heart Vascular Unit in the mid-Atlantic region. Alarm fatigue negatively effects safety and patient and nurse satisfaction. Structured hourly rounds can reduce patient call lights. The purpose of this DNP project was to implement and evaluate the effectiveness of nurse hourly rounding on call light frequency on a 30-bed inpatient Heart Vascular Unit. METHODS: This was a quality improvement project with pre- and post-implementation assessments on alarm fatigue and call light quantity. The nursing staff was measured with a self reporting instrument. Call light quantity was measured through alarm reports. Paper tracking forms audited staff adherence. INTERVENTIONS: Hourly nurse rounding was implemented over 14 weeks. Staff were trained in teaching sessions. Each hour a member of the nursing staff entered the patient’s room and assessed their needs. Rounds were recorded on the tracking forms. RESULTS: The clinical outcomes were number of call lights that occurred in a 24-hour period. There was no significant change between pre- and post-implementation measures. The perceptual outcome was alarm fatigue in bedside nursing staff; improvement was seen in the majority of assessment responses. CONCLUSION: Structured nurse hourly rounding reduced the perceived and measured alarm fatigue among bedside staff. No significant difference was seen in the quantity of call lights. Hourly rounding may reduce alarm fatigue and improve patient and nursing satisfaction.
    • Evaluation of Nurses' Competency in the Assessment of Neonatal Abstinence Syndrome

      Harrow, Cheryl (2013)
      Neonatal abstinence syndrome (NAS) is a growing concern with the increased rate of prescription and illicit drug use during pregnancy. Assessment of NAS requires nurses to have knowledge and a complex skill set to provide quality care. The purpose of this quality improvement project was to evaluate the impact of an NAS educational intervention and the use of a systematically approached NAS scoring tool upon the nurses' ability to accurately assess infants with NAS. Nurses at a private community hospital participated in a comprehensive educational intervention guided by a cognitive learning theory to improve their knowledge and skills in the assessment of infants at risk for NAS. The education program focused on the presentation of NAS symptoms and principles of the modified Finnegan NAS scoring tool. The nurses were taught how to use the tool to assess for NAS and the importance of consistent use among staff members. A pretest-posttest method demonstrated a gain in knowledge. There was a statistically significant increase from the pretest (M = 7.71, SD = 1.68) to the posttest scores (M = 9.06, SD = .98), t (33) = 5.68, P < .001. The mean increase from pretest to posttest score was 1.35 with a 95% confidence interval ranging from .868 to 1.838. The eta squared statistic (.49) indicated a large effect size. Four weeks later, a subsample of 12 participants scored videos and scenarios with predetermined NAS scores and were evaluated using an intraclass correlation coefficient which confirmed interrater reliability with a mean of .94 for the first video/scenario and .98 for the second. Comprehensive NAS education and the routine use of the modified Finnegan NAS scoring tool provided registered nurses with knowledge and skills needed to accurately assess infants at risk for NAS.
    • Improving Ineffective Communication in Long Term Care Settings

      Rucker, Airelle P.; Windemuth, Brenda (2019-05)
      Background Ineffective communication contributes to medical errors and sentinel events in healthcare, leading to fatalities and billions in malpractice cost. Nurses have a leading role in communicating patient information. In long-term care, ineffective communication and poor teamwork contributes to adverse events. Adverse events in our older adults can lead to hospitalizations, injuries, and death. Effective communication and teamwork are key components to providing safe patient care. Implementing a standardized handoff tool and team building curriculum can improve communication and teamwork. Local Problem Ineffective communication was a verbalized, observable practice problem at a long-term care facility in a suburban location in the Mid-Atlantic region. The purpose of this Doctor of Nursing Practice quality improvement project was to implement and evaluate the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum with a standardized handoff tool to improve communication and teamwork between nurses at this long- term care facility. Interventions During this quality improvement project, six nurses at a suburban long-term care facility learned two TeamSTEPPS modules: communication and team structure. Modules included strategies such as use of the Situation-Background-Assessment-Recommendation communication framework and used a validated handoff tool, Safer Sign Out. This quality improvement project occurred over 14 weeks. During week one, the nurses were informed about the practice change. During week two, the DNP project leader administered pre-surveys and educated the nurses on the TeamSTEPPS’s curriculum and handoff tool. During weeks three through thirteen, the nurses utilized the Safer Sign Out handoff tool to give report. Nurses were observed during each shift change during the first week on implementation. The project leader reviewed the handoff log for compliance and gave feedback. During week fourteen, nurses completed post- surveys. Lippitt’s Change Theory was used to guide this practice change. Results (Impact of change) The post- TeamSTEPPS Teamwork Attitudes Questionnaire revealed an increase in overall scores on the team structure and communication category but these changes were not significant, thus indicating only a limited overall improvement in the nurse’s attitudes about teamwork and communication. The post- TeamSTEPPS Teamwork Perceptions Questionnaire, revealed an overall slight increase in the scores from the team structure category and a slight decrease within the communication category; however, neither were found to be statistically significant. The data revealed that use of TeamSTEPPS did not result in significant improvements in the staff’s attitudes and perceptions on teamwork and communication. Conclusion Ineffective communication and poor teamwork in long-term care continues to lead to adverse events. Information is often lost during shift handoff. In this quality improvement project, several limitations may have impacted the results: a small sample size, a lack of involvement of an organizational champion or internal change agent, limited space to free text information on the handoff tool, and many internal organizational changes. Barriers must be addressed before implementing a communication and team-building curriculum. If barriers are addressed, then utilizing the TeamSTEPPS curriculum with nurses to teach teamwork and communication strategies, along with a validated handoff tool, may help to improve communication during shift hand-off.