Healthcare Delivery Systems

Improvement Project: Patient Focus

Hailey Clark, Lexi Avant, Lanie Ferguson, Amanda

Stevens, Jessica Farrone
November 14th, 2018
Overview of Patient Care Delivery System
● Banner University Medical Center
● Trauma Intensive Care Unit

Focus: Patient focus related to uncontrolled pain from a gunshot

wound
Microsystem Model: Leadership
● Charge nurse/ manager
● Act as mentors
● Team leaders
● Jim Collins’s Level 5 Leadership model-“have team building
skills and can help groups achieve shared goals”
● Supportive
● Charge nurse goes into ratio

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 63). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.
Microsystem Model: Organizational Culture and
Support
● Huddles/Patient Assignments
● Charge checked in every couple hours
● Team work
○ Through delegation- “Frequently, there is too much work
to be accomplished by one person.”
● New admits
● ICU charge nurses going to codes
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 525). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.
Microsystem Model: Patient Focus and Staff Focus
and IN Principle
● Team Rounds-“improved staff communication, problem
solving, patient outcomes, and staff satisfaction”
● Further Education/Clinical Ladder
● Tuition Reimbursement
● Patient pain rating
● Bedside report
● Integrative Nursing Principle: Integrative nursing is person-
centered and relationship-based
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 308-309). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.
Kreitzer, M. J. (2015). Integrative Nursing: Application of Principles Across Clinical Settings. Rambam Maimonides Medical Journal, 6(2), 1-8.
doi:10.5041/rmmj.10200
 Microsystem Model: Interdependence of Care Team

● Grand rounding: “Strategies for Promoting Evidence-Based

Decision Making in Establishing Clinical Best Practices”
● Residents and students on the units
● Codes: nurses and doctors work together
● RT on floor at all times
● PCT and nurse collaborate on patient care
● No vocera (use phones to call)
● Multiple doctors per patient

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 417-418). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.
Microsystem Model: Use of Information and
Healthcare Technology
● Internet access
● Effective computerized charting with strong wifi (Cerner)
● PCA
● constant vital monitoring
● 24/7 IT support
● Micromedex
● Pyxis
● Soft touch call light
● “Technological Innovations
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 63). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.
Microsystem Model: Process for Healthcare Delivery
Improvement
● Staff meetings hard to attend
● Skin surveys are done regularly
● Four eyes on new patients
● Chlorhexidine bath
● Report
● Evidence-based practices-clinical guidelines implemented
● Posters
● Ineffective medication disposal
● Pain follow up
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 117). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.
Microsystem Model: Staff Performance
Patterns
● Care management program
● Chart audits
● Badge awards
● Daisy awards
● Unit manager reviews
● Improve on monthly meetings
● Clinical ladder
● Positive environment
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 646). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.
Specific Aspect Targeted for Improvement
and Integrative Modality

● Patient-focus on acute pain recognition and management

○ Non-verbal cues of pain

○ Asking the patient pain levels if verbal

○ Anticipate needs of patient

● Improve staff listening to patient, educating on types of pain

management, understanding patient pain
● “Observational Pain Scales in Critically Ill Adults”
Stites, M. (2013). Observational Pain Scales in Critically Ill Adults. Critical Care Nurse, 33(3), 68-78. doi:10.4037/ccn2013804
Specific Aspect Targeted for Improvement and
Integrative Modality (cont.)
● Uncontrolled pain can cause further
physiological/psychological trauma
● Nurses are busy
● Proposed patient-focus improvement intervention:
PQRSTU/NPAT assessment and needed intervention
● Integrative modality: provide a massage to patients with
uncontrolled pain
○ Alternative to medication

○ Can be an intervention in the improvement plan

Buckenmaier, C., Cambron, J., Werner, R., Buckenmaier, P., Deery, C., Schwartz, J., & Whitridge, P. (2016). Massage Therapy for Pain—Call to Action. Pain
Medicine, 17(7), 1211-1214. doi:10.1093/pm/pnw092
Stites, M. (2013). Observational Pain Scales in Critically Ill Adults. Critical Care Nurse, 33(3), 68-78. doi:10.4037/ccn2013804
Leading the Plan for Healthcare Delivery
Improvement
● Email sent to staff and Present findings to staff at meetings
○ Rational-Empirical change- build educational team to

collect and “give current research as evidence to support

the change” to staff
● Educate staff on charting pain and intervention expectations
● Charting implementation for pain management
● Implement charting pain throughout the hospital
● Evaluate patient focus improvement throughout all areas
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed. p. 193). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.
Stites, M. (2013). Observational Pain Scales in Critically Ill Adults. Critical Care Nurse, 33(3), 68-78. doi:10.4037/ccn2013804
Timeline of Events
1 month: Inform staff of new charting policies

3 months: Education program for employees on charting

6 months: Implement the NPAT charting section on trauma ICU

9 months: Evaluation of patient improvement

1 year: Spread across all units in hospital

5 years: Implement in Banners nationwide

References
● Buckenmaier, C., Cambron, J., Werner, R., Buckenmaier, P., Deery, C.,
Schwartz, J., & Whitridge, P. (2016). Massage Therapy for Pain—Call to
Action. Pain Medicine, 17(7), 1211-1214. doi:10.1093/pm/pnw092
● Kreitzer, M. J. (2015). Integrative Nursing: Application of Principles Across
Clinical Settings. Rambam Maimonides Medical Journal, 6(2), 1-8.
doi:10.5041/rmmj.10200
● Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management
functions in nursing: Theory and application (9th ed.). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.
● Stites, M. (2013). Observational Pain Scales in Critically Ill Adults. Critical
Care Nurse, 33(3), 68-78. doi:10.4037/ccn2013804