The CKHS Nursing Strategic Plan: A Message from Robert Haffey
by Robert Haffey, MBA, M.S.N., R.N., CKHS Chief Nursing Officer
One of the most satisfying aspects of working in healthcare is the immediate payoff that can occur when change is made. Take, for example, the introduction of the Medication Administration Checking (MAK) system at CKHS as a means of providing additional safety checks during the medical administration process. Within one week of its launch, the system identified four scan errors which could have led to adverse events and patient harm.
Since our nursing retreat last year, we have made a number of broad changes across the health system, such as MAK, that have enhanced patient care and ultimately made us a safer, more efficient organization. Many of these changes have been driven by our Nursing Strategic Plan (NSP), which is comprised of tactics developed by staff nurses on the frontlines of patient care in collaboration with members of management (See the list of those involved in the development of the NSP tactics.)
I would like to commend those nurses from across the organization that has contributed to the work done within the four key areas addressed under the strategic plan – quality and safety, patient experience of care, professional caregiver experience, and accountability. These nurses include those who attended the spring strategic planning retreat, participated in the task force meetings to develop the specifics of the NSP and the members of Vision Day who are responsible for NSP implementation.
As a result of the hard work and determination of these and all our nurses, we’ve experienced several successes since we met. A prime example is the redesign of the shared governance model. This has been a significant undertaking and, while we are in the early stages of growth and development, we are seeing progress and improved communication, efficiency and accountability. Other successes that we have seen since we began implementing the NSP in July include the following:
Quality and Safety:
- A renewed commitment to hourly rounding has helped to decrease patient falls across the system.
- We’ve completed nursing education/re-education on hourly rounding and No Pass Zone.
- A renewed focus on VAP care bundles has increased overall compliance. Work continues in this area.
- The safety huddle tool has been developed and the goal is to implement this consistently on every nursing unit and shift across the health system.
- As mentioned earlier, MAK has been launched and nurses across the system have completed the mandatory education.
- The “5 Rights of Medication Administration” ensure the safe delivery of medications to the patient. MAK now enables us to audit system over rides for both medications and patients. While not every over ride is a medication error, we believe that increased vigilance will lead to their reduction.
- Our efforts to reduce/maintain VAP rates in our intensive care units have led us to strengthen consistent multidisciplinary rounds.
- Education for the “No Interruption Zone” is ready for roll out.
Patient Experience of Care
- We are spending more time reviewing plans of care with patients.
- To maximize communication with patients, we are working to standardize the communication boards (white boards) in patient rooms across the health system.
Professional Caregiver Experience
- Plans are underway to unveil the Daisy Award to CKHS.
- We are exploring the introduction of Schwartz Center Rounds system-wide.
- At the recommendation of staff, clinical directors are participating in Transformational Leadership education.
In addition to the aforementioned items, we are looking at ways to supplement our staffing. This includes expanding our pool of RNs to 75 in the spring and 100 by summer. These nurses will be part of our supplemental systemized staffing pool, which serves as our internal agency during periods of high census.
We’re also working to increase the availability of resource materials for our nurses. In addition to Lippincott’s Nursing Procedures 5th edition – a hard-copy reference guide that is now on every unit – we have purchased some specialty standards of practice for our Vision Day nurses working to merge policies for the system. We’re also considering purchasing Lippincott’s Nursing Solutions, an online resource that would be accessible on any hospital computer and by password, from home.
In the months ahead, we will continue to focus our efforts on reducing the incidence of falls, medication errors and VAP. We will also be placing a renewed emphasis on the reduction of CAUTI rates – which have been on the rise recently – and medication side effects. Additionally, we will be addressing concerns related to patient care – including communication, responsiveness and pain management – as well as key issues affecting our nurses in their day-to-day lives, such as job satisfaction, recognition and staffing.
Our journey to becoming a high reliability organization continues. Leadership recently completed its training with tools such as daily check in and unit safety huddles already implemented. Additional tools/behaviors are in the process of being launched. Physician training commenced in February and we are asking that some of our doctors serve as leaders and exemplars for staff members, who will begin mandatory staff training. Once training is complete, the focus will be to systematically adopt one tool at a time so that physicians and staff can build habits through reinforcement. The goal is zero events of preventable patient harm across Crozer- Keystone Health System.
I know that change can bring satisfaction, but it can also be very painful in the short-term. There’s little question that over the past eight months we’ve asked our nurses to endure a tremendous amount of change. Please know that these hardships – while difficult in the short term – are necessary steps that will ultimately allow us to achieve our goal of becoming a high-reliability, family centered organization.
In closing, I would like to recognize John Harper, MSN, RN-BC, clinical educator for Critical Care, who presented the closing keynote address, “Cardiac Monitor Leads in Critical Care Units – Potential Source of Healthcare-Associated Infections,” at the 7th Annual CKHS Nursing Research Symposium. John is an example of the expertise we have right here in our own health system, expertise that we will continue to call upon as we continue on this journey.
I am excited by the opportunities that lay before us this year and am looking forward to partnering with each of you to make CKHS an organization of which we can truly be proud.