©2013 MFMER | slide-1 Clinical Nurse Specialist Driven Practice Change: Standardizing Vital Sign...

©2013 MFMER | slide-1

Clinical Nurse Specialist Driven Practice Change: Standardizing Vital Sign and Oxygen Saturation Monitoring Practices

Kelly Derby, APRN, CNSSherry Wolf, APRN, CNSHeather Zak, APRN, CNS


Objectives:

1. Identify key drivers for change in nursing practice related to vital sign reassessment.

2. Examine factors contributing to variances in vital sign monitoring practice.

3. Describe actionable strategies for improving patient safety through vital sign reassessment.


Background

• Failure to rescue = “the inability of clinicians to save a patient’s life by timely diagnosis and treatment when a complication develops”

• (Gephart, McGrath, & Effken, 2011, p.275)

• Patient’s display signs and symptoms of impending arrest as early as 72 hours prior to an arrest

• (Subbe & Welch, 2013)


Failure to Rescue• Where do we fail?

• Failure to recognize clinical deterioration• Failure to escalate concerns• Failure to physically assess the patient• Failure to diagnose and treat appropriately

• (Moldenhauer, Sabel, Chu, & Mehler, 2009)

• Activities to prevent FTR events:• Surveillance• Timely identification of complications• Taking action• Activating a team response

• (Gephart et al., 2011)


DMAIC - Define • To standardize frequency of vital sign

monitoring of general care/progressive care patients following admission or transfer to a lower level of care and prior to dismissal

• To provide guidance for reassessment of patients with abnormal vital signs

• Vital signs • Temperature• Systolic blood pressure• Heart rate• Respiratory rate• Oxygen saturation


Scope

• Inpatient general and progressive care areas

• Adult

• Registered nurses

• Patient care assistants - PCA


DMAIC - Measure

• Mortality reviews revealed a gap in recognition of patient deterioration, specifically a gap in vital sign and oxygen saturation obtainment and reassessment

• Counterbalance measure: RRT calls


DMAIC - Analyze

• Literature review

• Internal Practice

• Benchmarking

• Reassessment


DMAIC - Improve

• Development of algorithm

• Input from stakeholders

• Pilot

• Education/roll out

• Development of new standards


DMAIC - Control• Outcomes

• Mortality review• RRT• Process measures (monthly compliance reports)

• Data audits• Every 4 hours at admission• Every 4 hours with transfer to a lower level of care• Full set of VS within 30 minutes of any abnormal VS• TID as routine practice• Within 2 hours of discharge

• Orientation

• Reiterating processes

• Practice convergence

• Continuing to monitor


Takeaways

• Assess for inconsistencies in your organization’s practice

• Seek opportunities for standardization

• Engage the bedside nurse

• Evaluate processes

• Embrace rapid cycles of improvement


V i t a l S i g n s .

Skipping just one could cost a person their life.


Questions & Discussion


ReferencesBarfod, C., Lauritzen, M. M., Danker, J. K., Soletormos, G., Forberg, J. L., Berlac, P. A., . . . Lange, K. H. (2012). Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study. Scand J Trauma Resusc Emerg Med, 20, 28. doi: 10.1186/1757-7241-20-28

Brown, H., Terrence, J., Vasquez, P., Bates, D. W., & Zimlichman, E. (2014). Continuous monitoring in an inpatient medical-surgical unit: a controlled clinical trial. Am J Med, 127(3), 226-232. doi: 10.1016/j.amjmed.2013.12.004

Hands, C., Reid, E., Meredith, P., Smith, G. B., Prytherch, D. R., Schmidt, P. E., & Featherstone, P. I. (2013). Patterns in the recording of vital signs and early warning scores: compliance with a clinical escalation protocol. BMJ Qual Saf, 22(9), 719-726. doi: 10.1136/bmjqs-2013-001954

Garvey, P. K. (2015). Failure to Rescue: The Nurse's Impact. Medsurg Nurs, 24(3), 145-149.

Gawande, A. The Checklist Manifesto: How to Get Things Right. Metropolitan Books; 2009

Gephart, S. M., McGrath, J. M., & Effken, J. A. (2011). Failure to rescue in neonatal care. J Perinat Neonatal Nurs, 25(3), 275-282. doi: 10.1097/JPN.0b013e318227cc03

Moldenhauer, K., Sabel, A., Chu, E. S., & Mehler, P. S. (2009). Clinical triggers: an alternative to a rapid response team. Jt Comm J Qual Patient Saf, 35(3), 164-174.

Subbe, C.P., Welch, J.R. (2013). Failure to Rescue: Using rapid response systems to improve care of the deteriorating patient in the hospital. Clinical Risk, 19, 6-11.

Yoder, J. C., Yuen, T. C., Churpek, M. M., Arora, V. M., & Edelson, D. P. (2013). A prospective study of nighttime vital sign monitoring frequency and risk of clinical deterioration. JAMA Intern Med, 173(16), 1554-1555. doi: 10.1001/jamainternmed.2013.7791

©2013 MFMER | slide-1 Clinical Nurse Specialist Driven Practice Change: Standardizing Vital Sign...

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