Valuing Nursing Treatment in Delirium · k 1 k 2 k 3 k 4 k 5 k 6 k 7 k 8 k 9 k 10 k 11 k 12 k 13 k...
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Valuing Nursing Treatment in Delirium Aim Statement: Within 6 months to reduce the requirement for nursing specials by 50% on the Medical Ward of Orange Health Service Background to problem worth solving An increasing number of requests for nursing specials with minimal patient assessment and concurrent organisational high falls rate warranted a review of nursing special utilisation. Team members • Sponsor/s (Guidance Team) • Catherine Nowlan General Manager, Orange Health Service • Project Team • Leanne Casey A/Director of Nursing and Midwifery Services • QI Advisor – Gillian Dimond Accreditation, Quality and Education • Anetta Westgeest NUM Medical Ward • Jenny Cahill NUM Surgical Ward • Angela Millard Aged Care CNC • Margaux Lister Medical Registrar • Consumers – David and Maureen (Volunteers) Author Leanne Casey Position Director of Nursing and Midwifery Services Email [email protected] Phone 6369 3702 ECLP Cohort 16 Plans to sustain change The LOP will de disseminated and compliance is mandatory. Monitoring of compliance will be through the Nursing Unit Managers and Campus Nurse Managers Documentation for the requesting of a nursing special will be imbedded with Nursing and Medical staff. The request form will be submitted to the District forms committee for review and endorsement. Measurement will be expanded to the three adult inpatient areas however inaccuracies will be avoided due to the implementation of electronic NHPPD reports linked to the rostering system. This will mostly eliminate human error in reporting Assistants in Nursing are undergraduate students who work for the organisation while studying. The workforce frequently rotates and all will have undertaken the training requirement within 12 months Results Outcome measures: Baseline data Process measures: Flow chart and form development Plans to spread /share change This project has been submitted to the Agency for Clinical Innovation- Innovation Exchange Future plans for project development Expand data collection to Surgical Ward and Coronary Care Unit to have a true reflection of project outcomes Data collation over 2017 Submit to the WNSWLHD quality awards 2018 if outcomes are consistent and sustained Further submissions will be dependent on service improvements Link to National Standards Standard 1 Governance Safety and Quality Standard 2 Partnering with consumers Standard 6 Clinical Handover Standard 10 Falls Literature review • Close observation by ‘specials to promote the safety of the older person with behavioural disturbances in the acute care setting. L Wilkes, D Jackson, S Mohan & M Wallace. Contemporary Nurse (2010) 36 p 131-142 • Acute care management of older people with dementia: a qualitative perspective. (2010) W. Moyle, S Borbasi, M Wallis, R Olorenshaw & N Gracia. Journal of Clinical Nursing 20, p 420-428. • Health Professionals Perspectives of providing Care to People with Dementia in the Acute Setting: Toward Better Practice. (2006) S Borbasi, J Jones, C Lockwood & C Emden Geriatric Nursing Volume 27 (5) p300-309 Solution 1 - PDSA Cycle Solution 2 - PDSA Cycle Local Operating Procedure Solution 3 - PDSA Cycle Results continued Process measures: Reduction in Specials requests Balancing measures: Falls reduction Discussion The heightened awareness of delirium and falls risk in the organisation may have impacted data analysis Electronic recording of NHPPD may have highlighted the inaccuracies of manual entries Limiting the project to the Medical Ward has not enabled a full understanding of the true impact of the project Overall Outcome of Project: The stretch goal was to reduce the number of nursing specials within 6 months on the Medical Ward at OHS. While this was statistically achieved, caution should be used in interpretation due to the impact of alternative quality initiatives and forced change to the data collection method. $ Cost saving Further comprehensive analysis will be required over each of the adult inpatient unit to understand the true cost savings of this project. A roadmap will need to be based around the reduction in nursing hours saved with no comparative increase in falls or delirium related incidents 0 50 100 150 200 250 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Week 13 Week 14 Week 15 Week 16 Week 17 Week 18 Week 19 Week 20 Week 21 Week 22 Week 23 Nursing Special Usage Medical Ward (hours) comparison 2015 July-Dec & 2016 Jan- June 2016 2015
Transcript of Valuing Nursing Treatment in Delirium · k 1 k 2 k 3 k 4 k 5 k 6 k 7 k 8 k 9 k 10 k 11 k 12 k 13 k...
Valuing Nursing Treatment in Delirium
Aim Statement: Within 6 months to reduce
the requirement for nursing specials by 50%
on the Medical Ward of Orange Health
Service
Background to problem worth solving
An increasing number of requests for nursing
specials with minimal patient assessment and
concurrent organisational high falls rate warranted a
review of nursing special utilisation.
Team members • Sponsor/s (Guidance Team)
• Catherine Nowlan General Manager, Orange
Health Service
• Project Team
• Leanne Casey A/Director of Nursing and
Midwifery Services
• QI Advisor – Gillian Dimond Accreditation, Quality
and Education
• Anetta Westgeest NUM Medical Ward
• Jenny Cahill NUM Surgical Ward
• Angela Millard Aged Care CNC
• Margaux Lister Medical Registrar
• Consumers – David and Maureen (Volunteers)
Author Leanne Casey Position Director of Nursing and Midwifery Services Email [email protected]
Phone 6369 3702 ECLP Cohort 16
Plans to sustain change The LOP will de disseminated and compliance is mandatory. Monitoring of
compliance will be through the Nursing Unit Managers and Campus Nurse
Managers
Documentation for the requesting of a nursing special will be imbedded with
Nursing and Medical staff. The request form will be submitted to the District forms
committee for review and endorsement.
Measurement will be expanded to the three adult inpatient areas however
inaccuracies will be avoided due to the implementation of electronic NHPPD reports
linked to the rostering system. This will mostly eliminate human error in reporting
Assistants in Nursing are undergraduate students who work for the organisation
while studying. The workforce frequently rotates and all will have undertaken the
training requirement within 12 months
Results
Outcome measures: Baseline data
Process measures: Flow chart and form
development
Plans to spread /share change This project has been submitted to the Agency for Clinical Innovation-
Innovation Exchange
Future plans for project development Expand data collection to Surgical Ward and Coronary Care Unit to have a true reflection of
project outcomes
Data collation over 2017
Submit to the WNSWLHD quality awards 2018 if outcomes are consistent and sustained
Further submissions will be dependent on service improvements
Link to National Standards Standard 1 Governance Safety and Quality
Standard 2 Partnering with consumers
Standard 6 Clinical Handover
Standard 10 Falls
Literature review • Close observation by ‘specials to promote the safety of the older person with behavioural
disturbances in the acute care setting. L Wilkes, D Jackson, S Mohan & M Wallace.
Contemporary Nurse (2010) 36 p 131-142
• Acute care management of older people with dementia: a qualitative perspective. (2010)
W. Moyle, S Borbasi, M Wallis, R Olorenshaw & N Gracia. Journal of Clinical Nursing 20,
p 420-428.
• Health Professionals Perspectives of providing Care to People with Dementia in the
Acute Setting: Toward Better Practice. (2006) S Borbasi, J Jones, C Lockwood & C
Emden Geriatric Nursing Volume 27 (5) p300-309
Solution 1 - PDSA Cycle
Solution 2 - PDSA Cycle
Local Operating Procedure
Solution 3 - PDSA Cycle
Results continued
Process measures: Reduction in Specials
requests
Balancing measures: Falls reduction
Discussion The heightened awareness of delirium and falls risk in the organisation may have impacted
data analysis
Electronic recording of NHPPD may have highlighted the inaccuracies of manual entries
Limiting the project to the Medical Ward has not enabled a full understanding of the true
impact of the project
Overall Outcome of Project: The stretch goal was
to reduce the number of nursing specials within 6 months on
the Medical Ward at OHS. While this was statistically achieved,
caution should be used in interpretation due to the impact of
alternative quality initiatives and forced change to the data
collection method.
$ Cost saving Further comprehensive analysis will be required over each of
the adult inpatient unit to understand the true cost savings of
this project.
A roadmap will need to be based around the reduction in
nursing hours saved with no comparative increase in falls or
delirium related incidents
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Nursing Special Usage Medical Ward (hours) comparison 2015 July-Dec & 2016 Jan- June
2016 2015
