Discussion 2

Practicum Project

 

     As the Associate Chief of Nursing Service for Geriatrics, one of the areas that I oversee is the Community Living Center or CLC.  The CLC is a 101 bed nursing home that serves our veterans who need short term, long-term, rehabilitation, transitional care, dementia and/or hospice services.  Recently, we have been experiencing a low score for our Quality Measure (QM) for pressure ulcers.  Specifically, we have a problem with pressure injuries to the heel areas. After the sacrum, the heel is the most common site for pressure ulcers to develop (Black, 2004).  Although the care plans and interventions for heel injury prevention are in place and all reviewed by the Interdisciplinary Team, many times those interventions are not accurately communicated to the front line team members.  I often see that the front line unlicensed nursing assistants don’t know the interventions put in place by the team, especially on the odd tour shifts.  I have also learned that not only do they not understand why the interventions should be in place, but also that the charge nurse never passed on the information during hand off reports. This needs to be improved.

 

Rationale for my Focus

     To focus on the handoff communication for my project and the educating the need to communicate accurate information is in line with the Joint Commission.  The Joint Commission estimates that nearly 70% of all adverse events were caused by a breakdown in communication (Glynn, Saint-Aine, Gosselin, Quan & Chute, 2017).  Having a good handoff between shifts and between neighborhoods in the CLC must occur.  All staff need to understand who is at risk for pressure injuries, who needs to be repositioned and what specific interventions need to be in place for each resident. The responsibility for this is transferred during change of shift handoff reports (Haque, Osterlund, & Fagan, 2016).  In one study of handoff reports from night shift, the authors found that a consistent tool for handoffs was needed (Higgins, Brannen, Heiman, & Adler, 2017).  Smooth and efficient handoffs are needed to provide clear communication of high risk residents and information for patient safety (Kear, 2016).  Validation of the need to focus my project on this topic occurred during recent audits completed by the nurse managers on the CLC units.  The audits showed that many interventions were not in place to prevent heel injuries for high risk residents on all three shifts and also that the nursing assistants stated they were not aware of the interventions or even understood the need.   

Project Goal & Objectives

     Nurses help coordinate the care plan and work together with the interdisciplinary team to ensure positive outcomes.  It is my goal to improve the pressure ulcer prevention program in the CLC.  To do this, my objectives will be to provide the front line staff with the necessary educational offerings on pressure ulcer prevention and to work on the handoff process between shifts and team members.  The nursing assistants will be given a pre and post test to measure the effectiveness of the training.  Audits of care plan interventions will continue to check to see if there is improvement once the handoff process has been improved.  Improving team dynamics will be essential to my project.  Long-term care is based on the interdisciplinary team concept, but that team needs to function effectively.  Collaboration between team members will improve nurse satisfaction and retention which can also improves care (Fulmer, 2016). 

Concerns and Questions

           I do think that preventing heel injuries in a nursing home is a large and complicated task.  But taking this in bite size portions and trying to work on improving the communication between shifts and between employees is a good place to focus my attention in this project.  For my colleagues, do any of you have a good shift handoff process that you can share with me? In long-term care, the off-going RN charge nurse reports off to the on-coming RN charge nurse.  The LPN and NA’s also get a handoff from their co-worker who had the same assignment. As I proceed with the part of my project that deals with improving the handoff process, how can I assure that the RN charge nurses will go to the front line staff (LPN and NA) and make sure they got the necessary important information? Suggestions on handoffs would be helpful.

 

References

 

Black, J. (2004).  Preventing heel pressure ulcers.  Nursing 2004, p. 17.  Retrieved from Walden Library Databases.

Fulmer, T. (2016).  Effective interdisciplinary teams: Do we really know how to build them?  Journal of the American Society on Aging, 40(1), 64-66.  Retrieved from Walden Library Databases.

Glynn, D.M., Saint-Aine, R., Gosselin, M, Quan, S., & Chute, J. (2017).  The role of unlicensed personnel in patient handoff.  Nursing 2017, 47 (3), 57-60.  Retrieved from Walden Library Databases.

Haque, S., Osterlund, C.S., & Fagan, L.M. (2016).  What’s ideal? A case study exploring handoff routines in practice.  Journal of Biomedical Informatics, 65, 159-167.  Retrieved from Walden Library Databases.

Higgins, A., Brannen, M.L., Heiman, H.L., & Adler, M.D. (2017).  Patient handoffs: Is cross cover or night shift better?  Journal of Patient Safety, 13(2), 88- 92.  Retrieved from Walden Library Databases.

Kear, T. M. (2016).  Patient handoffs: What they are and how they contribute to patient safety.  Nephrology Nursing Journal, 43(4), 339-342.  Retrieved from Walden Library Databases.