Preparing for Change

539The Journal of Continuing Education in Nursing · Vol 46, No 12, 2015

clinical updates Associate Editors: Elaine L. Smith, EdD, MSN, MBA, RN, NEA-BC, ANEF Karen L. Rice, DNS, APRN, ACNS-BC, ANP Author: Marie Agrell-Kann, RN, MSN, CDE, CWCN

Improving Quality Outcomes Using a Champion Model for Ancillary Nursing Staff

According to the Institute for Healthcare Improvement (n.d.),

2.5 million patients in the United States develop pressure ulcers annu- ally, with 60,000 patients dying as a result of the complications associ- ated with this condition. A financial burden is associated with pressure ulcers as well. In the U.S., pressure ulcer care “is estimated to approach $11 billion (USD) annually, with a cost of between $10,000 (USD) and $86,000 (USD) per individual pres- sure ulcer” (Sendelbach, Zink, & Peterson, 2011, p. 84).

As early as 2007, the Institute for Healthcare Improvement (n.d.)

began endorsing the use of a skin care cham pion model to facilitate improve- ment in skin and wound care out- comes. Many hospitals and health care systems have implemented such a model to drive an improvement in skin and wound care initiatives and ultimately to decrease their hospital- acquired pressure ulcer (HAPU) rates. Through the implementation of a champions model, the hospitals and clinics of Allina Health, Min- neapolis, Minnesota, were able to decrease their HAPU rate by 33%, with an estimated cost savings of $430,000 (Sendelbach et al., 2011). Similarly, the University of Penn- sylvania Health System was able to reduce the prevalence of HAPUs by 37% across four of its hospi- tals through the use of a champions model (Carson, Emmons, Falone, & Preston, 2012).

A literature review demonstrated that the majority of skin champion programs were designed with the registered nurse in mind. Although several programs involved or included nonlicensed nursing staff, few were designed specifically with the ancil- lary nursing staff in mind.

One such program, Skin–Saver CNA (Certified Nursing Assistant),

was implemented at Kindred Health- care, Louisville, Kentucky. Accord- ing to Kindred Healthcare, CNAs account for nearly 33% of the direct care productive work force, and they spend approximately 60% of their time at the bedside (Holmes, 2011).

The quality champion model de- veloped at one hospital in New York sought to maximize the impact of its patient care associates (PCAs) by empowering them with the knowl- edge necessary to take an active role in the recognition and prevention of HAPUs.

The hospital is an academic medi- cal center located in New York and has 806 beds and a staff of more than 6,000 individuals. The catchment area includes more than 1 million individuals between the ages of 18 and 44, more than 900,000 individu- als between the ages of 45 and 64, and approximately 500,000 individ- uals aged 65 and older.

WHAT IS A CHAMPION? Champions are opinion leaders,

facilitators, or change agents who promote the use of evidence-based practice through effective commu- nication and interaction with other staff. Their goal is the diffusion of new knowledge. They are advo- cates of new ideas or initiatives and work diligently to promote them (Berquist-Beringer, Derganc, & Dunton, 2009). Champions are lead- ers who enable change through the development of self and organiza- tional awareness. A question from

abstract The goal of this article is to

describe the implementation of a champion model for ancillary nurs- ing staff. As Quality Champions, nursing assistants attended special- ized education classes to promote improvement in quality outcomes related to skin care, diabetes care, and prevention of catheter-associated urinary tract infections. J Contin Educ Nurs. 2015;46(12):539- 541.

Ms. Agrell-Kann is Wound Care Specialist, North Shore University Hospital, Manhasset, New York. The author has disclosed no potential conflicts of interest, financial or otherwise. Address correspondence to Marie Agrell-Kann, RN, MSN, CDE, CWCN, Wound Care Spe- cialist, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030; e-mail: [email protected]. doi:10.3928/00220124-20151112-03

540 Copyright © SLACK Incorporated

a highly motivated ancillary staff member initiated the unique cham- pions endeavor described in this article. Knowing about the hospital’s nurse champion models for various quality initiatives such as decreas- ing catheter-associated urinary tract infections (CAUTIs), central line- associated bloodstream infections, patient falls, and pressure ulcers, one PCA asked, “Can we have a skin champion program for the PCAs?”

The Wound and Skin Program at the hospital is led by a team of advanced practice nurses who are certified in wound, ostomy, and continence care. A collaborating physician, who is a wound care specialist and a vascular surgeon, oversees the team, which also in- cludes a surgical physician’s assistant and a physical therapist certified in wound care. This interdisciplinary team conducts daily team meetings and wound care rounds to expedite the care of patients with complex wounds. The certified wound care nurses have been offering biannual skin champion classes for RNs since 2007. Lunch and Learn sessions were held on a monthly basis at the outset but are now held on a quar- terly basis. The RN skin care cham- pions conduct the monthly pressure ulcer prevalence rounds and serve as resources for skin and wound care issues in their units.

The hospital also has a diabetes champion program led by a certified diabetes educator and an interdisci- plinary diabetes team, whose qual- ity measures include the reduction of hypo- and hyperglycemia in the hospitalized patient and the increase in patient education and obtaining A1C blood tests.

All of the aforementioned cham- pions programs feature an RN as the champion. When designing a professional development program for PCAs, it was decided that select ancillary nursing staff would receive

special education about skin care, patient fall prevention, CAUTI pre- vention, and hypoglycemia manage- ment; thus, the PCA Quality Cham- pion Program was born.

WHAT IS A PCA QUALITY CHAMPION?

A PCA Quality Champion is a PCA who is an advocate for qual- ity patient care and a champion of quality initiatives in their unit. A PCA Quality Champion serves as a resource to others, ensuring that fellow staff are knowledge- able and safe providers of care with advanced knowledge of skin care, diabetes care, and prevention of CAUTIs. PCA Quality Champions are charged with promoting a unit culture of quality and demonstrate proactive approaches in the identi- fication and prevention of adverse outcomes. They also promote effec- tive and open communication among the members of the health care team.

The roles and responsibilities of the PCA Quality Champions were delineated in a document similar to a job description, which was shared with the nurse management staff. Potential champion candidates were selected based on their clinical per- formance, their ability to meet the criteria established in the roles and responsibilities mentioned above, and their internal motivation to par- ticipate.

In July 2014, the first group of PCA Quality Champions started on their journey. They attended an 8-hour on-site class. Speakers from various areas of the hospital led the sessions via lectures, presentations, discussions, and hands-on participa- tion. Fifty-nine champions attended the first class. The class proved to be valuable in many ways. PCA attendees were excited about their role in skin care and HAPU preven- tion. They embraced the idea of being role models charged with ensuring

that the protocols for skin care were being followed in their units, includ- ing patient turning and positioning, early identification of skin care is- sues, incontinence management, and use of appropriate devices for pres- sure ulcer prevention that included off-loading products and support surfaces and linen management. The PCA is directly involved in point- of-care testing, and thus would play a pivotal role in assisting with the management of hypoglycemia; therefore, the protocol for hypo- glycemia was reviewed at length.

The PCAs were curious about communication—how would they approach a fellow staff member who was not following protocol or policy? Effective communication techniques and when to escalate concerns were discussed during the class.

The PCA Quality Champions then attended monthly follow-up meetings. The goal of these meet- ings was to share information and discuss the progress of initiatives in their units and across the hospital. Topics included deep vein throm- bosis prevention and prophylaxis; linen and hazardous waste disposal; infection control (e.g., procedures for isolation); use of skin care products; review of blood glucose monitoring, including use of the new SAFETiCET™ lancet. Demen- tia education, with a focus on the roll-out of a special activity box to assist patients who are confused, was also provided. The PCA Qual- ity Champion group also designed a flyer, which was posted in hospital units, for the hospital’s Safety Week Program.

RESULTS To determine their response to

becoming a champion, the PCAs completed a survey on the 1-year anniversary of the program. Re- sponses to questions such as “What

541The Journal of Continuing Education in Nursing · Vol 46, No 12, 2015

do you like best about being a Qual- ity champion?” included:

• We feel pride in what we do as champions. • It’s important to know why you need to do something a cer- tain way, the reason behind it, not just doing it. • I like bringing new info back to my coworkers. • I like when staff come to me and ask me questions. • I like being involved in making decisions in my unit. • I feel honored to have this role. • It’s about doing the right thing all the time. • Now I get the chance to say something when I see some- thing—staff will hear me. • Empowerment from more learning and being educated.

One exemplar of the benefits of this program was when a PCA, empowered through her role as a champion, voiced her concerns to the nurse manager when she wor- ried that a nurse in the unit was not correctly following the protocol for hypoglycemia. Together, the concern was communicated and the nurse emerged with a proper under- standing of hypoglycemia treatment.

Although other initiatives throughout the hospital have had

an impact on decreasing hypogly- cemia, the PCA Quality Champion Program was one element that had an impact on both the occurrence of hypoglycemia and staff’s adher- ence to the hypoglycemia protocol. From May 2014 to September 2015, a 26% increase in fingersticks being repeated as per protocol was noted. Also, documentation of treatment for hypoglycemia increased by 23% between May 2014 and September 2015. Overall hypoglycemia for the hospital also decreased from 18% in May 2014 to 12% in September 2015.

The PCA Champions have con- tributed to the achievement of the hospital’s goal for HAPU reduction. The goal for 2015 was 41 occurrences annually; as of September 2015, there have been only 22 occurrences of HAPUs.

Positive results were noted by the Environmental Services Depart- ment when, after a presentation to the PCA champions on appropriate linen disposable, compliance with these techniques rose from 40% to 95%, with a cost savings associated with linen that no longer was able to be used now being returned to the laundry company for credit.

FUTURE IMPACT The PCA Quality Champion

Program has demonstrated a vari- ety of benefits for the patients, the PCAs, the health care team, and the hospital. Additional education, training, and practice improvement programs are underway to continue to develop the role and engagement of highly valued PCAs.

REFERENCES Berquist-Beringer, S., Derganc, K., & Dun-

ton, N. (2009). Embracing the use of skin champions. Nursing Manage- ment, 40(12), 19-24. doi:10.1097/01. NUMA.0000365465.01722.4b

Carson, D., Emmons, K., Falone, W., & Pres- ton, A.M. (2012). Development of pres- sure ulcer program across a university health system. Journal of Nursing Care Quality, 27, 20-27.

Holmes, C.G. (2011). My scope of practice: Skin-saving CNAs—Power in leadership and education. Ostomy Wound Manage- ment, 57(2), 20-21.

Institute for Healthcare Improvement. (n.d.). Prevent pressure ulcers: Getting started kit. Retrieved from http://www. ihi.org/topics/pressureulcers/pages/ default.aspx

Sendelbach, S., Zink, M., & Peterson, J. (2011). Decreasing pressure ulcers across a healthcare system: Moving beneath the tip of the iceberg. The Journal of Nursing Administration, 41, 84-89.

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