Nursing Achieves Excellent Patient Outcomes during Pandemic Challenges
Despite the historic challenges the past two years have brought to Goshen Health, nurses sustained high quality of care in the areas where nursing care directly impacts outcomes—inpatient falls, hospital-acquired pressure ulcers (HAPI), and catheter-associated urinary tract infections (CAUTI). The outcomes stand up against national benchmarks as truly exemplary, especially in the context of significant surges experienced during the COVID-19 pandemic.
The amount of perseverance and courage it took to achieve these outcomes should not be under-estimated. With daily challenges related to staffing, unexpected gaps in critical supplies, and relentless, high patient acuity, nurses pulled together, creatively and innovatively to navigate supply issues while compassionately supporting each other and their patients through heartbreak and loss.
Data supports the excellence in our nursing outcomes during this time compared with other organizations. Goshen nurses consistently outperformed national benchmarks in all areas most quarters. However, graphs and tables cannot capture the countless stories and testimonies from patients and visitors who were touched by their compassion and courage.
Spontaneous Breathing and Reduced Length of Stay
Patients on ventilators are at risk for lengthy hospital stays. Literature supports the use of nurse directed daily awakening and spontaneous breathing trials to decrease hospital length of stay. Peggy Rupp Wysong, MSN, RN, CCRN-K and Ron Cable, RRT reviewed the current practice in the Intensive Care Unit for spontaneous daily awakening and spontaneous breathing trials and discovered that the current evidence-based protocol for these practices was not being followed. They reviewed the hospital data which showed a higher than desired average hospital length of stay for ventilator patients. The leaders pulled a team together with a goal to decrease the average hospital length of stay for ventilator patients. The multidisciplinary team included nursing, pharmacy, application support, respiratory therapy, and intensivists.
The DIG team met in February 2021 to identify barriers to use of the current protocol and to correct those barriers prior to providing education to all involved disciplines. The DIG identified variation in practice from multiple disciplines leading to confusion as to expectations and the inconsistent adherence to the existing protocol. The DIG team reviewed the literature to assure the protocol reflected best practice and the team reached consensus that following the protocol was necessary to ensure optimal patient outcomes. Peggy led the team to develop a collaborative education plan. The format of the education to best reach all involved disciplines was agreed upon to include the following:
- Voice over PowerPoint created and assigned to and completed by ICU nurses and Respiratory Therapists on the hospital’s Electronic Learning Management System (HealthStream)
- One on one live education provided to ICU physicians by the ICU Medical Director and Clinical Nurse Specialist
- One on one education provided to ICU clinical pharmacists by the ICU Clinical Nurse Specialist and lead ICU clinical pharmacist
The education was provided in March 2021.The project was successful, and length of stay decreased for the time periods following the intervention.
We Honor Veterans Hospice Program
Goshen Hospice participates in a special program for veterans at end-of-life, which was adapted and sustained during the past two years.
We Honor Veterans improves the ability to recognize the unique needs of armed services veterans and their families and provide exceptional end-of-life care. Hospice nurses engage members of local veterans’ organizations and patients to better understand the care needs and concerns. Veterans may experience life’s transitions differently due to past military service. They may need to connect with other veterans, especially near the end of life to reflect on life experiences. Feedback from veterans encouraged hospice nurses to create a program where, if desired, veterans receiving hospice services may receive visits or phone calls from other veterans in the community to provide a listening ear and interaction with a former comrade in arms.
At the suggestion of other veterans, hospice nurses also created ceremonies for veteran hospice patients, recognizing them for their service. Seeing the patients rally, helping the patient get dressed or be up in a wheelchair or standing with their cap and saluting during the recognition ceremony is a proud moment for family, friends, other veterans, and the veteran hospice patient. When the veteran’s journey ends, the hospice nurses recognize the veteran one more time, draping them with the American flag. Veteran appreciation certificates are given to each veteran in hospice by either RN, Social Worker, or Chaplain.
Daily safety briefings were attended by over 30 operational leaders from across the hospital setting. The briefings are based on the principles of real-time information, deferring to expertise, alignment, and accountability. Reports are provided by leaders representing house supervisors, nursing leaders, pharmacy, procedural areas, laboratory, materials management, facilities, registration, public safety, and others.
Timely information about facility moves, patient placement, equipment issues, material shortages, and COVID-19 -related changes has proven invaluable to hospital operational leaders and Colleagues. Often situations can be efficiently and effectively addressed in the meeting with follow-up plans made to resolve issues with relevant leaders. The end of the briefing includes action items and communication plans, as well as an inspirational message shared by hospital chaplains to encourage resilience.
In addition to the daily safety briefings, shift huddles were implemented in 2020. Shift huddles served as a platform for shift coordinators and nurse leaders to gather to coordinate patient flow and plan for upcoming discharges and admissions. During the COVID-19 surges, these sessions proved invaluable to assure that resources were managed in the best possible way under difficult conditions. The huddles also provided direct communication between the facilities director and the shift coordinators during the patient tower construction project, enhancing the flow of information among key stakeholders in a timely manner.