NUR 550 Identify a quality initiative from your workplace

NUR 550 Identify a quality initiative from your workplace

NUR 550 Identify a quality initiative from your workplace

One quality initiative that has been rolled out in my workplace is replacing verbal nurse to nurse report with electronic SBAR report from admitted Emergency Department patients to some of the inpatient units. This initiative excludes the critical care or neurological units. The SBAR format of report consists of situation, background, assessment, and recommendation. This written communication tool is said to “help provide essential, concise information, usually during crucial situations. In some cases, SBAR can even replace an executive summary in a formal report because it provides focused and concise information” (SBAR | ASQ, n.d.). Barriers to this quality initiative have been the lack of acceptance from staff. Nurses receiving report prefer a verbal SBAR handoff so that they may ask questions for clarification and prepare for the patient’s arrival. The downfall of verbal report is that many times the nurse is not available to take report, and this delays care and patient transfer. This causes a backup in the Emergency Department to turn the exam room and begin caring for a new patient. Staff acceptance to change is common barrier. Other barriers to change include inadequate knowledge, skills, support of belief of change, lack of leadership or mentors, cultural or organizational influences, and budget restrictions (‌Melnyk & Fineout-Overholt, 2018).

References:

 

SBAR | ASQ. (n.d.). Asq.org. https://asq.org/quality-resources/sbar

 

‌Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-Based practice in nursing and healthcare (4th ed.). Wolters Kluwer Health.

I agree that one of the barriers to use SBAR electronic report is a lack of nurses acceptance. In my workplace we need

NUR 550 Identify a quality initiative from your workplace
NUR 550 Identify a quality initiative from your workplace

to use both written and verbal SBAR report for receiving and transferring the patient. Sometimes SBAR written communications can delayed due to distractions, insufficient time, and interruptions, on those occasions verbal report will be helpful. SBAR communication tool is easy to use and can be modified based on most of the clinical settings; however, it can be challenging to use for complex clinical cases such as ICU patients. Moreover, the use of SBAR communication tool requires educational training and culture change to sustain its clinical use. (Shahid et al., 2018).

SBAR is a reliable and validated communication tool which has shown a reduction in adverse events in a hospital setting, improvement in communication among health care providers, and promotion of patient safety. use of the SBAR tool for effective handoff and transfer of patient care in various health care settings, and comparison of SBAR tool with other communication tools to assess the effective communication and limitations of SBAR communication tool. (Shahid et al., 2018).

Reference:

Shahid, S., Thomas, S. Situation, Background, Assessment, Recommendation (SBAR) Communication Tool for Handoff in Health Care – A Narrative Review. Saf Health 4, 7 (2018). https://doi.org/10.1186/s40886-018-0073-1

 

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Do you know where the concept of SBAR originated?

One of the quality initiatives in my workplace is implementation of CAUTI prevention bundle. This helps to monitor clinical outcomes on a regular basis in order to make ongoing improvements in patient care and to continually assess issues regarding patient safety in order to prevent ,correct , and  to reduce errors and foster patient well-being. CAUTI  prevention bundle includes daily assessment of need, daily CHG bath, urinary catheter is to the thigh with a stat lock or other securement device, CUROS caps is on the sampling port, drainage system is intact and the plastic seal has not been broken, date of insertion   is written on the drainage bag, the bag is less than half full, drainage tubing is free of dependent loops, the drainage bag and tubing never touch on the floor or rises above the bladder, perineal and urinary  catheter care is performed every shift and as needed and documented.

Common barriers were:  difficulty with nurse and physician engagement; nurses work load ,  catheter insertion practices and customs in the emergency department, incorporating urinary management (e.g., planned toileting) as part of other patient safety programs, such as a fall reduction program; explicitly discussing risks of indwelling urinary catheters with patients and families; and engaging with emergency department nurses and physicians to implement a process that ensures that appropriate indications for catheter use are followed.(Krien et.al 2013) The most challenging aspect of translating evidence to practice is often related to changing behaviors and sustaining those behaviors rather than simply providing the education for change.(Fencl ,et.al 2017).

References:

 

Fencl, J. L. & Matthews, C. (2017). AORN Journal, 106 (5), 378-392. doi: 10.1016/j.aorn.2017.09.002.

 

Krein, S. L., Kowalski, C. P., Harrod, M., Forman, J., & Saint, S. (2013). Barriers to reducing urinary catheter use: a qualitative assessment of a statewide initiative. JAMA internal medicine, 173(10), 881–886. https://doi.org/10.1001/jamainternmed.2013.105

 

I can certainly imagine that nurse and physician engagement along with the sheer volume of your workload can definitely be a barrier to this quality initiative. I’m not sure about the patient volume at your organization, but our ED has really not seen a significant drop in patient volumes even though the pandemic has subsided. The volume of patients remains the same even sometimes higher, the acuity of the patients, while not as many have COVID, he is extremely high right now, and our overall CMI has been much higher than projected for this time of year. If your organization is struggling with the same, it can be difficult to implement any quality initiatives and departments experiencing this kind of workload. What are some things your organization is doing to lighten that and that workload for you? Have they even then able to determine and implement any interventions to help you?

A Quality Improvement Initiative and Barriers to Implementation

The identified quality improvement initiative is evidence-based practice (EBP). EBP connotes an insightful and cautious utilization of the best available evidence alongside patients’ preferences and values and also the clinical expertise to inform patient care decisions and delivery (Dagne & Beshah, 2021). EBP is credited for the positive impacts on the healthcare system including the promotion of safe and quality care and reduction in healthcare costs. Barriers linked to the implementation of EBP can be categorized into individual and organizational barriers. Individual barriers include heavy workload in nursing practice leading to inadequate time to adopt and implement EBP. Other barriers include poor understanding and inability to analyze literature, lack of interest among nurses to read the literature, poor critical analytical skills, and computer illiteracy. Organizational barriers include heavy work burden on the existing nursing workforce, inadequate vital resources for implementation, and lack of management support (Dagne & Beshah, 2021). Moreover, the acceptance and application of EBP in the healthcare industry is an expanding research area. As a result, this area is marred with inconsistent terminologies and poor application of theory, which is a significant challenge during EBP implementation.

Translation of research into practice is also characterized by massive barriers. The first barrier is difficulty in introducing and sustaining evidence alongside EBP protocols in the face of conflicting healthcare priorities. Also, translating research into practice is contextually inconsistent, which makes it hard to enhance research translation into practice (Dang et al., 2021). Other factors that cause barriers to translating research into practice include poor evidence-based directives, poor structures for training and continuing education, unfavorable organization traditions and policies, lack of inspiration among nurses, and resistance to change.

References

Dagne, A. H., & Beshah, M. H. (2021). Implementation of evidence-based practice: The experience of nurses and midwives. PloS one, 16(8), e0256600. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256600

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines. Sigma Theta Tau.