12191 (175, 176, 177) Paper Presentation 4 – Influencing Quality of Nursing Care Delivery

(175) Promoting Best Practice through Outreach
Jill Bauer, BSN RN, Children's Hospitals of Minnesota, St Paul/Mpls, MN

Abstract
As a leading hospital rich with information, resources, and a passion of caring for children, we feel an obligation to “share our wealth”. The development of our Neonatal Outreach Program promotes sharing and excellence in the care of infants with hospitals in our entire region. This program progresses referral staff expertise through clinical consultation, education and collegial support.

After meeting with rural hospital leaders and educators to assess their individual needs, we offer our resources, knowledge and expertise to them. Sharing and developing educational tools to fit their needs promotes best care for neonatal patients in their hospitals. Opportunity for individual referral staff growth in their profession advances everyone’s practice and helps to develop ongoing understanding of the needs of our colleagues in the community as well as our own.

As our Outreach Program advances levels of education and excellence in others, it also works to maintain strong partnerships with colleagues throughout the region. A strong nursing presence exists in our program, but we reach out to all health care professionals who ask. We openly share our resources without limitation and do so free of charge with the exception of some full day certification courses. Examples of outreach include:

-  Certification courses presented at referral facilities.
- Individual hospital needs assessments with tailored follow-up education.
- Shadowing of our staff by referral staff demonstrating our care of infants.
- Transfer case reviews with opportunity for discussion, consultation and debriefing.
- Mini-conferences/skill sessions to meet individual hospital needs.
- Policy/procedure sharing.
- Neonatal Simulation.

Learning Objectives
1. List two benefits of a neonatal outreach program.
2. Describe at least four steps in the development of a neonatal outreach program.
3. Name two valuable components of a successful outreach program.

Bibliography
George A Woodward, MD, MBA, FAAP, (2006). Outreach education. In American Academy of Pediatrics: Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients, 241-250.

Hainsworth, Terry. (2006). Development of Critical Care Outreach Nursing Services. Nursing Times., Volume 102(32), 25.

Yaeger KA, Halamek LD, Coyle M et al. High-Fidelity simulation-based training in neonatal nursing. Adv Neonatal Care. 2004;4:326-331.

Karlsen, K., The S.T.A.B.L.E. Program Instructor Manual. (2005).


(176) Identifying Electronic Tools That Can Assist in the Measurement of Nurse Practitioner Outcomes
Janice Wilson, DNP CRNP-BC , Mercy Medical Center, Baltimore, MD


Abstract
Background: Neonatal nurse practitioners (NNP) are significant contributors to overall neonatal outcomes. Their specific outcomes, however are often invisible and few frameworks exist that adequately measure them.

Purpose: To determine if an evidence-based electronic peripherally inserted central catheter (PICC) procedure note could be utilized as a tool to evaluate NNP performance/outcomes in a Neonatal Intensive Care Nursery Setting.

Methods: Using GE Centricity Perinatal Software, an evidence based three part electronic NNP PICC line procedure note was developed and implemented. A post implementation survey was conducted using the Clinical Information Systems Evaluation Scale. SPSS was used to analyze both survey results as well as the outcomes of the PICC line note.

Results: Over a three month pilot period, eighty one percent of note fields were completed in the insertion section of the note, 85% of fields were completed for the adjustment part of the note and 88% of the removal note fields were completed. The implementation was viewed as moderately to highly successful with a CISIES total score of 3.2.

Conclusions: The successful implementation and pilot of a clinical information system, in this case an evidence based electronic NNP PICC line procedure note, demonstrates the potential power of the electronic health record to serve as a tool in the evaluation of NNP performance, outcomes and competence.

Ongoing Data Collection: The PICC line note is currently being amended, with a plan to collect and analyze additional data over the next twelve months.

Learning Objectives
1. Describe the importance of the use of an electronic approach to the measurement of nurse practitioner outcomes.
2. Identify the impact that evidence-based guidelines can contribute to the generation of outcome data.

Bibliography
AARP, Swankin, D., Lebuhn, R. A., & Morrison, R. (2006, July). Implementing continuing competency requirements for health care practitioners (2006-16). Retrieved May 4, 2008 from http://www.aarp.org/ppi.

Allen, P., Lauchner, K., Bridges, R.A., Francis-Johnson, P., McBride, S.G., & Olivarez, A. (2008). Evaluating continuing competency: a challenge for nursing. The Journal of Continuingn Education in Nursing, 39(2), 81-85.

Cimino, J. J., Lee, N., & Bakken, S. (2005). Using patient data to retrieve health knowledge. AMIA 2005 Symposium Proceedings, 136-138.

Kleinpell, R., & Gawlinski, A. (2005). Assessing outcomes in advanced practice nursing practice. AACN Clinical Issues, 16(1), 43-57.

National Association of Neonatal Nurses, Pettit, J., & Wyckoff, M. W. (2007). Peripherally inserted central catheters guideline for practice (2nd ed.). Glenview, IL: National Association of Neonatal Nurses.



(177) Changing the Culture of Safety in the NICU
Shannon Sarver, RN PCF, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Coauthor: Jaime Rudolph, BSN RNC-NIC, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Abstract
Stated Purpose for the Session: To educate fellow neonatal nurses on the reduction of Serious Safety Events and the establishment of a culture of safety in the NICU setting by implementing a peer driven Safety Coach Program.

Background & Importance of the Topic: With National Patient Safety Goals surrounding the reducion of Serious Safety Events, this interdisciplinary program was developed to identify both positive and negative practices that impacted safety in the NICU. By identifying these practices, the staff is able to promote the positive practices and change the practices that hinder a positive outcome for the fragile neonatal population.

Description of What will be Covered: This presentation will describe in detail the Safety Coach Program from development through implementation and conclude with the rewards of the program. Description and Case Studies will be utilized to illustrate what is a Safety Coach, the methods used including the electronic Behavioral Observation Tool (eBOT), and how it impacts the neonatal population.

Future Direction: The future direction of this program is to establish a culture of safety in the NICU setting, ultimately reducing Serious Safety Events. This goal will be achieved through 200% staff accountability and improvement in areas identified through the Safety Coach Program.

Learning Objectives
1. State the role of the safety coach.
2. Describe how a safety coach affects the safety of the neonate and the reduction of serious safety events in the NICU.
3. Explain the methods used by a safety coach.
4. Identify how the information gathered by a safety coach is used.

Bibliography
Hunter, C., Spence, K., McKenna, K., & Iedema, R. (2008). Learning how we learn: an ethnographic study in a neonatal intensive care unit. Journal of Advanced Nursing, 62(6), 657-664.

Jirapaet, V., Jirapaet, K., & Sopajaree, C. (2006). The nurses' experience of barriers to safe
practice in the neonatal intensive care unit in Thailand. JOGNN: Journal of Obstetric,
Gynecologic & Neonatal Nursing, 35(6), 746-754.

The Joint Commission. 2010 National Patient Safety Goals (NPSGs). Retrieved October 12, 2009, from
http://www.jointcommission.org/patientsafety/nationalpatientsafetygoals.

Ursprung, R., Gray, J., Edwards, W., Horbar, J., Nickerson, J., Plsek, P., et al. (2005). Real
time patient safety audits: improving safety every day. Quality & Safety in Health Care, 14
(4), 284-289.