Exemplary Clinical Practice

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Improving Maternal and Newborn Outcomes

Perinatal nursing focused on improving maternal and newborn outcomes during 2022. We identified racial disparities in pain scores for our patients who were post cesarean birth and partnered with the Institute for Healthcare Improvement (IHI) and AdaptX to create a multidisciplinary team to address these disparities using PDSA (Plan-Do-Study-Act) cycles. We also focused on creating efficient processes to improve the time from when an unscheduled cesarean is called until the birth of the baby.

In addition, we identified that we had room for improvement with our hemorrhage rates and implemented a stage-based hemorrhage protocol. Nursing is also running monthly simulations on labor and delivery and postpartum to practice clinical skills, test policies for systems issues, and improve communication among the different disciplines.

Johns Hopkins Highest Level of Mobility

A system level quality improvement group was tasked to develop a standardized way to track and document mobility events.

The JH HLM (Johns Hopkins Highest Level of Mobility) was chosen as the tool to help nurses describe mobility events that happen during the day.

This is a 1-8 scale that describes the activity a patient does from lying in bed (score of 1) through walking 250 feet or more (score of 8).

These specific descriptors of mobility help to paint an accurate picture of a patient's daily activity.

This information informs the multidisciplinary team to help create and track progress toward mobility goals.

Dispatch Care: Winner of the 2021-2022 PAF Innovation Grant

It is very exciting that from over 100 applications from all over the organization and many disciplines, a nursing project was selected for the 2021-2022 winner of the UWM Patients are First Innovations Pilot. Dispatch was deployed on the NW campus in March of 2022. The pilot was so successful, Dispatch continues to be used in the Childbirth Center and the Ortho Neuro unit on the NW campus.

What is Dispatch?

Dispatch is an app that allows the right person to respond at the right time with the right equipment. It improves patient and staff satisfaction by improving communication and reducing wait times. Patients can express their needs directly to their care team with a tablet at the bedside with script in their primary language. The request alerts the appropriate staff member in English through the Dispatch app on their work iPhone. For example, the patient’s nurse is alerted for a need for pain medication and the housekeeper is alerted to a request for paper towels, etc.

Nursing Team Experience During the Pilot

What was so exciting about this pilot is that care teams were able to see their ideas for improvement become reality practically in real time. Dispatch is a small local start-up with very engaged leaders who spent a lot of time with team members listening to suggestions. The result was that staff were very engaged from day one. For example, a nurse immediately suggested that ‘I’m Hungry’ be removed because there was no action the care team member could take before responding. Hungry was immediately changed to ‘Check Glucose’ so the RN/CNA could respond with the glucometer and the patient could eat and/or order their meal. Dispatch is also customizable to the unit. For example, when a Childbirth patient moves from a labor room to a post-partum room, their selections change, now the patient can request help with baby care, etc. On the leadership side, the manager on 4th floor is thrilled to be able to assist patients in real time when patient request manager rounding through Dispatch.

Innovations in Patient Care

Current challenges in healthcare require that we work in new and innovative ways. Leveraging technology is an important aspect of how nursing teams can work smarter, not harder to provide high quality care. An example of this is from our Childbirth Unit. Pre-pandemic, the CBC nurses would group the day’s new families for new parent discharge teaching. Due to Covid, this is done in sequence and parents lose the benefit of hearing questions from each other. There is also more demand on RN time because they do the same teaching several times a day. Zoom meetings conducted on Dispatch with added Baby YouTube videos will be a new way to deliver this teaching. Additionally, patients are now able to order meals through Dispatch, significantly reducing the time patients and care team members spend on the phone waiting to place an order.

Undergraduate and Pre-Licensure Training

Each year, undergraduate and pre-licensure nursing students come to UWMC to learn from and work alongside our nurses and nurse managers. The students are given access to a network of distinguished staff, peers, and the surrounding community, which enables them to build lifetime connections with leaders in healthcare. By working with UWMC staff, nursing students gain real-world, hands-on experience in research and community clinics. They routinely collaborate on world-changing activities in the larger healthcare community.

In 2021, 491 undergrad and pre-licensure nurses were trained, totaling 34,861 hours. In 2022, nurses trained 703 undergraduate and pre-licensure nursing students, totaling approximately 49,913 training hours.

Infection Prevention & Employee Health

Melissa Ho’olulu, Adrienne Schippers & Lindsay Boyd

As we progress forward and reflect on 2022, one thing is clear, it was a very dynamic year keeping our staff and patients safe during complex times in healthcare. The Infection Prevention & Control Program, at the University of Washington Medical Center (UWMC), is part of the continuous quality improvement efforts to reduce the risk of infection, morbidity & mortality for patients, and promote staff safety. The infection control team provides routine surveillance and performs intensive data collection for communicable diseases, monitors for outbreaks and unusual pathogens, staff, and patient exposures, conduct facility and construction risk assessing and planning, oversees high level disinfection and reprocessing activities, and complies with licensing and regulatory mandates, monitors device associated infections, and ensures mandatory regulatory reporting to NHSN.

A nurse’s test site story

Kathleen Malone, RN

The comradery of the team itself was second to none. The bonds created by working consistently with the same team during a global pandemic was a support system for many.

The conditions varied due to the elements. The wind was a factor as well as a spotty wi-fi connection. Like a well-knit team does, we were a resourceful crew, relying on a person’s skills and recognizing weakness and helping out as needed.

There were times when the general public was not using their best behavior. We did a fantastic job of de-escalating,” “tapping out”, so to speak, and enlisting in the help of others. The UWNW security team helped out with set up/break downs, jumping vehicles with dead batteries and responding to calls within the garage test site.

The false closing pre-Delta was a precursor for the inevitable. Although the lay-offs didn’t go through since the team was summoned back to the site, the reality now present. We are needed but this will end.

It was a teary-eyed announcement made by Jenny Brackett and felt by all.

The garage isn’t an average office sight, but we made it work, encouraging and lifting each other up. The office where the admin tasks occurred bags were prepped and result calls happened was often filled with laughter, as it is the best medicine. We had challenges and took them in stride. I would do it all again. Thank you.

Not only was the attention on keeping our staff and patients safe from COVID-19 but we also revitalized efforts on our Patients Are First program to provide the highest quality of care to every patient every time. The back -to-basics campaign, is anything but basic, with intensive reviews, engagement with our leadership, CNSs, RN3s, frontline nurses, and unit practice councils; all actively engaging in quality rounding and audits with an emphasis to reduce hospital acquired infections and injuries.

Some wins over the year worth celebrating are Northwest ICU had 11 months of zero Central Line Bloodstream Infections (per 1,000 catheter days) and Montlake 5 Southeast had 7 months of zero. Montlake 7-SA had 9 months with zero Catheter Associated Urinary Tract Infections. Northwest 5th floor had 6 months with zero C. difficile infections (per 10,000 patient days). Montlake 5E has gone 362 days with no falls that sustained injury!

Employee health continues to be a pillar in supporting the health and safety of our staff. Throughout 2022, staff continued to track covid positive cases and exposures to provide information to support early testing and identification of any additional cases. Fit testing continues to be an ongoing regular activity for employee health to make sure staff stay safe in situations requiring a respirator. As new staff come through our doors, EH is responsible for ensuring staff meet vaccination and other requirements- so we are often one of the first groups to meet our new staff.

2022 saw another iteration of our vaccination clinics. The clinics at ML and NW administered 128, 385 bivalent doses to staff and patients. The team stood up to the challenge of bringing the clinics back online to help give our staff and community important protection heading into the respiratory season.

It is great teams, united vision, and one mission that makes the impossible seem possible. We are building systems that withstand change.