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Accelerated Onboarding for Unlicensed Personnel When Preceptors Are Limited
Get PDFProblem:
The timeframe between hiring unlicensed personnel (UP) to beginning the role within the organization began to increase due to limited orientation resources, rising staff shortages, and insufficient number of preceptors.
Purpose:
Accelerate the onboarding of UPs to decrease the workload for preceptors and reduce staff shortages, while generating competence and reducing costs for the organization.https://digitalcommons.centracare.com/nursing_posters/1151/thumbnail.jp
ICU CAUTI Incidence Reduction
Get PDFSituation:
Catheter-Associated Urinary Tract Infection (CAUTI) rates in the adult Intensive Care Unit (ICU) increased from nine infections in FY21 to 18 in FY22.
Backgroud:
CAUTIs are the most reported healthcare acquired infection. It is important for healthcare providers to understand the complications and effects of CAUTIs. CAUTIs contribute to extended length of stay, increased healthcare costs, and patient morbidity and mortality.
Most CAUTIs are directly related to inadequate urinary catheter care. Evidence based practice demonstrates a decrease in CAUTIs related to the use of Theraworx® Protect wipes twice daily (BID) and as needed (PRN) for patients with a urinary catheter.https://digitalcommons.centracare.com/nursing_posters/1156/thumbnail.jp
Clinical Nurse Specialists: A Rare Breed
Get PDFWhat is a CNS?: A clinical nurse specialist (CNS) is an advanced practice registered nurse (APRN) with graduate level education in nursing. CNSs are prepared to provided leadership, consultation, and clinical expertise for patients and their families, nurses, and systems. Have the autonomy to diagnose and treat based on advanced clinical assessment like other APRNs (Nurse practitioners, certified nurse midwives, certified registered nurse anesthetists). CNS work in all areas of healthcare like clinics, emergency departments, hospital units, entire healthcare systems, or even as independent practitioners/contractors.https://digitalcommons.centracare.com/nursing_posters/1152/thumbnail.jp
What I Need: Self Care at the Unit Level
Get PDFPurpose:
Self-care is individualized and best done when awarded on a small scale.
Goals:
For all employees of the ICU to: Feel valued outside of work Be recognized for taking care of themselves Participate in positive discussions Be rewarded for work life balance Be reminded of self-care Not feel alone with their thoughts Pause and reflect Help others, spouses, kids, etc.
Future plans include: Seasonal questions of things to see, places to explore Recipe sharing Hobby experts Focusing on staffs\u27 interestshttps://digitalcommons.centracare.com/nursing_posters/1160/thumbnail.jp
Stroke Education Compliance Improvement
Get PDFPlan: Per stroke best practice guidelines, stroke education must be provided verbally and in literature format post stroke. Our plan is to improve compliance and documentation of stroke education by improving staff awareness of patient\u27s stroke education status. by enhancing communication and improving the documentation process, nursing practice can be supported, and best patient care delivered. Per stroke guidelines, education on individualized risk factors is preferred by patients. Studies support that patient education is an effective method to improve vascular risk factors (Meschia, Bushnell, Boden-Albata, et al, 2014).
Act: As with prior to the implementation of adding notes to the secure chat, charts were audited daily for stroke education compliance and notes were placed for nursing in the Care Team Communication section of EMR. A stroke patient list for the hospital is sent to the unit educator Monday through Friday for review and follow up. The educator reviews charts for education documentation including individualized risk factors and literature being documented as given. We will continue this process as we have seen significant improvement over the last year. This will continue until educator does not have to send secure chat messages.https://digitalcommons.centracare.com/nursing_posters/1165/thumbnail.jp
Heated High Flow Oxygen Therapy Management of Respiratory, Swallowing/Dysphagia and Nutrition Needs
Get PDFProblem Patients diagnosed with COVID-19 pose challenges for oxygenation. Often requiring heated high flow oxygen therapy (HHFOT) for days to weeks, with literflow commonly over 40 L/min with maximum of 60 L/min. There is minimal research on aspiration risk at higher literflow, therefore practice included decreasing liter flow to 20 L/min for oral intake was standard. During oral intake, with literflow decreased to 20 L/min, patients\u27 oxygen saturations would quickly trend down. Alarms indicating low saturation would create anxiety, cause patients to eat faster potentially increasing risk for aspiration.
Solution For adult inpatients meeting criteria, increase maximum literflow allowed during oral intake from to 40 L/min. Develop guidelines for: oxygen supplementation during oral intake how/when to consult Speech Language Pathologist inclusion of dietitian earlier in hospitalizationhttps://digitalcommons.centracare.com/nursing_posters/1155/thumbnail.jp
Sterile Tubing Changes to Prevent CLABSIs in the NICU
Get PDFPurpose Statement:
NICU patients have a decreased risk of CLABSI infections when two-person sterile central line changes are implemented into central line maintenance bundles compared to bundles that only use one-person clean line change techniques.
Background:
Neonates admitted to the neonatal care intensive care unit (NICU) often require the placement of central lines for the administration of medications, fluids, parental nutrition, and hemodynamic monitoring. Despite their many advantages, central lines can lead to serious infections, known as cental line associated bloodstream infections (CLABSI). These infections are not related to an infection from another site and develop within forty-eight hours of removal. CLABSIs are a major contributor to morbidity and mortality in the NICU population and are costly to hospital systems. According to Mobley & Bizzarro, infants who develop CLABSIs can cost up to an additional $50,000 and add as many as ten days to their hospital stay when compared to other infants without CLABSIs (2017). An evidence-based approach that has shown to improve patient outcomes and reduce CLABSIs is the use of a bundle, which is utilized upon insertion and during maintenance of the central line. Based on the available research, the most common CLASBI bundle elements include: using maximum standard barrier precautions, using a specific skin preparation & line dressing protocol, daily central line need assessments, a two-person line change technique, specific education and training for staff, and quarterly audits (Payne et al., 2018). The St. Cloud Hospital NICU currently utilizes these practices expect for a two-person line change with sterile technique.https://digitalcommons.centracare.com/nursing_posters/1162/thumbnail.jp
A Comprehensive Review of COVID-19: Associated Endocrine Manifestations
Get PDFCoronavirus disease 2019 (COVID-19) has played a significant part in systematic damage, affecting lives and leading to significant mortality. The endocrine system is one of the systems affected by this pandemic outbreak. The relationship between them has been identified in previous and ongoing research. The mechanism through which severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can achieve this is similar to that for organs that express angiotensin-converting enzyme 2 receptors, which is the primary binding site of the virus. Endocrine cells widely express angiotensin-converting enzyme 2 receptors and transmembrane serine protease 2, the primary mediators initiating the acute phase of the disease. This review aimed to identify and discuss the endocrine complications of COVID-19. This primary focus is on presenting thyroid disorders or newly diagnosed diabetes mellitus (DM). Thyroid dysfunction with subacute thyroiditis, Graves’ disease, and hypothyroidism caused by primary autoimmune thyroiditis has been reported. Pancreatic damage leads to type 1 DM because of the autoimmune nature of the disease and type 2 DM because of post inflammatory insulin resistance. Because follow-up data on COVID-19 on the endocrine glands are limited, long-term investigations are needed to assess specific effects
Recognition of Nonconclusive Seizures in Patients After Cardiac Arrest Using
Get PDFBackground:
Evidence - Prevalence of nonconvulsive status epilepticus or other epileptiform activity in patients who are comatose after a cardiac arrest is between 12-22%. Consistent with the literature, at this facility approximately 12% were found to have non convulsive seizures. Prolonged epileptiform discharges may cause secondary brain injury and increased mortality. In 2020, the American Heart Association recommended EEG monitoring should be promptly performed and interpreted for the diagnosis of seizures in all comatose patients following cardiac arrest.
Local Problem - Comatose patients admitted to critical care after cardiac arrest who require targeted temperature management (TTM) have continuous EEG monitoring ordered STAT. Neurodiagnostic technologists who apply EEG monitoring are not available 24/7.
Conclusions/Implications: While the rapid EEG recording may have limitations compared to continuous recordings for diagnostic purposes, it has immediate feedback for monitoring of nonconvulsive status epilepticus. Continuous EEG monitoring can take 45 minutes to set up and much longer to obtain diagnosis of status epilepticus. Continuous EEGs have broader diagnostic capabilities, however, are not monitored continuously by neurology providers, which could delay the identification of seizure activity.
Recommendations: Continue immediate placement of rapid EEG if technologists are not available within one hour. Continue to replace rapid EEG with continuous EEG when technologist becomes available. Explore improved capabilities for more timely reading and diagnosis of continuous EEG.https://digitalcommons.centracare.com/nursing_posters/1159/thumbnail.jp
Pupillometry
Get PDFBackground: Measuring pupillary light reflex is a standard part of neurological assessment. Changes in pupil reactivity may indicate unfavorable outcomes, such as increased intracranial pressure and brain herniation. Physiologic and pharmacologic agents may affect pupil reactivity. In some instances, pupillary light reflex is the only piece of neurologic assessment readily testable.https://digitalcommons.centracare.com/nursing_posters/1158/thumbnail.jp