NursingCenter's Nurses Week Innovation Contest



In honor of this year's National Nurses Week theme, we asked you to share innovative things you are doing in your practice or that are happening in your workplace. We are so happy to share some of the top entries with you. The winner will be notified on Wednesday, May 15th, 2013 and will be awarded a free year's subscription to our CESaver program!
 



Congratulations to our winner ~ Doris, MSN, BHSA, RN!

We recently added a urologist to our hospital services (we are a small rural hospital). There had not been a urology service in many years so education was necessary. In trying to mock up how to train nurses to irrigate clots from a bladder, the nurse manager and I devised a “fake bladder with clots” which consisted of using the large balloon type punching balls (the kind we had as kids); then using a funnel, we introduced red jello broken down into small pieces (the jello was made with only the hot water portion of the directions to make it thicker). We then inserted a foley and inflated the balloon of the foley in the neck of the “bladder.”  Nurses then used irrigation syringes to introduce water into the “bladder” and then practiced irrigating clots from the bladder. Our urologist was very impressed and said he had never seen anything like that before!

 
Here are some more submissions with examples of how our colleagues are Delivering Quality & Innovation in Patient Care...

I am an RN coach in a large level 1 trauma hospital in Lakewood, Colorado. I coach high risk patients in the hospital and make a home visit with them and their family on discharge home, then follow by phone for one month. Many of my cardiac and diabetic patients are confused and overwhelmed by the necessity to follow special diets and restrictions. In addition to referrals to classes and rehab, I am having them download free apps into their smart phones. As these are interactive apps, it gets them engaged and some tell me they have fun with this. This decreases their anxiety and stress about managing their care. These apps help when grocery shopping as a bar scan is able to show the sodium, food value, and better options. Exercise and calorie counts are in apps. Family caregivers love the apps in shopping and motivating the patients. I have introduced these apps to the nursing staff on my floor, to our dietitians and the feedback has been all positive. I also refer patients to the library resources in learning disease self-care management, but these apps are always available and are such a great teaching tool. My favorite is the fooducate as they have one for diabetes too, my diary.
Hope this helps to spread the word to help other nurses in our mission of good health for everyone!

~ Kathryn RN,BSN,CTI coach

Our nursing labs have been converted to simulate nursing units.  Call lights (made with covered small size boxes, attached to wall outlet with cord), hand dispensers located in each unit, and all medication in carts reflect virtual medication on the computer.  Units are set up to simulate pediatrics, OB, and med-surgical units.  Phones are provided to simulate the process when obtaining doctor’s orders, with actual paper forms to write orders (forms provide carbon copy for instructor and student with noted corrections for record keeping).  Medication compliance issues can also be addressed, in order to practice communication skills with residents and/or family members. These are just some of the innovations implemented in our nursing lab, to mimic the “real world of nursing”.

~ Linda, MSN, RN
 
My colleague and I created a in situ mock code program called: Five Alive.  We use a mannequin from our simulation center, find an empty patient room and run 4 mock codes once a month. We try to make the situation as close to a real patient arrest.  Using video and discussion we debrief after each session, reviewing skills, techniques, and hand off communication.  We have received positive feedback from nurses who are new to nurses with 30 years of experience. But most of all we have improved the responders’ performance during an arrest.  

Initial findings revealed that an in situ mock MET/code simulation followed by debriefing improves the performance of nurse responders and time to CPR and defibrillation.  The data demonstrated a 70 % improvement in time to CPR, as well as a 70% improvement in the 3 minute goal to defibrillation between scenario one and scenario two. This is also a stimulating way to educate.  Our vice-president of nursing has asked us to continue our program and reach every nurse in the hospital.  We have had 300 nurses attend thus far.

~ Kathy, RN, MSN, CNS
 
To boost our patient satisfaction in our three critical care areas, we have labeled them a "No Pass Zone". If you are walking down a hallway and you see a patient bell on, you will answer it, even if it's not in your unit. Although it may not be "Your patient," you can assist with what needs to be done or locate that patient's nurse to take care of their immediate needs.

~ Donna

In the course of my practice I noticed that whenever I needed a vial of lorazepam {for my CIWA (alcohol withdrawal) patients or one of my patients with anxiety for whatever reason} I was taking precious seconds counting the remaining vials left in the Accudose medication cabinet.  The vials come from the drug company in a little cardboard box where they moved around as I counted them.  If only I had a little holder that would make it easier for me to count them quickly??  I shared my problem with my husband who is a woodworker and he made the first prototype out of wood, and then we took a risk and went through the process of having a plastic mold made and the subsequent manufacture of durable plastic "Vialcount" holders became a reality!  It only takes a few seconds to get a correct  'narc count' when I need a vial now.  We decided to also make a slightly larger size that would hold midazolam as well.  Most importantly the medication gets to my patient faster and I am able to count correctly (no count discrepancies)!  A picture may explain this better and we have a website vialcount.com and we are on Facebook (Vialcount) as well.  The nurses on our Medical/Oncology floor at Central Washington Hospital in Wenatchee, WA,  love this little innovative device--simple, yet so helpful. 
Thank you!

~ Melanie, CMSRN

Medical institutions across the United States use multiple technologies to improve patient safety.  The bar coding medication administration (BCMA) system is a technology shown to consistently improve medication administration processes and overall patient safety.  In our institution, following successful implementation of the BCMA system in 2006, nursing leadership investigated expanding this application to include the labeling and handling practices of breast milk in our 26 bed Neonatal Intensive Care Unit (NICU).  Prior to implementation of the system, breast milk management included a single RN verification process from the point of milk acceptance to administration and resulted in varying milk labeling practices, thus, increasing the potential for error.

The breast milk bar coding system (BMBCS) was implemented in the fall of 2009 to meet the following objectives: 1) improve patient safety through the prevention of breast milk misidentification and administration ; 2) improve standardization for identification and labeling of breast milk; and 3) prevent the loss of breast milk secondary to label dislodgement when storing breast milk in the refrigerator and freezer by converting to using Cryo labels, which are not affected by condensation.  
Implementation of the bar coding system required a multidisciplinary team approach to: 1) review product applications and compatibility with our hospital hardware, systems, and personal digit assistant (PDA); 2) determine potential impact of technology on present clinical practice and workflow; 3) determine what additional modifications and purchases were required to initiate the system; and 4) develop educational programs to instruct the entire staff on the use of the system.

It has been 3 years since the implementation of the BMBCS, and there have not been any reports of misadministration of breast milk when using the system and the system has effectively stopped misadministration in at least three reported situations.  Workflow issues are a challenge, especially when fortifying breast milk for multiples, so we continue to evaluate the system, our workflow issues, our practice, and make recommendations for future modifications.  We are now investigating the use of a breast milk bar-coding system for identification of donor breast milk.  The BMBCS has proven to be an effective method to ensure patient safety for breast milk administration, storage, and labeling of breast milk in the Neonatal Intensive Care Unit. 

~ Ann, BSN, NNP-BC

I developed and coordinate a mobile simulation lab that provides staff development education using human patient simulators to nurses at 11 area hospitals. Scenarios include high risk-low frequency cases such as: Malignant Hyperthermia, Neuroleptic Malignant Syndrome, Local Anesthetic Toxicity, Shoulder Dystocia, Amniotic Fluid Embolism, Pediatric Sepsis, and Neonatal Resuscitation. In addition we train staff in the recognition of complications and efficient care in the following patient conditions: Pneumonia with sepsis (emphasizing the information included in the Surviving Sepsis Campaign), CHF (including the core measure items), Stroke and STEMI all grounded in evidence-based practice. Furthermore we provide ACLS and PALS scenarios and testing. Our simulators include 2-newborns, 1-toddler, 1-child, 1-birthing female, 1-nursing care female, and 2-males. Our simulators are multicultural so educational content can include diversity training. We are in our third year of operating the mobile lab. For additional information, please visit www.coastalalliance.org and click on the Mobile Simulation Lab.

~ Denise, MSN, RN, CEN

Our Emergency Care Center has installed erasable white boards in each patient room.  The nurses are required to make hourly rounds and the Multi-skilled techs make half hour rounds on each patient.  All of the staff and physicians have received mandatory training regarding this program and utilize it with each patient that we come into contact with. The white boards have key features permanently imprinted on it including date, patient, nurse, physician, physician assistant, plan of care, patients personal plan/goal and the numerical/facial pain scale, time of last pain medication, time of xray, CT, US, labs and the expected time for results. The board sounds "busy" but is only about 18"x18" and provides the patient with so much needed information and almost every patient and/or family member remarks quite favorably that the use of the board allows them to participate and know what to expect in terms of their care.

The program is entitled A-I-D-E-T
A      Acknowledge...Good morning Mr/Mrs______ Acknowledge family and friends too!
I       Introduce.........."manage-up" yourself and others.  Include IPC (Individual Patient Care)question.  
D      Duration.....Inform patient of when Dr. will be in, when procedures will be done and how long they
        will take.
E      Explanation.......Always "narrate the care".  At time of discharge, verify they understand their   
        instructions.
T      Thank You.........Thank them for coming to our Emergency Care Center, "anything else you need or
        questions I can answer".

Key words:  Safey, Privacy, Comfort, Informed, "very good care", Clean, (New medication-Side effects)

8 Nursing behaviors  that are used EVERY time you are rounding

1) A-I-D-E-T with IPC (Individual Plan of Care) We ask the patients to participate in their plan of care with us
2) Perform scheduled tasks
3) Address "PPD" Pain, Plan of Care and Duration (include wait times)
4) Assess additional comfort needs, blankets, pillows, ice packs, educational TV
5) Conduct environmental assessment (Cleanliness and safety)
6) Ask "Is there anything else I can do for you? "I have time"
7) Tell them when you will be back
8) Document the round on log in room

By performing the hourly rounds and anticipating the patient/family needs, there is an increase in patient safety, improved communication, decrease in call bell use and other positive results such as improved patient satisfaction scores.

~ Hazel, RN, CEN, CCRN

I work for a state Department of Health in the Newborn Screening Program.  Our nurses follow up on infants with abnormal Newborn Screenings. Since last October we have been screening for Severe Combined Immune Deficiency (known as the "bubble-boy illness").  To date we have identified at least one infant with SCID.  On the horizon, our program will begin requiring screening for Critical Congenital Heart Defects. I am so proud as a Registered Nurse to be saving babies lives every day!

~ Marna, RN, BSN, M.Ed.

Starting in 1992, in Labor and Delivery and post partum, it was an exciting time as the unit grew by introducing the concept of "The Family Birthing" (aka LDRP) concept.  Over the last 16 years I have transitioned from Newborn Nursery to our new NICU. The thing that I believe is the breaking point is not having loved ones and family at your side for support. The most unraveling issue for families and society is when someone dies, especially a baby. This is why I am now striving to develop a coordinated response team for following our Safe Surrender policy. I feel a strong commitment to making people aware of the policy of our hospital and how it reflects the law of Abandonment vs. Safe Surrender. As I explained to the Emergency Department's educator "we do not want JCOH to come in and clean up a potential mess because we were not prepared". To sum it up we cannot assume we would know how to help a desperate parent. We can do everything possible in "good faith and a good conscience".

~ Caroline, RN