Magnet Recognition Program® Request for Additional Documentation
Homestead Hospital
Homestead, FL
MGN20140102
SE2EO The healthcare organization supports nurses' participation in local, regional, national, or international professional organizations.
SE2EOb: Provide two examples, with supporting evidence, of improvements resulting from a change in nursing practice that occurred because of clinical nurse involvement in a professional organization. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
It was not possible to evaluate the example. The narrative described nurses in the ICU spearheading the implementation of a noninvasive cardiac monitoring technology in 2012 and the goal “To improve the severity adjusted mortality ratio for severe sepsis at Homestead Hospital to 1.0 or less”. The narrative did not describe the change in nursing practice that occurred, so the correlation between an initiative and data depicting severity adjusted mortality ratio for severe sepsis could not be established. Timeline information described in the narrative and that depicted on the graph/data-table were not aligned.
Provide an example, with supporting evidence, of improvement(s) resulting from a change in nursing practice that occurred because of clinical nurse involvement in a professional organization.
______________________________________________________________________
It was noted that:
1. The resulting change in nursing practice that occurred because of clinical nurse involvement was not very clear in the original document. The narrative below delineates the change using a table format pre- and post-intervention in each step of the nursing process.
2. The date of the intervention presented on the original graph was incorrect. The graph below reflects the corrected date of the intervention, which is aligned to the intervention date on the narrative.
NAME OF INITIATIVE
Noninvasive Cardiac Output Monitoring (NICOM®)
Clinical Nurse’s Involvement in a Professional Organization
ICU Clinical Nurse Joyce Nealy, RN was a member of the American Association of Critical Care Nurses (AACN) as described in the initial document. Her involvement in best practices and the system-wide committee led to a positive change in practice and an improved and sustained outcome.
Change in Nursing Practice
The table below describes the change in nursing practice associated with the NICOM implementation in January 2012.
Change in Nursing Practice |
Pre-Intervention |
Post-Intervention |
Assessment |
Upon admission and then every shift, ICU Nurses completed the Severe Sepsis/ Septic Shock screening, which was based on sepsis guidelines. They would also assess patients’ hemodynamic status and fluid balance based on vital signs (pulse, blood pressure, heart rate); intake and output; and response to fluids, diuretics and vasopressors. |
ICU Nurses continued to complete the Sepsis/Septic Shock screening. Once a patient screened positive, they had the autonomy to apply the NICOM®, which enabled them obtain more detailed patient information. For example, they were able to assess their patients’ fluid volume and hemodynamic status more precisely. With NICOM®, ICU nurses were able to distinguish whether patients were euvolemic; needed more fluids; or had fluid overload by performing a passive leg raise maneuver and assessing the patient’s response. |
Planning |
When sepsis screen was positive, ICU nurses notified the physician. |
When patients were not responding as expected to the passive leg raise maneuver, ICU nurses would notify the physician using a standardized communication [Situation-Background-Assessment-Recommendations (SBAR)] report. They were able to provide physicians more detailed and specific information about the patient’s fluid status, which is a key component of the sepsis treatment bundle. |
Intervention |
ICU nurses simply implemented physician orders. |
Guided by the information derived from NICOM, ICU nurses used a nurse-driven protocol to judiciously titrate vasoactive infusions. This enabled them to achieve optimum hemodynamics and minimize cardiac output and stroke volume compromise. |
Evaluation |
Prior to the use of NICOM, the sepsis bundle (e.g., giving 30ml/kg of fluid until the mean arterial pressure [MAP] was 65mmHg or greater) was not consistently being followed. |
NICOM promoted better adherence to the sepsis bundle resulting in improved mortality ratio for severe sepsis. |
OUTCOME(S)
Exhibit SE2EOca: Mortality Ratio for Severe Sepsis in ICU
Analysis: Above graph depicts that the mortality ratio for severe sepsis in ICU remained consistently below 1 for 6 consecutive quarters after the implementation of the NICOM nurse-driven protocol,
Summary Attachments/Hyperlinks/Evidences
Exhibit SE2EOca: Mortality Ratio for Severe Sepsis in ICU