Liuying Wang

4/27/16

 Focus:

Performance Results related to use of

personal protective equipment by floor staff

Leaders maintain constancy of purpose, establish clear

goals and expectations, and foster a respectful culture.
Leaders take time to build knowledge, review and reflect, and
take action about microsystems and the larger
organization (Johnson, 2003).

Democratic staffs are comfortable putting insights about

hospital improvements
Charge Nurse supervise and provide assistance to the staff
during the shift.
Unit Nurse manager- establish goals, ensure that staff have up
to date skills and provide feedbacks to the staff
Clinical Nurse leader- ensure that the unit functions smoothly
Institute for Healthcare Improvement. (2016). Leadership. Retrieved from http://www.ihi.org/Topics/Leadership/Pages/default.aspx
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing, (8th ed.). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.

 Organizational

culture is a system of symbols

and interactions unique to each organization. It
is the ways of thinking behaving, and believing
that members of unit have in common. (Marquis
& Huston,2014)
On the unit
o Very open, nurse supportive of each other
o Morale boost
o Front desk workers
Marquis, B. L., & Huston, C. J. (2012). Leadership Roles and Management Functions in Nursing; Theory and Application. (7th
ed, pp. 268.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Patient

Focus
o Meet patient needs during care
o Mission is emphasized onto patient care
o Patient advocate representatives
o Patient-centered
Staff Focus
o An organization is in charge of
contributing to the growth of staff
development programs.
o Huddle board

Marquis, B.L. & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application. (8th ed. pp. 366).
Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins.
U.S. Department of Veterans Affairs. (2015). Honoring Veterans. Retrieved from http://www.tucson.va.gov/features/Honoring_Veterans.asp
U.S. Department of Veterans Affairs. (2016). Southern Arizona VA health care system. Retrieved from http://www.tucson.va.gov/index.asp

The care team uses an interdisciplinary approach but is not

always able to work together as an effective team.
o Overall, professional and appropriate
o Nurses helped each other
o PCT were on top of it
o Physicians did daily rounds on patients
Nurse were usually a part of the bed rounding, but not
always
o One physician easily to communicate with and worked well
in the care team
Another physician was not professional
o Gossiping was a problem

Joseph, R., Brown-Manhertz, D., Ikwuazom, S., Singleton, J. (2014) The effectiveness of structured interdisciplinary collaboration for adult home hospice patients
on patient satisfaction and hospital admissions and re-admissions. Joanna Briggs Institute Database of Systematic Reviews & Implementation Reports 12(7).
148-163.
Johnson, J.K.(2003). Clinical Microsystem Assessment Tool. Retrieved from:
http://clinicalmicrosystem.org/wp-content/uploads/2014/07/microsystem_assessment.pdf

 Technology

facilitates effective communication and

multiple formal and informal channels are used to
keep everyone informed all the time, listen to
everyones ideas and ensure that everyone is
connected on important topics. (Johnson, 2003)

On

the unit
o CPRS- documentation system
o BCMA (barcode medication administration)
Medication documentation system
o Wander guard

Johnson, J.K.(2003). Clinical Microsystem Assessment Tool. Retrieved from:

http://clinicalmicrosystem.org/wp-content/uploads/2014/07/microsystem_assessment.pdf

 Supported

by the continuous monitoring of

care, use of benchmarking, frequent tests of
change, and a staff that has been
empowered to innovate

Benchmarking

used frequently
o Unit aware of standards and will perform
better when watched

Johnson, J.K.(2003). Clinical Microsystem Assessment Tool. Retrieved from:

http://clinicalmicrosystem.org/wp-content/uploads/2014/07/microsystem_assessment.pdf

 Data

is sometimes collected on outcomes of

care and processes of care.
o CNL was in charge of audits, but was not

seen doing these audits

o Never given feedback on results of audits
o Performance depends on individual initiative
Staff was not required to clock in could arrive late
without being noticed
Staff not held accountable for ignoring PPE rules
Institute for Healthcare Improvement (2004). Clinical microsystem action guide: Improving health care by improving your
microsystem. Retrieved from http://clinicalmicrosystem.org/wp-content/uploads/2014/07/CMAG040104.pdf
Johnson, J.K.(2003). Clinical Microsystem Assessment Tool. Retrieved from:
http://clinicalmicrosystem.org/wp-content/uploads/2014/07/microsystem_assessment.pdf

 Focus:

Staff Performance Patterns

Goal: Improve staff performance patterns with a focus
on increasing compliance of PPE use.
Rationale
o Decreased adherence in Unit
Location of equipment in room
No mask in the room
Equipment runs out easily
Incorrect use of PPE
Inaccurate PPE signs
10

Positive Impact on Delivery of Care:

o Decreases Transmission of Infection
o OSHA Mandated
o Protects Healthcare workers and patients
Planned Interventions:
o Continued Training and Education
o Designated Staff RN perform PPE audits
o Publicize audits results
o PPE cart outside the room
o Noticeable standardized sign of PPE outside room

Beam, E.L., Beckerdite, M.E., Boulter, K.C., Gibbs, S.G., Smith, P.W. (2011). A method for evaluating health care workers personal protective equipment technique.
American Journal of Infection Control, 39(5), 415-420. doi: 10.1016/j.ajic.2010.07.009
United States Department of Labor. (2011). Occupational safety and health administration. Retrieved from
https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9777
Harris, A.D. et al. (2013). Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU. Journal of American Medical
Association310(15). 1571-1580.

11

1-2 months- Establish a committee to assess the staffs levels

of understanding of PPE and compliance
2-3 monthso PPE carts placed outside the room
o New signs introduced into the unit
o Educated on how to properly use signs
o Changes will be discussed during huddle
4-6 monthso CNL will develop an audit sheet
o conduct bi-weekly audits and publicize results
6-8 months- Train unit staff to perform audits and publicize
results on patient care unit
8+ month: Evaluate the interventions with nursing staff input
and adjust interventions based on feedback

12

Hennessy, K.A. & Dynan, J. (2014). Improving compliance with personal protective equipment use through the model for improvement and staff
champions. Clinical Journal of Oncology Nursing 18(5). 1092-1095.

Questions?!?

13

Hennessy, K.A. & Dynan, J. (2014). Improving compliance

with personal protective equipment use through the model for
improvement and staff champions. Clinical Journal of
Oncology Nursing 18(5). 1092-1095
Harris, A.D. et al. (2013). Universal glove and gown use and
acquisition of antibiotic-resistant bacteria in the ICU. Journal
of American Medical Association310(15). 1571-1580.
Institute for Healthcare Improvement (2004). Clinical
microsystem action guide: Improving health care by improving
your microsystem. Retrieved from
http://clinicalmicrosystem.org/wp-content/uploads/2014/07/
CMAG040104.pdf
Institute for Healthcare Improvement. (2016). Leadership.
Retrieved from
http://www.ihi.org/Topics/Leadership/Pages/default.aspx
14

Johnson, J.K.(2003). Clinical Microsystem Assessment Tool.

Retrieved from:
http://clinicalmicrosystem.org/wp-content/uploads/2014/07/
microsystem_assessment.pdf
Joseph, R., Brown-Manhertz, D., Ikwuazom, S., Singleton, J. (2014)
The effectiveness of structured interdisciplinary collaboration for
adult home hospice patients on patient satisfaction and hospital
admissions and re-admissions. Joanna Briggs Institute Database of
Systematic Reviews & Implementation Reports 12(7). 148-163.
Marquis, B. L., & Huston, C. J. (2012). Leadership Roles and
Management Functions in Nursing; Theory and Application. (7th
ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins.
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and
management functions in nursing, (8th ed.). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.
15

U.S. Department of Veterans Affairs. (2015). Honoring

Veterans. Retrieved from: http://www.tucson.va.gov/features/
Honoring_Veterans.asp
U.S. Department of Veterans Affairs. (2016). Southern Arizona
VA health care system. Retrieved from:
http://www.tucson.va.gov/index.asp
United States Department of Labor. (2011). Occupational
safety and health administration. Retrieved from
https://www.osha.gov/pls/oshaweb/owadisp.show_document?
p_table=STANDARDS&p_id=9777
United States Department of Labor. (2011). Occupational
safety and health administration. Retrieved from:
https://www.osha.gov/pls/oshaweb/owadisp.show_document?
p_table=STANDARDS&p_id=9794

16