Door #1
IV start kits are on backorder and nurses will need to gather their own supplies for now.
What is a huddle announcement? Rationale- this is quick information and all RNs need to know.
The new Orthopedic and Spine Program Coordinator has noted inconsistent practice related to the care of patients with a total knee replacement and wants to collaborate on creating a user-friendly, evidence-based patient care pathway.
What is the UPC? rationale- this is a practice problem to be solved. The UPC could invite/welcome interested others to join the effort but the UPC is the right group to lead the practice change.
The department has achieved their goal of 75% certified nurses.
What is a staff meeting, huddle announcement, or kudos board? Rationale- message and celebrate anywhere and everywhere!
There has been an increase in unassisted falls related to toileting in the past week on one unit.
What is the UPC? Rationale- UPC should investigate/ discuss why the increase. Are purposeful rounds happening? Are family members getting them up? Are there issues with bed alarms? Is it the same patient who is confused?
The Bladder Management protocol has been merged with the Urinary Retention algorithm and there is a new policy.
What is a staff meeting? Rationale- All RNs need to know but it might require some education/ explanation.
The unit is pursuing the PRISM Award and the NM wants to recruit team members to work on the application.
What is a staff meeting? Rationale- recruitment will require explaining the PRISM and the reason to pursue it, which all should hear.
As part of an RCA on a fall with injury, chart audits and discussions with the RNs caring for this patient revealed variation in how the risk factor of "impulsivity" was scored when completing the HDS, resulting in different scores shift to shift and variation in fall prevention measures.
What is the Fall focused Committee? Rationale- findings should be brought to this team for problem-solving and identifying next steps.
Nurses on unit B are reporting that patient handoffs from unit A to their unit are "still an issue."
What is the unit B UPC? rationale- the UPC should create a specific list of issues to be improved (to solve the right problem) and identify the key stakeholders of this process. Those involved must come together to problem-solve and agree on potential solutions to trial.
Nurses and PCTs are inconsistent in completing I&Os as ordered and there is confusion if the other has completed it.
What is UPC? Rationale- what is causing the confusion? More investigation is needed to solve the right problem.
The unit is not meeting target for their patient experience scores related to the Nurse Communication Domain.
What is a staff meeting? Rationale- Strategic goal performance should be shared with all staff, however, the UPC should dig into whether any of the 3 questions might be driving the poor Domain score and/or if established practice has drifted (e.g. BSR, rounding, updating whiteboard).
The L&D unit has reliably established QBL as standard practice to prevent PPH but recent data shows they have suddenly dropped from a compliance of >97% to below 75%.
What is either a Huddle Announcement or a staff meeting? Rationale- if its an established practice, asking the broader team about potential drivers is a logical start (have the scales disappeared? failure to stock pads?). Answers or ideas drives next step...
The NPDP needs to share that the unit will be implementing a Total Hip & Knee Care Pathway for nursing, which was developed by the Orthopedic and Spine Program Coordinator.
What is a staff meeting and /or planned education? Rationale- the care pathway is fully developed and does not require problem-solving.
A review of safety events via SERT uncovers similar medication errors have occurred on multiple IP units and in the ED.
What is the Coordinating Practice & Quality Council? rationale- the issue spans units and service lines so requires the CPQC to discuss how to address (e.g., more investigation, education, short-term task group)
An audit reveals that compliance with documenting VS per policy is consistently below 50% per month for 6 months.
What is a staff meeting? Rationale- Expected performance for safe practice should be related for all staff's awareness, however, discussion on why the gap exists and how to improve practice belongs in the UPC. E.g., failure to document? policy confusion? is it all staff or a smaller subset?
The unit is trialing a mid-shift huddle. Staff feedback indicates the huddle is inefficient and takes too long.
What is the UPC? Rationale- this is a practice change that requires more problem-solving (e.g., would a short list of what to report help?)
The new bariatric coordinator has identified opportunities for improvement related to best practices and discharge instructions for these patients post-op.
What is the UPC? rationale- the purpose of the UPC is to lead on meaningful practice changes through focused problem-solving. Their ideas can be shared with the unit for feedback and influence as potential solutions are identified and/or implemented.
There has been an increase in patients holding in the ED due to delayed admissions to the Acute Care units.
What is the Acute Care Practice & Quality Council? Rationale- delays are occurring on more than 1 unit. If discussion reveals units have different reasons, topic should go to their UPCs next.
A new graduate has an idea for their Residency project and wants to implement the change.
What is the UPC? Rationale- The UPC should review, but does not necessarily "own," all proposed practice changes for alignment with unit goals, need/utility, and support/feedback prior to and during implementation.
Important information is not being shared when there is a change of 1:1 observation sitters for behavioral health patients.
What is the UPC? rationale- this is a practice gap that requires discussion and problem-solving.
RNs and PCTs are learning the new Virtusense system and the NM is concerned the response times are above target.
What is the staff meeting? rationale- hearing from the larger team about potential barriers or issues with using the new system is the right place to start. The UPC can then discuss what is shared to identify potential solutions to address issues.