The shifting circumstances of the COVID-19 pandemic required many changes within hospitals, including changes to how care teams addressed quality and safety challenges. This has been especially important and true for nursing-sensitive indicators (NSIs) — those key statistics that tell an important story about care at the bedside. 

Before COVID-19, Sibley Memorial Hospital’s nurses took ownership and leadership to make positive changes to these indicators. They continued to assess progress and introduce evidence-based innovations aimed at these indicators, even as the pandemic continued. 

Fall Reduction

Changing and restricting the flow of people in and out of patient rooms to keep them safe from COVID-19 also required that Sibley’s nurses revisit their approach to managing and preventing patient falls.  

Today, nurse leaders hold a weekly fall debrief where frontline staff and nursing leaders gather to discuss any recent falls. Amy Sawyerr, M.P.H., B.S.N., R.N.C.-L.R.N., director of nursing systems, strategy and operations, says that when it comes to understanding the root causes for falls, clinical nurse participation is crucial. “We really want frontline nurses to come to debrief meetings to report in their own words about falls. It gives us the opportunity to hear the full story from the nurse in a non-punitive way, so we can identify areas for improvement, talk about best practices and track the data.”

In July 2021, the nurse leaders also restarted the Falls Committee as part of Nursing Shared Governance, which includes a clinical nurse champion from each unit. Unit champions are very knowledgeable bedside nurses who become the unit’s expert on falls.

At the unit level, medical-surgical unit nurses, in collaboration with a nurse from the patient safety and quality department, developed and piloted a novel tool to help guide their peers. In addition to helping nurses track all the available physical fall prevention safety measures, it also gives specific guidance to help clinical nurses communicate to patients and with each other about falls.  

“This tool guides the nurse to ask the patient how we can help keep them safe,” says Christine Inglisa, M.S.N., R.N., N.E.A.-B.C., director of medical-surgical and musculoskeletal nursing. “It also asks the nurse what the concerns are for keeping the patient safe, and that information is shared with every nurse caring for that patient.” 

Fewer CAUTIs

Before COVID-19, work was already underway to prevent catheter-associated urinary tract infections (CAUTIs). Though it took a temporary pause, the hospital’s multidisciplinary, nurse and IP co-led CAUTI committee resumed work in 2021. 

A multidisciplinary root cause analysis tool now helps identify areas for improvement. Additionally, the committee joined forces with an already successful model used for routine weekly central line process measure audits to prevent central line-associated bloodstream infections (CLABSIs). Manager of Infection Prevention and Control Jennifer Berry, M.P.H., C.I.C., says that the infrastructure was in place, so adding a foley audit was fast and easy to accomplish. 

That audit process gave nurse leaders the opportunity to teach clinical nurses how to complete the audits themselves, with the guidance and aid of their leaders to troubleshoot in real time. In the coming year, the committee hopes to expand these rounds to more units and incorporate more CAUTI committee members in the rounding process. Additionally, nurses from Sibley’s Nursing Quality Council, including Berry, are active participants in a health system work group that seeks to create a new nurse-managed bladder management algorithm for use by all the system’s hospitals. 

“Nurses know the patient better than anyone. It makes sense they are leading the efforts to put these things in place,” Berry adds.     

Decreasing HAPIs

A focus on reduction of hospital-acquired pressure injuries (HAPIs) has also continued. Building on previous momentum around HAPI-reduction in intensive care units, the hospital has zeroed in on best practices to eliminate these injuries. Unit-designated skin champions are experts on the policies and help each unit keep pressure injury prevention on the day-to-day priority list for the entire care team, including clinical nurses, patient care techs and nurse leaders.  

According to Dorothy Shi, M.S.N., R.N., C.W.O.C.N., a certified wound and ostomy nurse at Sibley, in the past year, the hospital’s nurse-led Skin Integrity Committee offered education programs about best practices as well. One of these Wound Care Education Days featured an external wound care nurse specialist who held a training and in-service at the hospital.

To track progress, the Skin Integrity Committee implemented a monthly pressure injury prevalence study. They also hold a weekly meeting to debrief and conduct root cause analysis for these injuries as they occur. 

NSI Education Fair Ties it all Together

In fall 2021, the Nursing Professional development and Education Department held a two-day, nursing-sensitive indicator (NSI) fair to reinforce the ongoing day-to-day work of NSI reduction. Activities included stations and educational content about the available tools and processes for every critical indicator: falls, CAUTIs, HAPIs and CLABSIs.

Sawyerr says that the NSI Education Fair “gave us the opportunity to re-emphasize the importance of these indicators for keeping our patients safe and helped us link success in these areas to the culture of nursing excellence at Sibley.”