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  Rotating Preceptors: (In)consistency is Key

  Rita Leone, Pamela Zawadzki, Catherine Horne, and Fatima Ibrahim

  Publication Date: 5-6-2024

  Preceptors facilitate unit orientation, a critical phase of the development of new graduate nurses (GNs) as they begin their nursing career. Nursing turnover has increased at a startling rate since the start of the COVID-19 pandemic and GNs continue to be in high demand, but the waning number of qualified registered nurse preceptors (RNPs) presents a challenge (McDermott, 2023). This lack of qualified RNPs is a critical concern of nurse leaders, creating significant challenges for training GNs. RNPs precepting GNs on a frequent basis can lead to burnout and job dissatisfaction. A rotating precepting model could lead to more choice and ownership for RNPs over the preceptorship process, opting in when enthusiastic and energized about teaching and opting out when near burnout (Barrett, 2020). RNPs also need continuing professional development to validate competency. Conversely, GNs may feel uncomfortable with an assigned primary RNP’s teaching style or personality. Nursing education collaborated with nurse managers to ensure GNs received quality preceptor support during their 10-week unit orientation while also incorporating job satisfiers to reduce burnout, increasing job satisfaction and nurse retention for both RNPs and GNs, ultimately improving care delivery and patient outcomes.

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  Rebuilding the Nursing Team on a Medical Unit

  Christina Maciborski, Sally Witt, and Kyle Kahsin

  Publication Date: 5-6-2024

  • Staffing challenges are complicated and multifaceted. Factors influencing registered nurse (RN) staffing include pursuit of agency contracts, continuing education opportunities such as completion of an advanced nursing practice role, burnout, retirement, economic pressures, and a competitive market2.
  • Almost 200,000 more RNs will be needed in the US each year per the U.S. Bureau of Labor Statistics1
  • The 6 North West Medical Progressive care unit (6NW) was largely affected by post-pandemic staffing and hiring challenges as evidenced by a functional vacancy rate of 70.3% in April 2023.
  • Literature supports collaboration between nurse leaders and Human Resources (HR) to create sustainable recruitment strategies2.
  • Unnecessary delays between interview and job offers can allow candidates time to pursue alternative offers and question the institution’s intention to follow up3.
  • Nurse leaders should use innovative and creative methods for RN recruitment and retention5.
  • The aim of this project was to utilize a multifaceted approach to RN recruitment and retention to achieve a decreased functional vacancy rate in the medical progressive care unit.

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  Virtual Reality for Labor Pain & Anxiety

  Kristen Maki and Kathleen Blair

  Publication Date: 5-6-2024

  Managing pain during labor is a main component of the daily work of a clinician in labor and delivery. Pain control and prevention of suffering are key components in this area of nursing (Frey et al, 2019). While pharmacologic approaches to pain control (ie. epidurals) are widely utilized and seek to eliminate pain, non-pharmacologic approaches to pain management are also sought after by patients. Coping is encouraged, self-confidence can increase, and well-being is at the forefront of non-pharmacologic interventions. Virtual Reality (VR) has been shown to be effective in managing acute pain in a wide variety of settings including burn patients, cardiac surgery, and labor patients.

  VR came to be in the 1980s to refer to a user-computer interface that allows for real-time simulation of an environment that users can interact with via multiple sensory channels (Lanier, 2001; Gonzalez-Franco & Lanier, 2017). So not only does it provide sound distraction but engages multiple senses while isolating a patient from the immediate clinical setting (Hoffman et al, 2011). VR has long been cost prohibitive to widespread application, however with advances in technology, the cost of high-quality headsets has decreased.

  Nurses who provide labor support play a vital, unique role in supporting birthing women. This is another tool that nurses can draw from to provide labor support, to women who meet criteria and are interested in VR. Additionally, assistive personnel who have been trained, are able to set up this modality for patients.

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  Responsive Neurostimulation (RNS) of the Centromedian Nucleus (CMN) of the Thalamus for the Treatment of Drug Resistant Idiopathic Generalized Epilepsy (IGE)

  Angelique Manasseh, Hannah Guider, Brooklynn Bondy, Sanjay Patra, David Burdette, M. Ayman Haykal, Nour Baki, Ashleigh Terrell, Michael Staudt, Christopher Parres, and Andrew Zillgitt

  Publication Date: 5-9-2024

  Idiopathic generalized epilepsy (IGE) accounts for nearly 1/3 of all epilepsies.

  Approximately 20-30% of people with IGE are refractory to adequate anti-seizure medication trials.

  RNS implantation is a unique closed-loop neuromodulation therapy, and case reports as well as case series have demonstrated improved seizure control in patients with drug resistant IGE.

  More recently, targeting the centromedian nucleus of the thalamus with RNS has been explored as a potential surgical treatment option for patients with drug resistant IGE.

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  Timing is Everything! Ordering Newborn Screens Within the Correct Timeframe

  Alison Mannella and Audrey Kalasky

  Publication Date: 5-6-2024

  Newborn Screening (NBS) is a public health program required by Michigan law to detect babies with rare but serious disorders that require early treatment. All babies should be tested to find the small number who look healthy but have a rare medical condition. The newborn screen is recommended to be drawn within 24-36 hours after birth, preferably within 24-30 hours of life.

  At William Beaumont University Hospital, lab has a six-hour window to obtain a lab once the order is placed. Previously, the clinical assistant (CA) on the Mother Baby Unit (MBU) would enter the NBS order to be drawn when the baby was transferred from Labor and Delivery. The CA would adjust the timing of the lab draw to 24 hours of life. This allowed the NBS to be drawn within the preferred 24-30 hours after birth. The process was changed in the fall of 2023, requiring the registered nurse (RN) to input the order for the NBS. The RNs were not adjusting the timing of the lab draw when entered, and NBS were either not being drawn or missed the 24–36-hour timeframe. The window to obtain the NBS is critical to obtaining results as quick as possible.

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  Heartbeat In A Bottle Initiative

  Miranda McFadden and Brooke Waligora

  Publication Date: 5-6-2024

  Death and the dying process are a reality on our unit, CICU. We take care of people who are at the end stages of chronic illness and acutely decompensate. When starting in the ICU, learning terms like “terminal wean” or “withdrawal of care” were used to communicate expected deaths between staff members. The healthcare culture around death in the CICU has been slowly changing toward a more holistic family-centered approach; however, we identified opportunities for improvement. We developed the Heartbeat in a Bottle Initiative. The aims of this project are to

  a) Develop a Heartbeat in the Bottle Initiative Protocol

  b) Help families with grieving process

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  Micro-Learning Improves Clinical Nurse Confidence and Success with Peripheral IV Insertion

  Holly McGran, Lindsay Colby, and Patricia Delgado

  Publication Date: 5-6-2024

  Peripheral intravenous catheter (PIVC) insertion is an essential inpatient nursing skill, although it is infrequently practiced during nursing school. Difficulty with PIVC access leads to worse patient outcomes including delayed care, increased pain due to increased access attempts, and more frequent use of central venous access which can lead to increased morbidity and mortality (Amick et al., 2022). Our nursing staff on 6S GYN/MED expressed the desire for additional education and opportunities surrounding PIVC insertion, so we looked to the literature. A study by Keleekai et al. (2016) used a blended learning strategy of simulation-based learning and self-paced online education which showed significant improvements in nurse knowledge, confidence, and skills in PIVC insertion.

  We also wanted to find a self-paced learning experience that was an alternative to hours of online modules or classroom instruction. Micro-learning is up-and-coming in the field of electronic learning that has a positive effect on the knowledge and confidence of health professionals using small volume tutorials, pictures, and short video clips (Zarshenas et al., 2022). We decided to utilize both micro-learning and the use of a hands-on venipuncture practice arm to educate and instill confidence in our clinical nurses surrounding PIVC insertion.

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  Early Ambulation Post-Surgery on a Medical Surgical Unit

  Sara McKerley, Rachel Gonzalez, and Kayla Bally

  Publication Date: 5-6-2024

  Early ambulation post-surgery is considered crucial for post-operative care and has several benefits for patient outcomes. Early ambulation helps to promote blood circulation, reducing the risk of deep vein thrombosis and pulmonary embolisms from forming. Patients staying in bed for a prolonged period may decrease lung function, increasing the risk of pneumonia. Patients staying in bed for prolonged periods of time may also cause constipation and ileus caused by immobility, ambulating patients helps to accelerate the digestive system, keeping patients on track for discharge.

  Early ambulation, within the first 24 hour post surgical time, is directly correlated shorter hospital stays and early recovery to help the patient return to pre-surgical baseline of ADLs. During the study of Kanejima, Yuji, et al, 2020, they found that the distance walked during the six-minute walking test improved by 52% at the time of discharge with the start of early ambulation with their coronary artery bypass graft patients. Early ambulation aids the return of gastrointestinal function. Often a patient must have a bowel movement prior to discharge, which could lengthen the patient’s hospital stay. Ni, Chunyan, et al, 2018, discovered patient who underwent liver resection and performed early ambulation had quicker return of gastrointestinal function.

  Hospital re-admission rates are also affected if ambulation is not encouraged after discharge. Robinson, Thomas N., et al, 2022, followed patients who had returned home after elective surgeries. These patients wore an accelerometer activity tracker to measure steps for the first consecutive 28 days post surgery. They found if patients had a decrease in their steps for two consecutive days had a 90% specificity for hospital re-admission. Early ambulation is not only important to return bowel function, baseline function, and shorten hospital stays, but to also decrease hospital re-admission rates.

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  Bi-Specific T-Cell Engager (BiTE) Therapy in the Medical Observation Unit (MOU)

  Laura McWhirter and Stacey Hegerberg

  Publication Date: 5-6-2024

  MOU is a medical observation unit. On a given day the nurses on this floor take care of general medical patients needing to be observed longer or needing more labs, imaging or procedures completed prior to the physician deciding whether to discharge the patient home or transferring the patient up to an inpatient room. A year ago, MOU was called to help out this specialized oncology population as they’re care requires 24 to 48 hours monitoring after receiving an immunotherapy called Bi-specific T-Cell Engager (BiTE) therapy. BiTE therapy helps attack cancer cells within the body by uses the body’s own immune response to initiate the T-cells to attack the cancer cell prompting more T-cells to initiate the same response on the cancer cells. The FDA has approved seven different therapeutics, under the BiTE therapy umbrella (Pancholi, 2023). These therapeutics are typically the patient’s last line of treatment after receiving 3-4 differing oncology therapies such as chemotherapy, radiation and other immunotherapies.

  There are side effects to monitor for, when a patient has received BiTE therapy. Some of the main risk factors are Cytokine Release Syndrome (CRS), neurotoxicity and infection. All of which can happen within hours to a few days after the therapy has been administered to the patient. Patient’s must receive the medication, administered subcutaneous or intravenously, at a certified REMs facility. Once the medication is administered the patient must be observed for 24-48 hours depended on which medication was chosen for the patient. CRS and neurotoxicity can be treated with steroids, IV fluids and a reversal agent called Tocilizumab. Without the patient coming to a controlled environment like the hospital for observation post treatment CRS, neurotoxicity and infection could spiral quickly causing permanent neurological issues to death. Making it vital to observe these patients in MOU.

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  From Data to Benchmark Distinction –Empirical Data Utilization in the PICU

  Tammy Muczinski, Beth Kring, Christine Batchelder, and Paras Khandhar

  Publication Date: 5-6-2024

  Virtual Pediatric Systems [VPS ] is the largest international pediatric intensive care database & largest international collaborative for care improvement. There are over 1.7 million cases in VPS for comparative analysis.

  VPS is more than just a data source. It’s a beacon of trust in the healthcare community. By assisting members of the VPS community to improve practice and operations using high-quality clinical data, it has earned its reputation as a trusted clinical and operational data source. With robust quality control and data management systems, VPS ensures exceptional data integrity, making it a powerful tool for clinicians, leaders, researchers, and accreditation bodies.

  Corewell Health Children’s Hospital, Royal Oak [CHE] PICU began entering data into VPS in August 2015. This project aims to utilize comparative analytics to drive process and quality improvements for the CHCH Pediatric Intensive Care Unit [PICU].

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  Crash Cart Education and Code Blue Lesson Plan

  Tanya Najim, Melissa Clement, and Abby Lampron

  Publication Date: 5-6-2024

  • Medical Surgical nurses lack of experience in code situations.
  • Multiple new nurses hired on 7NE Corewell East Royal Oak that lack experience in code blue and crash cart knowledge.
  • Education to increasing proficiency in crash cart, code supplies and code situation is required to facilitate better nurse confidence and patient outcome in critical situations.

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  Encouraging our NICU to "Read-A-Latte"

  Lauren Noble and Lisa Thousand

  Publication Date: 5-6-2024

  Who doesn't love curling up with a good book on a rainy day? Well, babies are no different! Reading a book to an infant is not only soothing to both parties, but also beneficial for brain growth and development. Studies have shown that infants begin hearing around 18 weeks in utero, and an infant can hear at the same level as an adult as they near full-term (36 weeks). Pediatric research has found that speech and language development can start as early as birth and reading to an infant daily can expose them to roughly 80,000 words in a year's time! Beginning early exposure to reading is an important habit to establish a strong foundation for language and encourage an early love of reading.

  Preterm infants in the Neonatal Intensive Care Unit (NICU) have been identified as having decreased language exposure compared to their full-term counterparts. Reading books to these babies helps support language advancement and encourages parental involvement in both their baby's daily care and their overall development.

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  Baby, Can You Hear Me? Improving the Timeframe of Hearing Screen Results Sent to the State of Michigan

  Nicole Norris and Audrey Kalasky

  Publication Date: 5-6-2024

  Hearing loss can have profound effects on an infant’s development. The state of Michigan's Early Hearing Detection and Intervention Program aims to produce better outcomes for children with hearing loss by identifying infants at risk and early intervention. A hearing screen is completed on all newborn infants as close to discharge as possible and results sent to the state. The hearing screen results were not being received by the state within the recommended timeframe of 7 days after performing the test in the Neonatal Intensive Care Unit (NICU). The director of Neonatology was receiving numerous notifications of missing hearing screen results. The aim of this quality improvement project was to review the process for sending the hearing screens to the state and implement changes to meet the 7-day timeframe.

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  Vascular Access Board Certification (VA-BC): A Magnet Recognized Certification and Evidence-Based Practice Model in Vascular Access

  Laura Palmieri and Margaret Ceresnie

  Publication Date: 5-6-2024

  In healthcare, having a board certification holds value that the professional possesses the appropriate qualifications to perform competently in their certified skill set and has obtained a specialized knowledge in the specific area studied. Vascular Access Board Certification (VA-BC) is a growing certification recognition for nurses and multiple healthcare professionals placing vascular access devices such as ultrasound guided intravenous catheters (USGIVs), peripherally inserted central catheters (PICCs), MST midline catheter devices and other central line placements. The Vascular Access Certification Corporation (VACC) administers the VA-BC exam which is the only nationally accredited exam that is multidisciplinary. The VA-BC is accredited by the National Commission of Certifying Agencies (NCCA), and is recognized by the American Nurses Credentialing Center (ANCC) for the Magnet Recognition Program.

  Board-certified nurses are invested in their practice and profession, thus creating informal leaders (Schumacher, 2018). They are expert resources and nurses with whom providers seek out to collaborate in providing the best care for their patients. With the knowledge gained through this certification, it continues to pave the way for delivering evidence-based practice vascular access care.

  The purpose of this preliminary prospective study is to highlight the value of being VA-BC and how this certification can help improve patient outcomes.

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  Incentive Spirometry vs. Blowing Bubbles in Pediatric Patients

  Dylan Perry

  Publication Date: 5-6-2024

  On a pediatric unit, does nurse education regarding incentive spirometry/blowing bubbles increase patient compliance.

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  Improving Relational Quality Between Nurses and Nurse Assistants

  Matthew Piotrowski, Sara Yu, Danielle Saleh, and Heather Gutpell

  Publication Date: 5-6-2024

  • The teamwork between the registered nurse (RN) and the nurse assistant (NA) is essential in healthcare delivery.
  • Successful teamwork promotes clear role identification and job expectations. When these components are unclear, patient safety outcomes and role satisfaction can be negatively impacted.
  • Individual perceptions of RN-NA teamwork may negatively impact the environment of care.
  • Breakdown of care can contribute to missed nursing care such as ambulating, turning, hygiene, feeding, and intake and output (I&O) documentation.
  • One way to promote successful teamwork is to assess the relational quality between the members of the team. Relational quality is defined by the effectiveness of exchanges between the leader (RN) and the team members (NA). Additionally, a main factor in RN-NA teamwork and collaboration is relationship building.
  • The literature identifies that patient report is one way to build relational quality, improve teamwork, increase communication and decrease missed nursing care.
  • Promoting RN to NA report creates the opportunity to clarify roles, responsibilities, and expectations of the shift. Receiving report empowers the NA to feel like a valued member of the healthcare team.
  • Report also contributes to a shared model of teamwork and supports team-based problem solving, compared to the disjointed perception when each role receives report individually.

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  Implementing AirTap in the MICU

  Scott Pugh, Cynthia Porritt-Rodriguez, and Lizzie Smagala

  Publication Date: 5-6-2024

  Intensive care unit patients are at risk for pressure injuries due to a variety of factors like friction and shear, increased moisture, and immobility. About 60,000 patients die as a direct result of a pressure injury each year. The cost to treat pressure injuries can range from $20,900 - $151,700 depending on the stage of the injury. The average length of hospital stay is nearly 3x longer with a pressure ulcer.

  Nurses play an important role in preventing pressure injuries in their patients. The MICU has a protocol and turn team for patients with Braden scores less than 18. Despite the team's best efforts with turning their patients every 2 hours, the MICU saw an increase in pressure injuries from January-July of 2023. Unit leadership decided to trial the Prevalon AirTap System, a system that can address the ease of turn, friction and shear, moisture, and immobility that includes:

  1. Prevalon Air Pump Technology (ease in boost/less friction/shear)

  2. Glide Sheet with grips / log roll handles (ease in boost/turn)

  3. Two Turning Wedges (sacrum offloading)

  4. Microclimate body pad (reduce moisture

  The aims of this product trial and implementation were to:

  1. Ensure sacrum offloading

  2. Increase ease and compliance with the unit’s turning protocol

  3. Reduce hip to hip pressure injuries

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  Newborn Screening Quality Improvement Project in the Neonatal Intensive Care Unit

  Jamie Richey and Audrey Kalasky

  Publication Date: 5-6-2024

  Newborn screens in the state of Michigan test for 59 different disorders. Timely diagnosis of these disorders provides the medical team and families with resources to treat or support these disorders and improves mortality and morbidity with early detection and intervention. After reviewing quarterly reports of Newborn Screening Quality Assurance provided to management by the state of Michigan, demonstrated the need for improvement in the process of obtaining newborn screens on site and ensuring the timely delivery of screens to the State. Quarterly reports provide data regarding late screens, receipt by appropriate day, unsatisfactory screen, NBS card number, returned Biotrust for health consent forms and NBS cards with incorrect demographic data are sent to every hospital in the state. This project focused on decreasing percentages of unsatisfactory screens and increasing receipt by appropriate day by providing nurses with proper procedure of obtaining appropriate blood samples and importance of timely submission to allow for courier pickup.

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  Care Transitions from Hospital to Home: A Novel Approach

  Mary Royse, Ester Joyce Szmyd, and Robert Lingerfelt

  Publication Date: 5-6-2024

  The goal of health systems is to improve the quality and value of care that is provided. One approach to achieve this is to impact the transition of care process, which begins before the day of discharge and continues after the patient has returned home. This process can be further complicated by gaps of care, patient confusion, lack of resources and poor communication with discharge instructions, all of which contribute to patient readmission or emergency room visits within 30 days of discharge. Due to its many complicated discharges, the 9 North Acute Care of the Elderly (ACE) unit was chosen to participate in a postdischarge care transitions call pilot. The purpose was to increase the response rate to the discharge survey phone call, intended to ensure the patient has made a follow-up appointment with their provider, gotten prescriptions filled and to answer any discharge questions the patient may have, with the end goal to prevent re-admissions to the hospital.

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  The Benefits of Promoting Safe, Early Progressive Mobility

  Mary Royse and Damian Tomasik

  Publication Date: 5-6-2024

  Hospitalization for an acute illness, although necessary, has inherent risks, including primarily a decline in functional status. This functional decline, commonly caused from staying in the hospital bed for prolonged periods of time, potentiates the risk for complications such as thromboembolism, muscle weakness, joint contractures, urinary incontinence, skin breakdown and a higher risk for falls. When functional status declines, the patient has a change in their ability to perform activities of daily living (ADLs), which in turn directly affects a safe discharge plan. Patients who were independent in their ADLs prior to admission, but no longer are, may now require discharge to a skilled nursing facility. The benefits for mobilizing patients early during hospitalization are numerous and include reductions in length of stay, delirium, pressure injuries, functional decline and most importantly fall prevention. To reduce patient falls, 9 North Medical participated in an early mobility project

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  Importance of Communication Boards for Patients with Communication Barriers

  Sarah Schoder and Kenny Brown

  Publication Date: 5-6-2024

  The 7 Center Acuity Adaptable unit cares for a wide diversity of patients. Many of these patients come in with some type of communication barrier, speech apraxia, stroke, dementia, traumatic brain injuries, deafness, selective muteness, learning delays or disabilities, intellectual disabilities, ALS, disabilities related to surgery, tracheostomy tubes, and many patients that speak another language. These patients may have communication difficulties. In the medical setting, it is especially important for healthcare professionals to meet both patients and their family’s needs. All patients have the right to communicate and participate in their treatment and express their immediate needs and preferences.

  Communication barriers can lead to increased pain for patients, misdiagnoses, drug treatment errors, and increase length of stay in the hospital, and even death. Proper means of communication will allow for safe and effective care for the patient. Kuyler and Johnson (2021), showed that the use of a communication board for patients in a critical care setting is an effective tool for communication. However, Kuyler and Johnson (2021) later stated that vocabulary or images on the communication board may need to be altered to the patient due to patients cultural and dialogue backgrounds. As health care professionals we can apply this into practice to help eliminate communication barriers many patients face; to allow the health care team to provide safe and effective care.

  Communication boards can help eliminate these barriers. Patients and healthcare workers can choose which type of communication board meets the patient’s needs. These boards increase patients' autonomy and help them communicate with healthcare professionals in an easy and effective way. Communication boards are one type of augmentative or alternative communication devices. Boards are inexpensive and easy to access. They may be discarded or sent home with patients to help patients communicate with the world outside the medical setting. This quality improvement project evaluated the effectiveness of communication boards in improving communication with patients with communication barriers.

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  Movement is Medicine: Implementing a Mobility Pilot on a Medical Unit

  Sumer Tuayma, Haley Szumlinski, and Annette Curtis

  Publication Date: 5-6-2024

  According to multiple studies, hospitalized patients are either inactive or in bed for 87–100 percent of the day. Prolonged immobilization can lead to functional decline and loss of muscle strength. Additionally, it can increase the risk for certain hospital-related complications such as falls and pressure injuries. In turn, this can lead to increased length of stay and patients requiring additional resources when discharged such as the need for sub-acute rehab placement or an extended care facility instead of returning home. A systematic review by Pashikanti, Lavanya MSN, et al., found that a standardized early mobilization protocol can significantly improve the functional status of hospitalized older adults and reduce the length of stay for patients with community acquired pneumonia (CAP) and patients who underwent lower-limb amputations. A study by Jones, Renata A. DNP, et al. found that after implementing mobility protocols, nurse-led patient mobilizations increased by 40 percent.

  A mobility pilot, led by three staff nurses was initiated on 8 Center, a 41-bed medical unit. They found that utilizing mobility protocols, gaining both staff and patient buy-in, conducting audits and reminding staff to get patients up for all meals improved mobility scores and decreased LOS, allowing more patients to return home. A nurse driven activity protocol was posted in the rooms for each patient with individualized goals based on their 6 Clicks score. We looked at the unit admission 6 Clicks score and compared it to the discharge 6 Clicks score to determine if our pilot made a difference.

  This quality improvement project evaluated the effectiveness of a nurse driven activity protocol compared to continued bedrest in effort to increase discharge mobility 6 Click scores, decreasing the need for extended care facilities and decrease length of stay (LOS).

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  Code Role Assignments

  Grace Vandersloot and Nisa Dillingham

  Publication Date: 5-6-2024

  We chose this project to create a calmer and more organized environment in the event of a code on our unit. There have been several codes recently, and we questioned if assigning roles at the beginning of each shift would help our unit be more prepared. Currently, no roles are specifically assigned at the beginning of the shift. Knowing expectations in advance will improve communication, teamwork, and patient outcomes.

  After reviewing multiple articles, we discovered that pre-assigning code roles are an effective way to improve teamwork in the event a patient goes into cardiac arrest. In one study, they used a quasiexperimental design to measure teamwork by utilizing a pre and post-test. The results showed that having clear distinguished roles during a code improved communication as well as boosted staff confidence in initiating those actions. Another article we researched initiated preassigned code roles but also held mock codes to practice these roles. With the use of mock codes in this study, it allowed team members to be familiar with their role, be confident in navigating the crash cart, and various equipment that is needed. Overall, these articles have given enough evidence to support that pre-assigning code roles would improve the organization of a code and patient outcomes.

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  Improving the Patient Experience Through Turns, Toileting, & Teamwork

  Maya Vulaj, Jacob Moores, Karen Kazyak, Kristina Ellis, and Lindsay Zagata

  Publication Date: 5-6-2024

  Falls and hospital-acquired pressure injuries represent a significant hinderance to the delivery of safe, quality patient care. These complications are associated with increased morbidity and length of stay, and also represent a significant financial burden. Efforts aimed at reducing their incidence are thus a key means through which nurses can improve patient outcomes and the overall patient experience. Through their work toward this shared goal, nursing teams have the potential to positively impact performance in addition to patient outcomes and quality of care by fostering teamwork and a positive work environment (Marquet & Ogaz, 2019).

  7NE had experienced a recent increase in falls and was in the process of redesigning their hourly rounding. When looking at the literature, the idea of scheduled toileting was discovered. The management, educator and staff collaborated to determine criteria for inclusion and the development of the rounding tool (Figure1).

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  Increasing Palliative Care Referrals in Heart Failure Patients

  Danielle Weinberger, Kathleen Bajorek, Samantha Start, and David Godell

  Publication Date: 5-6-2024

  • Heart failure is a highly prevalent disease that is associated with many negative health outcomes such as frequent hospitalizations, impaired quality of life, early mortality, and economic burden.

  6.2 million people in the United States are diagnosed with heart failure.

  $30.7 billion is estimated to contribute to healthcare costs for heart failure patients including medications, healthcare services, and missed work.

  • Palliative care is appropriate at any age or stage of incurable illness; it seeks to improve quality of life for patients and families through symptom-burden relief.
  • For heart failure patients, palliative care can address dyspnea, fatigue, and pain.
  • Literature supports that implementation of a screening tool standardizes identification of adults who may benefit from palliative care.
  • The aim of this evidence-based practice project was to implement a screening process for palliative care in the heart failure population to increase palliative care referrals.