As I write this blog, the Delta variant continues to spread -- exponentially. COVID-19 has served us disruption on a platter, affecting both performance improvement and outcome measures.
There is no doubt that COVID-19 has changed how we look at innovation and outcomes. Despite the overwhelming negative impacts of COVID-19, we’ve seen nurses become nimble, empowered innovators performing small tests of change to improve patient care processes, comfort or satisfaction: essentially outcomes. Even though many units remain on edge in a constant state of vigilance and readiness for the current or next surge of patients to come through their doors, we need to continue to collect data and analyze the impacts and outcomes of the changes we have made.
Impact
Nurses want to make sure they provide the best possible care for patients and families. The response to the first patients diagnosed with COVID-19 created an all-hands-on-deck approach to determine how to provide care safely and effectively while trying to understand how to mitigate the effects of the virus. Nurses led the way, innovating care delivery practices not used before, such as using extension tubing to keep IV pumps out of the room and more accessible.
During this pandemic, we’ve witnessed implementation of AACN’s Healthy Work Environment Standards with collaborative partners across your facility, to help achieve optimal outcomes. Nurses continue to prepare for and maintain safe and effective care for patients in the face of constantly changing recommendations and challenges with resource allocation, all while keeping themselves safe.
For example, you might have experienced:
- A quantifiable increase in HAIs and device utilization
- Surveillance and monitoring changes to understand and address the needs of patients with COVID-19
- Units converting to COVID-19 units and shifts in the typical patient population
- Patient acuity remaining high with lengthy hospital stays and continued high census
- A pause or decrease in elective care
- Changes in typical staffing and unit structures as a result of peers contracting COVID-19 and the need to bring in non-ICU nurses from other areas of the facility or even as travelers
- Requiring additional studies to clarify a differential diagnosis between COVID-19 and C. Diff
- Increase in multidrug-resistant organism (MDRO) infections in the unit or facility
In addition, CMS declared a number of waivers and paused the typical reporting requirements. And The Joint Commission paused its on-site visits. In some cases, CMS has announced they will freeze data for Hospital Compare until January 2022. This decision means the typical methods deployed on your unit to evaluate performance have likely been disrupted or even abandoned in favor of a focus on the immediate outcomes related to COVID-19. You have probably experienced a shift in patient populations as the cases of COVID-19 wax and wane, which creates challenges for monitoring outcomes consistently and effectively. This situation will continue to evolve as we move through the pandemic, and we will likely see changes to the outcomes measured and the definitions of indicators. Connecting with the healthcare quality team in your hospital can ensure alignment with collecting and evaluating outcomes against internal and external benchmarks during these uncertain times.
Innovation
You probably continue to face moments where you experience success as a disruptive innovator and feel the need to defend against a disruptive challenger. COVID-19 has created a space for nurses to drive innovation and make changes in a more nimble fashion. Who better than those on the front lines to think outside the box and implement emerging practices with small tests of change. With the ongoing changes in our understanding of the virus, nurses and other hospital staff have continued to propel improvements forward to ensure they provide the best care they can to patients and families. Some hospitals may have seen the following and many other effects:
- Decrease in MDRO infections due to improved infection prevention measures
- Supply chain disruptions
- Increased utilization of telehealth
As we continue to stay the course through this pandemic, nurses have the need and the opportunity to continue to drive innovation and positively impact patient outcomes. Many more studies and best practices will emerge as we continue researching and analyzing the data. As we move forward, consider what you can do to be a part of the evolution.
What changes do you hope to keep that were identified in your unit or facility? What positive changes do you want to see next?
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