CSI Summary
Available only to registered AACN.org users.
Project Topic:
Developed a nursing handoff tool to improve quality metrics for central line-associated bloodstream infections (CLABSI) and hospital-acquired pressure injuries (HAPI) by fostering better communication and collaboration among nursing staff
Hospital, City and State:
Providence Swedish Medical Center, Seattle, Washington
Unit:
Medical and Surgical Intensive Care Unit (ICU)
CSI Participants:
- Lynn Arsenault, BSN, RN
- Kirianne Green, BSN, RN, CCRN
- Nolan Miller, BSN, RN
- Lillian Payne, BSN, RN
- Cherry Rheinheimer, BSN, RN, CCRN
Project Goals/Objectives:
- Increase AACN Healthy Work Environment Assessment Tool (HWEAT) True Collaboration score from 3.25 to 3.45
- Increase HWEAT Skilled Communication score from 3.5 to 3.7
- 90% nurses implement the Kraken tool
- Decrease CLABSI standardized utilization ratio (SUR) to < or="">
- Decrease HAPI rates 50%
Project Outcomes:
- Increased HWEAT True Collaboration score from 3.25 to 3.59
- Increased HWEAT Skilled Communication score from 3.5 to 3.73
- All HWEAT standards scores increased
- 80% of nurses implemented the Kraken tool
- CLABSI SUR increased for MICU (1.273) and SICU (1.135)
- HAPI rates increased 35%
Project Overview:
The AACN Healthy Work Environment Assessment Tool (HWEAT) was distributed in early 2024. True collaboration and Skilled Communication were two areas identified that could be improved upon in order to reduce our CLABSI and HAPI rates and improve the overall health of our work environment.
Our team created the Kraken handoff tool to use as a reference during handoff and multidisciplinary rounds (MDR). It was every nurse’s responsibility to ensure the Kraken handoff tool was up to date. The Kraken handoff tool focused on elements from our quality indicator bundles that our unit was consistently missing e.g. CHG bath/linen change completed, protective heel boots on patients with a Braden < 18,="">
Our project was successful despite our postclinical CLABSI and HAPI numbers not reflecting this success. There are multiple systemic factors that contributed to the increase in our HAPIs and CLABSIs numbers. One example was that we found nurses lacked knowledge on how to report a HAPI which led to our baseline HAPIs being erroneously low. Though our CLABSIs increased during our project timeframe, we had a 38% reduction in our CLABSIs overall from 2023 to 2024. Our successes included massive improvements in our nursing practice. Root cause analysis (RCA) of our CLABSIs and HAPIs before our project showed there were gaps in our nursing practice. Post-project the RCAs showed there were no gaps in nursing practice, a significant improvement from our baseline data.
We repeated the HWEAT towards the end of our project. Our results showed a marked improvement in our aggregate HWEAT score and an improvement in all 6 HWEAT standards. The across-the-board increases of our HWEAT scores are a confirmation of what others have reported and what we have felt: Our project has improved our unit's nursing practice, the health of our work environment, and our nurses' own beliefs - that they can effect change.
Permission to Reuse Materials
The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.
Disclaimer
The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.