PAWS for Feedback: Creating a Culture of Safety One Patient at a Time

Oregon Health and Science University, Portland, Oregon

Nov 20, 2024

CSI Summary

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CSI Presentation

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CSI Toolkit

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Project Topic:

Increase skilled communication through effective feedback

Hospital, City and State:

Doernbecher Children’s Hospital, Portland, Oregon

Unit:

Pediatric Intensive Care Unit

CSI Participants:

  • Nichole McCaffrey, RN, CCRN
  • Brookelynn Moore, MSc, RN, CCRN
  • Holly Norsworthy, RN, CRNI
  • Taylor Wright, BSN, RN

Project Goals/Objectives:

  1. Increase Healthy Work Environment Assessment tool (HWEAT) communication score from 2.77 to 3.32 (20%)
  2. 90% adherence to safety checks
  3. Decrease PICU RN turnover 20%
  4. Decrease traveler usage 5%

Project Outcomes:

  1. Increased HWEAT communication score from 2.77 to 3.04
  2. All 6 HWEAT standard scores increased
  3. Adherence to safety check audits decreased from 57% to 31%
  4. Decreased PICU RN turnover 87.5% from 16 total RNs between March 2023 and September 2023 to 2 RNS between March 2024 and September 2024
  5. Decreased traveler usage by 6.4% from 15.4 of total PICU staff in November 2023 to 9% of total PICU staff in November 2024
  6. Potential fiscal impact $1,628,704 (doesn’t include decreased use of travelers). Team noted other factors, e.g. new RN contract were also responsible for this change in turnover and fiscal impact.

Project Overview:

The PICU had a decline in the overall health of its work environment trending from 2016, 2020, and 2024. We also had the highest rates of turnover in the hospital system, an increasing skills gap and widespread preceptor fatigue. To retain staff and grow our nurses, we strived to create a culture of safety through improved communication.

We aimed to increase frequency of effective feedback by providing training to nurse champions and distributed a feedback tool to utilize during safety checks at handoff and/or during all aspects of patient care. We offered prizes to incentivize and normalize giving and receiving feedback throughout the project and compared staff’s perception of feedback at the beginning and end of the project.

We were successful in improving our HWEAT scores and turnover rates. However, there have been other factors contributing to the health of our work environment including a new nursing contract, leadership changes and organizational restructuring. In the end, we learned that our problem was too large, and our specific intervention was not easily measured and did not have the full impact intended. Our project was successful in terms of contributing to decreasing turnover; however, we see this as a long-term commitment to impacting communication on specific patient outcomes.

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.