Safety First, Baby First!

Project Topic:

Revamping the Rounding Safety Checklist

Hospital, City and State:

University of Washington Medical Center, Seattle, Washington

Unit:

Neonatal ICU (NICU)

CSI Participants:

• Raisa Galbizo, MSN, RN, CNL, RNC-NIC
• Christina Joseph, BSN, RN, RNC-NIC

Project Goals/Objectives:

1. 100% use of the rounding safety checklist
2. Improve Healthy Work Environment Assessment Tool (HWEAT) True Collaboration score to 3.0 or above
3. Improve HWEAT Skilled Communication scores to at or above 3.0 Increase nurse retention 1%

Project Outcomes:

1. A 65% use of the rounding safety checklist
2. Increased HWEAT True Collaboration score to 3.72
3. Increased HWEAT Skilled Communication score to 3.99
4. All HWEAT standard scores increased
5. Increased nurse retention 1.07%
6. These findings resulted in a positive estimated annual fiscal impact of $96,514

Project Overview:

Between 2021-2023 the NICU had a high turnover rate resulting in staff burnout. The provider-generated safety checklist from January 2020 was no longer consistently used. Nursing staff were surveyed using the Healthy Work Environment Assessment Tool (HWEAT), which showed a low aggregate score and low scores in the standards of True Collaboration and Skilled Communication. Through a secondary feedback survey, the CSI team identified concerns about the inconsistency of morning rounds and lack of interdisciplinary communication. Comments suggested the use of checklists to provide more structure. The CSI team decided to revise the unused safety checklist and re-implement its use.

With input from key stakeholders, the checklist was revised to be more comprehensive and relevant to all patients in the NICU. It was printed, laminated, and secured to all roving computers. All staff were educated on the purpose of the checklist. Medical providers were expected to refer to the checklist when concluding their presentation on each patient.

The project was evaluated by assessing compliance with checklist use during morning rounds. In February 2025, nursing staff was re-surveyed using the HWEAT to evaluate the effect of the checklist on aggregate and individual standard scores. By February 2025 the checklist was being used 65% of the time. The HWEAT aggregate score improved from 3.14 to 4.14. We saw remarkable increases in all standards with notable increases in the standards of Skilled Communication from 2.97 to 3.99 and True Collaboration from 2.30 to 3.72. Nursing retention also improved by 1.07%.