So Fresh and So CLEAN: Improving Handoff Through Collaboration

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:

Improving nurse satisfaction regarding handoff, meeting standards of care.

Hospital, City and State:

Oregon Health and Science University, Portland Oregon

Unit:

8C Trauma/Surgical Intensive Care Unit

CSI Participants:

  • Annie Bridges, BSN, RN, CCRN
  • Corinna Hockman, BSN, RN
  • Sara Hussein, BSN, RN, CCRN
  • James Ranstead, BSN, RN, CCRN

Project Goals/Objectives:

  1. Improve Healthy Work Environment Assessment Tool (HWEAT) scores in True Collaboration and Skilled Communication 60%
  2. 25% decrease in nurse turnover
  3. 25% decrease in incremental overtime
  4. 25% decrease in central line associated blood stream infections (CLABSI)

Project Outcomes:

  1. HWEAT scores:
    • Aggregate score improved from 3.7 to 4.17
    • Skilled Communication score improved from 3.29 to 3.75
    • True Collaboration score improved from 3.14 to 3.69
    • All 6 standards increased
  2. Turnover was unchanged (8 RNs preclinical and 8 RNs postclinical)
  3. Incremental overtime improved from 75hr to 33hr per pay period (56% improvement)
  4. CLABSI improved from 6 to 1 (83% improvement)
  5. Potential annualized fiscal impact is $522,496

Project Overview:

The goal of our project was to increase nurse satisfaction through improvement in hand-off communication. When we surveyed our staff, we found that 75% of bedside RNs reported organized and clean patients and rooms as a top three priority when starting their shift. Additionally, both our nurse turnover and CLABSI rates exceeded the Magnet standard, and our incremental overtime averaged 75 hours per pay period.

For us, a big challenge was shifting our nebulous hopes of improving our unit culture to a tangible, actionable project.

When we first heard about this project, we were all so excited to learn strategies and skills to magically fix bullying or feedback. It was truthfully tough to shift our mindset to a more fiscally minded, tangible idea. However, once we started drilling down into what actually created a negative culture, including our own unit survey, it became a lot easier to identify a specific tipping point to intervene on.

We created an acronym, CLEAN, to streamline report and ensure standards of care were being met.

C: Cares (EVD, collar, urinary catheter, dressing changes)
L: Lines (labelled, dated, traced to patient, adequate volume)
E: Empty (counter, extra supplies, trash and linen if over 1/2 full)
A: Admit prep (empty room set up for admission)
N: Non-negotiables (time-sensitive meds and imaging)

Our swag was helpful in getting nurses on board that would otherwise be resistant to change. We audited use of the tool at 3 months, did 1:1 education with staff, and instituted new swag, e.g. mousepads with acronym.

Our outcomes showed no change in nurse turnover (8 preclinical and 8 postclinical, noting that 2 RNs left for CRNA school, and 2 moved out of state). We did exceed our goal for decreasing incremental overtime and decreasing CLABSI. For sustainability, we will continue to incorporate the tool as a standard of care in new hire and travel nurse orientation.

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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.