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Quality Improvement ProcessElizabeth RickardFerris State UniversityQuality Improvement ProcessQuality in nursing is of the utmost importance, because at the end of the day everything nurses do is for the better of the patient. I personally have not had a role in a quality improvement initiative, so I will be addressing a quality improvement project that Amanda Bourdon a nurse manager, has been involved in. Her project was so successful, that Spectrum Health adopted it hospital wide. This initiative is called “The No Pass Zone” which many other hospitals are doing as well. On the floor before initiation of the no pass zone, the call light response time was almost nine minutes. This has a huge impact on safety of the patient because shorter call light times are correlated with decrease falls and associated injuries (Tzeng, Titler, Ronis, & Yin, 2012, p. 1). Clinical NeedWhen taking a look at the aspect of safety it is seen that falls and injuries have resulted often times because a lack of timely call light answering (Tzeng et al., 2012). Before initiating the No Pass Zone it was observed that call light answering time averaged a nine long minutes. Patient use call lights for a variety of reasons some of which are urgent, sometimes not so urgent, and even sometimes by accident. According to Tzeng (2011) the reasons patients most often used the call light was to call for bathroom assistance, personal assistance, pain medication, intravenous pump problems, and to obtain information from the nurse. This clearly shows why call lights need to be answered in a timely fashion many patients will wait for so long and then take it upon themselves to use the restroom or to fulfill their own needs and put themselves in a risky situation. Current research supports prompt answering to reduce the risk to patients. This in turn can increase customer satisfaction, increase rate of reimbursement by governmental agency, help to retain certain statuses that the hospital is attempting to achieve, and decrease falls and injury.Interdisciplinary TeamAs many people as possible should be involved in the process as possible and from as many other disciplines as appropriate. Some of the people who should be involved in the review team are the day shift nurses, night shift nurses, charge nurse, case managers, nursing techs, and rehabilitation aids. Of course both day and night shift nurses should be a part of the team by being responsible for abiding by the change as well as coming up with goals and ways to help be able to answer call lights more quickly and holding others accountable when they don’t follow the no pass policy, as well as putting together a presentation for all staff about the new policy to be implemented. The charge nurses from day and night shift have the role of ensuring that everything is running smoothly so this will be a role of the charge nurse to facilitate critical thinking about whether or not the change is affective and that all for each shift the call light times are trending down. Case managers are in the unique position of being able to speak to patients about needs, so this will be their role to determine if the patient believes all their needs are being met while in the hospital. A nursing techs are responsible for working with nurses in coming up with the benefits to patients, staff, and organization of not passing call lights. The rehab aides are responsible for looking over presentation, and come up with questions that help to facilitate conversation, and thinking of ways to improve on their end. They will all work together and allow others to finish their thoughts or ideas politely with respect for one another’s opinions. Work to formulate and own the idea of the no pass zone.Data Collection and OutcomeThe data will be collected by recording the call light times before implementation and then after implementation. At the end of each shift an average will be determined and recorded by the charge nurse, it will be then compared after each week. A team meeting will happen at end of two weeks to discuss what is working and what is not working. Customer satisfaction surveys filled out by patients will be evaluated once a month before and after implementation, to see if it customer satisfaction has increased (Colancecco, Moriarty, & Litak, 2014). The outcome to be expected would be that 6 months after implementation of the no pass zone patients on two south will not wait longer than an average of three minutes for their call light to be answered by any member of the staff, as evidence by the decrease in recorded average time for call light response. Implementation Strategy In order to implement the no pass zone there will be two nurses selected on the day shift and two nurses from the night shift, one charge nurse from days and one charge nurse from nights, two case manager, four nurse techs, and three rehabilitation aides. There will be several meetings before the policy is implemented to discuss patient safety and what measures that can be affective to decrease call light response time. Each member the interdisciplinary team is going to be responsible for educating for about two minutes four individual members of staff once a week for a six month period (Colancecco, Moriarty, & Litak, 2014). The charge nurse will be responsible for talking with staff that are pulled to the floor, or other disciplines that are on the floor about the no pass policy, and reporting staff who are seen passing a call lights, and will be a target for the nurses out talking to staff to further education them. The interdisciplinary team will put together a five minute presentation with voice over for all staff (Colancecco et al., 2014). All staff will be required to view the presentation within two weeks before implementation. At the end of every week for the first 6 weeks the team will meet and the charge nurse will bring a record of the progress in call light times. The team will discuss what is working and what is not working, how often they see a staff member pass a call light, and a good strategy for a non-confrontational approach to talking with that staff member. The case manager will bring with her some information she has received from patients that she has spoken with about their satisfaction with call light response and their needs being met. The nurse manager will inform staff of customer satisfaction scores related to call light response, and the number of falls before and after implementation. If the call light response time is trending down after 6 weeks then the team will meet monthly. Every month the team will choose a member each discipline to be awarded for not passing call lights faithfully. The theory of navigating care (Yoder-Wise, 2015) is appropriate to consider when applying the no pass zone, because the success of this program will utilize the concept of forming relationships with other disciplines as well as with patients. In conjunction with no pass zone, nursing hourly rounds has already been in effect and is working to reduce call light usage on the floor. After six months the team will meet again and review the goal and all the supporting evidence and trends. The team will put together a presentation for staff to give them encouragement on their efforts towards the no pass zone. The team will then meet two more times every three months. At the end of the year the team will no longer meet, but are not relieved of their duties to educate new staff or staff that are not following policy. Even though this seems like a lot of time spent for the team members it is important to note that it is important that they have ample time to “work creatively and openly to find the solution that most fully satisfies all important concerns and goals to be achieved” (Yoder-Wise, 2015, p. 439). EvaluationThe progress towards the goal of reducing the call light response time is mainly evaluated by the record kept by the charge nurse of shift average trends, but also to review the other effects from other areas of care experienced by the patient. Nurse manager will also assess customer satisfaction surveys to observe improvement in the area of call lights, and record of falls on the floor throughout the time that the policy is being implementing. The case manager would have been asking patients that they have spoken directly with about call light satisfaction and their perception of their needs being met. The nurse role will be undertaking hourly rounds along with the no pass zone in order to reduce call light use, this will not be evaluated however nurse will see the benefits of hourly rounds with the reduction of call light use, be able to address any patient needs, and build a rapport with patients, which can have an effect on the satisfaction surveys. ConclusionWhen there has been a reduction in call light response time and call light usage there has been an increase in patient satisfaction and patient safety. The no pass zone policy is quite effective and planning for such a policy takes time. This is time well spent because though many nurses may not realize it but this can greatly impact an organization, nurses, and patients alike. This type of policy requires staff on the floor and off the floor to work together as an interdisciplinary team, while giving each of them a role in implementation, and clear goals that are attainable. In the end it comes down to doing what is right for the patient. ReferencesColancecco, E. M., Moriarty, S., & Litak, L. (2014). None Shall Pass...Without Answering the Call Bell [Entire issue]. Nursing, 44(1). , H. (2011, September/October). Perspectives of Patients and Families About the Nature of and Reasons for Call Light Use and Staff Call Light Response Time. MedSurg Nursing, 20, 225-234. Retrieved from , H., Titler, M. G., Ronis, D. L., & Yin, C. (2012). The Contribution of Staff Call Light Response Time to Fall and Injurious Fall Rates: An Exploratory Study in Four US Hospitals Using Archived Hospital Data [Entire issue]. BMC Health Services Research, 12(84). , P. S. (2015). Leading and Managing in Nursing (6th ed.). St. Louis, MO: Elsevier Mosby. ................
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