Year of Publication

2021

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Mandi Walker

Committee Member

Dr. Melanie Hardin-Pierce

Abstract

Abstract

Background: In November 2019, the University of Louisville Hospital merged and assumed operations of all KentuckyOne facilities. During the transition, a spike in hospital acquired infection rates ensued at Jewish Hospital, notably amongst the critical care units. In January 2020, a daily checklist was introduced to the critical care department. A Daily Checklist is a tailored communication tool designed to reduce communication error and improve adherence to patient safety measures. There continues to be a gap in adherence to the U of L daily checklist from both nurses and providers. Purpose: The purpose of this project was to improve multidisciplinary adherence to a daily review of a quality and safety checklist to ultimately reduce the incidence of hospital-acquired infections. Methods: This was a quality improvement project that included a retrospective review and prospective cohort design. The project was conducted on a 10-bed neurological and a 10-bed surgical-transplant critical care unit in a Level II Urban Hospital. The NICU/SICU departments’ nursing handoff document was modified to incorporate the U of L approved daily checklist which has been endorsed by the Agency of Health Care Research and Society of Critical Care Medicine. This tailored, reusable document (Daily Goals Document) was used for nurse-to-nurse handoff and multidisciplinary rounds. The project incorporated two Plan, Do, Study, Act (PDSA) cycles. The first cycle consisted of brief point of care training sessions for both nursing staff and providers, and the Daily Goals Document was modified to meet unit needs. The second PDSA cycle monitored multidisciplinary adherence to quality review during daily rounds. Descriptive and Inferential Data was collected for both study samples for PDSA Cycle 1 and 2. Results: There was a significant reduction of adherence to checklist review following the first PDSA cycle (NICU p p p.05), and a marginal reduction of Infection-related Ventilator Associated Conditions in the Neuro ICU. All pairwise comparisons are significant except Audit Form 2 versus the Daily Goals Document Audit (p < .001) for both foley and central line rationale documentation. Conclusion: Despite nurse acceptance of the Daily Goals Document, there was a reduction in verbal checklist adherence during multidisciplinary rounds and there was a marginal reduction in hospital-acquired infection rates. The Daily Goals Document is comparable to the Quality Audit Form as a tool for monitoring infection control data. Keywords: Daily Checklist, Quality Improvement, Multidisciplinary, Quality and Safety, Hospital-acquired infections

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