From B17 Bomber to Bedside: Using a Bundle Methodology to Enhance Quality

Purpose:
The burgeoning quality milieu challenges nurse leaders and healthcare organizations to deliver care that is safer and more effective. Our strategy better capitalizes on the use of a unit based staff specialist and systematically engages staff nurses in quality processes which optimize outcomes.

Significance:
Facing the dismal economic outlook, units underperforming to benchmark, and seemingly endless regulatory expectations (CMS-never events) it was clear that a major reconstruction of the current processes and roles would allow for optimization of quality outcomes at the unit level.

Strategy and Implementation:
A conference presentation spurned the administrator to evolve the unit based staff specialist from one focused primarily on staff orientation to one focused on the enhancement of critical thinking and quality improvement. Working collaboratively with the Director of Nursing Quality and Practice they developed a template based on a broad 'brainstorming' session to include content that was the most pertinent, critical and appropriate for a checklist. The current ‘Quality Bundle Tool©' consists of 134 items which address a wide array of topics. Each day a patient and nurse are selected on the unit. This review of medical record documentation focuses on enhancing critical thinking of staff, providing real time educational interventions and cooperatively developing enhanced plans of care. The goal is to rotate these reviews throughout the nursing staff and shifts to create a platform for addressing priorities of care, quality issues and compliance with processes.

Evaluation:
The ‘Quality Bundle Tool©' and process have been utilized since February 2009 - resulting in approximately 20 audits monthly per unit. Within in this division of units, falls decreased by 9% and medication errors were decreased by 28, while other divisions saw little or no change in the indicators.

Implications for Practice:
Despite challenging and complex health care environments, our approach has allowed clinical leaders to become unit-based ‘Chief Quality Officers' and engage staff in quality competencies. The bedside nurses on the medical surgical units have can improve and sustain a best practice culture.