A Staff Led Performance Improvement Initiative Utilizing NDNQI RN Survey Results

Purpose:
RN satisfaction with "enough help to lift and move patients" decreased on the 2009 NDNQI RN survey. The goal of this strategy was to promote a staff led solution to the problem of inadequate support for lifting and moving patients and to increase RN satisfaction with help.

Significance:
Lack of adequate resources to lift and move patients can lead to patient tissue injuries from inadequate repositioning and friction and sheer. More than 52% of nurses suffer chronic back pain and many nursing injuries are related to handling and moving of patients. (ANA Agenda, 2008-2009).

Strategy and Implementation:
The Unit Practice Council members collaborated with the CNS to develop a PDSA framework for their performance improvement project. A focus group of RN staff was conducted by the Unit Practice Chair. A fishbone diagram was used to categorize the cause and effect. The plan was to improve RN satisfaction with help lifting and moving patients within 90 days. Three interventions were identified to achieve this goal: 1) Distribution of staff ASCOM phone list to each staff member at the beginning of each shift to facilitate ease of contacting a peer for assistance 2) Collaboration with Physical Therapy Staff to re-educate RNs and ACTs on use of Hoyer lift. 3) Designation of lift support personnel through shift to shift assignment of a UAP to patients with mobility impairments.

Evaluation:
Nursing satisfaction with help to lift and move patients improved to 92.3% by the end of 90 days. Nurses reported the phone list improved their access to lift support (81%, felt competent to use the Hoyer lift (42%), and they always had a UAP assigned to the heavy to lift/move patients (85%).

Implications for Practice:
Many patients have limited mobility. Provision of adequate support to lift and move patients can decrease RN back injuries and patient tissue injuries from friction, sheer, and lack of repositioning.