Nursing Sensitive Outcomes Teams: Driving Home the Link Between Shared Governance, Process Reliability & Patient Safety

Purpose:
Nurses may be unaware of Nursing Sensitive outcomes and may not have the skills in PI methods needed to drive changes in structure and processes that lead to improvements. Our goal was to increase our nurse's knowledge of Nursing Outcomes, promote highly reliable processes, and teach PI methods.

Significance:
Nursing outcomes are the result of implementation of evidenced based care standards that are reliably practiced by the nurses. A framework for analyzing compliance with processes and equipping unit practice councils with PI skills can promote buy in for practice change and improve patient outcomes.

Strategy and Implementation:
Our innovation was the implementation of nursing sensitive outcomes teams on two intensive care units in a children's hospital. The teams were responsible for knowledge of guidelines and standards for each outcome and for auditing processes to generate reliable compliance data. The teams then collaborated with their peers at unit practice councils to prioritize PI initiatives and share accountablity for nursing outcomes. In the summer of 2009, we impelmented Nursing sensitive outcomes teams. All nurses attended a 2 hour inservice provided by the CNS and a staff champion. We foucsed on the impact of nursing care on patient safety and nursing outcomes. We reviewed infection control guidelines and best practices related to each outcome, developed a process audit, and trained each nruse on data collection. we provided instruction on the basics of performance improvement methodolgy using the IHI model for improvement. Process data and core cards were used to drive shared governance.

Evaluation:
The work of the outcomes teams resulted in improvements in process compliance in IV site checks, pain re-assessment and education, VAP reduction and pressure ulcer prevention. Additionally the nurses are able to speak to the key nursing outcomes and 4 nurses have had posters accepted by NDNQI.

Implications for Practice:
Sharing governance and accountablity for nursing sensitive oucomes teams using the team framework has three primary implications for a healthcare system: high process reliability, improved patient safety, and professional development of the bedside nurse.