NOW “Lead” this: SAFE CARE

Purpose:
NDNQI falls, restraints and CLBSI results alarmed leadership. Our goal was to improve outcomes by redesigning culture, create real time PI at the frontline, empower leaders and staff to stop the line, and include patients/families to achieve SAFE CARE for every patient every day.

Significance:
Confronted with the majority of unit fall rates at the 75th percentile NDNQI, rising restraint utilzation, CLBSI's skyrocking and a staff perception that these were not events but routine and a return of zero for nursing sensitive financial incentives, we had a crisis in nursing care.

Strategy and Implementation:
CNO with frontline nurses implemented a program: SAFE CARE. This transformed care across 18 units in 8 weeks. •Safety First: bedside system fall tool kit,restraint real time tracer tools •Awareness: fall “event'” notifications all leaders 24/7 •Focus: PI Leaders round daily empower staff to execute solutions, reinforcing stop the line team dynamics •Expectations: Charge RN led post fall and event debriefings •Communication: 24/7 shift huddles focus on results, NDNQI data, and care stories •Accountability: leader roles modified to empower resolution of issues daily using just culture tools and a narcotic witness program. Real time perforamnce feedback daily •Recognition: innovation reward program ie: staff led “silly band” contests engaging team, Best at the Bedside bonus plan utilizing nursing outcomes and NDNQI targets to reward staff for achieving goals •Excellence: “safety coach” program for frontline with CNO to instill passion for safety at the frontline

Evaluation:
Outcomes: • 80% reduction falls with injuries and a >50% improvement in units NDNQI mean •45% improvement hand hygiene • 71% reduction CLBSI rate •84% reduction staff narcotic diversions •NDNQI RN satisfaction 10 of 10 domains improved overall •Reduced restraint utilization 30%

Implications for Practice:
Comprehensive revised fall assessment tools, data reports used to communicate high risk patients, documentation double checks, and PI interventions led to practice modification as care plans and patient teaching dramatically improved achieving outcomes due to transparent feedback real time.