A Continuum of Quality and Safety

Purpose:
In order to support a culture of quality and safety for all shifts in the hospital, the role of the nursing administrative coordinator /quality and safety specialist was created. The goal was to provide a continuum of patient centered quality/safety and process improvement strategies at all times.

Significance:
Value based purchasing is changing the care delivery model. Our organizational strategy driven by our health system blueprint for quality aligns with this model. Increasing focus on value to our patients in the context of quality, efficiency, safety and cost extends to all shifts and all patients.

Strategy and Implementation:
Three distinct groups exist within nursing administration. Bed managers, patient care coordinators and quality and safety specialists. Communication was not coordinated and they operated in silos impacting there ability to provide real time support to staff nurses. The decision was made to merge the groups together into the role of Nursing Administrative Coordinator/Quality and Safety Specialist. All members were crossed trained with a specifically designed curriculum. The coverage model changed to integrate both day/night/weekend staff. Coverage consists of two dayshift coordinators, three night shift and two weekend coordinators changing from a single staff model. Information about the newly created role was disseminated throughout nursing and non-nursing areas. Each day the team divides the house and focuses on administrative priorities as well as quality and safety priorities in forums such as care planning rounds, staff huddles and individual staff solicitation.

Evaluation:
Assessment of impact is being evaluated. A major initiative carried out by the team was a reduction in 1:1 observation hours. The team is a resource to evaluate the need for observation, offer alternative interventions and track use. A measurable decrease of 25% sustained for 3 months has occurred.

Implications for Practice:
The team has shown capacity to impact practice. Future areas that will be evaluated are patient transfers from ICU to the floor to prevent bounce back, lead roles in rapid response and code calls and lead roles in process improvement initiatives centered on patient outcomes and 30 day readmissions.