Exemplary Professional Practice in Nursing at Inova
Inova Alexandria Hospital (IAH)
In 2017, a spike in Hospital Acquired Infections (HAIs) indicated drift from best practice, accentuating the need to address processes. Our novice workforce (70% of direct care nurses with two years experience or less) had little intentional education on preventing harm and were relying on novice preceptors. Nursing Essentials, a long-standing traditional day of learning for new nurses, included only 30 minutes on preventing harm and was evaluated for Need to Know and Nice to Know. We convened a multiprofessional team who expanded Nursing Essentials to two days with four hours of education specific to HAIs, comprised of didactic and simulation experiences. Additionally, preceptors were required to attend. Refocusing education on preventing harm and providing skill assessments increased knowledge and improved quality metrics related to infections. This approach also highlighted the influence of nursing care on outcomes. To further integrate these concepts, the annual skills fair also focused on preventing harm. Annual Skills Fair was aligned with Preventing Harm to validate all nurses knowledge and skills of the evidence-based practices associated with infection prevention. Strategies behind restructuring created consistent application of best practices across care environments, supports premise of promoting a healing environment with positive patient outcomes.
Inova Fairfax Medical Campus (IFMC)
Utilizing the Inova Professional Practice Model, IFMC Nurses are achieving high quality patient care outcomes. Reductions in falls, hospital acquired pressure injuries, Central Line Associated Blood Stream Infections (CLABSIs) and CatheterAssociated Urinary Tract Infections (CAUTIs) illustrate the nurses’ focus on exemplary clinical outcomes as the results of clinical practices grounded in evidence. Another example of an improved clinical outcome in 2017 is the significant reduction in time to electrocardiography (EKG) at the Reston ED. IFMC Nurses are also working to improve their practice environment while improving safety; a recent project in our Cardiovascular Intensive Care Unit (CVICU) focused on reduction of alarm fatigue through implementation of evidence-based critical alarm parameters. This resulted in a 30% reduction in the number of alarms per bed per day; equating to 40,000 less alarms per month.
Inova Fair Oaks Hospital (IFOH)
Utilizing the Inova Professional Practice Model, patients at IFOH continue to see exceptional patient outcomes. All nurse sensitive indicators consistently outperform benchmarks from other Magnet® facilities. The reduction or elimination of falls with injuries, hospital acquired pressure injuries, catheter associated urinary tract infection and catheter associated blood stream infections reflects the commitment of the IFOH nurse to patient safety and implementing practices that are evidenced-based. Several units have gone greater than one year without any hospital acquired infection or pressure injuries. Nurses at all levels of the organization contribute to outstanding patient experience scores which outperform benchmark scores in domains that are influenced by nursing.
Inova Loudoun Hospital (ILH)
With the Inova Professional Practice model guiding our care, the majority of units at ILH consistently outperformed the Magnet® mean benchmarks in the nursing sensitive indicators of falls with injury, Catheter Associated Urinary Tract Infections (CAUTI), Central Line Associated Blood Stream Infections (CLABSI) and Hospital Acquired Pressure Injuries (HAPI). Despite these excellent results, nursing units continue to focus on zero harm. In the 2017 National Database of Nursing Quality Indicators (NDNQI®) Nursing Satisfaction survey, 14 of our 19 nursing units exceeded the Magnet® mean benchmark in the nine major domains, which include adequate staffing, manager/leadership, foundations for quality of care, hospital affairs participation, autonomy, RN to RN interaction, professional development opportunities and access, and interprofessional relationships.
Inova Mount Vernon Hospital (IMVH)
In 2017, IMVH nursing has met or exceeded targets on quality indicators – including CLABSI, CAUTI, Clostridium difficile (C. diff), and patient falls. Falls rate went from 2.59 in 2016 to 1.70 in 2017 which was the best in the Inova Health System. The two Med-Surg Units had a combined total of nine patient falls.