Vol. 10 Issue 19
Medical-telemetry unit decreases hospital-acquired pressure ulcers and increases staff morale
In May, the nursing management team for the medical-telemetry unit at Gwinnett Medical Center, Lawrenceville, GA, met to discuss how to prevent pressure ulcers and patient falls. Previous educational efforts (e.g., staff meetings, inservices, etc.) had not made the desired impact among nursing staff. Based on a literature search, the team decided to implement daily safety huddles, in which all nursing staff meet for a few minutes at the start of a shift. Since their implementation that month, staff isolation has decreased and pressure ulcer incidence has decreased dramatically.
Safety huddles have been endorsed by the Leapfrog Group, the Institute for Healthcare Improvement and the Robert Wood Johnson Foundation. In a safety huddle, all nursing staff gather at the nursing station for a 5-7 minute meeting to facilitate communication about how to prevent falls and skin breakdown, and resolve customer service issues. At 8 a.m., a group page is sent to remind staff to gather promptly at 8:30 a.m. Staff members bring report sheets to the huddle and are congratulated for arriving on time.
All staff must be present for the huddle to begin, as this is important for team building. The charge nurse is the "cheerleader" of the group, and actively boosts morale and sets the tone for the entire shift. The charge nurse begins the huddle with a welcome to staff and particularly newcomers (e.g., float pool staff).
The charge nurse uses a list of topics to be discussed (see Hot Topics).
The list was derived from what is monitored and considered important to patient care. As the charge nurse reviews the list, staff members chime in regarding their patients, confirming or clarifying information the charge nurse may have received during the change-of-shift report. The huddle provides a check and balance for patient safety, as the charge nurse may become aware of new information. After identifying assignments with heavy (total care) patients, staff is encouraged to offer assistance to that nurse/nurse tech. This information also proves valuable in making assignments for the next shift.
Clinical manager Paula Thornburg, RN, reported staff supported the huddle idea based upon their experience in previous healthcare and other fields (e.g., restaurant work). Over time, nursing teamwork has become fragmented, Thornburg said; for example, in nurse-to-nurse report.
Dayshift supervisor Barbie Kozlowski, RN, said safety huddles have promoted awareness of what is going on unit-wide and who is working on their shift. Staff isolation has decreased, and the invigorated staff now functions as a team. Thornburg and Kozlowski said implementing the huddles has resulted in more team camaraderie and staff volunteering to help each other.
Patient results have been encouraging, as there were no hospital-acquired pressure ulcers for the month of May. The ultimate goal is to assemble without a page having to be sent. The safety huddle concept was rolled out to night shift in June. "I am enjoying [the safety huddles], they're getting everyone on the same page and impacting morale," Kozlowski concluded.
Because of the success of safety huddles on the medical-telemetry unit, all the med/surg units at the Lawrenceville campus now participate in daily safety huddles.
Sandy Dunbar is process improvement coordinator-med/surg services at Gwinnett Medical Center, Lawrenceville, GA.
- Patients at risk for falls (Morse Fall Scale score >55)
- Patients at risk for skin breakdown (Braden Scale score ²16)
- Patients who have pressure ulcers
- Any issues with patients/families
- DNR orders
- Patients on restraints
- Patients who cannot leave telemetry for tests
- Total care patients (heavy patients)
- Possible discharges
- Buddy nurse tech assignments