Evidence-Based Instinct

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The path to implementing a fresh idea in the healthcare realm can be a long one, but Lenore Henning, RN, wants nurses to know it’s worth the effort to share an idea that will enhance quality and safety in healthcare.

When she started nursing 38 years ago, doing what’s best for the patient wasn’t called evidence-based practice or patient-centered care, it was just the right thing to do.

“We talk about evidence-based practice these days; but back in the day, we didn’t go through any big trials,” she said. “We kind of said, this is what we have to do [that’s best for the patient] and it became the best practice.”

The Nursing Voice

When she worked on staff at Central DuPage Hospital in Winfield, IL, Henning found joining committees was a concrete way to contribute the knowledge she gleaned from the bedside.

She has worked on pneumonia protocols and fall prevention. Over the course of her clinical career, she implemented a patient admission checklist – “because nurses can’t rely on memory” – and developed a patient education folder that contained the myriad forms patients received, all now found in one place. (Today, she is a big fan of the electronic medical record.)

“If you have an idea that is a solution, it’s probably a problem for everyone,” she said. Henning’s most recent idea was to create a way to increase patient safety and satisfaction.

“Patients are the one constant in the whole equation,” she said. “Docs and nurses come and go, but the patient is always there. Over the years, I found the best way [of providing care]was to involve patients in their own care, and they ended up having better outcomes.”

Inspired Experience

When her father spent time in the hospital a few years ago, Henning recognized the need to keep call lights, nasal oxygen tubing, IV lines and any number of monitoring device cables off the hospital room floor and within the patient’s reach. She noticed the lines and tubing slid down the bed rail and often ended up on the floor where they became a fall risk, as well as an infection control issue.

Inspired by watching her father create a makeshift way to keep his IV lines and tubing in order and close at hand, Henning came up with a device that fits over a hospital bed rail, or on an IV pole, that keeps cords and tubing separated.

But the message she wants to spread is not about her product, per se, but about increasing patient and staff satisfaction and preventing injury and error.

“Patients can be harmed if their tubing is tugged on or bumped around, and they can trip over the lines,” Henning said. “If you can do something that demonstrates you are going to prevent harm, patients are happier.

“And for the nurses, all those lines are a tripping hazard. If you can improve staff vitality, for example, by not having them bend over to grab tubing from the floor, I think you have a happier work environment and people want to stick around.”

In addition, keeping track of lines and tubing helps make change-of-shift handoffs more efficient and safer. Henning proposes a tubing reconciliation policy be implemented at shift changes.

“When nurses change shift, organized lines and tubing can be more easily traced and the connections checked,” she said. “[Part of the policy I suggest] includes reminding patients never to reconnect a disconnected line themselves, but to call for help.”

The Big Picture

Henning only recently left the bedside herself and understands the time constraints on staff nurses, but encourages her colleagues to pursue their visions for safer patient care.

She developed her product concept with a “very small trial” in the ICU at Central DuPage to determine if patient and staff satisfaction would increase with the use of her “bedside entanglement avoidance tubing apparatus.”

Becoming a change agent also means looking outside your immediate environs to connect with like-minded professionals. Through the Coalition for Quality and Patient Safety of Chicagoland, Henning connected with Carrie Nelson, MD, who agreed to serve as the principle investigator on a slightly larger trial of her apparatus.

“Between hospitals and healthcare systems, there are learning collaboratives where your idea could fit a need that’s already there,” Henning said.

Barbara Mercer is senior associate editor at ADVANCE.

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