Paula L. Graham, RN, MS, CNS, nurse researcher, and nurses at Phelps Memorial Hospital Center in Sleepy Hollow, N.Y., have been busy putting research into practice at the facility. Motivated by improving patient care and outcomes, RNs have initiated evidence-based practice projects and have presented them at international, national and local conferences.
Editors Note: For more information about the research projects, contact Paula Graham at: [email protected] For a photo gallery of Nursing Spectrums visit, go to www.Nurse.com/gallery/Phelps.
Shared GovernanceFrom left, Lucy Engelhardt, RN, chief nursing officer; Meredith Frattellone, RN; and Barbara Vetoulis, RN; discuss Partners in Care: Rounding.
A Shared Governance Council on the 5 South telemetry unit called Pride in Practice focuses on Passion, Respect, Integrity, Dedication, Excellence, and formed a Clinical Practice and Education Council and a Management Council. After initiating the Shared Governance Council, the staff started hourly patient rounding, which resulted in improvement in the areas of patient satisfaction, patient safety, pain management and compliance with hand washing, which were validated with follow-up reassessments.
Fall PreventionFrom left, Anita Watson, RN, and Carol Daley, RN, presented the EBP project: Does daily bathing with chlorohexadene reduce hospital-acquired infections in intensive care patients?
To improve several outcomes: fall reduction, patient satisfaction, skin pressure reduction and pain assessment, staff on 5 North used Partners in Care: Rounding. After analyzing the data and discovering that a majority of falls occurred after 11 p.m., with most occurring between 4 and 6 a.m., on night shift, a second med-surg tech on the night shift was added, leaving one tech free to round between 1 and 7 a.m. After a significant reduction in falls, 5 North was selected to pilot a 3 to 11 p.m. rounding position. A committee for change implemented the 4Ps rounding, and over time, rounding was extended to the day shift, which completed the 24-hour rounding initiative. A new rounding form has been developed that included all three shifts and the 4 Ps. The experience on 5 North will serve as a model for other clinical units.
Reducing InfectionFrom left, Kathleen Scherf, RN; Lori Presby, RN; and Martha Maresco, RN, talk with Eileen Williamson, RN, about Prevention of Deep Vein Thrombosis in the Perioperative Patient.
Anita Watson, RN, and Carol Daley, RN, presented the EBP project: Does daily bathing with chlorohexadene reduce hospital-acquired infections in intensive care patients? As part of a study led by Westchester Medical Center, Watson and Daley and staff implemented daily bathing of ICU patients with chlorohexadene-impregnated cloths. Data has been collected since April 2008 and will continue through the end of 2010. Currently, EBP results include reduced central line-associated blood stream infections in the ICU, increased patient and staff satisfaction, and reduced waste. This study will be presented this spring at the Society for Healthcare Epidemiology of America.
DVT PreventionPictured from left are Paula Graham, RN; Roselle Lutewak, RN; and Melissa Geraldez, RN.
Kathleen Scherf, RN; Lori Presby, RN; and Martha Maresco, RN, presented the Prevention of Deep Vein Thrombosis in the Perioperative Patient. After analyzing the literature and looking at current practices at Phelps, RNs recommended the hospital use a standardized risk-assessment tool that will make DVT assessment more efficient and include the recommended protocols for prophylaxis categorized according to the patients level of risk on the assessment tool.
DVT ProphylaxisFrom left, standing are Anita Watson, RN; Margaret Cotter Santos, RN; Pam Lovis, RN; Martha Maresco, RN. Seated from left are Nancy Turrone, RN; Carol Daley, RN, CCRN; and Paula Graham.
Roselle Lutewak, RN, Page graduate students and maternal child staff have validated through research that early mobilization for low-risk patients undergoing Cesarean section is the preferred and cost-effective means for DVT prophylaxis. In their study, Deep Vein Thrombosis Prevention in Women Undergoing Cesarean Section, they identified the need for valid and reliable risk assessment tools to ensure quality prevention. Pace graduate students on the project were Edna Glassman-Lackow, RN; Eleanora Melster, RN; Jean Palucci, RN; and Jessica Sulit, RN, with Lillie Shortridge-Baggett, RN, Pace University faculty. Lutewak plans to present the EBP project for approval to the OB/GYN department.
Margaret Cotter Santos, RN, and Carol Daley, RN, presented the EBP project, Early Mobility in Mechanically Ventilated Patients, and discussed the nursing interventions and the three stages of mobility described in the study, which include such activities as active and passive range of motion, dangling, out of bed to a chair, increase in limb and trunk strength and using a walker. The nurses also identified the goals of early mobilization, staff requirements and criteria to withhold mobility interventions.
In addition, other nurses at Phelps Memorial Hospital Center are engaged in a number of research projects. Some of those EBP projects include:
Quantitative Results of Consistent Characteristics Found in Presurgical Assessment of Patients at High Risk for Obstructive Sleep Apnea by Ellen Parise, RN, and Nancy Turrone, RN
The Quantitative and Qualitative Results of a Rapid Response Team in a Community Hospital by Cheryl Burke, RN; Wanda Moore, RN; Carolynn Young, RN; Nancy Fox, RN; and Paula Graham, RN
Maternal Child Health Patient Safety Initiative by Rosemarie Rocchio, RN, and Barbara Bruno, RN
An Evidence-Based Communication Tool for Partners in Wound Care by Diane OBrien, RN, and Crystal Valencia, RN,
Prevention of Pressure Ulcers in the Surgical Patient by Lori Presby, RN
Phelps Memorial Hospital: Re-engineering Care Patient Throughput by Lucy Englehardt, RN, Pamela Louis, RN: and Paula L. Graham, RN
Pain and Sedation Scale Study, by Martha Maresco, RN