In 2020, the medical intensive care unit (MICU) at South Texas Veterans Health Care System in San Antonio received the DAISY Award for Extraordinary Nurses in Patient Safety.
It’s a great honor the MICU team earned by instituting initiatives that have nearly eliminated central-line associated bloodstream infections, catheter-associated urinary tract infections, pneumonia, ventilator-associated events, and falls. This is no small feat. And it took teamwork to get it done.
Empowering the MICU Team
The DAISY Foundation’s signature program recognizes nurses and clinical teams throughout the year for extraordinary, compassionate care. The coveted award places emphasis on efforts to improve workforce and patient safety.
The South Texas Veterans Health Care System’s MICU team of 27 RNs and five nursing assistants was initially recognized for its compassionate care of a veteran patient over more than two years. During their time with the patient, the MICU increased situational awareness, or their ability to perceive and comprehend a patient’s status and project the course of action, from 62% to 98%. The result is safer patient care and better staff communication, according to a DAISY press release.
“Following high-reliability principles, the team began conducting twice-daily huddles, enlisting hand hygiene ‘sheriffs,’ and using evidence-based care bundles for infection prevention,” according to the release.
Staff engagement led to the high-quality care delivered on the MICU, said Michael Pomager, MBA, RN, CEN, chief nurse, critical care — as did empowering nurses to drive nursing practice. “This culture has resulted in favorable performance metrics, positive patient experiences, and high staff morale.”
The MICU team’s success in nearly eliminating hospital-acquired infections and falls can be attributed to many factors, including having a strong commitment to serving America’s veterans. They also created a culture with a foundation in shared governance and leadership support, according to Celida Martinez-Vargas, DNP, RN, who was nurse manager MICU/CCU/DARRT [Dedicated Acute Rapid Response Team] from September 2016 to August 2020.
But, above all, it has been important to ensure each team member is engaged in every process in the unit, Martinez-Vargas said.
“For the past two years the team has put in place many systems to prevent hospital-acquired infection and have created a culture that is preoccupied with failure,” she said.
That preoccupation pushed to implement measures such as:
- Implementing safety huddles
- Multidisciplinary rapid rounds
- Catheter-associated urinary tract infection bundles
- Central-line associated bloodstream infection bundles
- Ventilator-associated event bundles
- Hand hygiene sheriff
“Having these systems in place has made us exceptionally consistent in accomplishing our goals in avoiding potentially catastrophic errors and/or events,” said Martinez-Vargas.
Increasing Situational Awareness
The MICU improved situational awareness through enhanced communication initiatives learned from their Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) and HRO training, according to Martinez-Vargas.
“The initiative developed and implemented was the charge nurse-driven safety huddles. These huddles occur twice a day before the change of each shift and take approximately 10 minutes,” she said.
Team members share information during the huddle about the census, staffing for the day, and each patient’s acuity, providing an opportunity for team members to bring up concerns, needs, or what they appreciate related to safety, methods and practice, equipment, supplies, and staffing, Martinez-Vargas said.
There have been many lessons learned that can help other nurses improve patient care and safety, but it all comes down to the heart of nursing, according to Martinez-Vargas. Nurses should continually investigate their hearts to remind themselves about why they are nurses, their mission, and doing the right thing even when no one is watching.
Every huddle and meeting start with reviewing the system’s mission and vison.
“This helps to bring us back to center,” Martinez-Vargas said. “One of the lessons that we have learned is to celebrate the short-term goals we have reached, or as my grandfather would tell me, ‘…you need to stop and smell the tortillas!’ It is important to celebrate your short-term goals so that this will continue to give you the momentum needed to reach those long-term goals.”
Achieving Success Isn’t the End of the Journey
Nursing practice continues to change and evolve, said Pomager, and the unit is successful part because of the team’s “willingness to continuously reassess their processes to incorporate current evidenced-based practices and/or credible clinical guidelines,” he said. “This was especially apparent when the team modified their injury and infection prevention strategies for the critically ill COVID-19 patients.”
The MICU team has learned many things since receiving the DAISY recognition and the arrival of the COVID-19 pandemic, Martinez-Vargas said. The MICU’s processes have been tested and the team has learned that it is imperative that all critical care units are standardized in all processes, or bundles, related to preventing hospital-acquired injuries, she said.
“We must stay committed to ensuring that education is provided to everyone. During the pandemic, a [hospital-acquired injury] bundle book was created, and this has been instrumental in ensuring we are all on the same page,” Martinez-Vargas said.
Jose D. Martinez, BSN, RN, CCRN, a nurse in the MICU/CCU/DARRT at STVHCS, said the initiatives have had a multifaceted impact on the MICU.
“The promotion of continuous education definitely allows me to not only be a more competent nurse but also to instill a high standard for our practice and outcomes,” Martinez said. “We are able to see the results through diligent work, and this in turn provides our team with a sense of cohesion and camaraderie. In a naturally stressful environment, knowing that our teammates are looking out for each other definitely helps to reduce that stress. I believe this absolutely affects our patients in a positive way, as can be seen by our great results.”
Take these courses related to infection prevention:
Cutting Out CLABSIs: Preventing Central Line-Associated Bloodstream Infections
(1 contact hr)
Central line-associated bloodstream infections (CLABSIs) affect an estimated 400,000 patients each year in the United States. Nurses can play a significant role in reducing these troubling facts. Adhering to a group of evidence-based interventions known as the central line bundle has been proven to reduce the incidence of CLABSIs in healthcare settings. Components of the central line bundle focus on the proper insertion and maintenance of central lines to reduce infection rates.
MRSA: More Work to be Done
(1 contact hr)
Methicillin resistant Staphylococcus aureus is an important pathogen in healthcare facilities and the community and is asymptomatically carried by people who are healthy, have chronic diseases, are hospitalized, or are in long-term care facilities. It also can cause serious infections, including bloodstream infections, pneumonia, wound infections, skin and soft tissue infections, urinary tract infections, and meningitis. All healthcare team members must play an active role in adopting, modeling, and encouraging practices to prevent the spread of MRSA in healthcare facilities. These include consistently performing hand hygiene, using contact precautions for patients with MRSA, and ensuring appropriately disinfected equipment.This module discusses hospital and community acquired MRSA infections, the history of MRSA, transmission, treatment, and prevention methods.
Hand Hygiene and Skin Antisepsis
(.5 contact hr)
Whether at the surgical site or on the hands of the healthcare provider, human skin is inherently laden with resident and transient flora. This course addresses ways to reduce pathogens on the skin of caregivers and surgical patients to reduce the risk of infections. It provides historical context and explains proper glove use and skin antisepsis, surgical scrubs, and pre-op cleansing. The course also discusses types of antiseptic solutions and considerations for their use.