Patient Focus: NICU Quality Improvement

Keelie Gallagher, Robin Harrington, Hailey Pettis, Victoria Towers, and Taylor Weidner
4.26.2017

1
Overview of Patient Care Delivery System

Banner University Medical Center-Tucson

Neonatal Intensive Care Unit (NICU)

Patient Focus: related to physiological effects of

a noisy environment

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Microsystem Model:
Leadership

Democratic leadership: a focus on we

The leaders of the microsystem promote the
purpose, goals and expectations of the group.

Banners Values
o People above all
o Excellence
o Results

Institute for Healthcare Improvement. (2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Marquis, B.L., & Huston, C.J. (2015d). Leadership roles and management functions in nursing theory and application
(8th ed., pp. 40). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins. 3
Microsystem Model:
Organizational Culture and Support
The larger organization looks for ways to
support the work of the microsystem and
coordinate the hand-offs between microsystems
Banner NICU
oSupporting one another
oRNs very welcoming to new grads and
students
o Instances of gossip

Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Marquis, B.L., & Huston, C.J. (2015d). Leadership roles and management functions in nursing theory and application
(8th ed., pp. 452-456). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
4
 Microsystem Model:
Patient Focus & Staff Focus
Patient focus
oNICUs must use family-centered developmentally
supportive care
oDevelopmental care specialists
oInvolvement of parents
Staff focus
o Beyond clinical skills, a new graduate nurse must
be socialized into the context of nursing practice.
o Thorough orientation process
o Training needs to be more useful
Altimier, L., Kenner, C., & Damus, K. (2015). The Wee Care neuroprotective NICU program (Wee Care): The effect of a comprehensive developmental care training program on seven neuroprotective
core measures for family-centered developmental care of premature neonates. Newborn and Infant Nursing Reviews, 15(1), 6-16. doi: 10.1053/j.nainr.2015.01.006

5
Crimlisk, J. T., Grande, M. M., Krisciunas, G. P., Costello, K. V., Fernandes, E. G., Griffin, M. (2017). Nurse residency program designed for a large cohort of new graduate nurses: Implementation
and outcomes. MEDSURG Nursing, 26(2), 83-104. Retrieved from http://ezproxy.library.arizona.edu/login?url=http://search.ebscohost.com/login.aspx?
direct=true&db=rzh&AN=122315808&site=ehost-live
Microsystem Model:
Interdependence of Care Team

Team-based models of primary health-care

teams delivery have been created to achieve
several benefits to the health system, health
care providers, and patients

Banners Strengths
o Communication
o Addressing concerns

Institute for Healthcare Improvement. (2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Marquis, B.L., & Huston, C.J. (2015d). Leadership roles and management functions in nursing theory and application
(8th ed., pp. 321). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins 6
Microsystem Model:
Use of Information and Healthcare Technology

Technology has revolutionized nursing and

healthcare
oIntegration of information with patients
oIntegration of information with providers and
staff
oIntegration of information with technology
Technology on unit: EPIC charting, barcoding
medications, Micromedex, phones
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from
http://www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Marquis, B.L., & Huston, C.J. (2015d). Leadership roles and management functions in nursing theory and application
(8th ed., pp. 452-456). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
7
 Microsystem Model:
Process for Healthcare Delivery Improvement

Benchmarking is the process of measuring

products, practices, and services against best-
performing organizations
Banner UMC Tucson NICU
o Benchmarking
o Unit Improvement Projects (CLABSI)
o Process Audits
o Annual staff evals with clinical lead and unit
manager, empowerment
Marquis, B.L., & Huston, C.J. (2015). Leadership roles and management functions in nursing theory and application (8th
ed., pp. 547). Philadelphia, PA: Wolters Kluwer health/Lippincott Williams & Wilkins.
8
 Microsystem Model:
Staff Performance Patterns
Ability to do the job and Banner UMC Tucson NICU
access to professional o Chart audits/outcome audits
development
opportunities o On-unit education
Resources in the o Safe staffing (ratios,
workplace, such as experience, etc.)
equipment and
procedures o Peer review and eval
Clarity about the o Safe practice unit guidelines
requirements of the role
Expectations of
and policies
behavior, both formal o RN turnover rate
and informal

Shaw, A., & Blewett, V. (2013). Good Practice Guide for Performance Management for Nurses and Midwives in
Victorian Public Health Services. Retrieved from
http://www.health.vic.gov.au/__data/assets/pdf_file/0005/764321/Final-guide_April-2013.pdf
9
 Specific Aspect Targeted for Improvement

Noise in NICU has a negative effect on the

neonates

Banner NICU can have very loud rooms due to:

oCrying infants
oLoud phone ringtones
oPersonal conversations between nurses
oFamilies of infants chatting

Laubach, V., Wilhelm, P., & Carter, K. (2014). Shhh Im growing: Noise in the NICU. Nursing Clinics of
North America, 49(3), 329-344. doi: 10.1016/j.cnur.2014.05.007
10
 Specific Aspect Targeted for Improvement
(cont.)
Studies have shown
oPhysical and behavioral effects that affect
development
oLong-term neurosensory and physiologic
outcomes
oAgitation and increase morbidity

Goal: Reduce damage to infants due to noise

oReduction in noise will improve patient
outcomes and reduce morbidity
Laubach, V., Wilhelm, P., & Carter, K. (2014). Shhh Im growing: Noise in the NICU. Nursing Clinics of
North America, 49(3), 329-344. doi: 10.1016/j.cnur.2014.05.007 11
 Leading the Plan for Healthcare Delivery
Improvement

NAS rates increasing

Literature: NAS withdraw includes loud, high
pitched cries
Literature: Noise adversely affects the
physiological stability of intensive care neonates
Timeline

Morale Education Implementation Evaluation

1-2 mo 3-4 mo 5-8 mo 9-11 mo
Hassanein, S. M. A., El Raggal, N. M., & Shalaby, A. A. (2013). Neonatal nursery noise: Practice-based learning and improvement. The Journal of Maternal-Fetal & Neonatal Medicine, 26(4), 392-395.
Jansson, L. M., & Velez, M. (2012). Neonatal abstinence syndrome. Current Opinion in Pediatrics, 24(2), 252-258.

Tolia, V. N., Patrick, S. W., Bennett, M. M., Murthy, K., Sousa, J., Smith, P. B., et al. (2015). Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs. The New England Journal of Medicine, 372(22), 2118-2126.

Western Australian Centre for Evidence Based Nursing & Midwifery. (2013).
management of the infant with neonatal abstinence Syndrome (nas) literature Review Retrieved April 25, 2017, from http://speciosum.curtin.edu.au/local/docs/nas/NAS_LitReview_V2.pdf
12
 References

Altimier, L., Kenner, C., & Damus, K. (2015). The Wee Care neuroprotective NICU program (Wee Care): The
effect of a comprehensive developmental care training program on seven neuroprotective core measures for
family-centered developmental care of premature neonates. Newborn and Infant Nursing Reviews, 15(1), 6-16.
doi: 10.1053/j.nainr.2015.01.006
Crimlisk, J. T., Grande, M. M., Krisciunas, G. P., Costello, K. V., Fernandes, E. G., Griffin, M. (2017). Nurse
residency program designed for a large cohort of new graduate nurses: Implementation and outcomes.
MEDSURG Nursing, 26(2), 83-104. Retrieved from http://ezproxy.library.arizona.edu/login?url=http://
search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=122315808&site=ehost-live
Hassanein, S. M. A., El Raggal, N. M., & Shalaby, A. A. (2013). Neonatal nursery noise: Practice-based learning
and improvement. The Journal of Maternal-Fetal & Neonatal Medicine, 26(4), 392-395.
Institute for Healthcare Improvement.(2015). Clinical microsystem assessment tool. Retrieved from http://
www.ihi.org/resources/pages/tools/clinicalmicrosystemassessmenttool.aspx
Jansson, L. M., & Velez, M. (2012). Neonatal abstinence syndrome. Current Opinion in Pediatrics, 24(2), 252-258.
Laubach, V., Wilhelm, P., & Carter, K. (2014). Shhh Im growing: Noise in the NICU. Nursing Clinics of North
America, 49(3), 329-344. doi: 10.1016/j.cnur.2014.05.007
Marquis, B.L., & Huston, C.J. (2015d). Leadership roles and management functions in nursing theory and
application (8th ed., pp. 452-456). Philadelphia, PA: Wolters Kluwer health/ Lippincott Williams & Wilkins.
Shaw, A., & Blewett, V. (2013). Good Practice Guide for Performance Management for Nurses and Midwives in
Victorian Public Health Services. Retrieved from http://www.health.vic.gov.au/__
data/assets/pdf_file/0005/764321/Final-guide_April-2013.pdf
Tolia, V. N., Patrick, S. W., Bennett, M. M., Murthy, K., Sousa, J., Smith, P. B., et al. (2015). Increasing incidence
of the neonatal abstinence syndrome in U.S. neonatal ICUs. The New England Journal of Medicine, 372(22),
2118-2126
Western Australian Centre for Evidence Based Nursing & Midwifery. (2013). Management of the infant with
neonatal abstinence Syndrome (nas) literature Review. Retrieved April 25, 2017, from
http://speciosum.curtin.edu.au/local/docs/nas/NAS_LitReview_V2.pdf

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