Optimizing interprofessional

relationship and motivation to

decrease MRSA related hospital
acquired infection rates

Daisy Aguilar, Gladys De Bolivar,

Emily Rich, Casee Scott
 Opening Mindful Moment
Let’s all take a moment to sit up and close our eyes. Breathe deeply and think of
something that brings you joy.
 Presentation Objectives

01 Objectives 02 Concept Map

MFI: Model For

03 Improvement 04 Conclusions
01
Objectives
● Introduction to hospital acquired MRSA
video
● Summary of Whitney's case study
● Definitions of related terms
● Background & significance
● Literature synthesis
● Making connection To Err is Human
● Concept Map, INPs, & CAS.
● Resolved Healthcare Issues
● Model for Improvement-PDSA
● Summary & discussion questions
● Pearls of wisdom
● Closing Mindful moment
Introduction to Hospital Acquired MRSA
 Summary of Whitney’s Case Study
● Whitney is admitted into the hospital for appendicitis.
● Her neighboring patient had MRSA & his caregiver was at his bedside.
● The caregiver of her neighboring patient, Kelly, left the room without disposing her
gloves, & contaminated the counter of the nurse’s station with MRSA.
● Denda (nurse behind counter) did not clean the contaminated space.
● Whitney’s nurse (A) touched the MRSA infected counter.
● Nurse A did not properly perform hand hygiene before entering Whitney's room or when
changing Whitney’s IV site.
● Doctor noticed signs of decline with Whitney & did not mention suspicions.
● Whitney contracted MRSA and as a result, died.
 Definitions
HAI Hospital-acquired infections are nosocomially acquired infections that are not present or
incubating at the time of admission to a hospital (Monegro et al., 2021).

MRSA Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is

resistant to several antibiotics (CDC, 2021).

Run Chart Run charts are graphs of data over time and are one of the important tools for assessing the
effectiveness of change (Institute for Healthcare Improvement, 2021).
 Definitions (continued)
Common Variation Expected causes that are inherent in the system (Institute for Healthcare Improvement,
2021).

Special Cause Unnatural causes that are not part of the system, but arise due to specific circumstances
Variation (Institute for Healthcare Improvement, 2021).

Four phases of a QI 1. Innovation — coming up with new ideas for changes.

2. Pilot — testing a change on a small scale.
project 3. Implementation — making the change the new standard process in one defined setting.
4. Spread — implementing the change in several settings (Institute for Healthcare
Improvement, 2021).
 Background and Significance
Problems identified in Whitney’s case study:

● MRSA is one of the most common pathogens within the healthcare system, causing
invasive infections, sepsis, and even death (Kourtis et al., 2019).

● Poor understanding of communication and leadership processes in the healthcare

governance reflect general lack of understanding of the internal workings of
governance, staff, and patient outcomes (Brown, 2020).

● Lack of leadership presence deters management from effective leadership and poor
accountability for staff (Hudson, 2020).

All of these problems are significant to warrant a QI proposal that focuses on

finding a solution that decreases MRSA related hospital acquired infection
rates on medical-surgical units.
 Synthesis of Literature
Problems
● Poor leadership involvement
(Sfantou et al., 2017).
● Poor implementation of hospital
policies (Ghiasipour et al., 2017).
● High rates of MRSA related
hospital-acquired infection
(Kourtis et al., 2019).
Plans
● Daily “bed huddle;” the
involvement of nurse’s,
managers, & medical directors
of the units lead to overall
improvement (Beverly et al.,
2018).
Purpose
● Effective leadership is critical to lead
an organization to successful patient
outcomes. (Sfantou et al., 2017).
● Reduce MRSA hospital-acquired
infection incidences (Beverly et al.,
2018).
● Nursing leadership shows
improvements, and involvement of
staff to help care for patients at the
bedside level (Brown, 2020).
 Making the Connection

● To Err is Human Documentary

● 1.7 million hospital-acquired infections every year.
● 69% of the 1.7 million could have been prevented.
● Errs impact patient and families.
● Hospital-acquired infections lead to complications beyond a patient’s initial
diagnosis, possibly resulting in death.
● These mistakes lead to as many as 440,000 deaths annually.
(Eisenberg et al., 2019)
02
Concept
Map
Integrative nursing principles,
structure, process, and
outcomes
 Patient & Informatics
Complex Adaptive Systems (CAS)
● Incorporating a daily “bed huddle”
among interprofessional team
members had a positive outcome in
reducing MRSA infections, therefore
improving patient safety and quality.
(Beverly et al, 2018)
○ This correlates with INP #1
because bed huddle will
positively impact patient care
outcomes. .
● There is a risk for hospital-
acquired infections, such as
MRSA, if clear logical reporting or
open communication is not
enforced by hospitals.
○ This correlates with INP
#1 because patients are
influenced by their
environment therefore if
there is a lack of
communication. then it
puts the patients care
outcomes at risk.
 Health Care Issues

● Hospital-acquired infections (MRSA) ● Lack of adequate leadership

○ Potential safety concern because it is easily ○ Impacts the proper quality of
care due to poor management.
transmissible.
○ INP #1: Persons whole systems
○ INP #1: Persons whole systems inseparable
inseparable from environments.
from environments.

● Poor communication
○ At risk for patient safety and quality of
care.
○ INP #4: Integrative nursing is person-
centered & relationship based.
 03
Model for
Improvement
Overview of the Model for
Improvement (MFI)
Model for Improvement (MFI) Overview
Model for Improvement: seeks to set aims, establish measures, and
decide on changes needed.

Optimizing interprofessional relationships and

motivation to decrease MRSA related hospital acquired
infection rates.
•Does a daily “bed huddle” between nurse managers
and unit medical directors affect MRSA rates?
• How do leaders and nurses describe their
experience with a daily “bed huddle”; what barriers and
facilitators emerged along with recommendations for the
next PDSA?
Optimizing interprofessional relationships and motivation to
decrease MRSA rates

● Utilizing daily “bed huddle” to optimize communication between nurse

management, medical directors, and staff to reduce rates of MRSA.
○ How does implementing daily “bed huddle” by nurse
management and medical directors affect MRSA related hospital
acquired infections?
○ How do nurse management and medical directions who utilize
“bed huddle” describe their experiences, facilitators, & barriers
along with suggested recommendations?
 PDSA – Plan the Test of Change
Consider
● Data will be collected by the PDSA
team along with a member from HIT &
a QI team member from a hospital in
Phoenix, AZ between 11/01/21 -
11/25/21
•
Predictions
● Implementing daily “bed huddle” will
decrease the number of MRSA related
hospital-acquired infections.
● Providers will provide their experience,
any facilitators & barriers they may
have encountered utilizing “bed
huddle”, & suggested recommendations
for the next PDSA cycle.
 PDSA – Plan the Test of Change
Data Collection Plan
● Process measure being improved:
○ Using ‘bedside huddle’ between nurse managers and unit medical directors to decrease the
number of MRSA related hospital acquired infections.
● We will collect providers positive descriptions of their experiences
○ Facilitators feedback
○ Barriers encountered & recommendations for the next PDSA cycle.
● Data will be collected by:
○ PDSA team along with a member from HIT and a QI team member from a hospital in
Phoenix, AZ between 11/01/21 - 11/25/21
● The QI expert from the hospital will analyze.
○ Team members will report the findings to their division, hospital management, & director
meetings.
 PDSA – Do
Describe theoretical results you would expect
Expected Run Chart Results

● Implementing daily ‘bedside huddle’ between nurse managers and

unit medical directors will lower rates of MRSA related hospital
acquired infections.

● Over the period of 24 days between 11/01/2021 and 11/24/2021,

data will show a decrease in number of MRSA related hospital-
acquired infections.
Run Chart
 PDSA – Study

Prediction Learning Summary:

● The number of MRSA ● After implementing the
related hospital- daily “bed huddle” there
● Implementation of daily “bed
acquired infections has been a decrease in huddle” in a hospital resulted
will decrease. MRSA related hospital- in signs of improvement and
acquired infections. potential to optimize
interprofessional relationship
● Attitude toward daily ● Daily “bed huddle” added a
and motivation to decrease
“bed huddle” would be hands on approach for
positive. nurse managers and unit rates of hospital-acquired
medical directors to be MRSA infections.
more involved with other
staff and patients.
 PDSA - Act
● Continue to pursue daily “bed huddle” between nurse
managers and unit medical directors, but include a monthly
debrief to include rates showing decline or improvement
based on rates of daily “bed huddle”

● Consider having a scribe for “bed huddle,” to record

accurate information based on patient’s conditions and
items discussed during the huddle to look back on.

● Include the charge nurse in the monthly debriefs to retrieve

feedback from staff regarding manager and unit medical
director implementations and involvement.
04
Summary,
Questions to
Class,
Reflections, &
Pearls of Wisdom
 Summary of...

PDSA QI Project Process: IN Principes Incorporated:

● Case study and background
● Understanding main themes
● Organizing information
● Forming a layout and presentation
● Focus on whole systems inseparable from their
environment.
● Evidence based practice to inform future
implementation of effective practices.
● Reduce number of MRSA hospital-acquired
related infections on the medical-surgical unit.
 Questions to the Class
Question #1
● Do you think the involvement of nurse managers and unit medical directors on the medical-
surgical floor would lead to better patient outcomes and lower rates of hospital-acquired
MRSA infections?

Question #2
● How can nursing management and medical directors be more involved on the floor to
give the hospital a more holistic view and ability to focus on holes in the system to
decrease hospital-acquired infections? What barriers prevent this?
 Reflection: Facilitators and Barriers

Barriers Overcoming Barriers

Facilitators ● Scheduling between individual time ● Discussion board and related
● Teamwork constraints. questions
● IHI ● Confusion over the instructions and ● Clear communication between
● Evidence informed practice expectations. team members

● Integrative nursing principles ● Technological errors ● Delegating tasks

● Human errors ● Communication with Dr. Laws
● Misunderstandings/ when instructions are unclear.
miscommunications
 Pearls of Wisdom
● We recommend meeting in-person for
the PDSA and powerpoint to avoid
miscommunication between team
members as it involves plenty of
brainstorming, clear communication,
and cohesive teamwork to help improve
the process and cohesion of the project.
● We also recommend weekly check-ins
with team as well as reaching out for
help.
● Integrative nursing is person-centered and
relationship-based. So on our next project, our
team will make sure to always consider each
team member’s strengths and weaknesses as
well as listening deeply and providing different
options and/or alternatives to support each other
through these projects and this program while
navigating the difficulties of life.
 Closing Mindful Moment
Take a moment to center yourself, wherever you are.
Close your eyes.
Take three deep and cleansing breaths, exhaling through your mouth with a sigh.
Return to your normal breath, taking note of where there may be tightness or tension in your body.
Breathe into those tight spaces, relaxing your shoulders, unclenching your jaw & hands, & releasing the space between your
brows.
Think of 3 incredible things your body has done for you today.
(This could be as simple and remembering to breathe, your heart remembering to beat, your legs being so strong and capable
of taking you where you need to go).
Think of 3 challenges you have faced and overcome despite all odds this year.
You are strong, you are worthy, you are capable.
You are enough.
Remind yourself why you are here.
Place your hands at heart center, bow your head, & thank yourself.
Thank yourself for all that you have done, for you.
 References
● Beverly, A. L., Hill, M. M., Camins, B. C., & Lee, R. A. (2018). Decreasing CLABSI incidence associated with decreasing MRSA
bacteremia LabID incidence. American Journal of Infection Control, 46(6), S82. https://doi.org/10.1016/j.ajic.2018.04.160

● Centers for Disease Control and Prevention. (2021, August 10). Methicillin-resistant Staphylococcus aureus (MRSA).
https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/mrsa.html

● Health Science Channel. (2015, August 21). MRSA-H: Hospital Infections [Video]. YouTube. https://youtu.be/rd09ksLEpfM

● Institute for Healthcare Improvement. (2021). 2 tools to understand variation in your improvement journey.
http://www.ihi.org/communities/blogs/two-tools-to-understand-variation-in-your-improvement-journey

● Institute for Healthcare Improvement. (2021). Run chart tool | IHI - institute for healthcare improvement.
http://www.ihi.org/resources/Pages/Tools/RunChart.aspx

● Kourtis, A. P., Hatfield, K., Baggs, J., Mu, Y., See, I., Epson, E., Nadle, J., Kainer, M. A., Dumyati, G., Petit, S., Ray, S. M., Ham, D.,
Capers, C., Ewing, H., Coffin, N., McDonald, L., Jernigan, J., & Cardo, D. (2019). Vital signs:Epidemiology and recent trends in
methicillin-resistant and in methicillin-susceptiblestaphylococcus aureusbloodstream infections — united states. MMWR.
Morbidity and Mortality Weekly Report, 68(9), 214–219. https://doi.org/10.15585/mmwr.mm6809e1

● Kreitzer, M., Koithan, M., & Weil, A. (Eds.). (2018). Integrative nursing. Oxford University
Press. https://doi.org/10.1093/med/9780190851040.001.0001

● Monegro, A. F., Muppidi, V., & Regunath, H. (2021). Hospital acquired infections. In StatPearls. StatPearls Publishing.