Empirical Quality Results

Magnet-designated organizations serve as pioneers of future care, developing and demonstrating solutions to numerous problems that are part of today’s health care systems. As caregivers at a three-time designated Magnet institution, ChristianaCare nurses value data collection and use outcomes data to inform improvement and quantify excellence.

Perfecting care, one process at a time Perfect care process monitoring

To achieve highly reliable care, the Nursing Quality and Safety Council identified the need to establish a standardized process for monitoring compliance with evidence-based practices for harm prevention.

The council engaged key stakeholders in creating Perfect Care Bundle process monitoring tools for achieving zero preventable harm in catheter-associated urinary tract infections (CAUTI), hospital-acquired pressure injuries (HAPI), central line–associated bloodstream infections (CLABSI), and falls. The evidence-based process monitoring strategies help identify areas for improvement in nursing practices with the goal of perfect care. As a direct result of the initiative, since the initiative began in July 2019: • Hospital-acquired infections have decreased by 41%. • Overall hospital-acquired pressure injuries have decreased by 12%. • Falls with major injuries have decreased by 20%.

All hands in to reduce hospital-acquired pressure injuries (HAPIs)

Among the improvements that led to a 44% reduction in Patient Safety Indicator PSI-3 HAPIs that include stages 3 and 4 and unstageable injuries:

• Introduced education, training and a hands-on competency assessment for nurses and patient care technicians.

• Improved pressure injury prevention processes, practice and documentation for all areas of care, including perioperative services and the Emergency Department.

• Increased interprofessional engagement, awareness and practice related to skin integrity, pressure injuries, care planning, documentation and coding.

• Developed and implemented a nursing practice accountability toolkit.

• Hired a wound ostomy continence (WOC) nurse certified pressure injury preventionist focused on pressure injury prevention, and a medical director for the WOC team.

• Implemented a virtual process for WOC nurse-verification of all pressure injuries using Cerner Camera Capture technology that resulted in a significant increase in validated pressure injuries, including injuries that were present on admission. • Developed a standardized process monitoring pressure injury prevention through the

Perfect Care tool and interactive dashboard.

Zero Harm Awards

ChristianaCare’s Zero Harm committee awarded a total of 86 Zero Harm Awards across our three campuses and HomeHealth in 2020. The awards are for areas with zero cases of preventable patient harm for 12, 24, 36, 48, 60 or 72 consecutive months. Our patients are safer because of our caregivers’ commitment to zero harm, and we are proud to acknowledge all 2020 Zero Harm awardees at our Wilmington (W), Newark (N) and Cecil County (C) campuses and HomeHealth (HH).

Catheter-Associated Urinary Tract Infection (CAUTI)

12 months: C Intensive Care Unit, C PCU, C MSU, C SSU, N Surgical Critical Care Complex, HH CD Team 1, HH PDN

24 months: N 5E, W 4W, N 2C, W Wilmington Intensive Care Unit, N 6A, W 6W 48 months: N 3A

60 months: N Transitional

Central Line-Associated Bloodstream Infection (CLABSI)

12 months: C Intensive Care Unit, C PCU, C MSU, C SSU, HH CD Team 2, HH NC Team 6, N Transitional Neuro Unit, W 6W, N 4D, N 6B, W 8S 24 months: HH CD Team 1, HH CD Team 3, HH NC Team 2, HH NC Team 3, HH NC Team 4, HH NC Team 6, HH NC Team 7, HH PDN, N 5D 36 months: W Wilmington Intensive Care Unit, W 3M

Methicillin-Resistant Staphylococcus Aureus (MRSA)

12 months: C Intensive Care Unit, C PCU, C MSU, C SSU, N 5A, N 5D, N 6B, N 5E 24 months: N Transitional Medical Unit, N BMT 36 months: N Transitional Surgical Unit, W Wilmington Intensive Care Unit 48 months: N 4D

60 months: N 4B

Clostridium Difficile (C. Difficile)

12 months: N 3A, W 7N, C Intensive Care Unit, W 5N, N 5A, N BMT, N Medical Intensive Care Unit, N 4E, N Surgical Critical Care Complex, W 6S 24 months: N Transitional Neuro Unit, W Wilmington Intensive Care Unit

Falls With Major Injury

12 months: C BHU, C CDU, C Emergency Department, C Intensive Care Unit, C MIC, C SSU, N 5B, W 6W 24 months: N Neuro Critical Care Unit, N ED, W 8S 36 months: N 4A, N 6C 48 months: N 5A, W 4W, N 6B, N Surgical Critical Care Complex, N 3A

All Falls

12 months: N Transitional Surgical Unit 60 months: N Neonatal Intensive Care Unit

Antenatal Steroids

12 months: N 2M, N OB Triage