Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements This annual newsletter highlights some of St. Michael’s best practice achievements with examples of how our nursing teams are implementing, evaluating and sustaining best practice guidelines (BPGs) into standardized processes that support evidence-based nursing practice.
A Champion for Quality Thomas Sawyer had been in his role as a registered nurse on 9CC Trauma and Neurosurgery for four years when he volunteered to help with a quality project: implementing staff-led debriefing after critical incidents. “Incidents like verbal and physical abuse or significant code blues (when someone is experiencing cardiopulmonary arrest) didn’t happen regularly but when they did, it would end with everyone just dispersing,” he said. “We didn’t have a standardized process to discuss what happened, what could have been done differently and how we were all feeling. We also didn’t have a means of bringing our feedback forward.”
Six months after launching, the debrief tool is still in use on 9CC and it is making an impact; staff feel empowered to reflect and share their thoughts and recommendations after an incident. Their collective feedback is shared with the unit’s CLM who Sawyer works with to address concerns brought forward and ensure closed-loop feedback is shared with everyone who was involved in the incident.
As part of the best practice guideline (BPG) on Stop Harm and Violence, Sawyer, a newly minted BPG Nurse Champion, was able to help create a debrief tool to be used in these situations. He connected with staff to understand what needed to be included, trained charge nurses to initially facilitate the discussion and advocated for the tool’s use after it launched. “It was really refreshing – I would come into work and people would tell me that there was an incident and they used the debrief tool to process it effectively as a team,” he said. “The initial feedback was very positive – sensitive topics and safety concerns were brought forward during debriefs and attendees were able to critically review outcomes and felt their concerns were validated. Staff said they felt more supported knowing the unit was prioritizing their wellness and safety.” Continued on page 3 BPSO stands for Best Practice Spotlight Organization, the designation awarded by the Registered Nurses’ Association of Ontario (RNAO) to organizations upon successful implementation, evaluation and knowledge translation of established nursing best practice guidelines (BPGs). St. Michael’s has been a proud designated BPSO since 2012.
Falls Prevention on Inpatient Mobility with Bridgette Abas, RN and Shawna McIntyre, Clinical Nurse Educator Falls can be a major risk for anyone recovering in hospital – not only can they be painful on their own but they can delay the time it takes for patients to get back to full health and back home. Bridgette Abas, a registered nurse on St. Michael’s inpatient mobility unit and a Best Practice Guideline (BPG) Nurse Champion, is working with her team to help decrease the number of falls for her patients. “We just hit 36 days without a fall – a record for us,” she said. “I started working on the falls prevention BPG [through the Registered Nurses Association of Ontario’s Best Practice Spotlight Organization, which St. Michael’s is part of] in September last year. In February, we launched a tool to help our team check in with patients on specific issues that have been shown to help prevent falls.” The tool is used during rounding which is completed by clinical assistants, nurses, occupational therapists, physical therapists and physiotherapy assistants three times a day – at 1, 3 and 7 p.m. – times that have been identified as high risk based on falls data. In these visits to every single patient on the unit, the team asks about the four Ps: potty, positioning, pain and personal needs. These four issues – someone needs to use the washroom, is in pain, needs to move and can’t on their own or has something else they’d like to do – are often the root causes of why falls happen. “Our patients are receiving specialized care related to orthopaedics and neurology – and they’re prone to falls,” said Shawna McIntyre, a clinical nurse educator on the unit and a BPG unit mentor. “The tool Bridgette implemented was based on data of falls specific to our unit – what led to 2 I August 2019
each fall, what could have prevented it, what time of day it happened. We customized this approach to make sure it would have the most benefit to our patients in an effort to keep them safe.” This intervention comes on the heels of a successful implementation of rounding throughout the night shift that’s helped decrease falls during those hours. Putting something similar in place during the day was a challenge as care teams tend to be busy with other responsibilities. Hence, the threetimes-a-day rounding, rather than every hour. “We found that many falls were happening during shift change so we knew we needed to target this time period,” said McIntyre. “We were strategic in our approach – and it’s working.” The team now has a running total on a board in the unit of how many days it’s been since their last fall. Their new goal: try to beat their current record of 36. A big part of what they’re doing is embedding accountability and responsibility for reducing falls into the team – they’re talking about falls at huddles, educating new staff on orientation and celebrating their successes. “I believe this achievement has been a result of the collaboration on our unit – we had everyone involved working towards a positive improvement for our patients,” said Abas. “It’s been such a great experience being able to be part of this project and seeing the impact it’s having on the people we’re caring for.”
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For Sawyer, it’s been an eye-opening experience. “It’s really empowering to know that the opportunity is there to challenge current practices. If there’s an area you feel could be improved, don’t feel discouraged. There’s an entire process and team to help support and guide you in implementing, evaluating and sustaining those evidence-based changes,” he said. “BPG nurse champions are helping to uphold and refine our current standards of care. By prioritizing workplace and employee health, we can ultimately provide the best quality care to our patients and their families.”
This year recognized our seventh year as a designated RNAO Best Practice Spotlight Organization (BPSO) and the implementation of 39 best practice guidelines (BPGs) since 2009. There were 32 BPG quality improvement initiatives implemented across 24 different clinical areas from October 2018 to March 2019. These initiatives were led by 42 BPG Nurse Champions and supported by BPG unit and Professional Practice mentors. The 2018-2019 BPG Nurse Champions and their mentors were recognized at a pinning ceremony during the Nursing Week Best Practice Guideline Sustainability Poster Gallery Walk. Congratulations to all BPG Nurse Champions and mentors for their outstanding work and contribution to advancing safe quality care! St. Michael’s launched its three-year BPSO candidacy journey Nursing Week 2009 and achieved its designation in spring 2012. We continue to search for and implement the best possible evidence into clinical care while integrating and sustaining new BPGs. Our BPSO designation is aligned with our commitment to using best evidence to advance nursing and clinical practice that ultimately raises the standard of care.
A few words from Murray Krock Director, Nursing Practice and Education
The 2019/20 BPG Communities of Practice (CoPs) will welcome new and returning BPG Nurse Champions along with their mentors. As a CoP, they will come together to share knowledge, advice, tools and problem solving strategies in a supportive learning environment that facilitates the implementation and sustainability of BPGs and also, leadership development. August 2019 I 3
Who Were Our 2018/19 BPG Nurse Champions?
A BPG Nurse Champion is a registered nurse selected to lead, facilitate and inspire the BPG implementation and evaluation process in their local unit. From October to March 2019, there were 44 BPG Nurse Champions from across 23 clinical areas who led BPG initiatives in their local areas/departments. To learn more about our 2018/19 BPG Nurse Champions visit St. Michael’s BPSO intranet page. 4 I August 2019
What are key qualities of a BPG Nurse Champion? •
A nurse who demonstrates initiative and commitment to best practices in their current role;
•
Passionate about a BPG topic, patient population and the potential outcomes that can be achieved;
•
Has the ability to lead, coordinate and facilitate an initiative/ project and, Role models positive clinical leadership
2019 Nursing Week BPG Sustainability Poster Gallery Walk In May 2019 we celebrated St. Michael’s seventh year as a designated RNAO BPSO and the implementation of 39 BPGs since 2009. Annually during Nursing Week, BPG Nurse Champions showcase their work during the BPG Poster Gallery Walk. The event demonstrates quality improvement (QI) initiatives that are informed by RNAO BPGs and contribute to quality patient care. During this event, we celebrated and recognized the many nurses and teams who were instrumental in implementing the 32 BPG quality improvement initiatives across 23 different clinical areas from October 2018 to March 2019. BPG Nurse Champions and their mentors received custom designed “BPG Champion” and “BPG Mentor” pins in recognition of their dedication to excellence in patient care and quality improvement. The 2019 Piera Cardella Scholarship was presented during the event to the Inpatient Mobility Unit for their BPG initiative entitled ‘Managing Responsive Behaviours on the Inpatient Unit. Joining in the celebration was Heather McConnell, RN, BScN, MA(Ed) from the RNAO. Heather is the Associate Director of Guideline Implementation and Knowledge Transfer at the RNAO. Heather provided inspiring opening remarks and spoke to the importance of nurse Champions and the critical leadership role they have in making meaningful improvements to the quality of patient care and the work environment. International RNAO BPSOs visitors also attended the event with the RNAO to learn about our BPSO achievements. The visitors came from Peking University First Hospital in Beijing, China and Lanzouh University Second Hospital in Lanzouh, China. If you missed the BPG Sustainability Gallery Walk and want to learn about more about the BPG initiatives, BPG posters can be viewed on SMH BPSO intranet page.
From left to right: Murray Krock, Director, Nursing Practice and Education; Heather McConnell, Associate Director of Guideline Implementation and Knowledge Transfer at the RNAO; Ashley Skiffington, Former Evidence Based Practice Nursing Manager; Jenna Moulder, Clinical Nurse Specialist, TNICU; Vanessa Rosario, RN, TNICU
From left to right: Olga Krasik, RN, Inpatient Mobility; Jennifer Cardella
RNAO BPSOs visitors from China; Heather McConnell, Associate Director of Guideline Implementation and Knowledge Transfer at the RNAO; Ashley Skiffington, Former Evidence Based Practice Nursing Manager
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HIGHLIGHTS FROM LAST YEAR...
BPG COMMUNITIES OF PRACTICE From October 2018 until March 2019 32 BPG quality improvement initiatives were implemented across 23 different clinical areas. These initiatives were led by 44 BPG Nurse Champions and supported by 32 BPG Unit Mentors and 4 Mentors in Professional Practice. Supporting Best Practice Guideline (BPG) Nurse Champions is important to assure success as we continue our Best Practice Spotlight Organization (BPSO) sustainability and designation with the Registered Nurses’ Association of Ontario (RNAO). In addition to mentorship, Communities of Practice (CoP) have been used to support the development of BPG Nurse Champions and teams in implementing and sustaining BPGs. The first half of the CoP was dedicated to round table discussions that gave BPG Nurse Champions the opportunity to share experiences, including successes and challenges, related to implementing their BPG initiatives. The second half focused on methodologies of quality improvement and education in support of the professional development of BPG Nurse Champions, providing them with strategies and tools that could be applied to the implementation of their BPG initiatives. The evaluation and feedback received from BPG Nurse Champions who participated in the 2018/19 Communities’ of Practice was positive. Here are a few comments from BPG Nurse Champions.
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Please continue to do this work, to offer these opportunities and to advertise even more so. I don’t think enough people recognize the value of what is taught, the support given, and the fabulous outcomes that are a result of being involved in this initiative. You’re all amazing mentors and I congratulate you on a job well done :)
I cannot begin tell you enough on how well run, beautifully organized, useful and pertinent this opportunity was. An absolutely fantastic opportunity for any RN. I will be recommending this to anyone and everyone. Sharing with other BPG champions
National and International Visitors St. Michael’s Hospital (SMH) is recognized as an exemplar RNAO Best Practice Spotlight Organization and is periodically asked by the RNAO to host national and international BPSO visitors. This year SMH has hosted visitors from Spain (January 2019), Peking University First Hospital in China (April 2019) and from Peking University First Hospital in Beijing, China along with Lanzouh University Second Hospital in Lanzouh, China (May 2019)
RNAO BPSOs visitors from Peking University First Hospital in Beijing, China with Ashley Skiffington, Former Evidence Based Practice Nursing Manager
St. Michael’s Hospital Hosted RNAO BPSO visitors from all over the world.
Canada • Toronto • Nova Scotia
International • • • • • •
China Australia Israel Spain Columbia Chile
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39 BPGS & Counting‌ St. Michael’s is one of the few BPSO organizations that have implemented a total of 39 RNAO BPGs 1. Assessment and Management of Pain 2. Assessment and Device Selection for Vascular Access 3. Assessment and Management of Foot Ulcers for People with Diabetes 4. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition 5. Assessment and Management of Venous Leg Ulcers 6. Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour 7. Breastfeeding Best Practice Guidelines for Nurses 8. Caregiving Strategies for Older Adults with Delirium, Dementia and Depression 9. Care and Maintenance to Reduce Vascular Access Complications 10. Care Transitions 11. Client Centred Care 12. Crisis Intervention 13 Decision Support for Adults Living with Chronic Kidney Disease 14. Delirium, Dementia and Depression in Older Adults 15. Developing and Sustaining Effective Staffing and Workload Practices 16. Developing and Sustaining Interprofessional Health care: Optimizing patients/clients, organizational and system outcomes 17. End of Life Care During the Last Days and Hours 18. Engaging Clients Who Use Substances 19.Embracing Cultural Diversity in Health Care 20. Establishing Therapeutic Relationships (ETR) 21. Integrating Smoking Cessation into Daily Nursing Practice 22. Interventions for Postpartum Depression 23. Managing and Mitigating Conflict in Health Care Teams 24. Nursing Management of Hypertension
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25. Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease 26. Person and Family Centred Care 27. Preventing and Managing Violence in the Workplace 28. Prevention of Falls and Fall Injuries in the Older Adult 29. Preventing and Mitigating Nurse Fatigue in Health Care 30. Professionalism in Nursing 31. Promoting Safety: Alternative Approaches to the Use of Restraints 32. Promotion of Continence using Prompted Voiding 33. Risk Assessment & Prevention of Pressure Ulcers 34. Screening for Delirium, Dementia and Depression in Older Adults 35. Strategies to Support Self Management in Chronic Conditions 36. Supporting and Strenghtening Families through Expected and Unexpected Events 37. Stroke Assessment Across the Continuum of Care 38. Woman Abuse: Screening, Identification and Initial Response 39. Workplace Health, Safety and Well-Being of the Nurse
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Congratulations to the following BPG Nurse Champions, Mentors and teams who have presented BPG work at external conferences in 2018/19: C. Santiago, The Constant Care Working Group
Developing the Constant Care Guidelines for an Acedemic Health Science Network
Nursing Leadership Network
Toronto ON
March 22-23, 2019
Leading Evidence-Based Organizations
RNAO Best Practive Guidelines Clinical Summer Institute
Barrie, ON
June 2018
Improving Complex Symptoms in Palliative Care: An Educational Approach
Canadian Hospice Palliative Care 2018 Learning Institute
Ottawa, ON
June 14-16, 2018
M. McCrady, A. Kidane
Nurse Led Initiative and Implementation of Transfer of Accountability Tool in the Breast Center
30TH CANO/ACIO Annual Conference
Charlottetown, PEI
October 26-29, 2018
C. Gonzales, M. Laylo
Integrating Smoking Cessation Practices Among Cancer Patients in an Ambulatory Cancer Setting
30TH CANO/ACIO Annual Conference
Charlottetown, PEI
October 26-29, 2018
S. Scime.
Optimizing Sexual Health and Emotional Well-Being for Breast Cancer Patients and Survivors through Nurse-Led Interventions
30TH CANO/ACIO Annual Conference
Charlottetown, PEI
October 26-29, 2018
Designing a 3 Pronged Approach to Supporting Frontline Nurse Champions Implement Best Practices
Nurse Leadership Network
Toronto ON
March 28-29, 2019
M. Krock, C. Santiago.
A Collaborative Initiative to Address Potential Safety Risks in Intrahospital Patient Transitions
Nurse Leadership Network
Toronto, ON
March 28-29, 2019
M. Krock, C. Santiago.
Supporting the Journey of a Patient on Constant Care: A Collaborative Approach
Nurse Leadership Network
Toronto, ON
March 28-29, 2019
M. Krock
V. McLean, E. Rhodes
A. Skiffington.
Nursing Professional Practice staff update… Welcome to Susan Beswick, our new Evidence Based Practice Nursing Manager. Susan joins us from Headwaters Health Care Centre, where she managed intensive care, cardiac and medicine units and wound and skin programming. Prior to this role, she was the clinical manager of an acute care for the elderly unit and manager (interim) for inpatient nephrology at Humber River Hospital. She is also a former clinical practice leader at Humber River Hospital. Susan is a former research coordinator in Nursing Research at St. Michael’s. In that role she co-created and led the implementation of a strategy for using feedback performance data in clinical nursing, including coaching clinical nurses and managers on the selection of relevant performance indicators and the interpretation and use of data to inform practice. She was also St. Michael’s site coordinator for a national study on nursing quality indicators. Thank you to Ashley Skiffington for her valuable contribution to Nursing Professional Practice at St. Michael’s Hospital. Ashley has decided leave St. Michael’s Hospital in order to spend more time with her family. While we are sad to be losing Ashley, we are happy that she will be taking the opportunity to focus on family.
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BPG Word Search Find the words below to refresh your BPSO vocabulary! P W X D M S Q S I Y G F D V E T K T V H O Q K Z N G O T R S X I I T L Z Q A F P
T N E M E T A T S M I A X B R H V Q R I B N R O R A A F I E G U Z T T U F K E U
R X I P N O R W G G C E Q V V U R B H T G R Z O E J C H K N K Q X P A X F M U E
M B I F U E D N T A R Z E E C W D V F G P M H D T Y N D Y I C B D L N Y R Z R H
D K I W D R L A U Y G P N N Y H D P Q H W Z N F W N J B G L N W I D G W V T D P
Q E L G D C H F Q C L B G F Q O R V I N J O T Q U E E Y C E C T G E A T S I B H
N Z S K S R J B D U I N I U H Q P M H X V S X L X T V M X D Y G U S C E L U J G
C L B I Z F G E T P T R C C R K G T O A P W U F V X G J Q I E G W I L S Y W M N
V Y E M G M T R E A X R E M J H L X V I A J C Z G O Q L M U Z N F R O J T U L U
B N B J K N P V Q Y W W F F Y P A E L P M X Q H U O S P B G K T E E B G I A G J
F Q W H C F A A A S A L W J S P U E L A Y P J S O E R Y C E W B N D K W L J Q I
H B M X X W T T E L B C Q B S U C W C G F F L A W O S D C C V S I S J P I J H K
S P D E P A M R I L Y D G Z R X X H K L E B E E V Q H N M I L S E T Q Y B R K T
H G J Y M C U Z E O D J I U D V W F K A B B A E M Q T Z G T Z S P A R B A Q O T
D N M X K S J I G J N I A P E W R Q Q V K H M W N E S L D C K B U T I H N B O R
Z U I J A O C Z N M I J X W L M L V H B F E B V K J N G J A P J F E T W I F I L
V R X E N R N J A I A X I I J P B M W Q N Z C Q W B N T Q R I F V H E U A U C W
V S M G L Q R U H D Q U I Q R S H J I T I I J O W I A H A P B D D G V W T N F W
E E Q F X U N R C C S E E R F N G D C Y L V K L P M V J W T L E U M O Y S Y Q C
D C G N J J N T X Y Y U E B X O K X N Y H R D P T B X V L S I D Q Z C D U A E Y
AIM STATEMENT BEST PRACTICE GUIDELINES BPG NURSE CHAMPION BPSO CHANGE COMMUNITIES OF PRACTICE CURRENT STATE DESIGNATION DESIRED STATE EVALUATION
N H I J D Z S P O K K V X V T E G Q T H Q E A X C M B D P E A O G J H T S F S A
S A L T J Q T O H F E H X J Q Q N V G M Y M C Q S U P B B B Q S N N K X T A F Q
O M E Z C Z J G D D H Y Z B G F F D Y D S B P L A N D O S T U D Y A C T H N I G
R P Z F J A C T N P E W P I G P B T I S F Z V M R F K A P J V K D H K G O L L K
S I V L S I R U V R W S J B O E T N E M E V O R P M I F O L E D O M C Y P T C Q
B O Y B E P E P H N W X A T X R G C H K H K A G P C L J M C H H L V B A S F P L
F N L S E M M S F V E C N B L Z O S X X D T R Z V R Z E Y G D F X N E B U R R H
D B I G J S J Y U O U W L U E R B I I U J D R A Y J Q C S M S H B M L A J V A Y
J T T A T L V E A R S I O M P C G A Q R Q O X Q Y D H L Y K N O T Q N G N F M W
B L W R I L Y E R Z J E T M P P N J P J H Q V I I W A N X Z M J M J M P G I H G
M D Y H E V O E Q Z R S I C V M D E S O M L M K O E Q L M P B R L N A A I E H T
O U F G W H N Y M K S L W T N E M G D Q L G X C G M N I Y L V F V W P M F A I K
O F C S X T F E R B I F A I I P E O E I D V M V V Z D B C T V F V I C H T V M A
L J S O S Y J B Y X E S X M S N X V I C V X G W F T I Z E Q Y P I Z S R M B A V
A O U T V L J J X N P P N A W P U R R M A E D X H N K M Q C S Q W S S R G F I E
L M A S E J A C O H W U J Z A A I M Z G D Q O O C X K F Z X R T Y G M D G K V J
V T P D K C Q R F E I C F E B A U O M R J Z W U N U E M R R W R N T S O R G J Q
E M K E V A L U A T I O N S W Z R I A O D Y I D B N G P R A K D R K I L T I L J
E P W E O U Z Y O M Y H Q I C G F N E X C A E Y M U Z F Z O Y J W Q R Z M K A Q
F Z O C M R G N Z J H F S G K A K V G P U Y S A T O E M S C L P D C S Q N J Z X
EVIDENCE BASED IMPLEMENTATION MEASURES MENTOR MODEL OF IMPROVEMENT PLAN-DO-STUDY-ACT PROCESS MAPPING QUALITY IMPROVEMENT SUSTAINABILITY
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Did you know? You can access BPG Nurse Champion Tools on the BPSO intranet site under Tools and Resources
FAST FACTS Over the course of our 2016-2019 BPSO Designation Term… 1
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125 RNs participated
86 BPG
27 St. Michael’s nurses
in BPG CoP and implemented 87 BPG initiatives
posters displayed during Nursing Week BPG Sustainability Gallery Walk
presented BPG work externally at national and international conferences
STAY TUNED!
Starting in October, a new group of nurses will take on the role of BPG Nurse Champion to lead the implementation, evaluation and sustainability of BPG initiatives in their local units.
Check out our BPSO Intranet Site to learn more about the BPG initiatives that have been implemented over the past years Stay tuned...
Please send your comments or story ideas to Marta Sliz slizm@smh.ca Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements is an annual newsletter created by the Nursing Practice and Education Department at St. Michael’s Hospital. Design by Medical Media Centre, St. Michael’s Hospital