Celebrating Success: How Two Units Turned Results Around

To appreciate how far you’ve come, sometimes you have to remember where you began. That could easily be the case at CRMH for 8 Mountain ICU and 9 Mountain ICU.

In 2019, both units had some of the highest rates of hospital acquired infections (HAIs), which is one of 222 measures our Clinical Advancement and Patient Safety (CAPS) team monitors through six programs (including U.S. News and World Report rankings) to define how well we’re providing quality care.

“Rankings and metrics are difficult to put into perspective,” says Chief Quality Officer Suzanne Kraemer, M.D. “Our teams are really focused on patient outcomes.”

Decreasing HAIs—which can be caused by different conditions, including the use of Foley catheters and central lines—is one way we’re improving patient outcomes. And 8MICU and 9MICU are leading the pack in best overall improvements. Each unit had 9 HAIs in FY20, but none during FY21.

“They went from being units with the worst HAI rates to the best,” says Hunter Choate, senior director of Nursing Quality.

Committed to Change

Collaboration and Curiosity are two of our core values. It’s not surprising they also happened to be the foundation for helping 8MICU and 9MICU reduce their HAIs—a key measure to providing quality care.

8 Mountain ICU

Teamwork has been a key component in preventing HAIs on 8MICU. The unit came together and pushed each other to redefine how they approached ICU care:

• Initially, they took many steps to reduce HAIs, but learned it was most important to maintain those efforts through rounding and regular HAI prevention discussions, as well as daily reporting on operations.
• Consistent monitoring and correcting workflow barriers are also important to their long-term success.

In spite of having the sickest patients imaginable, 8MICU has still been improving Quality outcomes.

Dr. Kraemer says, “8MICU has been the COVID-19 unit for 17 months, and nearly 100% of their patients had Foley catheters and central lines for weeks on end. Yet, they improved when they could have easily just accepted that an HAI would be impossible to prevent.”

Interdisciplinary support has been instrumental to 8MICU's success.

“When I took over the unit last year, we had a very difficult patient population that presented some unique challenges that the team had not faced in the past,” says Russell Beggarly, B.S.N., R.N., C.C.R.N., nursing unit director for 8MICU. “I am proud of this team and grateful to our nurses, nursing assistants, respiratory therapists, physicians and the interdepartmental support for their creativity and commitment to quality patient care that made this work achievable.”

9 Mountain ICU

Like 8MICU, 9MICU has been successful in reducing HAIs because of the entire team’s Collaboration and dedication to their patients.

• From doctors and nurse practitioners, nurses, clinical associates, the leadership team and partners at Infectious Diseases, everyone made it a part of their daily routine to have Quality discussions about preventing HAIs. 
• The nurses on 9MICU take the lead on evaluating why (central) lines or Foleys are in place, and are invested in removing them as soon as possible.
• Clinical associates help to complete Bladder Management Protocol through frequent bladder scanning and other supportive measures, while providers thoughtfully listen to staff concerns, making it a daily point to evaluate lines and Foleys for each patient.
• The team has also eliminated External Ventricular Drain (EVD) infections on the unit. A collaborative effort between multiple departments helped to create new policies and protocols that focused on the EVD dressing and tubing. In addition, the nursing staff is solely responsible for increasing sterility when dressings are changed or when the device is accessed at any point. Weekly EVD rounding gives the team extra support to do this work, as well as real time feedback to provide education.

“The work here in the NTICU is intense and demanding,” says Olga Taylor, R.N., M.S.N., C.N.M.L., unit director for 9MICU. “We continually remind our team that what they do is significant to patient outcomes, while also making a profoundly positive impact in our community. Their continued commitment to do what is best for our patients by continually learning and adopting new best practices is what makes our unit capable of such accomplishments.”

One thing’s for certain, Curiosity is in action in both units.

Hunter says, “A culture change has transpired. The staff on these units are asking questions and have the desire to provide the best outcomes for patients. That’s ownership and that's what is making a difference.”