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| San Ramon Regional Medical Center received a Best Nursing Team award from Advance for Nurses |
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| San Ramon Regional Medical Center received a Best Nursing Team award from Advance for Nurses. An article about our entry was printed in their latest issue.
On the Same Page
Communication enables a team to elevate the delivery of evidence-based care.
By Sarah Lebo
The nurses on the San Ramon Regional Medical Center core measures team could be seen as "guideline specialists" of sorts, down to the strategies they've outlined for their weekly meetings: Come on time, be prepared, no sidebars or interruptions, bring a printed agenda, don't blame, bring an open mind with possible solutions and stay on task. This team means business, and their purposeful direction has led the successful implementation of evidence-based interventions for patients diagnosed with heart failure, MI and pneumonia at the facility.
Attention to Detail
"It's a monumental process to make sure everything is just right for the core measure patient. But the staff doesn't miss things because the steps are so clear," explained Cathy Lacy, RN. "Our core measures process, with the paperwork and the procedures, increases our efficiency by providing clear guidelines on what to do."
Those guidelines were originally outlined by the core measures team, which was responsible for establishing a consistent, standardized method for identifying core measure patients. They then developed a system for communicating and delivering the recommended evidence-based care, as well as accurately documenting that care.
"We've benefited the hospital due to our powerful communication from the administrative level to the individual RNs taking care of this specialized population. We've been able to reduce communication barriers between nursing units through the processes we put in place," said Satveer Dhaliwal, BSN, RN, assistant director of med/surg services. "'Core measures' has become a household name at San Ramon."
Zeroing In
Eighteen members regularly participate on the team. It includes the chief nursing officer, directors and assistant managers of med/surg, telemetry, ICU and the emergency department, the quality assurance nurses, case management, infection control, education, a care coordinator and the director of the cardiovascular program. Staff nurses also are involved at times in problem solving, case discussions and as participating guests to the core measures meetings.
And while the team is known for being driven, they have learned to be flexible too. They evolved from initially being a review panel into a strategic planning and action research team.
"Our primary focus has been to develop processes allowing immediate identification, appropriate treatment, documentation and accurate coding of our core measure patients. We began by looking at the processes that were already in place, reviewing known best practices and describing a vision of how we wanted the processes to work. Our next step was to do a gap analysis, looking for areas we needed to improve," said Pam Pshea, MSN, RN, chief nursing officer.
Now there is a core measure patient list, a tracking tool for each patient on that list and color-coded charts that are placed in the medical record. Still, it is a constant challenge to continue to determine areas of breakdown when the standards have not been met.
"Often this is most challenging when it's busy on the unit and we're maxed out," Lacy said. "Prior to a patient's discharge, the nurse is supposed to give that chart to the charge nurse to be sure everything has been done. If the patient leaves and we see something hasn't been done, we have a problem."
At that point management flags the case for recommendations on what to do better next time.
Sweet Success
"Over the past year, we achieved 96.2 percent in our overall delivery of nurse-sensitive, recommended evidence-based care for core measure patients," Pshea said. "The significant impact of the process changes the core measures team has implemented and fostered have improved communication, quality of care, patient outcomes, accurate billing and improved our publicly reported data scores."
Because of these improvements, the medical center also received the annual Performance Achievement Award by the American Heart Association's Get With the Guidelines Coronary Artery Disease and Heart Failure programs.
"Being a part of the core measures team is a wonderful opportunity to truly see teamwork in action, collaboratively working toward a common goal that will benefit the patient," Dhaliwal said. "We all enjoy everybody working together on a united front to give good patient care - and doing it in a very tangible, organized way. It's a higher level of nursing care."
Sarah Lebo is a freelance writer based in Royersford, PA.
Copyright © 2008 Merion Publications
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