The implementation of a designated alert team to improve patient safety and nursing staff perceptions of patient safety

Abstract

<p>Poster presentation</p><p>Session E presented Tuesday, October 1, 10:00-11:00 am</p><p>Purpose: This performance improvement project was designed to improve patient safety and nursing staff perception of patient safety by implementing a designated alert team rotation to care for trauma, stroke and critically ill patients upon arrival to the ED. Prior to this, certain room assignments within the department included responsibilities on alert teams. Nurses working in these rooms were taken from their patient assignment to care for alert patients, while their existing patients were assumed to be cared for by other nurses in the area. The creation of a designated alert team rotation comprised of nurses who did not have other patient responsibilities improved patient safety as patients were not assumed to be cared for by other nurses with their own patient load and improved nursing staff perception of patient safety. </p><p>Design: The Plan-Do-Study-Act (PDSA) model was used to guide this project. A pre/post survey was used to identify success of the intervention. </p><p>Setting: Tertiary care urban medical center with 633 inpatient beds. The emergency department is a Level II trauma center with 140,000 annual visits. Approximately 300 registered nurses and technicians are employed in the department. </p><p>Participants/Subjects: All registered nurses and technicians employed in the department were eligible to participate in the pre/post implementation surveys. Participation was voluntary and anonymous. No IRB approval was needed. </p><p>Methods: The current staffing model was revised in order to release nurses from a patient assignment and allow them to care for medical alert patients. It was recognized that to commit to this model, additional department staff was needed. This was supported by department leadership. A 24 question survey, developed by a small group of staff nurses involved in the process change, was designed to garner staff feedback on current and future medical alert processes. It was emailed to all nurses and technicians on staff prior to the implementation of the designated alert team role and 8 weeks after the implementation of the designated alert team. Descriptive statistics and 2 tailed-t tests were used to analyze data. </p><p>Results/Outcomes: Implementation of a designated alert team impacted staff perceptions of patient safety. Prior to the intervention, few staff felt the alert process was safe (9%); 8% felt the process allowed them to provide quality care; and 12% felt not enough resources were available to care for patients they left behind while caring for medical alert patients. After the implementation of a designated alert team, 71% felt the process was safe, 69% felt it allowed them to provide quality care, and 38% felt there were enough resources were available to care for patients. This practice change had a statistically significant effect on nursing staff perceptions of patient safety (p=0.02). </p><p>Implications: The need for creativity in staffing solutions to improve patient care and safety will increase as use of emergency services increases. Staff nurses are an excellent source of information about existing processes and implementation of change. Involving staff nurses in change processes within the department creates a collaborative environment which can have a great impact on patient safety and nursing staff perceptions.</p>