Rounding checklists can help hospital care teams improve patient outcomes. New research points to the potential for patient-specific checklists as a valid way to effectively translate the latest evidence into clinical practice.
These checklists can be helpful tools during daily rounds when multidisciplinary patient care team members convene to discuss each patient’s status and care plan. However, if too complex or generic, the checklists may instead become a burden, taking up valuable time with minimal impact.
One way to customize rounding checklists is to have an individual serve as a checklist prompter, listen to the conversation, eliminate items as they are addressed, and remind the team to consider any remaining elements that should be discussed. These customized approaches assume that a prompter is reliable for confirming whether each checklist element is addressed
“Measuring Performance on the ABCDEF Bundle During Interprofessional Rounds via a Nurse-Based Assessment Tool” found that a single trained observer serving as a checklist prompter can reliably assess whether rounding discussions among the multidisciplinary patient care team addressed elements of the ABCDEF bundle. The evidence-based bundle includes various elements related to pain, agitation, delirium, ventilator care, and family engagement.
Researchers from the University of Pittsburgh, Pennsylvania, and other institutions conducted the study at two intensive care units (ICUs) at UPMC, a tertiary care medical center that is an academic affiliate of the university.
The team developed a paper-based assessment tool with a series of Yes/No items related to the ABCDEF bundle, allowing a nurse observer to circle whether an element had been addressed during rounds
Two nurses performed in-person observations of multidisciplinary morning rounds on 15 observation days in the fall of 2021. Most rounding discussions occurred in the hallway rather than the patient rooms due to institutional norms and COVID-19. The observers listened independently only to the rounding team’s discussions, without looking at the patient’s electronic health record or looking for visual cues from the patient’s room
In total, 53 different patients were observed, with 33 of them receiving invasive mechanical ventilation. Because ICU admissions often last multiple days, discussions often address the same patient over different days. The nurse observers documented 118 patient discussions, and their dually observed discussions are the basis for calculating reliability and agreement.
“Checklists are frequently used as a strategy for increasing adoption of the ABCDEF bundle, and our research has several important implications for performance improvement and quality measurement in the ICU,” says lead author Andrew J. King, PhD, research assistant professor of critical care medicine at the University of Pittsburgh School of Medicine.
The results indicate that nurses can identify when a rounding checklist element has been addressed and, therefore, might not need to be repeated during a readout of the checklist. This added flexibility enables a shorter, patient-specific checklist, which could streamline workflows.
In addition to empowering clinicians to customize checklists for each patient, the study shows that critical care nurses are ideal candidates to be independent checklist prompters during rounds.
The researchers also conclude that the assessment tool created for the study could serve as the basis for occasional strategic measurement of team performance, especially during emergency response, shift handoffs, and other times when team communication is essential.
Have you ever wondered what it’s like to work as a vascular access nurse and what this job offers? Here are the basics that you need to know.
Rebecca Myers, MSN, RN, VA-BC, NPD-BC, is a Vascular Access Nurse (aka PICC nurse). Her hospital experience includes critical care, education, and vascular access.
Rebecca Myers, MSN, RN, VA-BC, NPD-BC
How did you get interested in being a vascular access nurse? What drew you to it? How long have you been doing it?
I started my nursing career in ICU and was always interested in learning new skills. In 2011, there was an opportunity to join an all-ICU RN PICC team. We trained with a seasoned team from a sister hospital. We rotated as the PICC nurse for the hospital and outpatients for a week at a time and worked in ICU the rest of the time. In addition, we placed lines for our hospital patients and outpatients needing long-term IV therapy.
Now, I am a full-time vascular access nurse.
Explain what a vascular access nurse does. What types of patients do you serve? What do you provide for them?
As a vascular access nurse, I consult to determine the best vascular access for a patient. I work in an inpatient setting and provide ultrasound-guided peripheral IVS, midlines, and peripherally inserted central catheters (PICCs) to patients requiring IV therapy.
I educate nurses about vascular access, choosing the best option for a patient, and advocating for a patient’s vein preservation and health. In addition, I educate patients about their access and what to expect before and after the procedure and answer any questions.
Did you need to get additional education for this position? Please explain.
Yes. There is an educational component required before any hands-on training. The classroom portion is an 8-hour course with successful completion needed before moving on to simulated hands-on training.
Once competence is achieved with simulated insertion techniques, we trained with a seasoned partner at a sister hospital. The requirements are to place a minimum of 10 lines successfully under supervision before moving into placing lines independently.
My hospital system uses a uniform approach for all vascular access nurses. We use Infusion Therapy Standards of Practice to guide our practice and incorporate Michigan Appropriateness Guideline for Intravenous Catheters (MAGIC) to aid in choosing the right line for each patient.
What do you like most about working as a vascular access nurse?
I love participating with patients, nurses, and physicians. I love being an expert in my field and having the knowledge and experience to help a patient through a procedure that has uncomfortable moments.
My master’s degree is in education, so I also love the education part of my position. There is an element of autonomy to my position that is professionally satisfying. I have been a nurse for more than 15 years and enjoy using my experience in this way.
What are your biggest challenges as a vascular access nurse?
Challenges change with time. When I started, the challenge was consistency and gaining the staff’s trust. I have now been at my current hospital for over four years. There is always an element of education that needs to be ongoing. Nurses and physicians are changing, and keeping the information readily available is key.
I send out a newsletter about 4x a year with summary tables for MAGIC, reminders, updates, and clickable links for more information. The more everyone knows, the better for all of our patients. The biggest challenge is to keep the communication flowing and fresh.
What are your greatest rewards as one?
The greatest reward of being a vascular access nurse is when a patient says I did a good job. Or family tells me they can see that I am experienced and trust me.
Anytime I can do something that makes a positive difference is the best reward.
Is there anything else that is important for our readers to know?
I want readers to know it is never too late…for anything! I became a nurse after my children were adults. It is the most satisfying and enriching thing in the world. It took me a minute, but I found my tribe in nursing. So whatever your dream is, go after it!
Nursing provides so many varied opportunities! It is still a great field. If you are feeling overwhelmed at the bedside, try something else.
AACN joins hospitals and healthcare organizations in recognizing certified nurses for their professionalism, leadership, and commitment to excellence in the care of patients and families as part of Certified Nurses Day, Sunday, March 19.
As healthcare becomes increasingly complex and challenging, nursing certification has become an essential mark of excellence. Specialty certification reaffirms nurses’ commitment to using the best evidence to provide care for patients and families. Achieving certification demonstrates to patients, employers, and the healthcare team that a nurse’s knowledge reflects national standards and a strong personal commitment to patient safety.
In honor of the national celebration of certified nurses, we chatted with Elizabeth Scruth, PhD, MPH, RN, CCRN-K, CCNS, FCCM, FCNS, CPHQ, 2022-2024 chair of the board of directors of AACN Certification Corporation, the credentialing arm of the American Association of Critical-Care Nurses (AACN) and the executive director for clinical quality programs, data analytics and tele-critical care at Kaiser Permanente NCL about her career in critical care nursing and why she chose to get certified.
Tell us about your journey to becoming a nurse.
I started as an RN in the outback of Australia in a town called Kalgoorlie where mentorship and resources in the hospital were limited. I graduated from a hospital diploma program in Western Australia and spent many years as an RN before I went back for my undergraduate and graduate degrees.
Why did you decide to become certified?
The experience of working in critical care for many years with a diverse group of patients gave me the confidence to explore certification. From that humble start, I started exploring certification to further advance my knowledge and practice. Upon certification, I felt like I had given myself a gift. I value that gift and wear the credentials with pride. Certification demonstrates to everyone that I have that specialized body of knowledge and practice in critical care and that at the center is patient safety.
Nurses are held in high regard by the public, and it is important for all nurses to be able to speak to Certification and what it means to the RN and the patient and family in their care. Certification elevates the nursing profession and demonstrates to all that nurses are committed to their area of practice and patient safety.
How are you making a difference in the community where you work?
My current role within Kaiser Permanente also involves serving the communities in which we live. I am part of the local AACN Chapter and regularly engage with critical care nurses in Tele-Critical Care (remote ICU monitoring), where all RNs are certified with CCRN. I am actively involved in community work as part of my commitment to the mission and vision of Kaiser Permanente, including members and the public asking about what certification is all about.
What do you like best about your nursing career?
From my early beginning as a graduate nurse in Kalgoorlie – Western Australia, I have been fortunate to have been offered many opportunities to grow professionally. My career has been over two continents, and I have learned so much. The people I have met and the nurses I have worked alongside have encouraged me to seek further education and certifications. The best part of nursing is mentoring others and building capacity for the future. We highly need educated and certified RNs now and in the future. Anything less is unacceptable.
Please talk about your commitment to patient safety.
Patient safety is woven into every aspect of nursing and is part of standard care. As both a critical care certified RN and a quality professional, I am excited to see that patient safety is at the forefront of all quality and safety initiatives, and both patients and families are involved in the design of new paradigms of care. RNs are the gatekeepers for patient safety and spend the most time with the patient providing a 360-degree view of the care plan needed to ensure safety is at the center of care.
Do you have any wisdom to share with other nurses considering getting certified?
To nurses considering certification, my advice is simple: GO FOR IT! You can do it. You have the knowledge – and then wear the credentials with pride! Speak up about your certification and be proud of your accomplishments. Encourage those around you to become certified too.
A New York hospital reduced the incidence of medical device-related pressure injuries (MDRPIs) following a tracheostomy to zero for four years, according to a study published in AACN Advanced Critical Care.
The intervention used evidence-based resources from the Preventing Pressure Injuries Toolkit funded by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.
A key part of the new clinical process was a revised PDT tracheostomy procedural kit and documentation. During insertion, a polyurethane foam dressing was placed under the tracheostomy flange and secured with sutures and a flexible holder. The foam dressing remained in place for seven days, with primary care nurses assessing the site at least every 12 hours. As clinically indicated, the dressing was changed to a standard nonwoven gauze drain sponge after seven to 10 days.
The results showed that suturing a foam dressing as part of PDT tracheostomy insertion can reduce the incidence of associated MDRPIs.
The authors are Hazel Holder, DNP, MSN, RN, ACCNS-AG, CCRN, and Brittany “Ray” Gannon, PhD, MSN, AGPCNP-BC. Holder is a critical care clinical nurse specialist at NewYork-Presbyterian Westchester, and Gannon is a nurse scientist at NewYork-Presbyterian Hospital, New York City.
“When COVID-19 increased demand for healthcare equipment, we were able to refine our processes, transition to a revised PDT tracheostomy kit and maintain the integrity of the initiative,” Holder says. “We took a multidisciplinary approach that engaged all related specialties, with surgical site assessment and any clinician concerns discussed during daily rounds.”
Before the initiative, in 2018, the incidence of healthcare-associated pressure injuries (HAPIs) was 1.39% for all ICU patients. Tracheostomy MDRPIs accounted for 0.19% of the incidents (15 HAPIs, including two MDRPIs in 1,077 patients). However, of the two PDT tracheostomies performed, both patients experienced MDRPIs.
In 2019, the overall HAPI incidence decreased to 1.30%, with nine tracheostomies and no MDRPIs. The tracheostomy MDRPI incidence remained at zero for the next three years.
During the four years of this project, 22 PDT tracheostomies were performed in the ICU, with the foam dressing placed at the point of insertion in all procedures.
The project was conducted with another unit-based program to address the overall rate of unit-acquired HAPIs, which may have contributed to increased vigilance.
The Beacon Award for Excellence lauds hospital units that employ evidence-based practices to improve patient and family outcomes. The award provides gold, silver, and bronze recognition to hospital units that exemplify excellence in professional practice, patient care, and outcomes. Recognition is for a three-year term.
AACN President Amanda Bettencourt, PhD, APRN, CCRN-K, ACCNS-P, praises the exemplary efforts of the unit teams who achieved the Beacon Award for Excellence.
“During the height of the COVID-19 pandemic, Beacon units were truly a light showing the way forward, as these teams demonstrated an ongoing and steadfast commitment to providing safe, patient-centered, and evidence-based care to patients and families,” she says. “This achievement is not only a tremendous honor, but it also provides meaningful recognition of their efforts to achieve excellence in patient care and create a healthy work environment.”
Results from AACN’s most recent national nurse work environment study indicate that nurses who work in Beacon units and units obtaining Beacon recognition report healthier work environments and higher quality of patient care than nurses who don’t work in Beacon units.
Recipients of a gold-level Beacon Award demonstrate staff-driven excellence in sustained unit performance and improved patient outcomes that exceed national benchmarks. Silver-level recipients demonstrate continual learning and effective systems to achieve optimal patient care. Bronze-level awardees successfully develop, deploy and integrate unit-based performance criteria for optimal outcomes.
Sixty-six units received gold-level Beacon awards, the program’s highest distinction. Among the 2022 recipients, Arnold Palmer Hospital for Children in Orlando, Florida, had five units recognized with gold-level awards. Morristown Medical Center, New Jersey, had three units earning gold-level honors, with another two earning silver-level awards. University Hospital in San Antonio, Texas, also had five units receive Beacon awards in 2022 – three silver and two gold. Eight other hospitals had two units recognized with gold-level awards.
The only international hospital recognized in 2022 was Fundación Santa Fe de Bogotá, in Colombia, a first for the country. Three units at the hospital received silver-level Beacon awards, and a fourth unit earned a bronze-level award.
A total of 34 hospitals had multiple units honored with an award in 2022, demonstrating a system-wide approach to caring for acutely and critically ill patients and their families.
Twenty-nine units at 18 Texas hospitals attained Beacon status in 2022, the most for any state.
The American Association of Critical-Care Nurses (AACN) updated its landmark standards for tele-critical care nursing practice, offering specific recommendations for developing and enhancing tele-critical care programs.
The consensus statement reflects current evidence, best practices, and the expert opinions of AACN’s nine-person Tele-critical Care Task Force. It underscores how the contributions of tele-critical care nurses continued to expand by embracing additional risk assessments, interventions, and patient safety measures.
During the pandemic, tele-critical care nurses addressed the loss of experienced nurses from the on-site team, leaving a knowledge gap. Their work includes mentoring on-site nurses, facilitating the ongoing development of newer nurses, and supporting excellent nursing care.
The AACN updated its landmark standards for tele-critical care nursing practice, offering specific recommendations for developing and enhancing tele-critical care programs
The initiative brought together tele-critical care nursing leaders from varied backgrounds to share their expertise and dynamic front-line perspectives, resulting in a comprehensive, patient-centric update. The task force was led by Theresa Davis, Ph.D., RN, NE-BC, CHTP, FAAN, and Lisa-Mae Williams, Ph.D., RN, CCRN-K, two national leaders in tele-critical care nursing.
“Tele-critical care programs have become more pervasive with advances in technologies and expansions in modalities, and the number of patients served,” Davis says. “We’ve seen significant growth in tele-critical care services, including expanding beyond traditional critical care areas, medical-surgical units and even home-care settings. This document offers a broader definition of the term ‘teleICU’ to reflect how these nurses contribute to care beyond intensive care units.”
“In addition to caring for patients, tele-critical care nurses are helping to address the experience gap by providing an extra layer of support and expertise to the on-site team,” Williams says. “Knowledge and expertise are precious commodities, especially when caring for critically ill patients. Mentoring a novice nurse, a float nurse, or traveling nurse can instill a greater sense of confidence, while peer-to-peer collaboration can help on-site colleagues feel more supported.”
The consensus statement’s practice recommendations include essential elements for tele-critical care nurses, nurse leaders, and their healthcare organizations.
The document includes clinical scenarios with real-world examples of how clinicians implemented each key recommendation in various environments, including natural disasters and the COVID-19 pandemic. An increased focus on the importance of equity, diversity, and inclusion has been integrated throughout the document, beginning with its first recommendation and continuing through the practice model and clinical vignettes.
The statement includes the AACN Tele-critical Care Nursing Practice Model, which provides the conceptual framework for implementing and evaluating tele-critical care nursing practice.
