Some of the most satisfying quality improvement efforts are the “quick wins” in which you make a meaningful contribution to patient care without having to invest a great deal of time, effort, or money.
Anne Arundel Medical Center in Annapolis, MD, has seen success with a number of quick wins that leaders there say could be implemented at other facilities or inspire other quality professionals to find their own small but meaningful changes.
One quick win involved the bedside drinking water containers at the facility, notes Chief Nursing Officer Barbara Jacobs, MSN, RN. The hospital had been using the standard plastic pitchers found in many facilities. When you’re 80 and not well, it’s hard to hold on to that pitcher and pour water into a cup, she explains.
The hospital switched to large see-through plastic cups with a handle and a straw, which were much easier for patients to use.
“We increased our oral intake for patients by 60%. That has had a profound difference in maintaining the hydration of older patients,” Jacobs says. “Keeping patients hydrated reduces the chances of delirium, which in turn reduces other risks.”
The cups have measurements on the side so that the patient, family, and nurse can see how much has been consumed, explains Lil Banchero, RN, senior director of the Institute for Healthy Aging at Anne Arundel Medical Center. Nurses and family can more effectively monitor and encourage the patient to hydrate because the water can level can be seen at a glance.
The new cups also reduce spillage, which is important for maintaining the dignity of the patient, Banchero says. They cost a little more than the standard plastic pitcher.
Mobility Techs Expand Role
Anne Arundel also improved mobility for elderly patients by rearranging expectations for technicians who assist with moving patients. Without increasing full-time equivalents, the hospital redesigned roles for those technicians, with one “mobility tech” being reclassified as a “quality tech.” This was part of educating the staff about the importance of mobility and setting higher expectations for the amount of mobility.
“It used to be that as a nurse, you felt good about getting the patient out of the bed and into a chair. Or they might walk three feet,” Jacobs says. “We’ve completely changed the expectations so that we’re getting them on their feet and moving in a productive way. Simply pivoting into a chair is not enough.”
The mobility techs now take patients for a group lunch, improving both their mobility and their social interaction, Jacobs says. This counters the common threat of social isolation for older patients and results in improved cognition, she says.
“We have family members saying their dad seems more alert and actually wants to get out of bed and go to lunch,” Banchero says. “That was a quick win with no added resources. We had one patient who was readmitted and was upset when she wasn’t immediately taken to lunch with the others.”
The increased mobility also allows physical therapists to concentrate on those who need the most attention to become ambulatory, since nurses don’t have to wait on physical therapy to ambulate every patient, Banchero says. The better mobility also improves the hospital’s length-of-stay metrics.
“We found that sometimes we would have patients who were still in the hospital only because the doctor wrote an order for physical therapy, when they actually didn’t need a physical therapist to get them up and walking,” Jacobs says.
What Matters Most
Anne Arundel also had quick success with emphasizing what matters most to the patients and having that drive care decisions. Hospital leaders felt strongly that patient care should be oriented toward what matters most to the patient, and that can be quite different among individuals, Jacobs says.
For some patients, what matters most might be their grandchildren. Others might say their pets at home. Still others might say music or a goal like walking again.
Whatever it is, the hospital puts it on a whiteboard in the patient’s room, showing everyone “what matters most.” The hospital provided T-shirts with that slogan to the staff and encouraged employees to talk to patients about what matters most to them.
“Anyone who walks in can see the whiteboard and strike up a conversation and ask about the grandkids or what kind of music the patient loves,” Jacobs says. “We want to know that we’re touching what matters to this patient, helping them focus on that and get better so they can enjoy that, rather than us deciding what should matter to them.”
Letting Patients Sleep
One offshoot of that effort was the realization that expectant mothers consistently used the phrase “healthy baby” as what mattered most to them. The hospital picked up on that and purposefully uses that phrase often in discussing maternal care, Jacobs says.
Similar revelations came in other units where patients had consistent focus on a particular issue like pain relief or going home, Banchero says. That information also was used to direct patient care and how staff members interact with patients.
Anne Arundel also moved away from routinely collecting vital signs during the night so that patients’ sleep was not disturbed unless necessary.
“Sometimes those checks are necessary, but a lot of times, there is no justification for waking a patient up at 2 a.m. to check their blood pressure. You’re doing more harm than good by disturbing their sleep, so we worked with our medical guidelines and adjusted our electronic record so it doesn’t automatically prompt for those checks during the night,” Jacobs says. “That was an easy win, something that made sense to everyone and could be done very easily.”
- Lil Banchero, RN, Senior Director, Institute for Healthy Aging, Anne Arundel Medical Center, Annapolis, MD. Phone: (443) 481-1000.
- Barbara Jacobs, MSN, RN, Chief Nursing Officer, Anne Arundel Medical Center, Annapolis, MD. Phone: (443) 481-1000.