Datascope excellence in multidisciplinary team collaboration award.

Editor's note: Sponsored by Datascope, these awards honor innovative contributions to collaborative practice by nurses who care for acutely and critically ill patients and their families. At least one of the collaborators must be an active AACN member. Recipients of the award are:

Medical Intensive Care Team

Kalamazoo, Mich.

Bronson Methodist Hospital

Our 14-bed Medical Intensive Care Unit (MICU) multidisciplinary team includes the staff RNs, intensivists, nurse manager, clinical nurse specialist and administrator, along with Pharmacy, Dietary, Respiratory Therapy and Infection Control personnel. Daily rounding allows all team members to offer input for advancing patient care. This collaborative team also facilitates the implementation of evidence-based practice bundles (VAP, CR-BSI, Severe Sepsis/Septic Shock) to improve outcomes. The team used creative techniques to implement these bundles, with the assistance of the staff RN champions who provided the education. VAP prevention included an evidence-based protocol as well as a cake decorated with figures representing key protocol components. To ensure compliance with CR-BSI prevention requirements, a checklist was placed on our line cart as a reference and tracking tool. A video starring multidisciplinary team members was professionally produced to increase awareness of early sepsis management. In addition, a sepsis clinical pathway utilizing the Surviving Sepsis Campaign guidelines was developed to encourage efficient delivery of evidence-based care. A Daily Goals Sheet, completed during team rounds, focuses on patient issues and develops plans to discharge the patient from the MICU. Annual admissions rose by 160 patients with an additional 13.3 patients admitted monthly. Length of stay fell by 0.9 day/month, average ventilator days fell by 0.89 and VAPs declined to 1.6/1000 device days. CR-BSIs have been all but eradicated at a rate of 0.15/1000 line days. Through utilization of the sepsis video and pathway, compliance with each guideline rose 20%-30%, and there was a decrease in mortality of 11%. Staff satisfaction was at an all-time high of 98% with a turnover rate that fell from more than 10% to about 2%.

Stroke Multidisciplinary Team

Tallahassee, Fla.

Tallahassee Memorial HealthCare 

Tallahassee Memorial Hospital was recently approved by The Joint Commission as a "Designated Stroke Center." Although the application process began about a year ago, the foundation for developing protocols and staff has been in place for some time. This foundation was based on our Stroke Team and especially our CNS, with a collaborative protocol developed by a passionate physician-champion. Our Stroke Team includes a dedicated stroke nurse from the VNICU and the floor, a physical therapist, occupational therapist, speech-language pathologist, clinical dietician, case manager, social worker, pharmacist, service line administrator, organization improvement advisor, music therapist and student interns. The use of evidence-based guidelines and ongoing staff in-services allowed the latest research to be incorporated into treatment conversations and therapeutic applications. The tradition of a block nursing assignment did not serve the needs of our stroke population. I, as the nurse manager, agreed with our physician that stroke patients needed a consistent nurse. Stroke nurse assignments are based on diagnosis and not location. Since we began the application process, the Stroke Team has developed scripts and standardized questions for its daily team rounds to help focus on key clinical and curative issues. Since implementing our team approach to stroke, the average length of stay has dropped one full day. Our daily multidisciplinary emphasis on collaboration versus competition and on conversation versus confrontation has not only improved patient outcomes but has led to a camaraderie previously unknown. This group of clinicians in individual "silos of care" has been transformed into a highly motivated team of stroke experts ... a true circle of excellence.

CICU Outcome Facilitation Team

Milwaukee, Wis.

St. Luke's Medical Center

The Outcome Facilitation Team (OFT) process in our unit creates a multidisciplinary environment to identify and meet patient needs. We strive to reduce length of stay, clarify priorities of care, identify risk factors and eliminate barriers to health and well-being. Each patient is reviewed daily by a multidisciplinary team directed by nursing and incorporating input from social services, nutrition services, speech therapy, physical therapy, occupational therapy, pharmacy services, utilization management, respiratory therapy, chaplaincy and physicians. Through this collaboration, infection control concerns and unit needs are highlighted and resolved. Evidence-based practice is supported and reviewed frequently. The OFT process has been invaluable for stress ulcer prophylaxis, pressure ulcer prevention, promotion of advance directives, DVT prophylaxis and development of standard protocols for patient care. By having all disciplines at the table, we create comprehensive and individualized patient care objectives. These objectives can then be realized quickly and efficiently to provide quality care and minimize cost. Long-term patients with complex medical needs typically have multiple medical consults as well as rehabilitation, social and spiritual needs. The OFT process supports the medical needs of the patient by involving the E-ICU doctor and nurse. The E-ICU is an off-site interactive team who reviews patient vitals, labs, assessment data and orders to improve outcomes. The E-ICU doctor and nurse are present via teleconference during OFT rounds to provide a unique perspective, which promotes interdisciplinary partnership and fosters healthy relationships among staff. We reduced our ventilator-associated pneumonia and central line infection rates to zero and continue to maintain high patient satisfaction scores.