1. St. Francis Critical Care: Nursing Unit Assessment
Kayla Hopper, Kerri Jo McDaniel, Alex Rodriguez, Baylee Stephens, Kailey Sweatman, & Sam Trupp

2. St. Francis Located in Columbus, Georgia
Nursing Manager: Kelli Koelsch
Intensive care unit (ICU)- 13 beds
Critical care unit (CCU)- 10 beds
Overflow care unit (OCU)- 4 beds

3. Who is Kelli Koelsch?
Nursing manager for both the CCU and ICU units at St. Francis hospital
Worked bedside for 12 years
Has been a nurse manager for 2 years
Advice:
Know how to multi-task
Always identify communication as a problem
People skills are a must
Have to be able to admit that you are wrong

4. Mission
St. Francis, a community-owned, Catholic healing ministry exists to provide exceptional health care services, in partnership with physicians, for all those in need.

5. Vision
St. Francis will be the preeminent health care delivery system in the Chattahoochee Valley and surrounding communities- the first choice of patients, physicians, associates and payers for health, wellness and life.

6. Core Values/Goals Excellence Professionalism Courage Compassion
Creativity
Open Communication
Mutual Respect
Ethical Behavior

7. Unit Culture Good interpersonal relationships
Friendly with peers, patients, and families
Teamwork
Good orientation for new nurses

8. Conflict Resolution Strategy
Open communication
Hear both sides of the story before a decision is made
Address the problem with each person individually
Have a meeting with all individuals involved

9. National Patient Safety Goals
Pressure ulcer prevention
NPSG : Assess and periodically reassess each resident’s risk for developing a pressure ulcer and take action to address any identified risks.
Central line-associated bloodstream infection prevention (CLABI)
NPSG : Implement evidence-based practices to prevent central line-associated bloodstream infections.
Catheter-associated urinary tract infections (CAUTI) prevention
NPSG : Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections.

10. Pressure Ulcer Prevention
Nationwide:
2.5 million patients per year acquire a pressure ulcer
Pressure ulcers cost $9.1-$11.6 billion per year in the U.S.
About 60,000 patients die as a direct result of a pressure ulcer each year
St. Francis Critical Care Unit:
In the beginning of 2012, the ICU had 2 pressure ulcers and the CCU had 2 pressure ulcers
As a result, they reevaluated the policies and procedures
Purchased new critical care beds
Set up turn teams on ICU and CCU
Designate 2 nurses per shift to remind all the other nurses about positioning
Chart position every 2 hours

11. Financial Issues on the Unit
Core measures and reimbursement complications
Performance based
Must score well to be reimbursed for care
Performance is tracked throughout the year by submitting data.
If they don’t submit data/score well, they don’t get reimbursed.
Sample data that is graded
Post-operative patients have to have their Foley catheter removed by post-op day 1
Have a blood sugar less than 200 post-op

12. Need for Change on the Unit
Change needed: Reporting at the bedside
It is a standard of nursing practice that report be given at the bedside.
Driving force:
The unit implemented a policy that nurses give report at bedside (except for some personal patient information).
Restraining force:
It is difficult to shift from reporting in the nursing station because it is a habit.

13. Patient-centered Care
Open visitation policy
Except for the quiet time at night or during certain procedures
Visitors can’t stay on the unit over night, but the waiting room is always open
Physician explanation
Physician should make the decision of whether to discuss patient- care and interventions with the family or another group of doctors if the patient is unable to make their own decision

14. Continuous Quality Improvement Measures
Hospital-wide measures that are more focused on this unit
Acute coronary syndrome policy
Goal: 90 minutes to cath lab
Stroke
CT within 3 hours
TPA if indicated
CABG
Prevention of sternal infection
Ventilator-associated pneumonia
CAUTIs and CLABIs

15. Leadership Skills Focus on interpersonal relationships
Facilitates feedback to ensure that communication remains open
3 staff meetings offered per month for the sake of communication
Power of motivation
Team building
Consistent feedback
Discipline policy
1st offense: documented, but education on the error is the focus
2nd offense: verbal warning
3rd offense: write-up

16. Current Recruitment and Retention on the Unit
They do not have any bonuses, referral bonuses, or any huge effort in place in the CCU
Recruit within the hospital using the clinical ladder
Retention/Attrition Rate:
They do have a retention problem because people go back to school (nurse practitioner and CRNA schools)
Average years worked is 5
Big turnover every 2 years for people going back to school

17. Staffing Process Normally a 2:1 ratio Exceptions to the 2:1 ratio:
Open heart, balloon pump, induced hypothermia, or if the patient has coded or is at risk for coding
All of these would be a 1:1 ratio
Floating
Try to avoid calling in other unit nurses because CCU/ICU is so specialized
If it is a necessity, they prefer to call nurses from telemetry

18. QUESTIONS?

19. References
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