June 30, 2006

Data management driving MICU’s Magnet efforts

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Data management driving MICU’s Magnet efforts

Spring Morse, R.N., right, walks Sara Angelly through the Dashboard information system in the Medical Intensive Care Unit.  
Photo by Anne Rayner

Spring Morse, R.N., right, walks Sara Angelly through the Dashboard information system in the Medical Intensive Care Unit.
Photo by Anne Rayner

The Medical Intensive Care Unit (MICU) staff is using its focus on quality to connect the dots between elevate and the pursuit of Magnet Recognition.

“We wanted to do a better job of showing staff how they impact patient care and various benchmarks,” said Julie Foss, MICU manager. “When we talk to staff, these data make the issues come alive and allows each person to get directly involved in quality goals.”

Foss literally locked herself in her office and started crunching numbers from the unit's Dashboard information tracking system, which allowed a level of detail never before available. The result was valuable, quantitative information that showed trends, improvements and challenges for staff.

Foss started gathering data according to the five pillars of elevate — people, service, quality, growth and finance — and posting them around the unit. She first focused on “people,” which is also Magnet Force no. 5, and posted data that recognized the staff's commitment. Items such as registered nurse turnover showed Vanderbilt's MICU is consistently below the national turnover rates. She also produced data to show that staff rounding programs has grown tremendously, starting with 11 percent participation last July and reaching as high as 95 percent participation more recently.

“The metrics of Dashboard have gotten us attached to the reality of what's going on in the units and given us a place to focus around improvement,” said Robin Steaban, administrative director of Cardiology and inpatient medicine. “We are perfecting it and have started to use it to drive change.”

Magnet Recognition is the highest level of recognition for health care centers that provide nursing care determined by the American Nurses Credentialing Center (ANCC). Only 2 percent of hospitals in the country are Magnet Hospitals. VUMC has more than 170 Magnet Champions or staff leaders representing every major department and clinic. The accreditation process will culminate with a site-visit this summer.

Foss's passion has always been quality — an elevate pillar as well as a key element in Magnet Recognition.

The 26-bed MICU is the place where acutely ill, non-surgical patients who also have chronic complications like diabetes, heart disease, etc., go for intensive care.

The unit keeps close watch on several quality outcome measures, including nosocomial infection rates such as urinary tract, central blood line and ventilator-related pneumonia infection rates to ensure excellent care.

Identifying and communicating messages that will impact the behaviors of the more than 90 members of the staff can be difficult, so Foss once again turned to the numbers to explain the unit's quality goals.

When she presented this data and trend information to staff, it bonded the group closer together to pursue the common goal. She found more people asking questions, making suggestions and investing themselves in the outcomes. For instance, the staff has focused on decreasing ventilator assisted pneumonia. The national average is 9 percent, and the MICU's goal is 4.97 percent. During the last several months, the staff has worked together to address this issue and the trend is going down. In May, the rate was 3.5. Equipped with this data, the staff is using the same approach on all its quality measures.

Steaban cites the MICU's collaboration between staff and leadership as one of its greatest strengths. “They know what the metrics are and there is a united effort to problem-solve together,” said Steaban.

She adds, “Julie is an incredible leader. The quantitative information she is using allows the staff to get involved early on to solve problems, and that results in greater traction for problem resolution. It's a much better approach than a manager sitting in isolation in an office trying to determine appropriate interventions.”

“Our staff is doing the hard work, day in and day out,” said Foss. “I'm just putting the numbers in a spreadsheet.”

Unit managers and its six Magnet Champions are also planning to use the figures in their one-on-one training in preparation for the Magnet site visit. Storyboards are also on the way.

“It's about making our information accessible and using it to improve quality,” said Foss.

She admits the push is on in preparation of the Magnet site visit, but strongly believes this approach is what elevate is all about.

She believes this information is so helpful, she will continue this approach from now on.