NHS is a RNAO Spotlight Organization
Since 2003, the Niagara Health System has been honoured to be selected as a Nursing Best Practice Spotlight Organization in Ontario by the Registered Nurses Association of Ontario. The partnership reflects the Niagara Health System's demonstrable track record with RNAO Best Practice Guidelines, in addition to the knowledge, skill and experience of the NHS's Project Team.
"Spotlight Organizations are considered leaders in the field of nursing best practice guidelines," says Doris Grinspun, Executive Director of RNAO. "This partnership reflects very positively on the executive and nursing leadership at the centre and work done by staff at the Niagara Health System. We continue to work collaboratively with the Niagara Health System and the other Spotlight Organizations in planning, implementing, evaluating nursing best practice guidelines and disseminating knowledge from demonstrated experiences with guidelines across the country."
The RNAO's Best Practice Guidelines are systematically developed recommendations that address clinical situations based on best available evidence. The guidelines assist clinical professionals to deliver the best possible care to consumers.
"The Niagara Health System fundamentally believes that it must continue to strive to improve the care and services for the population we serve," says Debbie Sevenpifer, NHS President & CEO. "One of the essential mechanisms for doing so is the implementation of Best Practice Guidelines. We are very proud to have been selected a Spotlight Organization."
Nursing continues to evolve throughout the NHS. RNAO's Best Practice Guidelines (BPG) continue to influence change in clinical and professional practice. As part of a comprehensive nursing strategic workplan, we have several key priorities. One of the priorities is the implementation of a model of care delivery – Patient/Client Centred Care. Collaboratively, we will implement RNAO's BPG – Client Centred Care across the seven sites within the NHS. We are not only including nurses, but all allied health professionals and staff in our implementation and educational plans. As a Gold Member of the Centre of Excellence with RNAO as of March 2007, we are utilizing the Centre of Excellence for education on the Client Centred Care BPG.
Our second major priority is the Developing and Sustaining Leadership BPG. As a partner in the Healthy Workplace Initiative, we have provided several workshops to 75 Charge Nurses and Clinical Managers on Developing and Sustaining Nursing Leadership BPG. This is the tool we are using as our framework for nursing leadership across the NHS. Our nursing leadership meetings are now conducted monthly to engage learning and debate using this Best Practice Guideline on nursing leadership.
Our third priority is the further implementation of the Pain Assessment BPG and its integration throughout the Medical Program. This is being led by our two champions in collaboration with the Program Leadership.
The NHS is truly excited about maintaining our BPSO status and we are committed to moving forward with all of these excellent initiatives.
Over the last few years, the NHS has implemented and is evaluating the following Best Practice Guidelines:
- Integrating Smoking Cessation into Daily Nursing Practice
- Prevention of Falls and Falls Injuries in the Older Adult
- Risk Assessment and Prevention of Pressure Ulcers
- Assessment and Management of Pain
- Asthma Care Guidelines for Nurses: Promoting Control of Asthma
- Reducing Foot Complications for People with Diabetes
There has been significant progress in the development of multiple Best Practice Guidelines (BPG) at NHS hospitals. The sustained efforts of Nursing Leaders, Educators and point-of-care Nurses who are Project Leads, have produced some excellent outcomes.
In keeping with most other hospital organizations, the NHS is facing the challenges associated with change. In doing so, the integration of the RNAO BPGs have served as a catalyst to make decisions, empower staff, improve outcomes and create a common nursing goal in many situations. We are gratified to participate in this work and are focused on the continuation of this and other BPG work
Smoking Cessation
This initiative was under the leadership of Annette Railton at Welland Hospital Site in the first Spotlight year. The entire staff of Registered Nurses was offered education on the counselling methods, outlined in the guideline, to assist the client to stop smoking. Pre and post tests were conducted to ascertain the level of knowledge transfer. These are currently under analysis. In addition, the data necessary to assess practice change is being collected. It is hoped that the information will help us understand the best method of influencing implementation of best practice with clinicians.
This endeavor also produced alliances with Brock University, fellow clinicians and community supporters. These alliances are being developed to further the project.
The Welland pre-operative clinic was the site of a RCT to assess the effect of an intensive intervention, based upon the BPG, to promote smoking cessation in this population. To date, 34 subjects are enrolled. Preliminary results show some promise. The Champion of the Smoking Cessation BPG has been asked to assist the corporate NHS in an endeavor to impact on smoking cessation with the staff.
Prevention of Falls
Under the leadership of Debbie Roberts, this endeavor was undertaken at Welland Site's Woolcott Wing (Complex Continuing Care Unit) initially. The NHS has an organization-wide program that the team used as its base. The Champion and team assessed the root cause of falls on the Woolcott Wing. They also used the BPG to assess medication practice. They conducted audits into the compliance of falls risk assessment tool use and concluded that the current tool is too complex. They are currently in the process of choosing a new tool. The team has worked with data from Risk Management. They are planning to develop an improved process that can be applied throughout the NHS.
Pressure Ulcer Prevention
St. Catharines General site was the original implementation site for this project, which proved very successful. Practices were reviewed and education was given to the nurses on best practice. The work of the Champion infiltrated all levels and resulted in improved wound care, better purchasing practices and new equipment acquisitions. Prior to the transfer of the inpatient beds to St Catharines General Site, nurses at Ontario Street Site were provided with an introduction to the BPG work and NHS practices. The inpatient beds were then transferred to SCG Site and staff transferred. Preparations are now underway to post the educational material on the NHS intranet.
At Port Colborne General Site two Champions, Anne Spencer and Donna Dubeil from Greater Niagara General Site, began the work of integrating best practice for wound care in a medical surgical unit. Anne and Donna have co-ordinated an educational package based on the SCG work and have scheduled delivery of the sessions to co-ordinate with the Fall in service education scheduled by the manufacturer of the newly-purchased surfaces. An NHS wound prevalence study serves as the base line for this work. It is anticipated that this will be used as an outcome measure also. In addition, Douglas Memorial Hospital Site has asked the Champions to work with their staff.
Pain Management
This is a joint implementation involving St. Catharines General and Greater Niagara General Site Champions. The Champions have developed a new pain tool, conducted pre-tests on staff knowledge and developed mechanisms for staff education. They are developing and revising a self-learning package that they intend to disseminate to a wider group should it prove effective. With the support of the Nursing Professional Practice Council, the Champions are currently assessing the management of pain through application of the tool and supplementary client interviews. Mary Lou has also engaged the Pediatric Program in developing a Pain Assessment Tool for their patient population.
Asthma
Mary Stranges, RN, BPG Champion
Launched in the summer of 2005, this project coincided with the opening of an outpatient asthma paediatric clinic at Welland Hospital Site. Mary has received a good deal of information from other organizations that have expertise in the area. Mary has also developed a teaching package, a pre-test and post-test, an asthma kit with all the teaching props for staff and a package for the parents. This will be delivered by the end of 2005. In addition, they are getting baseline data on the prevalence of asthma-related ER visits and admissions.
Care of the Diabetic Foot
Lisa Berry, RN, BPG Champion
This project, launched in September at Ontario Street Site (OSS), has Lisa Berry as the designated Champion. Lisa is a member of the Dialysis Unit and is in the early stages of implementing her BPG as a result of the program transfers between NHS Sites.
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