Nurses speed up response time on patient isolations
Labs notify ICU staff quickly
ICU nurses at Cary Medical Center in Caribou, ME, are using a simple system that significantly reduces delays in alerting RNs of the need to isolate certain patients for infectious conditions.
The system addresses a serious gap in communication between the hospital laboratory and bedside nurses that in the past has created unnecessary delays, even oversight, when dealing with patients who need to be isolated immediately, says Darlene Higgins, CPHQ, quality management coordinator of the 65-bed community hospital.
The process requires that lab technicians notify unit nurses once they determine that a patient has proved positive for any infectious condition, including the presence of vancomycin-resistant enterococcus or positive Clostridium difficile.
Lab techs must notify unit nurses by phone, but they must also document the information on lab reports that are relayed to the ICU computer. The standard reports have been amended to include the sentence: "Patient must be put in isolation," when referring to certain patients, Higgins says.
System creates nurse accountability
RNs who receive the notification are then required to document the facts personally in the patient record and confirm with the lab that they received the notice by providing their full names in the electronic reply.
The nurse is then expected to follow up on hospital infection control procedures that include the need to move the patient to an isolation room, Higgins says. "The patient is moved first. The physician is called afterward."
In the past, patients with tuberculosis and other infectious diseases were being overlooked by delays in reports getting back from the lab, Higgins says. "And sometimes a report would get back and sit in an in-basket for hours."
The change has cut the amount of time involved from hours to minutes, Higgins notes.
In addition to speeding up the isolation process, the change has "cleared up a lot of ambiguity," says Virginia Gagnon, RN, CCRN, nurse manager of the special care unit, a combined medical and surgical ICU at Cary.
In the past, "we weren’t sure whether the patient truly needed isolation, or whether to call the attending physician first. This has allowed us to move rapidly in moving the patient," Gagnon recalls.
The system has not resulted in an increased volume of patients being moved to isolation, Gagnon remarks. "We are still seeing only about one patient per month. But that one patient is being isolated much sooner than in that past," she adds.
Earlier this year, the initiative received recognition by the Best Practices Network as an important process improvement. The Network is a collaboration of several clinical organizations, including the American Association of Critical Care Nurses in Aliso Viejo, CA.
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