In an intensive care unit (ICU), nurses treat seriously ill patients and provide critical care. These specialized staff members are the closest clinicians to patients, monitoring advanced equipment such as ventilators, feeding tubes and catheters, and administering sedatives and pain medications. Given their frequent interactions, direct care nurses are ideally positioned to understand patients’ needs and identify opportunities for improvement. And yet, most nurses do not see themselves as innovators.
Marian Altman, Ph.D., RN, CNS-BC, CCRN
Clinical Practice Specialist, American Association of Critical-Care Nurses
In 2012, the American Association of Critical-Care Nurses (AACN) sought to change that perspective by launching AACN Clinical Scene Investigator (CSI) Academy. In this project-based program, teams of two to four nurses work together to address a patient-care challenge in their units.
For example, nurses in the cardiac surgical ICU at Cedars-Sinai Medical Center in Los Angeles observed errors and discrepancies in patients’ IV drips, pacemaker settings, and chest-tube water levels. They attributed these errors to the lack of a standardized handoff report, which communicates patient information between nursing shifts or hospital units.
The team collected feedback from the staff and created a new handoff tool that focuses on patient safety checks. They introduced the new report with visual aids and incentivized its use by asking nurses to enter their handoff partner into a raffle when the new handoff routine was completed.
Since the project’s launch, discrepancies and errors have been reduced dramatically, and the unit culture has an increased focus on safety.
Empowering nurses
More than 500 nurses in over 100 hospitals have participated in CSI Academy, with projects addressing patient safety issues like injuries, infections, and falls. Teams also seek to improve their unit environment by looking critically at staffing models, employee satisfaction and nurse confidence.
By empowering nurses to be change agents and innovators, patient safety increases and clinicians are more engaged. As Regan Morimoto, a CSI Academy participant from New York Presbyterian/Morgan Stanley Children’s Hospital, said, “I had a lot of ideas but didn’t know how to focus them or where to go. CSI Academy lit a flame and I’ve been unstoppable.”
