Parenting in the ICN with MFICare

UCSF will be the first US hospital to implement an innovative approach to Family Centered Care in the Intensive Care Nursery (ICN).

Our Canadian colleagues conducted a major clinical trial across every ICN in Canada studying Family Integrated Care (O’Brien, 2013). Results are very promising and show improved breast feeding, earlier hospital discharge and reduced parents stress scores. “Research suggests that infants admitted to the NICU and cared for under the FICare model grow faster and have less stress, spend fewer days in the NICU, and are less likely to be readmitted to hospital after discharge, compared to infants cared for primarily by staff. These infants are also more likely to be breastfed and for a longer time, which provides a host of long-term health benefits. The improved confidence and skills of parents in FICare increases parental readiness for the transition from hospital to home, improves management abilities at home, and lowers parental anxiety. Finally, parental involvement helps staff feel more confident in the abilities of the parent, which will help facilitate getting everyone home as soon as possible” (www.familyintegratedcare.com). The model is based on parent engagement, education and support. Parent stress during and after having a child in the ICN is quite significant; PTSD symptoms are present in a large percentage of parents after an ICN stay. Long-term stress of this nature interferes with bonding, growth and development in the child, significant health related illness in parents and the highest divorce rate in couples after such experiences. Patient and family engagement improves many aspects of hospital performance, which includes safety, quality, financial performance, patient/parent reports on experience of care, patient outcomes, and employee satisfaction (AHRQ). Our Canadian colleagues have challenged our team to bring this success and model/philosophy to the US. In bringing this to the UCSF BCH ICN, there are four major novel components of care to our ICN:

  1. A new peer parent mentor program. This involves recruitment and training mentor parents to support current parents in the ICN as well as ongoing support for mentor parents.
  2.  Daily group parent education sessions related to the care and diagnosis of their child will be a new component. This will not only provide daily education for parents but potential peer group benefits.
  3. Specialized Nursing training regarding Ficare philosophy and components of care.
  4. We have developed an APP for parents that aims to support parent engagement, education and peer support. (We have very fortunate support from Wills Way Foundation, Intuit, PTBI)

After more than 2 years of planning, engagement with our alumni parents and innovation of the mobile App, we have started enrollment (baseline data collection) Nov 1, 2016. There are 4 other nurseries preparing to join the study (UCLA 2 campuses, UCSF Benioff Children’s Hospital Oakland, Community Regional Medical Center in Fresno, Kaiser Santa Clara). UCSF will be the pilot institution and our program and training information will be shared. It is critical that we assess the effectiveness and impact on parents, volunteers and staff well before our larger study results are available. There is no qualitative component to the study to date with potential for rich information unavailable through larger study aims.

Aims

Explore the challenges and successes in program implementation of Family Integrated Care (including mobile enhanced FiCare via app) for parents. Specifically:

  1. What are the needs of parents who have infants in the Neonatal Intensive Care Unit?
  2. What do parents perceive as supportive to their parenting role
  3. What behaviors and programs support parents with an infant in the neonatal intensive care unit.

Potential Impact to UCSF Medical Center:

The UCSF Benioff Children’s Hospital Intensive Care Nursery is a 58 bed Regional Tertiary level 3 nursery with 950 infants seen each year. There are over 200 nurses. With our facility being the first training institute for a US study, we must be prepared for immediate evaluation of our training, tools and implementation plan.

Approach and Sample

Research design: Ethnographic qualitative approach primarily based on symbolic interaction
Data collection: In person (recorded) interviews, focus groups, observation and field notes.
Data analysis/interpretation: Semi structured interviews with parents will be analyzed after transcription for thematic interpretation. Observations will include parent education sessions, bedside education. Focus groups on program will be conducted with parents, in their education session. Ten parent interviews (including maternal and paternal interviews) and 2 focus groups will be conducted. Analysis will include assessment of the needs parents and perceived support and will include standard care and education in the ICN, MFICare materials, observations and interviews with parents. Analysis will be based on a symbolic interaction framework (Blumer, 1969). This includes the assumptions that meaning arises from a social and self-reflective process, that informants and investigators jointly create knowledge and findings, and that investigators must enter into the world of the people being studied (Rehm, 2005).

Principal Co-Investigators: 

  • Robin Bisgaard RN MSN CN IV, Benioff Children’s Hospital, Intensive Care Nursery
  • Linda Franck RN PHD FAAN, UCSF School of Nursing

Reducing Urinary Tract Infections in NICHE Hospitals

This is a multisite study (including UCSF), cluster-randomized controlled trial of performance audit and feedback at NICHE hospitals. The University of Colorado is the prime grant holder of the coordinating center. The specific aims of the study are to implement and test a methodology for information technology supported surveillance of urinary catheter duration and CAUTIs. An audit and feedback intervention on catheter duration and CAUTIs will also be tested.

Co-Principal Investigators: 

  • Daphne Stannard, RN, PhD, CNS
  • Carla Graf, PhD (c), MS, RN, CNS

Additional Investigator: 

  • Sandra Ng MSN, RN-BC, Informaticist

Research staff:

  • Sherrie Christesen, RN, BSN, CN IV

Practical Use of the Latest Standards for Electrocardiography (PULSE)

The PULSE Trial is a NIH-funded, 5-year (2008-2013), multi-site, randomized clinical trial about implementing practice standards for ECG monitoring and examining the effect on nurses’ knowledge and skills, quality of care and patient outcomes. The long-term aim is to improve nursing practices related to ECG monitoring in hospital settings for better detection and diagnosis of cardiac arrhythmias, myocardial ischemia and drug-induced prolonged QT syndrome.  Sixteen participating national / international hospitals (including UCSF Medical Center) are involved in this trial.

Despite advances in hospital electrocardiographic (ECG) monitoring technology, monitoring practices are inconsistent and often inadequate. Barbara Drew, RN, PhD from the UCSF School of Nursing spear-headed American Heart Association practice standards to improve hospital ECG monitoring. We are now implementing these practice standards in two units at UCSF (10ICC and 10CVT) in a study called the PULSE Trial (Practical Use of the Latest Standards for Electrocardiography). 

Nurses complete an education intervention that is web-based and unit “champions” assist in changing and improving practice. If implementation of the practice standards is associated with improvement in quality of care and patient outcomes, then there is the potential for improved care and outcomes for the millions of patients who require continuous ECG monitoring while hospitalized.

Principal Investigators:  

  • Barbara J. Drew, RN, PhD, FAAN, FAHA - Professor at UCSF School of Nursing
  • Marjorie Funk, RN, PhD, FAHA, FAAN - Professor at Yale University School of Nursing (NHLBI Grant)

UCSF Site Coordinators:  

  • Cass Piper, RN, MS, CCRN, CNS
  • Elise Hazlewood, RN, MS, CNS
  • Noraliza Salazar, RN, MS, CCNS

Advancing Nurse Leaders: A Research Study to Psychometrically Test a Measure of Leadership Development Outcomes

This research study will determine if two new surveys are strong and refined enough to be used in future research.  The surveys measure a nurse leader's development based on specific important job functions.

One version of the survey will be given to nurse leaders in California and the other to her/his employer.  A California nursing organization, Association of California Nurse Leaders (ACNL), has been offering a nursing leader development course for over five years.  The researcher will ask those participants and their employers to complete the testing of these two surveys.  Statistical tests, such as factor analysis and reliability and validity testing, will determine which items we will retain on the survey and if additional work is needed to strengthen the two surveys.

Co-Principal Investigators

  • Ann Mayo, RN, DNSc – University of San Diego
  • Linda Searle Leach, RN, PhD – University of California Los Angeles
  • Virginia Terra-Hodge, RN, MS – University of California San Francisco

Funded by American Association of Nurse Executives Seed Grant

GCS2: Generating Clinical Standards with the Glasgow Coma Scale

The Glasgow Coma Scale (GCS) was introduced by Teasdale and Jennett in 1974 as a tool to aid in objectively measuring the neurological status of a patient.

The GCS has achieved international acceptance and continues to be widely used, although studies have shown that it can be used  inconsistently by HCWs and clinical data can be mis-interpreted (Edwards, 2001; Ingram, 1994; Waterhouse, 2009). There have been unsuccessful attempts to replace or supplement the GCS with alternative tools, such as the Full Outline of Unresponsiveness tool (FOUR) (Fischer, 2010). The GCS remains the gold standard for neurologic screening and is built into APEX, the new electronic health record for UCSF Medical Center. 

To ensure standardization of the use of this tool, the research team has created a pre- and post-survey to assess knowledge of the GCS and application of the GCS using clinical scenarios and an educational program that will be available to nurses who consent to be in the study. In addition, there is a brief demographic section to the survey on the pre-survey only.

Co-Principal Investigators

  • Susan Khan, RN
  • Daphne Stannard, RN, PhD, FCCM

Co-Investigators

  • Courtney Trump, RN
  • Catherine Enriquez, RN
  • Karen Chisholm, RN

BCMA Simulation Training to Improve Medication Administration Safety Practices

It has been estimated that medical errors, including medication errors and adverse events, rank as the 8th leading cause of death in the United States (Hoyert et al., 1999). An error is defined as “an unintended act (either of omission or commission) or as an act that does not achieve its intended outcome” (Leape, 2007).

Medication administration is a complicated process involving many overlapping systems and complex human factors (San et al., 2012). A failure in any one system or point in the process can cause an error—and this error often happens during the drug administration process (Hicks et al., 2006; Stavroudis et al., 2010). While some errors are benign, others can cause patient harm and/or death. Fortunately, technological advances have enabled many healthcare facilities to institute bar-code medication administration (BCMA), which has been shown to reduce medication errors in various settings in  hospitals, including intensive care units, transitional care units, and acute care areas (DeYoung et al., 2009; Helmons et al., 2009; Paoletti et al., 2007). BCMA can prevent errors related to the timing of medications and has also been shown to reduce wrong-patient, wrong-drug, wrong technique and dose omission errors. However, BCMA as a safety technology is only as effective as its utilization. In other words, traditional medication administration practices must be altered in order to leverage the full safety benefit of BCMA. 

Changing practice is never easy. And while the actual act of administering medication may be similar across areas, the workflows surrounding medication administration—from order to patient administration—varies widely. Staffing, patient population, pharmacy support, and even the built environment all have a profound impact on the workflows surrounding medication administration. UCSF Medical Center has implemented BCMA as the new safe medication administration method for many inpatient areas starting in the Spring of 2012. Nurses, pharmacists, and respiratory therapists have been trained for BCMA using a three pronged approach: viewing an online orientation module; attending a training class; and participating in simulated patient scenarios that focused on BCMA and medication administration workflows.

Simulation is the cornerstone of training in organizations requiring high reliability, such as aviation, nuclear power, and the military (Frengley et al., 2011). The Institute of Medicine (2000) has advocated HPS as an effective way of training healthcare professionals. To reduce variation and to reinforce medication safety processes, UCSF Medical Center instituted a simulated experience, alongside more traditional training approaches, to prepare healthcare professionals for BCMA. It is expected that the results of this study will yield insights that will have great impact to UCSF Medical Center. For example, the Department of Nursing Education and members of the simulation training team can revise and adapt simulation scenarios in the future by better understanding how healthcare professionals perceived the usefulness of this initial simulation experience.

Principal Investigator

  • Daphne Stannard, RN, PhD, FCCM

Co-Investigators

  • Maureen Buick, RN, MS 
  • Adam Cooper, RN, MSN 
  • Craig Johnson, RN, MSN, FNP 
  • Melissa Lee, RN, MS, GCNS-BC 
  • Sandy Ng, RN, MSN, RN-BC  
  • Kathy Lee, RN, PhD, FAAN – UCSF School of Nursing 

Funded by UCSF 2012 Synergy Grant

Individualizing Assessments of Risk to Reduce Falls in UC Hospitals

Falls during hospitalization can lead to serious injuries and death. Consequently, policymakers have developed robust incentives for hospitals to reduce falls.

After UCLA’s Ronald Reagan Medical Center (RRMC) implemented a new innovation in 2010, the 5P Fall Prevention Method, falls declined by 30%.  The primary objective of this project is to have nurses at Santa Monica Medical Center (SMMC) and UCSF Moffitt-Long Hospital Complex (UCSF) critically and uniformly incorporate the fifth “P” (Preventing Falls) into their current hourly rounding practices, thereby assessing individual patients’ risks of falling and mitigating those risks on an ongoing basis during hospitalization. A secondary objective is to improve collaboration among providers with the ability to influence fall risk during hospitalization. 

Co-Principal Investigators

Catherine Walsh, RN, MSN – UCLA Medical Center
Teryl Nuckols, MD, MSHS – UCLA Medical Center
Carla Graf, RN, MD, CNS-BC – UCSF Medical Center

Funded by University of California Office of the President Collaborative Research Grant