The DAISY Awards for Extraordinary Nurses are given to nurses who display extraordinary and compassionate care throughout the year. More than 3,600 healthcare facilities throughout the U.S. as well as 21 other countries participate annually in the program. Nurses who received the DAISY award from their organizations between January 2017 and June 2018 were eligible for the 2019 IHI DAISY Awards.
"We saw an incredibly diverse pool of nominees with strong dedication to their patients and to providing safe health care," saidPatricia McGaffigan, RN, MS, CPPS, vice president, safety programs, IHI. "These honorees demonstrate nursing skill and expertise matched by compassionate care, collegiality with peers, and a commitment to advancing their profession."
Jobic Ray Butao, RN, BSN, CCRN, of West Kendall Baptist Hospital in Miami, the recipient of the individual award, was chosen for working with hospital executives to initiate nurse sensitive indicator outcome-specific leadership rounds in the ICU and leading efforts to reduce central-line associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Over an 11-month period there were no cases of CLABSI and just one case of CAUTI in the ICU. Due to the success of his efforts, these practices are being implemented throughout the hospital.
The wound ostomy nurses at the University of Iowa Hospitals & Clinics (UIHC) will receive the team award for their technical skill and knowledge as well as their leadership in promoting interprofessional teamwork and their compassionate care of patients. This eight-member team cares for patients with all manner of wounds – from pressure ulcers to ostomy wounds. Thanks to their efforts, the hospital is below national benchmarks for pressure ulcers for both adult and pediatric patients. They also created an interprofessional committee to address hospital-acquired pressure injuries.
"We are so proud of our wound ostomy nursing team," said Cindy Dawson, MSN, RN, CORLN, chief nurse executive, UIHC. "They demonstrate excellent clinical care every day through their interprofessional teamwork, use of evidence-based care, and outstanding quality improvement work. This award truly highlights the incredible work they do every single day for patients, family, and staff."
The Emergency Medicine Trauma Team at Children's National Medical Center in Washington, D.C., will receive an honorable mention for its work in improving patient and workforce safety by meeting the mental health needs of pediatric patients in the emergency department. As a result, Children's has seen a 53% decrease in reported aggressive or violent events toward staff along with zero need to use restraints.
Portfolios house evidence of the increased knowledge, experiences, skills, and abilities nurses achieve throughout their careers, displaying their personal mastery and professional maturity.
The concept of a professional portfolio is not a new concept in nursing, but a review of available literature reminds nursing leaders of its value regarding personal and professional development and advancement for nurses.
A well-developed portfolio is a chronological, visual representation of a nurse's professional growth. The portfolio does not replace a nurse's curriculum vitae (CV) or résumé, but rather it is the supporting documentation that validates what is stated on the CV. Whereas a nurse's CV or résumé is an overview of past education, employment, skills and other pertinent professional activities, the portfolio provides a detailed look at a nurse's accomplishments.
Purpose of Portfolios
Portfolios are a visual way to look at all the career experiences nurses have encountered in their lives and across the many paths they have chosen—to celebrate the successes, to learn from challenges, and to enthusiastically anticipate whatever comes next.
Each portfolio is a collection of exemplars, artifacts, and other evidence organized in an electronic or hard-copy binder, for example, for a specific purpose or audience. Each nurse will build his or her portfolio based on its intended purpose, whether personal, academic, or professional advancement.
Creating a master portfolio that can be adapted when needed can provide a foundation for extracting whatever artifacts are required for specifically targeted audiences (e.g., new hire or career advancement). They showcase nurses' knowledge, skills, experiences, and accomplishments related to selected goals or objectives. Portfolios are NOT prescriptive; they are fluid and dynamic, providing past and present evidence (artifacts) demonstrating competence and competency related to experience, professional practices, processes, quality, and relationships.
Benefits of a Portfolio
The primary purpose of a master portfolio is to document, categorize, and showcase knowledge, skills, and abilities (KSA); growth; and progress as an individual, a student, and as a professional. This is especially critical for healthcare providers and nursing students learning and working in increasingly complex communities of education and practice. Building a portfolio invites nurses to engage creatively throughout the process to do the following:
Establish a strategic record of personal, academic, and professional activities and accomplishments over time
Guide critical decisions related to personal choices and volunteer activities, goals for education and training, and professional opportunities
Tangibly demonstrate learning and KSAs in specific areas of study and practice
Validate and improve competence through narratives that connect reflective practice to practice standards and advance relevant and purposeful competencies through continual professional development
Provide more detailed exemplars for performance-based interviews, applications for employment, scholarships, grants, bonuses, or promotions
Speak to specific qualifications required for various positions when entering academia or the workforce and for transitioning into new roles
Document required artifacts to illustrate portfolio-based competency assessments for regulatory agencies, accreditations, performance appraisals or evaluations, or certifications (e.g., VA Nursing Professional Standards Board reviews; American Nurses Credentialing Center certification renewals, American Academy for Preceptor Advancement certifications for Preceptor Specialists)
Explore and map the quality, safety, and expansiveness of personal mastery, academic progress, and professional development (e.g., serving on various committees, projects and task force groups, and interprofessional collaborative teams; completing preceptorships and mentorships)
Guide academic and career planning (e.g., artifacts for progressive career ladders)
Reflect on personal growth and development acquired through study, work, and applications of knowledge to meeting personal goals and gaining wisdom (e.g., show enhanced critical thinking skills and abilities to safely engage in complex projects or activities)
Capture previous work and lived experiences, challenges met, and life lessons learned for academic or work credits
Communicate the highest level of personal mastery and professional preparation through multiple media (e.g., technology) and other artifacts
Portfolios contribute to any conversation nurses will have as they grow and develop personally, academically, and professionally, regardless of the paths they take. Portfolios are significant resources for nurses to showcase competence and practice improvements, with artifacts demonstrating abilities to narrate lived experiences and the insight gained through reflection and reflective practice.
New Jersey is one of eight states that require hospitals and nursing homes to report staffing ratios.
In 2008, New Jersey began requiring hospitals and nursing home to publicly report the number of patients per nurse and a recent study out of Rutgers, found the law has led to better nursing staffing ratios.
The study, published in Policy, Politics, & Nursing Practice is the first study of its kind to evaluate the effectiveness of this particular requirement. Since the law went into effect, the number of patients decreased in 10 out of 13 specialty areas of care.
“Nurse staffing, particularly for registered nurses, has been shown to have a direct impact on patient outcomes, such as rates of infection, falls, heart attacks, and even death. Insufficient nurse staffing also can affect a patient’s length of stay in the hospital,” said lead research Pamela de Cordova, PhD, RN-BC, an assistant professor at Rutgers School of Nursing, in a release. “By reporting and analyzing the data and ensuring that nurses are included in staffing discussions, patient outcomes can be improved.”
The following specialties showed the most significant change of RN staffing:
Neonatal ICU, number of assigned patients decreased from 2.1 babies assigned in 2008 to 1.9 babies assigned in 2015
Pediatrics, number of patients decreased from 2.7 children in 2008 to 2.4 children in 2015
Medical-Surgical unit, number of patients decreased from 5.5 patients assigned in 2008 to 5.1 patients assigned in 2015
Only the adult open psychiatric specialty saw an increase between 2008-2015 in their staffing ratio. The number of patients assigned to an RN during this time increased from 5.8 patients per nurse to 6.1 patients. The study found that the closed child psychiatric and adult ICU specialties saw no change in the number of patients assigned to RNs.
Hospitals and nursing homes are mandated by the law to submit detailed information about nurse staffing levels, including the number of patients assigned to each staff type, within sight of the patients, to the New Jersey Department of Health, which shares the information online.
New Jersey is one of eight states (five required by law and the other three, electively) that require hospitals and nursing homes to report staffing ratios.
Nurses say highest satisfaction points are those related to patient care.
A new report from the Arch Collaborative says 62% of nurses reported being pleased with their overall electronic health record (EHR) experience, compared with just 16% of physicians. The group surveyed 70,000 clinicians, including 28,000 nurses.
The report identified two areas of success that successful facilities have in common: strong initial and ongoing education and shared EHR ownership. Nurses typically have a longer training period than physicians which can have an impact on how comfortable they have using the program. Indeed, 56% of surveyed nurses agreed that their initial training/education factored into their positive response, compared to just 43% of physicians who reported having a strong initial training/education period.
In terms of EHR ownership, nurses (59%) slightly edged out physicians (52%) when asked about their thoughts about the EHR vendor. They were also asked to rate themselves regarding whether they felt a personal sense of ownership over the EHR, 78% of nurses reported their confidence in their ability to use the EHR vs. 56% of providers who reported the same.
Other areas that nurses overwhelmingly expressed greater satisfaction than providers: 67% of nurses agreed that the EHR is helpful in terms of patient safety, while only 47% of providers feel the same. Nearly 62% of nurses report the EHR enables them to deliver high-quality care. Also, 60% of nurses reported that the EHR allowed them to deliver better patient-centered care.
While nurses provided high favorability for the EHRs, they acknowledged there are areas that need improvement. Over half the nurses surveyed reported the need for improved integration with outside organizations. The same number of nurses agreed that the EHR improved efficiency and provided them with needed analytics, quality measures, and reporting.
There doesn't seem to be one particular reason for nurses to get more patient-focused insights from the EHR than providers, according to the report's authors.However, the authors recommend organizations examine why this is the case and how nurses use the EHR to benefit patients as well as how to improve the provider's experiences with EHR.
Nurses are in a unique position to coordinate partnerships and provide the kind of patient-centered care needed to address the health issues of the 21st century.
Healthcare leaders find themselves in a unique situation as traditional medical care may not be enough to address increasing health problems, specifically those that are often referred to as “diseases of despair.” These diseases or health issues are both physiologic and socio-economic/emotionally based, and include issues such as substance abuse, mental health, maternal mortality, and low birth weight.
"There is growing recognition that medical care alone is insufficient to address growing health problems of today's world," said Patricia Pittman, PhD, the author of the report and co-director of the George Washington University Health Workforce Institute, said in a release. "Nurses are uniquely positioned to coordinate partnerships and provide the kind of holistic, patient-centered care that can address the current rise in substance abuse and other diseases of despair."
Pittman identifies four areas employers and policymakers should consider in to expedite expanding opportunities for nurses to change where and how they practice.
1. Core functions of nursing need to be strengthened regardless of where nurses work
Once these have been identified and strengthened, nurses should be able to determine which tasks can be given to other team members, freeing them to focus on high priority issues. Functions include, but are not limited to the following:
Extending compassion and trust with patients, their families, and communities.
Assessing the unmet needs of patients, families, and communities.
Building partnerships within and outside healthcare to find solutions to issues.
2. Work at the intersection of other disciplines or professions
The report authors suggest that by working at the intersections of discipline, or working with groups that aren't necessarily connected, innovation for nurses is greater than if they work within pre-set boundaries.
3. Aligning nursing education with the core functions
Right now, nurses have a basic understanding of population health but might be unprepared to conduct population assessments, according to the report. Nursing education needs to have a stronger focus on population health, health equity, as well as programs to ensure diversity within the nursing workforce.
4. Practice and policy
Employers, educators and policymakers should be willing to work with nurse leaders to create jobs with roles that build trust, establish partnerships and provide care that can help patients, families, and the entire community stay healthy.
The AACN opposes cuts to healthcare, education, and research in Trump's proposed budget for 2020.
The American Association of Colleges of Nursing (AACN) issued a strong response late last week to President Trump’s proposed fiscal year budget for 2020.
The proposed budget includes substantial cuts to Medicare and Medicaid over the next 10 years. The budget calls for an $800 billion decrease in funding for Medicare and a $200 billion decrease in funding for Medicaid. Additionally, the president's budget also recommends cutting $8.5 billion from the Department of Education.
In the release, the AACN said they "strongly oppose decreasing federal dollars by this magnitude and believes that safeguarding the public is not only done through defense, but by supporting academic and public health efforts as well."
This budget cut affects institutions for higher education and will have an impact on educating the nursing workforce in all communities throughout the country, including rural and underserved areas.
"Supporting the growth of the nursing workforce is a necessary investment to ensure that the nurses educated today are ready for the challenges of tomorrow. Nursing is not immune to what would result in diminished financial support for undergraduate and graduate students, as well as our faculty and programs," says Deborah Trautman, PhD, RN, FAAN, AACN president and chief executive officer.
Additionally, the AACN states discrepancies in the amount of proposed cuts to Title VIII Nursing Workforce Development programs. Only one program, the NURSE Corps, a scholarship program, is unaffected and the budget stays the same at $83 million in FY 2020. The National Institutes of Health faces cuts of $5 billion, which if passed, will reduce the National Institute of Nursing Research’s budget by $23 million.
"Federal funding for Title VIII Nursing Workforce Development programs is essential to our nursing schools, students, and profession,” said Ann Cary, PhD, MPH, RN, FNAP, FAAN, chair of AACN's board of directors, in a release. “Cuts to these programs directly impact the health of America and conflict with the academic nursing mission to prepare a highly-educated nursing workforce."
The number of nurse practitioners has grown exponentially in the last year.
The number of nurse practitioners (NPs) in the U.S. has grown substantially over the 10 years, according to survey results recently released by the American Association of Nurse Practioners (AANP). According to the survey, there are an estimated 270,000 licensed and practicing NPs in the U.S., which is slightly higher than the AANP’s projected 248,000 NPs from March 2018. This number is twice the number of practicing NPs in 2007 (120,000).
Licensed nurse practitioners have been treating patients since the 1960s, when their role was initially intended to address pediatric well visits in rural areas in Colorado.
According to the survey, the 2018 State of the Nurse Practitioner Profession, almost 70% of respondents hold a certification in family care, 12% hold a certification in adult care, and six percent hold a certification in adult-gerontology care. Only four percent of respondents have a certification in pediatrics. While the authors of the study acknowledge that many NPs hold more than one certification, they do not identify how many NPs hold multiple certifications.
"NPs are the providers of choice for millions of patients," said AANP President Joyce Knestrick, PhD, APRN, CFNP, FAANP, said in a news release. "Current provider shortages, especially in primary care, are a growing concern, yet the growth of the NP role is addressing that concern head-on. The faith patients have in NP-provided health care is evidenced by the estimated 1.06 billion patient visits made to NPs in 2018."
According to the survey, NPs work in a variety of communities. One in six of the 4,300 respondents practice in urban areas and practice in hospital outpatient settings. More than 15% of the respondents said they work in communities with a population of less than 10,000. Roughly 5%of respondents work in communities with a population of less than 2,500. In those rural areas, NPs typically practice in rural health clinics.
The study also shows that NPs are committed to the communities they practice in – almost 60% said they will remain in their community for six years or more and 44% anticipate remaining in their current practice long-term.
Job satisfaction amongst NPs is high – nearly 77% of respondents were either satisfied or very satisfied with their employment at their practice site.
In terms of practice settings, the top five settings NPs work include: hospital outpatient, hospital inpatient, private group practice, private physician practice, and community health center.
Creating a healthy environment while simultaneously decreasing hostility is the most effective approach that leaders can take to enact change at the organizational level, a nurse leader says.
The nursing profession routinely tops the list of Gallup's annual survey that measures public opinion of the most trusted occupations regarding honesty and ethical standards. Yet, what the public may not realize is that inside the nursing profession, there are reports of bullying, incivility, and disruptive behaviors among nurses, creating unethical situations within healthcare work environments.
Disruptive behaviors among nurses have become so pervasive that the American Nurses Association (ANA) created a policy in 2015 in an attempt to reduce them.
According to the ANA position statement, nurses must "create an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect." Key points of the position statement include:
The nursing profession will not tolerate violence of any kind
Nurses and leadership must work together to create a culture of respect
Evidence-based strategies to prevent and mitigate incivility, bullying, and workplace violence must be adopted
Additionally, The Joint Commission issued a Leadership standard in 2008 (LD.03.01.01) that addresses disruptive behavior in two elements of performance (EP). Specifically, the healthcare organization must have a code of conduct that defines acceptable behaviors as well as disruptive. Further, The Joint Commission requires that healthcare leaders have a process in place to manage both behaviors.
Mitigate disruptive behaviors
Disruptive behaviors among nurses can include refusing to work with a particular nurse, ignoring a call to help with a patient that requires multiple nurses, and ostracizing a nurse without explanation, as examples. Kathleen Bartholomew, RN, MN, author of Ending Nurse-to-Nurse Hostility, says that nurse managers need to get on the unit and observe behaviors, especially at shift change. "They need to watch for the non-verbal [clues], such as raising eyebrows, making faces, etc., and make it about ALL of us as a team instead of an individual issue," she says.
What are some actions nurse leaders can take to reduce these behaviors? Jenny Shrapnel, BSN, PICU manager at Rady Children's Hospital in San Diego, and Bartholomew recommend:
Observe the staff in action. How is the staff interacting with each other? Are there cliques?
Conduct staff surveys. Send out annual staff surveys to gauge engagement. Bartholomew recommends surveying the newest nurses about their experiences, "Did we make you feel welcome at all times?"
Set clear expectations with the nursing team about which behaviors are acceptable and which are not.
Don't listen to gossip. Both Bartholomew and Shrapnel stress the importance of nurses finding out the facts of any complaint before reacting.
Educate staff about appropriate behaviors in meetings. To help combat disruptive behaviors in her unit, Shrapnel holds 30-minute educational sessions during her monthly meetings.
The consequences of disruptive behavior can lead to a decrease in morale and affect retention, and cause burnout, and it can also indirectly affect patient safety, says Shrapnel. "If you have a nurse causing disruption, the behavior could have a detrimental effect on the patient."
According to a 2008 survey of healthcare professionals, 71% of respondents felt disruptive behaviors were linked to medical errors, 27% felt disruptive behaviors were linked to patient mortality, and 18% were aware of a specific adverse event as a result of disruptive behaviors.
Strategies in action
After a string of disruptive behaviors on her unit and low employee engagement scores indicating a need for updated processes to manage the behaviors at Rady Children's, Shrapnel reevaluated how to more effectively address this issue.
In a joint decision, Shrapnel and the organization's leadership sent out a staff survey to determine whether disruptive behaviors were still an issue and to gauge if there had been any improvement. The results were unchanged from the previous year.
"The results hadn't changed at all, [along with] the employee engagement scores; the nurses needed help," she says. "And that's when I took the bull by the horns."
As a first step, Shrapnel had the nursing team undergo DISC personality testing. The goal of the testing was to help the team members understand the strengths and weaknesses of each personality type. Therefore, when communicating with other nurses, they had a better understanding of how receptive the other person would be to the conversation and how to address individuals based on their personality type, Shrapnel explains.
"The AACN standards say we must be as competent in our communication skills as we are in our clinical skills," says Bartholomew. "As a profession, we are missing a critical skill set."
Role-playing was also a way to practice positive communication among nurses. During a recent education session, Shrapnel paired the nurses into groups and had them discuss real examples of difficult conversations or conflicts they've had with other nurses. Shrapnel then provided handouts to the groups that helped them brainstorm how they can respond in a positive way when a similar situation occurs.
The communication strategies that Shrapnel has implemented are relatively new, but there has already been a noticeable change in the work environment and not just with the staff on her unit. A former colleague and consultant on disruptive behaviors visited the floor recently and remarked that the attitude and environment is completely different from just a few months ago, Shrapnel says.
By providing the tools to more effectively communicate with each other, the staff is working as a team and the clique that once existed on the floor has dissipated. "This is still a work in process, but this has made an improvement for the team," Shrapnel says.
Power of teams
In Bartholomew's book, she says that creating a healthy environment while simultaneously decreasing hostility is the most effective approach that leaders can take to enact change at the organizational level. She says leaders must firmly establish board and senior leadership team commitment to decrease hostility and make harm visible. Making harm visible means framing disruptive behavior as a safety issue, she says, while also stressing the importance of working as a team.
The effect on teamwork cannot be minimized. Teams that work together well produce respect and trust, Bartholomew notes.
She says by shifting the power structure from a hierarchy to a team/tribe, you:
Provide a constructive feedback system for accountability and performance
Provide leadership training and confrontation skills training for managers
Provide assertiveness training and confrontation skills training for managers
Monitor the organizational climate
Increase social capital—build a strong informal network
Editor's note: This story was updated on May 17, 2019.
Forty-two percent of non-pregnant nurses and thirty-eight percent of pregnant nurses reported never using a gown while administering antineoplastic drugs to patients, according to NIOSH survey.
Nurses are exposed to antineoplastic drugs, or chemotherapeutic drugs, when they administer these drugs in pill or liquid form to patients who are battling all forms of cancer. The drugs, while working to kill rapidly dividing cancerous cells of a patient can also be harmful to the healthy dividing cells of the nurse, including the cells of a developing baby.
The study, one of the first to delve into the use of PPE by pregnant and non-pregnant female nurses while administering chemotherapy medications, gathered the results of nearly 40,000 respondents over an eight-year period.
In spite of long-standing recommendations to use safe handling precautions when dealing with antineoplastic medications, many of the respondents reported not wearing gloves and gowns – the minimum PPE requirements.
NIOSH reports the following results for pregnant and non-pregnant female nurses:
Twelve percent of non-pregnant female nurses and nine percent of pregnant nurses reported never using a gown when administering antineoplastic drugs
Forty-two percent of non-pregnant nurses and thirty-eight percent of pregnant nurses reported never using a gown
One in 10 pregnant nurses did not always wear gloves while administering these medications during the first 20 weeks of pregnancy
"NIOSH has worked extensively to protect workers who handle antineoplastic drugs, many of which are known or probable human carcinogens," said Christina Lawson, Ph.D., epidemiologist and lead author of the study. "Many of these drugs can also damage a person’s fertility or harm a pregnancy, for example by causing a miscarriage or birth defects, so we wanted to look at the health of pregnant nurses for this study."
Survey respondents did not offer insight as to why they did not use the recommended minimal PPE (which is just gloves and gowns). However, other studies cite the following explanations as to why PPE was not used: skin exposure was minimal, PPE not provided by employer, and simply not part of the protocol. Another study found that 15% of respondents did not believe chemotherapy could be absorbed from contaminated surfaces.
Based on the results of the survey, the study authors recommend expanded and updated training in the use of PPE for nurses administering these medications.
The study was the result of a collaboration between NIOSH researchers, investigators from Harvard T.H. Chan School of Public Health, Harvard Medical School, and Brigham and Women’s Hospital in Boston, Massachusetts.
Nurses helped improve their colleagues' understanding of sepsis at Penn Presbyterian Medical Center in Philadelphia.
Over the past several years, themed escape rooms for team-building events has been all the craze. And, thanks to some creative nurses, these RNs used an escape room concept for improving nurses and other healthcare professionals' knowledge about sepsis.
At least 1.7 million adults in the U.S. develop sepsis each year and nearly 270,000 die each year from that diagnosis, according to the CDC. Further, one in three patients who die while in the hospital have sepsis.
And while a recent survey conducted by theSepsis Alliance found that sepsis awareness has increased in the U.S. significantly since 2017 (up 65% in 2018 from 58% in 2017), only 12% of adults can correctly identify all four symptoms of sepsis: higher- or lower-than-normal temperature, infection, mental decline, and extremely ill.
"One of the main reasons we decided to create an escape room was so we could include people who weren't nurses … without as much of a background with sepsis knowledge," Gabriel explains.
Why an escape room?
Paula M. Gabriel, MSN-RN, and Casey Lieb, MSN-RN, nurses at Penn Presbyterian Medical Center, a 355-bed acute care hospital in Philadelphia, and members of Penn Medicine Sepsis Alliance education team, were tasked with creatively educating their healthcare colleagues on sepsis awareness for World Sepsis Day last September.
The original idea for the escape room started in 2017 when Lauren McPeake, RN, BSN, created a simulation-based escape room to educate the nurses on her geriatric unit on the care of sepsis.
McPeake, a former emergency department nurse, noticed that sepsis wasn't being treated as a medical emergency on the unit, like it was in the ED. "I noticed frustrations around how many orders are generated when doctors think a patient is thought to be septic," she says. "I also noticed that people didn't understand why they were doing certain things, so I chose sepsis as the first simulation."
The simulation-based escape room was a hit with McPeake's colleagues, which sparked the idea of an interdisciplinary escape room for World Sepsis Day. As members of Penn Medicine Sepsis Alliance, Gabriel and Lieb thought an escape room where participants had to solve puzzles and riddles would be a fun and creative way for their colleagues to learn.
Gabriel and Lieb had the full support of leadership when discussing their ideas to promote sepsis awareness.
Members of the Penn Medicine Sepsis Alliance Education and Communications workgroup presented different ideas of how to promote sepsis awareness to the hospital board, and the board supported the idea of the escape room overwhelmingly.
"Most people that have been through an escape room thought it would be an interesting way to get the word out about sepsis awareness, and we also wanted to create buzz around the Sepsis Alliance," says Gabriel.
How the escape room works
A variety of healthcare professionals—social workers, physical therapists, physicians, nursing assistants, nursing students, members of the infection prevention team, and quality team staff—signed up online to participate in the escape room, according to Lieb.
In the Penn Presbyterian sepsis escape room, teams of six to eight people were locked in together and asked to use critical-thinking skills and teamwork to complete a mission to learn about sepsis. The teams had 25 minutes to detect and treat sepsis in a mock patient before they could escape the room. They did this by solving four puzzles and responding to clues.
One puzzle teammates had to solve involved an IV pump set up with four antibiotics that were tangled together and only two working IVs. The team needed to determine, with the help of distractors, which antibiotics to run and what order needed to be administered.
"The escape room format allows different types of learning, so you have people that are auditory, visual, or kinesthetic learners [and] they can touch things and talk through things. You have to use your critical-thinking skills and think outside the box," Gabriel says. "There's that pressure element of having to escape something in a certain amount of time and you know it's a different way of learning, compared to the traditional, ‘Come and sit in a classroom' and have somebody give you information."
The escape room was open from 5 a.m. to 2 p.m. to ensure that night shift workers could participate in the event, according to Gabriel. Gabriel and Lieb oversaw the escape room event throughout the day.
Once each team completed the mission (or in a couple of cases, some didn't), the teams debriefed with Gabriel, McPeake, and Lieb who informally evaluated the participants' understanding of sepsis. According to Lieb, the evaluations showed the participants had a better understanding of sepsis treatment after participating in the escape room.
Studies have found that training nurses on sepsis identification has positive outcomes. A Norwegian study found that after sepsis identification was integrated into nursing patient assessments, they found that early detection of sepsis slowed the progression of the disease and improved survival rates in a 30-day time frame.
Additionally, according to the American Association of Critical-Care Nurses, 80% of sepsis deaths can be prevented when patients receive a rapid diagnosis and treatment for sepsis.
During the debriefing, Gabriel and Lieb also explained the Penn Medicine Sepsis Alliance tools and internal website available for staff.
"We wanted people to know about our toolkit, the resources that we have for nurses, physicians, and staff so they can better educate themselves about sepsis and better understand what Penn's response is to the national sepsis crisis," says Gabriel.
Applying the concept into the future
"One of the great things about the escape room concept is that it is simplistic and can be applied to pretty much anything if you sit down and put some time into it," Lieb says. "It's a great tool for learning within a hospital setting. It's a great way to get people interested and have fun while they're learning something new as well."
The escape room was so popular across the healthcare disciplines, the nurses held a second day in October to accommodate the people who were unable to attend the first day. Based on this popularity, Gabriel and Lieb are considering using this concept in the future. Lieb thinks they will apply the concept to other topics and disease processes going forward.
"We've both been able to witness nurses and staff utilizing some of the tools from our toolkit that went through the sepsis escape room, so seeing it translated into practice is very exciting."
Michelle Clarke is a managing editor at HealthLeaders.
