The following initiatives were praised by the Magnet Commission as exemplars.
The Brigham Frailty Identification and Care Pathway (Interprofessional Collaboration, EP5A)
Half of the hospital’s trauma patients are ages 65 and older, and a multidisciplinary team from the Division of Trauma, Burn and Surgical Critical Care set out to identify specific components of care to improve outcomes for these patients. The team held meetings with multidisciplinary stakeholders and reviewed literature to develop a new identification and care pathway and educated all staff, including nurses, patient care assistants, trauma and critical care faculty and residents and fellows from Surgery, Emergency Medicine, Obstetrics and Anesthesiology.
The impressive results of the changes they made in the care of these patients include:
A 30 percent decrease in risk-adjusted mortality;
A 47 percent decrease in the major complications rate; and
A decrease in the absolute delirium incidence rate from 50 percent to 26 percent.
The team conducts multidisciplinary rounds twice a week and holds monthly check-ins. In addition, an online educational module was developed for all clinical staff on Tower 8.
“This is exceptional work,” said Jeanette Ives Erickson, DNP, RN, FAAN, a member of the Commission on Magnet Recognition. “Through evidence-based practice and training, you have really improved the lives of many of your patients.”
Leadership Amid Shortage of IV-Administered Opioids (Interprofessional Collaboration, EP5B)
The response and leadership within the hospital during the national shortage of IV-administered opioids has yielded excellent patient outcomes and demonstrated incredible teamwork. “This exemplar highlights Maddy’s leadership in helping to guide not only the nursing staff, but also the entire organization through the shortage,” said Ives Erickson of Maddy Pearson, DNP, RN, NEA-BC, chief nursing officer and senior vice president of Patient Care Services.
These efforts are led by a multi-disciplinary team that developed strategies to ensure the best care of patients during this challenging time. This includes frequent communications to all staff involved in the response and the care of these patients.
Ethics Committee and Additional Ethics Resources (Available Resources, EP17A)
Nurses and other clinical staff have a plethora of resources available to them to address ethical issues, including the Ethics Committee, co-led by Martha Jurchak, PhD, RN, and Nicholas Sadovnikoff, MD.
“This is exemplary interprofessional teamwork with the aim of this committee to create a moral community focused on education, policy development and consultation,” said Ives Erickson. “Staff throughout the organization noted to the appraisal team how they feel safe and supported in advocating for their patients. This committee has done fabulous work not only educating people and advancing practice at the Brigham, but also sharing this good work through the Harvard bioethics course.”
While the Ethics Committee and other resources are available to staff throughout the hospital, the example included in BWH’s body of evidence was specific to the Neurosciences ICU.
Nursing Director Shaun Golden, MS, RN, convened weekly ethics rounds led by Jurchak, the executive director of Clinical Ethics, to encourage members of the interprofessional care team to discuss and analyze ethical issues or concerns. Any member of the care team can recommend a case for discussion, and staff are respectful of each other’s different perceptions of ethics concerns. The rounds, which began in 2006, have provided a forum for team members to discuss the unique challenges they face in caring for patients with neurological diseases.