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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Issue 10 

Susan Wisniewski

Necessity is the Mother of Re-Invention

By Susan Wisniewski, CPHQ

Remember fashions from the 1980s? Acid-washed skinny jeans, bell bottoms, tunics, oversized cardigans, and Converse tennis shoes were all the rage. Fast forward to 2012 and you’ll see acid-washed skinny jeans, boot-cut pants, shawl collar cardigans, and Converse tennis shoes. I guess it’s the people, not clothing who re-invent themselves.

What were you watching on television in the 1980s? Remember 60 Minutes, Dallas, football and Miami Vice? With the 1990s came situation comedies like Cheers and Home Improvement. Today, we’re still watching 60 Minutes, a plethora of reality shows like Survivor and Dancing with the Stars, and cop/detective shows like Law and Order and Rizzoli and Isles. I’m not sure if television entertainment has re-invented itself or there are just more choices.

The world of healthcare is not immune to change. Definitions of quality in healthcare have shifted over time from the 1970s’ retrospective audit model to the 1980s’ monitoring and evaluation model to the 1990s’ development of performance standards. The new decade brought a new focus on quality, safety and improvement in organizational performance. Today we continue that focus but have also added the importance of transparency. We operate in a way that makes it easy for others to understand our actions or decisions, resulting in slow movement rather than re-invention.

Surveys have also changed. In the 1980s, every policy and procedure manual from every department was brought into a large conference room, filled only with surveyors and executives. Accreditation was determined by the completeness of our policies and a tour of patient care areas. Patient safety was important and there was an emphasis on quality assurance. Today, surveyors talk with patient care staff, especially nurses, about their roles and responsibilities and how they provide great care to patients. Surveyors want to review documentation and talk about patient care practices to ensure that practice reflects policy.

To meet these challenges, Children’s Hospital re-invented itself in ways that are both exciting and successful with a focus on performance improvement and patient safety. The tracer program transformed the foundation for survey preparation. Responsibility for learning and applying standards was assigned to supervisors, managers and directors. Today it’s all about tracers. On tracer days, team members are seldom seen without their standards handbook. Our practices are measured against these standards. Since our accreditation survey in 2006, tracers have dominated our approach to assessing patient care and evolved over time.

Consistent use of patient tracers helps staff gain the confidence to articulate our practices and how they meet our policies and standards. Tracers led to improvement in our environment by identifying issues and facilitating training, and ensuring patient/visitor/staff safety. Tracers assisted human resources and medical staff services by identifying individuals for a thorough record review to determine the completeness of their records.
With five years of experience, our tracer program has expanded its value and influence.  In addition to patient tracers, system tracers are now conducted with a goal of evaluating all parts or steps of a system or process. Examples of new system tracers include medication management, safety and security, and cleaning, disinfection and sterilization. The team will soon introduce a radiation safety tracer.

We re-invented the program once again. The “new” part of this process is using staff from each of the areas involved to actually develop the tracer. For instance, staff from the pharmacy had a major part in the design of the medication management tracer and determining compliance. These individuals conduct the initial tracers to ensure all aspects of the process are assessed. Who could be better than the staff that works in the area?

We anticipate The Joint Commission’s survey in Aug./Sept. 2012. Our tracer program will become even more robust. Patient tracers will be scheduled mornings, afternoons and early mornings. The team will go to each area of the Hospital at least one time during the year to conduct system tracers as mentioned above. Talking with staff is the best way to identify training needs so we can continue to support strong, safe patient care. We will be ready when the surveyors arrive.

One thing we don’t need to re-invent is this equation: keeping kids safe = ready for survey.


References 1980s in fashion; 1990s in fashion; 2000-2009 in fashion., Fads of the 1980s, 1990 TV, 1999 TV, Best Shows of the 2000s
The Healthcare Quality Handbook, A Professional Resource and Study Guide, Janet A. Brown, 2008, “The Joint Commission Evolution”, p.1-7.



In This Issue

Becoming The BEST

Evidence, Research and Quality Improvement in Clinical Practices

Intentional Care of the Spirit - A Nurse's Gift to Her Community

A Nursing Career - Challenges in Care for Ourselves

Nephrology and Peritoneal Dialysis Clinical Nursing: What Goes On In Here?

Surviving Childhood Cancer

Necessity is the Mother of Re-Invention

Patient Satisfaction Comments