Sacred Heart University DigitalCommons@SHU Dr. Henley DNP Projects College of Nursing 5-2022 No Pass Zone: A Quality Improvement Project Casey St. John Sacred Heart University, st.edu Follow this and additional works at: https://digitalcommons.edu/dnp_projects Part of the Medical Education Commons, and the Nursing Commons Recommended Citation St. No pass zone: A quality improvement project.
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For more information, please contact ferribyp@sacredheart.edu, lysobeyb@sacredheart. 1 No Pass Zone: A Quality Improvement Project Casey St. John, BSN, RN A DNP project submitted in fulfillment of the requirements for the degree of Doctor of Nursing Practice Geraldine Budd Ph., FNP-BC, FAANP; DNP Project Faculty Advisor Katherine Hinderer, PhD, RN, CNE, NEA-BC; Practice Mentor Sacred Heart University Davis & Henley College of Nursing May 2022 2 This is to certify that the DNP Project Final Report by Casey St. John has been approved by the DNP Project Team on 3/23/2022 for the Doctor of Nursing Practice degree DNP Project Faculty Advisor: Geraldine M.
Budd PhD, FNP-BC, FAANP Practice Mentor: Katherine Hinderer PhD, RN, CNE, NEA-BC 3 Acknowledgments First, I would like to thank my advisor Dr. Budd and my project mentor Dr. Hinderer for their continued guidance throughout this project. Secondly, I would like to thank my fellow co- workers who participated in this project.
Lastly, I would like to thank my mother for her continued support throughout my academic career and my partner Hector who has lovingly supported my educational advancement. 4 Table of Contents Acknowledgements………………………………………………………………………….p 3 Table of contents………………………………………………………………………….…p 6 Problem Identification, Development of Clinical Question, and Evidence Review………….…p 7 Background and Significance of Problem…………………………………………………….…p 7 Description of Local Problem/Organizational Priority……………………….p 7 Focused Search Question…………………………………………………………………….p 9 Evidence Search…………………………………………………………………………………p 9 External Evidence……………………………………………………………………………….p 9 Evidence Appraisal, Summary, and Recommendations……………………………….p 12 Intervention/Practice Change………………………………………………………….…………………p 14 Measures and Analysis.p 15 Resources………………………………………………………………………………………p 16 Review for Ethical Considerations…………….p 19 Process Measures………………………………………………………………………p 19 Outcome Measures………………………………………………………………….…p 20 Return on Investment……………………………………………………………….…p 22 Barriers Encountered During Implementation …………………………………….……………………… p 23 Key Lessons Learned………………………………………………………………….p 23 Implications of Project Results to Organization and Practice Community……….p 23 Plans for Dissemination………………………………………………………….…… p 24 Plan for Sustainability………………………………………………………………………….…p 26-27 Tables & Figures Tables: Table 1 Nurse Identified Barriers to Reduced Response Time to call bell lights……… p 19 Table 2 Nurses Identify education and implementation of the No Pass Zone for call bell lights…………………………………………………………………………………. p 21 Table 3 Return on Investment……………….p 23 Figures: Figure 1 Process Map…………………………………………………………………….p 8 Figure 2 SWOT Analysis…………………………………………………………….…p 17 Figure 3 HCAHPS Composite………………………………….p 18 Figure 4 Increase in staff responsiveness on Press Ganey Reports…….………p 21 Figure 5 Call bell Wait time Audits 2021………….……p 22 Appendices: Appendix A Description of Evidence Search……………………………………….…p 28 Appendix B Article Analysis……………………………………………………….…p 31 Appendix C Levels of Evidence & Outcome Synthesis Tables…………………….…p 38 Appendix D Institute Review Board Decision……………………………………….…p 42 Appendix E Educational Cornerstone Module………………….…p 43 Appendix F No Pass Zone Unit Posters…………….…p 45 Appendix G Staff Audit Form……….p 46 Appendix H Project Poster…………………………………………………………….p 47 Appendix I Project Abstract for Dissemination……………………………………….p 48 6 Abstract Introduction: Patient call-bell lights are a means for communication from a hospitalized patient's room to staff members. This DNP project involves staff and patients on a 28-bed pediatric medical-surgical unit.
The aim was to implement a No pass Zone for patient call bell lights. Additionally, this project served to aid in increasing staff responsiveness to answer patients' questions and concerns. Methods: Staff completed a Cornerstone education on the No Pass Zone. Data was collected from pre/post-implementation staff surveys and pre/post-implementation Press Ganey scores.
Weekly staff audits on direct observation of staff response to patients' call-bell lights. Results: A total of 35 out of 61 medical-surgical unit staff completed the educational Cornerstone module. Press Ganey reports showed an increase in staff responsiveness to call bells from 71.43% in June 2021 to 78.62% in October 2021, and 79. Post-project surveys showed 87.50% of staff who completed the measure agreed that implementing a call-bell management protocol resulted in quicker staff response times.
Staff audits showed patient wait times decreased from 10-15-minutes to a 2-3-minutes. Conclusion: The No Pass Zone proved an adoptable protocol for patient call-bell light response that demonstrated benefit on one hospital unit. Staff voiced positive feedback to staff responsiveness. Lastly, with adequate staffing levels and the willingness of staff and supervisory roles, the No Pass Zone can effectively improve the current workflow.
Key Words: No Pass Zone, call bell, call light 7 Problem Identification, Development of Clinical Question, and Evidence Review Background and Significance of Problem Patient call bell lights are a means for communication from a hospitalized patient's room to staff members on a medical unit. Patients admitted to the hospital often spend most of their time in their rooms, leaving patients with limited opportunities to ask questions or voice concerns. The primary means to contact the healthcare team and the nurse is a call bell. Most reasons for using a call bell are pain medication, repositioning, food or fluids, and help to the bathroom.
On average, hospital floors receive approximately 7000 call bell alarms per month, establishing the call light as an essential communication tool for hospitalized patients (Ransco et al. In the hospital setting, responding to a call bell light can be difficult when a nurse tends to other priorities. This delay in care can often lead to a patient feeling neglected or unheard (Lee et al. Studies have determined that the response to call bells is a crucial component of patient satisfaction.
Patients are most likely to give negative feedback after discharge on surveys when staff responsiveness is delayed (Stokowski, 2017). In facilities which a standardized approach to call bell lights were in effect, there was higher staff compliance (Lee et al. A team approach is necessary for appropriate staff response times. Education on proper procedures to educate patients on call lights is essential to increase patient satisfaction.
Description of Local Problem/Organizational Priority This Quality Improvement (QI) project involves staff and patients on a 28-bed pediatric Med Surg unit in the Hartford County, CT area. The global aim is to implement a No Pass Zone for patient call bell lights. By working on this problem, I expect we will increase patient 8 satisfaction and decrease staff fatigue. Several nurses working on the Med Surg unit have been observed by individual nurses and care team members ignore call lights and walk through the hallway without checking on patients in distress.
Some factors that have impeded prompt responses to call bells include high acuity patient assignments, decreased staffing levels, and low staff morale. Call bell response is an essential ongoing issue hospital-wide, as voiced by patients and employed staff. Figure 1 identifies the current Med Surg floor’s call light process. A No Pass Zone in a hospital means not passing by a patient's call bell light without first entering the room to see if the patient is okay.
Staff are expected to evaluate to the patient's needs, and the healthcare team member either solves the problem or refer them back to their assigned nurse. In this project patient and staff surveys regarding the response to call bells will provide data and information to guide a quality improvement process implementing a No Pass Zone on a pediatric Med Surg unit. Figure 1-Process Map 9 Focused Search Question In pediatric patients and their families who are admitted to the Med Surg unit (P), does the implementation of a No Pass Zone for call light management (I) versus current standardized call light management (C), improve patient satisfaction and staff responsiveness (O)? Evidence Review Systematic Search for Evidence: Process and Results A search of the following databases was conducted; CINAHL, MEDLINE, and the Academic Search Premier. The keywords searched were; call bell, call light, call light intervention bundle, call light response, call bell use, staff perceptions and call light, and patient perceptions and call light.
The filters that were applied were from the USA, published between 2009-2021. The search was for call bell education, staff, and patient perceptions on usage and how they affect patient satisfaction scores (See Appendix A). Staff on the medical surgical unit were surveyed on their current practice with patient call bell lights before initiating the No Pass Zone. Most staff said that having a call bell management system would improve workflow.
Staff reported on their surveys that due to high acuity levels and short staffing levels, response times have become delayed. Press Ganey reports on staff responsiveness were reviewed before initiation and revealed a 62. The preliminary data from staff and Press Ganey reports indicate a need to improve patient call bell response times. 10 Evidence Appraisal, Evaluation, Synthesis, and Recommendations Nine articles were reviewed, focusing on implementing interventions to respond to patient call bells efficiently.
Convincing evidence supported the use of call bell interventions (one level II: randomized control trial (RCT) and four-level IV: EBP implementation). In addition, patient satisfaction regarding call bell response times (two level III evidence case- control study, two-level IV: EBP implementation) (See Appendix B). Summaries of Levels of Evidence (LOE) and outcome synthesis tables of the nine studies support using the patient call bell in practice (see Appendix C). The nine studies' level of evidence was strongly linked to levels 2, 3, and 4.
Level 4 was most of the studies listed. The use of a call bell in clinical practice included call bell frequency, call bell response times, call bell functions, length of stay, patient satisfaction, call bell importance and call bell peak. The evidence's commonality showed a direct link to the significance of call bell education, call bell response times, and their direct effect on patient satisfaction overall. Based on this Evidence, the recommendation was to implement an intervention such as the No Pass Zone for patient call bell lights to improve patient satisfaction in the hospital setting directly.
Evidence from the literature includes a study by Tzeng (2010) that conducted a cross- sectional survey involving four hospitals in the Midwestern region of the United States between 2008 and 2009 to investigate nurses' perspectives on the nature and reasons of patient-initiated call bells. About 808 staff nurses completed the survey. The study revealed that the key reasons for call bells related to toileting assistance, pain medication, and intravenous-related problems. Each staff nurse responded to about 6 to 7 call bells per hour, with an average response time of about 4 minutes (Tzeng, 2010).
About 49 percent of the respondents indicated that patient- 11 initiated calls were important to patients' safety. About 77 percent of the respondents reported that patient-initiated calls were significant, while 55 percent agreed that the call bells required immediate attention. A significant percentage of the staff nurses, about 53 percent, believed that patient-initiated calls hindered them from performing essential aspects of their day-to-day work. The attitudes and beliefs regarding patient-initiated calls varied across hospitals, with the junior staff demonstrating an increased tendency to disregard call bells.
Lee, Crouse, and Gipson (2016) investigated the outcomes of implementing a No Pass Zone in a 76-bed acute care hospital in Pennsylvania. The hospital reported low patient satisfaction scores relating to nurses' response to call lights. The quality improvement committee developed a standard system-wide approach to the No Pass Zone that included a standard process of answering a call light and resolving the staff response through a call system. All the concerned workers received education and training on handling patients' requests and obtaining assistance for patient cases requiring specialized skills.
The No Pass Zone project's assessment involved quality improvement measures such as evaluating the average number of call lights answered per minute, call lights answered by non-nursing staff, and the HCAHPS scores. The researchers identified a consistent and significant improvement to all three quality improvement measures. The staff's percentage of call lights answered improved from about 85 percent to 92 percent within six months of the No Pass Zone system (Lee, Crouse, & Gipson, 2016).
