title: Nursing lessons from the MHA keystone ICU project: developing and implementing an innovative approach to patient safety.
abstract: Given the pivotal role of nurses in providing and supervising patient care, it is essential that nursing professionals are engaged fully in making care safer. Nursing involvement was instrumental in the Michigan Health and Hospital Association Keystone ICU Project, which resulted in rapid reduction in catheter-related blood stream infection rates and ventilator-associated pneumonia rates. Nurses of every credential and every nursing position participated in this broad scale improvement effort. This article describes the MHA Keystone ICU Project, including challenges implicit in changing nursing practice and team behavior in the ICU. The improvement strategies implemented by Keystone ICU teams, and lessons learned by nurses engaged in the work, are likely to have application in other clinical settings.
authors.affiliation: Quality and Safety Research Group, Johns Hopkins University, Baltimore, MD, USA. cgoesch1@jhmi.edu
authors.forename: Christine A
authors.initials: CA
authors.lastname: Goeschel
authors.forename: Annette
authors.initials: A
authors.lastname: Bourgault
authors.forename: Maria
authors.initials: M
authors.lastname: Palleschi
authors.forename: Pat
authors.initials: P
authors.lastname: Posa
authors.forename: Denise
authors.initials: D
authors.lastname: Harrison
authors.forename: Lei Lani
authors.initials: LL
authors.lastname: Tacia
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Adamczyk
authors.forename: Debbie
authors.initials: D
authors.lastname: Falkenberg
authors.forename: Linda
authors.initials: L
authors.lastname: Barbret
authors.forename: Patricia
authors.initials: P
authors.lastname: Clark
authors.forename: Kara
authors.initials: K
authors.lastname: Heck
authors.forename: Marguerite
authors.initials: M
authors.lastname: O'Neil
authors.forename: Virginia
authors.initials: V
authors.lastname: Pitts
authors.forename: Kathy
authors.initials: K
authors.lastname: Schumacher
authors.forename: Deborah
authors.initials: D
authors.lastname: Sidor
authors.forename: Maureen
authors.initials: M
authors.lastname: Thompson
authors.forename: Ellen
authors.initials: E
authors.lastname: Wahl
authors.forename: Diane M
authors.initials: DM
authors.lastname: Bosen
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D003422:Critical Care / Q000458:organization & administration*; D003659:Decision Making, Organizational; D006801:Humans; D017053:Infection Control / Q000458:organization & administration; D007373:Interinstitutional Relations; D008824:Michigan / Q000453:epidemiology; D020380:Needs Assessment; D024802:Nurse's Role / Q000523:psychology; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control; D016730:Program Development; D015397:Program Evaluation; D017751:Safety Management / Q000458:organization & administration*; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012954:Societies, Hospital / Q000458:organization & administration*; D017749:Total Quality Management / Q000458:organization & administration*