Nursing lessons from the MHA keystone ICU project: developing and implementing an innovative approach to patient safety.
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.
Goeschel
Christine A
CA
Quality and Safety Research Group, Johns Hopkins University, Baltimore, MD, USA. cgoesch1@jhmi.edu
Bourgault
Annette
A
Palleschi
Maria
M
Posa
Pat
P
Harrison
Denise
D
Tacia
Lei Lani
LL
Adamczyk
Mary Ann
MA
Falkenberg
Debbie
D
Barbret
Linda
L
Clark
Patricia
P
Heck
Kara
K
O'Neil
Marguerite
M
Pitts
Virginia
V
Schumacher
Kathy
K
Sidor
Deborah
D
Thompson
Maureen
M
Wahl
Ellen
E
Bosen
Diane M
DM
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*