CASE STUDY 16-1 Implementation Practices: Audit, Education, and Leadership Strategies
Silena Sexton
It is important for organizations to run smoothly and efficiently. Process improvement is important to every organization when issues arise and when analyzing the everyday tasks to be accomplished. Leadership is an important driver and facilitator for process improvement within an organization. Leadership support and leaders who are willing to approach a problem with evidence-based practices find sustainable solutions. A leader’s approach to a problem can have a great impact on how others view the problem, and the practice involved. The implementation process when making changes also depends on the leader and the culture that the leader creates. Below is a problem that was discovered by a leader as well as staff members. It is discussed in detail as well as the results. In a busy emergency department (ED), it was noted by an educator that pediatric patients were consistently being under-triaged. This partially comes from nurses feeling undereducated about pediatric patients and not having enough guidelines regarding the triage process for pediatric patients within the organization. A new scale was built by the educator and a team of staff members and implemented in the ED. The scale was tied directly into the current triage system, Emergency Severity Index (ESI). When a pediatric patient arrives in triage, he or she is to be scored on this scale, and the score determines the appropriate the ESI level for the patient. This will be repeated and documented once the pediatric patient is brought back to a room. This scale gave nurses objective information to use and document for pediatric patients. Chart audits were done initially to ensure that documentation was being done on all the pediatric patients. Triage scores were also checked when the chart audits were done. There was a notable difference in the triage scores after the system was implemented. The implementation of this process was supported by leadership. The process was discussed with the charge nurses, and they were educated about it. Then it was presented to the rest of the staff members. Much education was done to validate the new process. This was an essential implementation strategy focused on didactic and role-modeling effective assessment of the ESI. The importance of leadership in the implementation process was crucial. Leadership presented the change in a positive way; received much staff input during the change; and allowed staff members to voice all opinions, good and bad. This cultivates a positive climate, which can also affect how an organization implements evidenced-based practice and adapts changes when needed to improve the safety of patients.
Case Study Questions
1. Discuss how educating and role-modeling facilitated effective implementation of the ESI. 2. What tips for leading and facilitating teams could the nurse leader in this case study best coach and mentor nursing staff members?
