Being a nurse is more than a job at Schneck Medical Center.

It’s a lifestyle that requires continual education to learn the newest information and techniques to not only get better at what they do but to improve the health outcomes of their patients and the community.

Last month, a group of nurses from 13 different departments at the Seymour hospital presented evidence-based practice projects.

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After months of researching different topics related to their fields, participants created posters to display their findings and conclusions.

They presented their work April 29. The projects were judged by Dr. Lana Watson and Dr. Laura Watson from Indiana University-Purdue University Columbus.

In many cases, the results of their work already have been or are in the process of being implemented at Schneck to improve patient care.

Protecting at-risk babies with car seat challenge guidelines

The overall winners of the contest were obstetrics nurses Christina Hughes, Ariel Burton, Angela Rowlett and Danielle Brown.

Their project investigated car seat challenges for at-risk newborns, including premature babies, babies with medical conditions that can cause oxygen desaturation and underweight infants born to mothers using opioids.

“A car seat challenge is something that we do for any baby that is born less than 37 weeks gestation because they may or may not be physiologically ready to ride in a car seat,” said Hughes, coordinator of the hospital’s car seat challenge program.

The group’s research suggested having standardized infant car seat challenge guidelines promoted for the safe transport of at-risk infants, so they revised Schneck’s existing policy.

“We started looking at updating our policy last year, and when I looked at it, there was a lot of questioning as to what is a fail, so a baby that is not ready to ride in a car seat,” she said. “Our policy was a little vague.”

So Hughes started to review literature on the issue to see what available research was saying.

“Well, it’s a lot vague,” she said. “There’s not a lot of agreement on what is considered a significant desaturation or a significant bradycardia.”

Bradycardia is an abnormally slow heartbeat.

Hughes said she was lucky to find one article on a study that was done in 80 hospitals in the New England area that detailed what each one did and their car seat challenge pass/fail rates.

“That helped a lot,” she said. “We were able to take a look at all of the data out there and then bring it together using the general consensus to make sense of what we wanted to try to do here.”

Interventions that were implemented at Schneck included feeding the infant one hour before the car seat challenge, obtaining vital signs before the testing and then every 15 minutes during the test and observing the infant in their car seat for at least 90 minutes to ensure they are placed appropriately.

A child will fail the test if their oxygen saturation drops below 90% for at least 15 seconds. The hospital’s previous policy stated the oxygen level could not fall below 88%, and there was no time frame established.

If a child fails the test, then the hospital will provide parents with information on how to use a car bed, which is an alternate child restraint system that allows a child to lie flat instead of semi-reclined like most car seats.

In order to implement the change in policy, the team has been educating Schneck physicians and has created a handout for parents explaining the hospital’s car seat testing and guidelines.

“In changing our policy, we’ve made things a lot easier for us because our pass/fail rates now are very specific,” Hughes said. “I think our staff is a lot happier now with the change.”

The negative effects

of fatigue on nurses

First runner-up went to the 4 North moderate acute adult care unit, or MAACU. Nurses Stephanie Vaughn and Megan Bailey researched the effects of fatigue on nurses, including turnover and adverse patient events.

The team did a survey of intensive care unit and MACCU nurses at Schneck and discovered 73% of ICU nurses were unable to sit down and take a break and free up patient responsibilities entirely. A total of 50% of MAACU nurses said the same thing, Vaughn said.

The survey responses showed nurses don’t often take breaks because their break room is too easily accessed. Seventy-three percent of nurses in the ICU said they didn’t have a place to go to take a break, while 88% of MAACU nurses said they did have a break room.

The difference is that MAACU’s break room is away from the nurses station and is closed off with a door, making it not as easily accessed by other staff members, Vaughn said.

“They think there is too much going on so that they feel like their break is interrupted just from sitting back there,” she said. “Nurses also are nervous with leaving their patients in the hands of someone else and feel guilty for leaving someone else to care for their patients.”

After reviewing different literature on the topic, the biggest finding was nearly 50% of nurses nationwide reported fatigue made it difficult for them to perform safe patient care at least some of the time, she said.

“It’s also very important for people to understand that fatigue affects nurses mentally, emotionally, psychologically and not just physically, so there’s an entire circumference of things to address there,” she said.

Their research suggested nurses be able to take at least a 15-minute break within the first eight hours of their shift in a clearly designated area.

“Breaks should be taken away from the nurses station and allow for mental debriefing,” Bailey said.

Because of their research, the hospital is revising its policy.

“This is a big deal because right now, you can be fired if you are found napping on your break,” she said. “This is going to take a big policy change, but we’re on the right track.”

They also are implementing a quiet break room to be shared by ICU and MAACU nurses that will include a curtain, a recliner and dimmed lighting so they can “get away,” Bailey said.

“This not only helps the nurse feel energized. It also helps decrease medical errors and pressure ulcers and decreases turnover rate,” she said. “So that’s why it’s important.”

Preadmission screenings prior to endoscopy procedures

Second runner-up went to endoscopy department nurses Mikayla Ross and Denise Shoemaker. Their project was on the benefits of having a PACE nurse in their department. PACE stands for Preoperative Assessment, Consultation and Education.

“They check to see if anybody needs anything certain or needs cardiac clearance or needs further information on prepping for a procedure,” Ross said.

The problem they came up with is how surgical patients get preadmission screenings from the PACE department, but endoscopy patients do not.

“We found out that we were losing a lot of revenue and having a lot of day-of cancellations because of problems that we didn’t see ahead of time,” Ross said.

The team decided to answer the question, “How do endoscopy patients that receive preoperative contact with a PACE nurse compare to patients that only receive written instructions prior to their procedure?”

They collected data from the first two quarters of 2018, and only 22.6% of endoscopy patients were being prescreened ahead of time, Ross said. By the end of the year, that figure was down to 15%, and 8.5% of patients were being canceled day-of procedure.

Also, it takes 47 minutes on average to get a patient ready for an endoscopy procedure if they are not prescreened, Ross said.

During that time period, they estimated the hospital lost nearly $80,000 in revenue just from day-of cancellations caused by things that could have been caught ahead of time, she said.

The team came up with a plan to implement a PACE nurse at least three days a week in the endoscopy department to make contact with patients before their procedures.

In the first couple of months of 2019, the improvement was evident, Ross said, with 52% of patients being prescreened.

“So it went up quite a bit,” she said.

Day-of cancellations dropped to 6%, and the time to get a patient ready decreased to 35 minutes.

“Not a huge difference when you look at the numbers, but it still did go down,” she said.

In conclusion, they determined having a PACE nurse in endoscopy would save $27,000 per year on average just on the reduction of patient time.

“We’re still working on it,” Ross said. “We’re still trying to make sure that we can set aside that time for the PACE nurse, but our results are showing that it is improving.”