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Recommended Citation
Selby E, Dziura S, Jamil M. Nurse-Driven Sepsis BPA Usability Improvement. Nurse-driven Innovations in Care Redesign and Delivery podium presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Nurse-driven Innovations in Care Redesign and Delivery podium presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Introduction & Context
A site noted a safety trend related to the Sepsis Best Practice Advisory (BPA). Cause analysis determined that BPA usability contributed to delays in ordering sepsis labs per nurse-driven protocol and led to a serious safety event. The goal was to enhance BPA usability and increase compliance with the protocol.
Implementation Strategy
Nurses partnered on BPA redesign to improve wording, clarify when to order labs, and simplify ordering. To evaluate the new design, the Human Factors Engineer and stakeholders conducted a usability test. Usability testing gathers observations and feedback from end-users to identify opportunities before investing resources in a modification. Frontline nurses interacted with new BPA prototypes and successfully ordered labs appropriately based on patient scenarios. Nurse feedback was overwhelmingly positive. Escalation to many stakeholders was necessary to gain approval for system-level adoption. The BPA changes went live at all Midwest Region sites in March 2024.
Outcomes & Impact
The Midwest Region increased ‘Open order-set’ responses (favorable) by more than 7 times (1.2%à8.9%) pre- to post-implementation. The site nearly doubled (6.2%à11.4%) favorable responses post-go-live and BPA-related safety events decreased by 83%. On a post-implementation survey, the New BPA rated more positively on ease of use, understandability, and ease of ordering labs. Participants feel more confident with the New BPA (average rating 4.2) than the Old BPA (average 3.7) (1=Not Confident, 5=Extremely Confident). Nurses highlighted that the New BPA is “eas[ier] to understand” and “safer.”
Insights
After cause analysis directed by safety events, nurse-led BPA enhancements were validated through usability testing to clarify and reinforce nurse-driven processes. Post-implementation data exemplifies that the enhancements are positively impacting patient safety through achieved project goals.
Implications
Usability testing is an innovative approach to modify care delivery processes, drive nurse-led change, and enhance patient safety. This project’s interventions are broadly applicable and can help improve sepsis processes and outcomes.
References
Evans, L. et al. (2021). Surviving sepsis campaign: International guidelines for management of
sepsis and septic shock 2021. Critical care medicine, 49(11), e1063-e1143. doi:10.1097/CCM.0000000000005337
Hass, C. (2019). A Practical Guide to Usability Testing. In: Edmunds, M., Hass, C., Holve, E. (eds) Consumer Informatics and Digital Health. Springer, Cham. https://doi.org/10.1007/978-3-319-96906-0_6
National Patient Safety Foundation. (2015). RCA2: Improving Root Cause Analyses and Actions to Prevent Harm. Boston.
Sepsis Alliance. (2023). Sepsis fact sheet [PDF file]. https://www.sepsis.org/education/resources/fact-sheets/
Document Type
Oral/Podium Presentation
Publication Date
11-13-2024
Nurse-Driven Sepsis BPA Usability Improvement
Introduction & Context
A site noted a safety trend related to the Sepsis Best Practice Advisory (BPA). Cause analysis determined that BPA usability contributed to delays in ordering sepsis labs per nurse-driven protocol and led to a serious safety event. The goal was to enhance BPA usability and increase compliance with the protocol.
Implementation Strategy
Nurses partnered on BPA redesign to improve wording, clarify when to order labs, and simplify ordering. To evaluate the new design, the Human Factors Engineer and stakeholders conducted a usability test. Usability testing gathers observations and feedback from end-users to identify opportunities before investing resources in a modification. Frontline nurses interacted with new BPA prototypes and successfully ordered labs appropriately based on patient scenarios. Nurse feedback was overwhelmingly positive. Escalation to many stakeholders was necessary to gain approval for system-level adoption. The BPA changes went live at all Midwest Region sites in March 2024.
Outcomes & Impact
The Midwest Region increased ‘Open order-set’ responses (favorable) by more than 7 times (1.2%à8.9%) pre- to post-implementation. The site nearly doubled (6.2%à11.4%) favorable responses post-go-live and BPA-related safety events decreased by 83%. On a post-implementation survey, the New BPA rated more positively on ease of use, understandability, and ease of ordering labs. Participants feel more confident with the New BPA (average rating 4.2) than the Old BPA (average 3.7) (1=Not Confident, 5=Extremely Confident). Nurses highlighted that the New BPA is “eas[ier] to understand” and “safer.”
Insights
After cause analysis directed by safety events, nurse-led BPA enhancements were validated through usability testing to clarify and reinforce nurse-driven processes. Post-implementation data exemplifies that the enhancements are positively impacting patient safety through achieved project goals.
Implications
Usability testing is an innovative approach to modify care delivery processes, drive nurse-led change, and enhance patient safety. This project’s interventions are broadly applicable and can help improve sepsis processes and outcomes.
References
Evans, L. et al. (2021). Surviving sepsis campaign: International guidelines for management of
sepsis and septic shock 2021. Critical care medicine, 49(11), e1063-e1143. doi:10.1097/CCM.0000000000005337
Hass, C. (2019). A Practical Guide to Usability Testing. In: Edmunds, M., Hass, C., Holve, E. (eds) Consumer Informatics and Digital Health. Springer, Cham. https://doi.org/10.1007/978-3-319-96906-0_6
National Patient Safety Foundation. (2015). RCA2: Improving Root Cause Analyses and Actions to Prevent Harm. Boston.
Sepsis Alliance. (2023). Sepsis fact sheet [PDF file]. https://www.sepsis.org/education/resources/fact-sheets/
Affiliations
Advocate Illinois Masonic Medical Center