Medical Intensive Care Unit at UCI Health
August 2023
Medical Intensive Care Unit
at UCI Health
MICU
UCI Health
Orange
,
CA
United States
Sonia Ramos Lane, RN; Muriel Moyo, RN; Ann Charity Aliman, RN; Janette Rodes-Sanchez, RN; Yehanh "Hanh" Sarcona, RN; Kim Hicks, RN; Rheena Jumangit, RN; Mina Chang,RN; Jennifer Cook, RN; Taylor Covington, RN; Arlene Dalisay, RN; Zina De Los Santos, RN; Marlon Edwards, RN; Tatiana Jimenez, RN; Tracy Kelly, RN; Mike Parayao, RN; Jon Pasco, RN; Henry Perez, RN; Jishita Rathod, RN; Jannine Relova, RN; Diana Romero, RN; lecelSalas, RN; Joseph Salunday, RN; Charlie Son, RN; Rommel Jude "RJ" Valera, RN; Saveth "Amanda" Wallrich, RN; Mike Watson, RN; Anna Wist, RN; Byran Yamzon, RN; Dora Barajas, RN; Katrine "Kat" Bautista, RN; Jasmin Billones, RN; Rowena Castellano, RN; Ryan Cordell, RN; Angela Cudia, RN; Ailyne De Guzman, RN; Armando Ebbay Jr., RN; Gerardo Fuentes, RN; Chelsie Garcia, RN; Kurt Hilliard, RN; Lynnsey Hong, RN; Robert Ike, RN; Eun Kim, RN; Kayla Le, RN; Sandy Le, RN; Lucas Lee, RN; Maria Ojo, RN; Tasanee "Tas" Poarch, RN; Lauren Quiambao, RN; Edma Sy, RN; Olivia Soto, RN; Milton Wong, RN; Jhoyce Buterl, SHA; Rosario Prokis, SHA; Claudia Serrano, SHA; Modesto Carbales, SHA; Raymundo "Ray" Gonzalez, SHA; Noah Lumbris, SHA; April Aporongao, HUSC; Janette Barajas, HUSC; Fernando Castro, HUSC
SHA = Senior Hospital Assistant (Nursing Assistant)
HUSC= Unit Secretary
SHA = Senior Hospital Assistant (Nursing Assistant)
HUSC= Unit Secretary
When I saw the criteria for the Daisy Team Award:
1. A Team that exemplifies UCI Health’s values and embodies our mission
2. A Team with members that are role models of collaboration and teamwork made a difference in the lives of patients, families, employees or community
Our MICU Nursing team came to my mind, and this is why:
Accountability
As the MICU nursing staff, we recognize the significant responsibility we have to ensure the success of our organization UCI Health. We foster a culture of accountability through our collaborative efforts to enhance care. Examples include: 1) Our SHAs and HUSCs are leaders in our unit who serve as our hand hygiene champions. They are empowered to hold everyone in the department to the correct hand hygiene standards to ensure we keep our patients safe. 2) We hold daily palliative care huddle a true demonstration of the collaborative environment we foster in MICU. The huddle includes social workers, case managers, MICU physicians, palliative care physicians, and MICU nurses. Each team member is accountable for showing up to this meeting each day at 1130 with active participation by each team member present. Through this meeting, we have been able to help establish a healthy work environment where there is a constant dialogue about patient care needs and even staff needs when there is moral distress. Everyone comes prepared to contribute with a goal of ensuring patient psychosocial needs are met, patients are appropriately placed, and any team concerns are addressed. 3) Each day nurses and physicians work collaboratively to ensure we are not overutilizing central lines, and when we have a central line in place each day necessity is discussed.
Similarly, with the foley catheters necessity is assessed and unnecessary catheters are pulled out.
Respect
We cultivate an environment of mutual respect and trust by allowing each team member to have a voice in the department. All team members can openly express their thoughts and feelings. We established a “care conference” to help open dialogue between nurses and physicians when there seems to be a disconnect between what our nurses are seeing and doing for the patient and the physician’s treatment plan. The care conference provides a safe space and an avenue for nurses to fully and openly express their concerns with no fear of backlash. This care conference included MICU and palliative care attendings, social work, case management, nurse managers, charge nurses and the concerned bedside nurses.
Integrity
Our staff contribute to the provision of quality and safe care by the actions they take when no one else is watching. Examples include handwashing practices to prevent harm, turning our patients to prevent pressure injuries, performing foley catheter-central line-oral care for our patients to prevent infections, preventing wastage of supplies, etc. Our exceptional outcomes related to nurse-sensitive indicators, low staff injury rates, and high compliance rates with quality metrics demonstrate integrity among staff.
Innovation
Our staff embraces change and they are open to creating new approaches in clinical practice. We are proud to say we have two innovations from the MICU nursing team that have been adopted hospital-wide.
1) The “Exfoleyate” Campaign is the early foley catheter removal which entails following the Nurse Driven Protocol for removal and utilization of alternative urine collecting methods. This early foley catheter removal campaign is led by our unit CAUTI champions, our nurse managers, our infection prevention nurse, our nurse educator, and CNS. The approach has been effective such that we have seen an 95% drop in CAUTIs in MICU. Our MICU was able to achieve 16 months CAUTI free.
2) To ensure improved identification of primary sources of infection which are not CLABSIs we came up with the “why, where, what else” questions. These are questions that the encourage discussion among nurses and physicians before drawing blood cultures to make certain all possible sources of infection that are clinically indicated are cultured. By doing so we have an empowered nursing staff that advocate for patients and drive testing stewardship
Question 1.Why – why are we drawing the cultures?
Question 2. Where – where is the current suspected source?
Question 3.What else – what else could be a source?
These questions have been added to our hospital-wide blood culture kits to serve as reminders for all nurses and physicians to have these discussions before blood cultures are drawn.
MICU currently has 3 nurses who are actively working on their CNIII projects, further demonstrating the zest for innovation and desire for growth among staff in MICU.
Service
Our ultimate goal is to provide the best care. For this we realize in order for us to provide the best care we must prioritize providing excellent service for each other as a team. We view each staff member as a link making up a circle with our patients and family in the center. If one link is broken, we fail to protect the patient and their family. As such, providing excellent service to each other allows us to provide excellent service to our patients, families, and key stakeholders within the organization.
Excellence
We are committed to achieving the highest level of excellence in patient care, discovery and education.
We believe we have created an environment that embodies our mission to be “the best place to give and get care” and exemplify our values. For everything described in this nomination, our MICU team is truly a DAISY Team.
1. A Team that exemplifies UCI Health’s values and embodies our mission
2. A Team with members that are role models of collaboration and teamwork made a difference in the lives of patients, families, employees or community
Our MICU Nursing team came to my mind, and this is why:
Accountability
As the MICU nursing staff, we recognize the significant responsibility we have to ensure the success of our organization UCI Health. We foster a culture of accountability through our collaborative efforts to enhance care. Examples include: 1) Our SHAs and HUSCs are leaders in our unit who serve as our hand hygiene champions. They are empowered to hold everyone in the department to the correct hand hygiene standards to ensure we keep our patients safe. 2) We hold daily palliative care huddle a true demonstration of the collaborative environment we foster in MICU. The huddle includes social workers, case managers, MICU physicians, palliative care physicians, and MICU nurses. Each team member is accountable for showing up to this meeting each day at 1130 with active participation by each team member present. Through this meeting, we have been able to help establish a healthy work environment where there is a constant dialogue about patient care needs and even staff needs when there is moral distress. Everyone comes prepared to contribute with a goal of ensuring patient psychosocial needs are met, patients are appropriately placed, and any team concerns are addressed. 3) Each day nurses and physicians work collaboratively to ensure we are not overutilizing central lines, and when we have a central line in place each day necessity is discussed.
Similarly, with the foley catheters necessity is assessed and unnecessary catheters are pulled out.
Respect
We cultivate an environment of mutual respect and trust by allowing each team member to have a voice in the department. All team members can openly express their thoughts and feelings. We established a “care conference” to help open dialogue between nurses and physicians when there seems to be a disconnect between what our nurses are seeing and doing for the patient and the physician’s treatment plan. The care conference provides a safe space and an avenue for nurses to fully and openly express their concerns with no fear of backlash. This care conference included MICU and palliative care attendings, social work, case management, nurse managers, charge nurses and the concerned bedside nurses.
Integrity
Our staff contribute to the provision of quality and safe care by the actions they take when no one else is watching. Examples include handwashing practices to prevent harm, turning our patients to prevent pressure injuries, performing foley catheter-central line-oral care for our patients to prevent infections, preventing wastage of supplies, etc. Our exceptional outcomes related to nurse-sensitive indicators, low staff injury rates, and high compliance rates with quality metrics demonstrate integrity among staff.
Innovation
Our staff embraces change and they are open to creating new approaches in clinical practice. We are proud to say we have two innovations from the MICU nursing team that have been adopted hospital-wide.
1) The “Exfoleyate” Campaign is the early foley catheter removal which entails following the Nurse Driven Protocol for removal and utilization of alternative urine collecting methods. This early foley catheter removal campaign is led by our unit CAUTI champions, our nurse managers, our infection prevention nurse, our nurse educator, and CNS. The approach has been effective such that we have seen an 95% drop in CAUTIs in MICU. Our MICU was able to achieve 16 months CAUTI free.
2) To ensure improved identification of primary sources of infection which are not CLABSIs we came up with the “why, where, what else” questions. These are questions that the encourage discussion among nurses and physicians before drawing blood cultures to make certain all possible sources of infection that are clinically indicated are cultured. By doing so we have an empowered nursing staff that advocate for patients and drive testing stewardship
Question 1.Why – why are we drawing the cultures?
Question 2. Where – where is the current suspected source?
Question 3.What else – what else could be a source?
These questions have been added to our hospital-wide blood culture kits to serve as reminders for all nurses and physicians to have these discussions before blood cultures are drawn.
MICU currently has 3 nurses who are actively working on their CNIII projects, further demonstrating the zest for innovation and desire for growth among staff in MICU.
Service
Our ultimate goal is to provide the best care. For this we realize in order for us to provide the best care we must prioritize providing excellent service for each other as a team. We view each staff member as a link making up a circle with our patients and family in the center. If one link is broken, we fail to protect the patient and their family. As such, providing excellent service to each other allows us to provide excellent service to our patients, families, and key stakeholders within the organization.
Excellence
We are committed to achieving the highest level of excellence in patient care, discovery and education.
We believe we have created an environment that embodies our mission to be “the best place to give and get care” and exemplify our values. For everything described in this nomination, our MICU team is truly a DAISY Team.