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Accountability:
Outcomes:
At MCCG the Nursing Practice Council (NPC) is the designated
work group with the responsibility of oversight for the
development and revision of hospital wide patient care
procedures and guidelines based on professional standards,
consistent with the state NPA, and supported by current
scientific literature and research to enhance the nurse’s
ability to make independent decisions concerning patient care
management. In the last two years the NPC completed a number of
initiatives to by working collaboratively with all units to
implement the new processes.
Examples of NPC hospital wide initiatives include:
• Heparin Induced
Thrombocytopenia (9.3a)
• NG tube placement (9.3b)
• Patient care procedures, customized for MCCG within the CV
Mosby program, which includes checklists, skills demonstrations
Emergency Center (EC)
Nurses in the EC make independent decisions every day while triaging patients.
The Triage Nurse in the EC is the first to see a patient who presents for
treatment. This nurse performs a brief focused assessment, obtains the patient
history, and utilizes national standards from the ENA and the Agency for Health
Research & Quality Emergency Severity Index Score (ESI) to formulate a triage
decision. The ESI is a five level triage algorithm (9.3e) that provides
clinically relevant classifications of patients on the basis of acuity and
resource needs. Using the ESI the nurse is able to rapidly identify patients who
require immediate attention and more accurately identify patients who could
safely and more efficiently be seen in a fast track area. It is the triage
nurse’s decision that sets the initial course for care received in the EC.
 Women’s
Ambulatory Health (WAH)
The patient care delivery model in WAH is case management and
team care with collaboration between nurses, OB/GYN residents
and patients. The WAH develops such policies as Non-Stress Test
(9.3f) to guide nursing practice. Professional standards are
utilized to develop these protocols. Some of the organizations
whose standards are utilized include AWHONN, ACOG, CDC, and the
American Society for Colposcopy and Cervical Pathology (ASCCP).
WAH has established a Journal Club as well. An educational
article posted for staff to read on a monthly basis is later
discussed at staff meetings. A primary source of the articles
for this club is AWHONN Lifelines and CE Direct. Topics reviewed
include: Discussion of new / revised standards of care, or
policies, patient education strategies, new surgical techniques
and expected patient outcomes.
Neonatal Intensive Care Unit (NNICU)
Nurses in NNICU who used the Pediatric Sun Score for pain
assessment felt the pain scale was inadequate to evaluate the
pain of preterm infants. The UC took the initiative to conduct a
literature review to identify evidence based neonatal pain
scales. From their research they adapted the Management
/Monitoring: Premature Infant Pain Profile (PIPP) Infants 37
Weeks developed by Stevens B, Johnston C, Petryshen P, et al in
"Premature Infant Pain Profile: Development and Initial
Validation", Clinical Journal Pain, 1996. The UC developed a
protocol and worked with the Neonatologist and Neonatal NP to
develop a Neonatal Pain Management Order set (9.3g). The council
collaborated with the DBE to develop staff education. Training
was completed (9.3h) and the new practice was instituted in May
2008. As a result of the new scale, the documentation of
effective pain management has improved from 0% to 100%.
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