Providence Alaska Medical Center
Anchorage, Alaska
One Year.....One Team
Paragon Coaches (L to R):
William A. Brock, MD, FCCM
Vice President & Chief Quality Officer
Presbyterian Hospital, Plano, TX
Sarah L. Darwin, RN, MSN
Director of Critical Care & eICU
Sentara Norfolk General Hospital
Norfolk, VA
Providence Alaska Medical Center (L to R):
Rose Timmerman, Clinical Nurse Educator
Margaret Auble, ACC Nurse Manager
Jackie Mossakowski, Chief Nursing Executive
Remarkable Steps Toward Excellence!
The staff at Providence Alaska Medical Center (PAC) knew the time was right to implement change in their intensive care unit (ICU). A newly formed intensivist group provided an optimal opportunity to move from nurse-driven clinical improvement to multiprofessional team-driven change and staff was eager to take advantage of the help. They possessed the drive and looked to the Society of Critical Care Medicine (SCCM) for additional support and resources to ensure change was sustainable and measured. They eventually found this support in the Paragon Critical Care Quality Implementation Program™ and, one year later, the team is able to demonstrate their significant progress and great success.
PAMC was invited to attend a Surviving Sepsis Campaign Regional Training program held in Seattle. The opportunity to include as many hospitals on the Northwest coast as possible in the training was SCCM’s goal. While the PAMC team could not attend the regional training, the invitation sparked the beginning of what would become a truly successful journey for the hospital. PAMC continued to communicate with SCCM staff and when the Paragon was launched, PAMC was first to engage. The depth of PAMC’s commitment to excellence and the wide range of critical care improvement projects that were possible, including the implementation of the sepsis bundles, quickly became clear.
Jackie Mossakowski, RN, BSN, MAT, chief nursing executive at PAMC, had purchased SCCM’s ICU REPORT product. PAMC used the index tool to survey staff in the unit and to get an overall sense of the areas that might be prime for change. After reviewing the results, Paragon chair and coach William A. Brock, MD, FCCM, and coach Sarah L. Darwin, RN, MSN, talked with PAMC about becoming involved with the Paragon. The Society would provide the resources and expertise, and PAMC would do the hard work on the ground. Timing couldn’t have been better for the hospital so PAMC soon signed on to become a Paragon hospital.
During an intense two-day site visit to PAMC’s sparkling and impressive ICU, the Paragon advisors formed a substantive bond with the team. Meetings were held at all levels including senior administration to discuss all the positive aspects of care at PAMC and areas where change might enhance both outcomes and staff satisfaction. The staff had the will to improve, they just needed guidance from those who understood the challenges they were facing and could provide the connection the team needed to work within timelines.
Over the next year, through teleconferences, email, and participation in the North American Surviving Sepsis Campaign Summits, the Paragon coaches observed a critical care team transitioning from great to excellent. Multiprofessional rounds and communication among care providers and with the patients’ families improved. Palliative care staff became valued members of the critical care team. A full-time data collector/quality improvement specialist was added. A critical care council charter was developed to help streamline meetings and improve communication among all providers and administration. Importantly – and with commendable effort within the emergency department and ICU – sepsis mortality dropped from 28% in 2007 to 14% in the first six months of 2008. Staff took the lead on developing a comprehensive sepsis brochure for the Providence Health System to share their success with their colleagues and spread their knowledge. And with remarkable dedication, the team began to tackle any and all factors that might lead to ventilator-associated pneumonia in their unit. Multi-professional rounds, sedation interruption, CASS tube trials, more timely spontaneous breathing trials, equipment maintenance, and many other factors were put to rapid cycle change. The incidence of ventilator-associated pneumonia headed toward zero.
At the one-year mark, the PAMC team was resurveyed to ascertain how much improvement had actually taken place between the initiation of the pilot and the conclusion. The results are as follows:
Finalizing the engagement has been bittersweet for all, but the relationships among the coaches, SCCM, and the PAMC staff continue. Learning and sharing has occurred in both directions. PAMC is now spreading its success to Providence’s Kodiak Island Medical Center and its 25-bed acute care unit. Congratulations and many thanks are extended to the PAMC team for their dedication to excellence and for helping to demonstrate the power of Paragon.
