Running head: QUALITY IMPROVEMENT 1

Ashley C. Bingham

Quality Improvement

Professional Role Development: Servant Leadership

NUR 4144

October 17, 2017

Dr. Ellcessor

I pledge Honor Code

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Quality Improvement: Daily CHG Bathing

The field of nursing is in constant evolution. This constant state brings changes frequent

changes to protocols, policies and procedures. Change can be a challenge and can meet

resistance amongst the nursing staff. The nursing manager plays a vital role in evaluating the

needs of the unit through open dialogue amongst the staff. Discussion about how to implement

the change is important for the success, not only for the staff, but for improved patient

experience and outcomes. The purpose of this paper is to explore a current initiative that was

developed to support a policy change and how it promoted positive outcomes and quality

improvement (QI). According to the U.S. Department of Health and Human Services Health

Resources and Services Administration (HRSA), quality improvement Consists of systematic

and continuous actions that lead to measureable improvement in health care services and health

status of targeted patient groups. The Institute of Medicine (IOM), which is a recognized leader

and advisor on improving the Nations health care, define quality in health care as a direct

correlation between the level of improved health services and the desired health outcomes of

individuals and populations (hrsa.gov, 2011).

In the Bon Secours Health System there is a model called Reliable Care Accountability

Matrix (2.0) that is being used to ensure reliable, evidence-based, compassionate care for every

patient, every time (Bon Secours, 2017). Using this model, the hospital can set goals and

measure quantitative data to see if/how those goals are being met. This model supports the

HRSA process of QI, using a systematic approach for measurable outcomes.

The hospital has many policies to support nursing practices and protocols. Each unit can

take those policies and create initiatives to increase implementation of the policy to ensure good
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outcomes and compliance. The QI project this paper will be discussing in the use of CHG wipes

on every patient every day and what the unit has initiated to make this happen.

The policy CHG Daily Bathing and Line Disinfection states, Daily Chlorhexidine

Gluconate (CHG) bathing has been shown to reduce the microbial skin burden and help prevent

healthcare-associated infections. The CHG is fast-acting broad spectrum, and kills most bacteria

and viruses (Bon Secours Policy, 2017, p.1). This supports multiple RCAM initiatives to

increase C. Diff prevention, CAUTI prevention and SSI prevention.

The nurse manager and the clinical care lead (CCL) of the unit complete daily audits of

daily CHG bathing on every patient. The reports were showing a lack of compliance with this

policy and this was brought to the nursing staff at a monthly meeting. In the book Lead Like

Jesus, authors Ken Blanchard and Phil Hodges write of four domains: heart, head, hands, and

habits (Blanchard & Hodges, 2005). These domains represent different factors that influence

servant leaders in using Jesus as a role model. The heart and head represent internal factors such

as motivation, intention, beliefs and morals and how they influence ones leadership. The hands

and habits are external factors that represent helping others accomplish their goals with the use

of supportive relationships.

As a nurse manager using these domains are essential for success. Serving others rather

than being served (heart) must be the foundation. Using a visionary role (head) will help guide

others to see the purpose of this new teaching. Coaching (hands) peers to be successful is

important for individual buy-in to the new process and builds team cohesiveness. Finally, using

daily practices with the goal to live as God would want (habits) will encourage positive and

worthy acts.
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Using the five exemplars of servant leadership will guide the nurse manager to

implementing this change to the unit. These exemplars are: model the way, inspire a shared

vision, challenge the process, enable others to act, and encourage the heart (Ellcessor, PPT,

2017).

By modelling the way, the nurse manager is showing the unit that this is a priority and

that the manager is willing to also put in the work to make it happen. Using the staff meeting as

a safe place to discuss the policy and the decline in compliance exemplifies inspiring a shared

vision. Making sure every person on staff is 100% aware of the new policy and knows how to

practice the change is an important to see if this may be contributing factor to the low

compliance. Asking each person if they know how to bathe the patients using the CHG bathing

technique will be included in this process to inspire a shared vision. Challenging the process is

the basis of why the unit needs to have this discussion. Is there a better way the unit can increase

performance? As it turns out there is... and so the creation of a visual reminder in the form of a

rubber duck magnet came about. The magnets would be placed on the outside of the patients

door every morning at shift change. The rubber duck indicated that the patient still needed a

CHG bath for the day. If the rubber duck was removed, this would indicate to the staff that the

CHG bath was complete. It was even further decided that day shift would bathe the majority of

the patients minus 2-3 total care patients, as day shift typically has more resources allowing more

man hours to be allocated to the bathing and aid of patients who were independent or in need of

partial assistance.

As the nurse manager uses a democratic leadership style, valuing the staffs input enabled

others to act. Using the collective idea of the rubber duck magnet gives the team ownership of

the initiative and its future success. By evaluating the needs of day and night shift encourages
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the heart. By sharing the work load and recognizing each shifts challenges is helpful to the

entire team. Overall the main focus of this initiative is not only to be compliant with the policy,

but more importantly increasing infection prevention and making the patients safety the number

one priority.

Professional Practice Implications

Reflecting on this initiative and the changes on the unit, there are some professional

practice implications learned. One being an emphasis on patient education of patient safety and

how those are met through nursing interventions. The nursing staff are aware of why CHG baths

are important, but this may not always be conveyed to the patient. Taking the time to thoroughly

explain why nursing interventions are being used, not just CHG baths, but with all practices will

help the patient understand its importance. Specifically, to CHG baths, once the patient is

educated, they will have a better understanding on how much focus nursing staff gives to patient

safety in regards to increasing infection prevention.

A second implication is the need for staff involvement when it comes to changes within

practice on the unit or in the hospital. If the nurse manager had been able to have the discussion

on the policy change, a unit specific approach may have been available. This may not always be

possible, but it is critical to think of how a change will effect the unit as a whole in the day to day

operations and also the unit culture. Engaging in those meaningful conversations earlier on may

prove to be effective for all nursing staff involved.

Outcomes Evaluation

The new unit initiative started off a little shaky. Getting into the routine of placing the

magnets every morning was somewhat of a challenge. The team had to identify who would be

responsible for placing the magnet. Asking the unit secretary to place the magnets each morning
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was helpful because it would be done at the same time the nurses name/zone phone number was

placed on every patient door frame. Once this was established the initiative started off well.

After about a month the daily audits were increasingly reaching 100% compliance. Kudos were

sent out via email to highlight some of the Patient Care Technicians (PCT) who were

consistently getting all the daily CHG baths every morning before 1000. This recognition

encouraged the unit to keep up the good work. Continually our outcomes were improved in the

form of slowly increased Hospital Consumer Assessment of Healthcare Providers and Systems

(HCAHPS) scores and decreased hospital acquired infections. Overall the rubber duck magnet

initiative was a success and helped improved patient experience and outcomes for the unit.
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References

Blanchard, K. & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.

CHG Daily Bathing and Line Disinfection [Policy No. PF6113]. (2017, April 4). Bon Secours

Health System, Inc. Richmond Region (BSR).

Ellcessor, B. (2017). Five Practices of Exemplary Leadership [PPT].

Reliable Care Accountability Matrix (2.0). (n.d.). Retrieved October 17, 2017, from

http://spweb/localsystems/gvl/nursing/Pages/RCAM.aspx

U.S. Department of Health and Human Services Health Resources and Services Administration

(HRSA): Quality Improvement [PDF]. (2011, April).