The Neurosurgical Intensive Care Unit at University of Colorado Hospital has retained its spot among the nation’s elite ICU’s, earning a silver-level Beacon Award for Excellence from the American Association of Critical-Care Nurses (AACN). The three-year designation, issued in December, is good through 2018.
The designation was issued to the Neuro ICU based on its success in improving patient outcomes and developing practices that align with the AACN’s six Healthy Work Environment Standards:
- Leadership structures
- Staffing level practices
- Staff engagement
- Effective communication and learning development
- Evidence-based practice
- Outcomes measurement
Units earn gold, silver or bronze awards based on their success in meeting these standards.
“The Beacon Award for Excellence recognizes caregivers in stellar units whose consistent and systematic approach to evidence-based care optimizes patient outcomes,” AACN President Karen McQuillan said in a press release. “Units that receive this national recognition serve as role models to others on their journey to excellent patient and family care.”
Of the roughly 6,000 ICUs in the United States, just 225 are Beacon-designated, said Neuro ICU Nurse Manager Frank Newsome, RN, CNRN. Five of these units are in Colorado. However, UCH’s Neuro ICU is the only “neuro-specific” unit – meaning it cares only for patients with neurologic problems – in the state to earn this distinction. Nationally, just 13 neuro-specific ICUs have earned Beacon awards, Newsome added.
“Gaining this recognition from the AACN accrediting body is huge,” said Mary Holden RN, MS, nurse manager of the Burn Center, who until recently also served as nurse manager for the Neuro ICU.
The unit received the silver designation in spite of dramatic changes since 2012, when it earned a gold award. In May of 2013, the unit moved from a 10-bed space in the Critical Care Wing to a new 24-bed home in Anschutz Inpatient Pavilion 2. To provide care in the larger unit, the number of staff doubled from 35 to 70. Bringing on so many new nurses added to the challenge of training in the fundamentals of quality improvement and outcomes measures, such as preventing infections, pressure ulcers, and patient fall rates, Holden said.
“The report really covers two different units,” she said.
The transition probably played a role in its rates of central line associated blood stream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) rising between 2013 and 2014. With time to “settle in,” however, the unit was able to improve both of these measures significantly between 2014 and 2015, Holden noted.
The report contained plenty of positive feedback. For example, the unit drew high marks for its efforts to engage staff by creating a unit-based council, soliciting feedback from staff, and using the Employee Engagement and NDNQI (National Database of Nursing Quality Indicators) surveys to assess needs on the unit.
“We’ve used staff input to address needed improvements,” Newsome said. “The staff then make the changes.”
The authors of the report reflected this point, praising the quality and commitment of the nursing staff and adding, “nurses are engaged not only in providing expert care at the bedside, but are [also] engaged in projects at the unit and organizational level.”
Those qualities are essential for nurses in the Neuro ICU, Holden said. “We have to have nurses who want to excel, to be on committees, and to pursue professional development,” she noted. “They have to be engaged with what we’re trying to do in using infection-prevention bundles and other improvements.”
Simply pulling together the application for the award was a challenge in itself, Holden said. Keri Gulliford, RN, a charge nurse on the unit, was an essential part of the unit’s success in achieving Beacon designation. Gulliford solicited and collected information for the each of the criteria questions from various staff members, then pulled together the report, which could not exceed 50 pages. There was no site visit and no opportunity to respond to the AACN’s assessments, Gulliford said.
Gulliford and the entire Neuro ICU staff had a tough assignment, but their work to earn the Beacon Award was worth the effort, Newsome said.
“It shows staff that everything we do makes a difference,” he said. “We have hard work on our unit, but nurses can see the results.”
The work continues. To meet the AACN’s standards for a gold-level designation, the unit will need to “demonstrate excellent and sustained performance and patient outcomes.” That is the goal for 2018, Newsome said.
“Opportunities for improvement were identified and work continues to improve the care that the patients in the Neurosurgical ICU receive,” he said.