Title: Innovative nurse-driven solutions to complex patient issues: MPAC certification
Dr. Liisa Kathleen Ortegon, DrBA, MAA, BSN, RN, NE-BC, CPD, Dr. Shannan Hamlin, PhD, RN, Dr. Nicole Fontenot, PhD, RN, Dr. Hsin-Mei Chen, PhD
Houston Methodist Hospital, USA
Abstract: Serious adverse events (SAEs) occur in a significant proportion of hospitalized patients. Studies show these SAEs are often iatrogenic and preventable in many cases, as they are commonly preceded by documented evidence of physiological instability (hypotension, tachycardia, tachypnea, etc.), at times up to 24 hours before the event. Patient risk and outcomes are dependent upon the number and severity of vital sign (VS) derangement. Unfortunately, in patients with abnormal VSs almost 50% of nurses are unaware and therefore unable to intervene.
Nurses who spend the most time with patients are best suited to recognize subtle changes in a patient’s condition. Delayed recognition of deterioration is a significant factor in patients who experience failure to rescue (FTR) and SAEs while hospitalized. In fact, when delayed recognition is extended to 4-8 hours, patient risk of mortality more than doubles.
Based on significant evidence that a comprehensive physical assessment prevents FTR and SAEs, we conducted a large-scale nursing quality improvement project titled Methodist Proficiency Assessment and Competency (MPAC) Certification. The goals of MPAC Certification are to establish basic nursing care expectations and standardize nursing practice throughout the hospital by 1) prioritizing nurse’s initial comprehensive physical assessment, 2) advance nursing practice through improvements in nurse’s critical thinking, clinical skills and communication and 3) create a culture of patient safety by improving early nurse recognition of patient deterioration.
Using direct observation, we collected baseline data (n=180) on randomly selected RNs conducting a physical assessment on their patients. Data showed 27% of nurses completed a comprehensive (head-to-toe) physical assessment.
More than 100 4-hour MPAC Certification training classes were held with over 1900 (96% of nursing staff) successfully completing their MPAC Certification. Post-MPAC audits (n=614) show a 45% improvement in nurses conducting a comprehensive assessment.
As a result of improved nurse surveillance, our hospital has shown a significant reduction in delay time from the first subtle sign of change in patient condition to activation of the Rapid Response Team. This reduction in delay time (7.41 hours; p=.000) from pre- and post-MPAC Certification is a strong indication that nurses who prioritize their time and conduct a comprehensive physical assessment at the beginning of their shift, can improve patient safety by early recognition and intervention when patients have a change in their condition.
Audience Take Away:
- The audience will be able to take the information back to their respective institutions and immediately implement the salient aspects of the MPAC Certification and track progress.
- The audience will understand the impact that a knowledgeable and skilled nursing workforce can have on patient safety and outcomes.
- The audience will be able to understand the importance of executive support to advance nursing practice through evidence-based solutions.