Hawaii

“The idea came from our manager, when one of our young, alert patients fell and got an injury. We were all upset,” says Jenalyn Andres, RN, one of the union co-leads for her department’s UBT.

That incident spurred nurses on the 4 East-Malama West unit-based team at Moanalua Medical Center in Hawaii to set a goal to cut the number of falls in half within 12 months—from 18 in 2013 to nine or fewer by the end of 2014. The team exceeded its goal and had only six patient falls in 2014.

Steps to success

Team members adopted the No One Walks Alone falls prevention program, pioneered at the San Diego Medical Center, to help them reach their goal. The team set up a standard process to ensure success. Some of the elements of the plan included:

• checking that all bed alarms are on at the start of shift and during the shift
• having alarm pads for chairs readily available in rooms, ready for patients who get out of bed and into a chair
• placing nonskid socks on patients’ feet
• positioning call lights within reach
• using walkers to help patients become mobile

Andres, a member of Hawaii Nurses Association, OPEIU Local 50, says the team educated patients and families by sharing literature with them that included tips on preventing falls and information about the No One Walks Alone protocol. The protocol starts with the assumption that all patients are fall risks, instead of nurses trying to identify which patients are at risk. Patients are accompanied every time they get up, especially to and from the bathroom, which is when most falls occur.

Troubleshooting “hot spots”

As part of the team’s process improvement, it identified “hot spots”—things that could happen that could prevent success. For example, the team quickly discovered that it had different types of patient beds on the unit, with different bed alarms. Some of those alarms weren’t wired into the nurse call system, so staff members had to follow the sound of the alarm to figure out which patient needed assistance—which meant it took longer to get to the patient.

The UBT worked to get the issue fixed, and as a result, “a project was opened with facility maintenance and beds have been switched to a universal cord, which resolves the problem,” says Manlee Velasco, the unit’s manager and management co-lead. “In the few cases where the cord wasn’t compatible, new beds have been ordered.”

The team has had five falls so far this year, which came before the cord issue was resolved. 

Spreading a successful practice

The overall success of the prototcol has been noticed by other teams and “all of the inpatient units at the Moanalua Medical Center are now using the program," says Kim Lu, RN, the 4-East unit’s other UBT union co-lead and also a Hawaii Nurses Association member. 

The practice is a great example of spread for another reason: The “No One Walks Alone” slogan and program was created by a San Diego Medical Center UBT in Southern California that was involved in a Joint Commission pilot in 2012.

The Moanalua Medical Center in Honolulu is saving the planet, one unit-based team at a time.

The Ambulatory Surgery Recovery UBT started collecting small bags of recyclables on its own in March. But team members resorted to some “trash talking,” and now the entire medical center collects about 30 pounds of recyclables each week.

“The original goal was to help our aina (land) thrive,” says Avis Yasumura, RN, the team’s union co-lead and member of the Hawaii Nurses Association, OPEIU Local 50. “Being on an island, there are limited space and resources.”

The region estimates that since October 2010, the recycling has diverted 7.1 tons from the landfill and saved several hundred dollars in recycling fees.

The ASR team started by identifying items on its unit that a local vendor was willing to collect and recycle: irrigation bags, wrappers for intravenous tubing and operating room “peel packs” (sterile wraps for drapes, instruments, gowns and gloves). The team used tests of change to successfully gather and segregate the items.

ASR shared its effective practices in several ways, including:

• a PowerPoint presentation on products that can be recycled
• “Going Green” editions of its UBT newsletter and fliers with pictures of recyclables
• helping other units order blue recycle containers and arranging for pick up with the EVS department

The team also promoted the project at Hawaii’s first UBT fair, with a colorful storyboard display, complete with examples of recyclable products.

“It was the talk of the UBT fair,” says ASR co-lead Janet Lundberg, nurse manager of procedural sedation. “This recognition inspires all UBTs to take risks.”

More than 10 teams at the 300-bed center are recycling now.

Where did the ASR unit get the recycling bug in the first place? Carolyn Sandison, an HNA nurse, was inspired by an LMP bulletin board poster in her break room about the blue-wrap recycling project at Sand Canyon Surgicenter in Southern California.