Paper Presentation: Program Development — Nursing Practice Advocate: An Innovative Role Created to Reduce Harm While Supporting and Engaging Bedside Nursing Staff (228-1)

11:30 am – 12:30 pm Saturday, October 30

In 2019, inpatient pediatric hematology/oncology (PHO) and stem cell transplant (SCT) units within a children’s hospital experienced an increase in central line–associated bloodstream infections (CLABSIs) and mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs).

Investigations and direct conversations with staff revealed gaps in standard care related to nurses stating inadequate time to complete and/or focus on nursing tasks. Through further discussion, we found that staff were not taking lunch breaks, which can contribute to decreased staff satisfaction and increased errors. These concerns led to the creation of the nursing practice advocate (NPA) role in 2020. The NPA is a bedside RN out of staffing who focuses on harm prevention, nurse satisfaction, burnout, and the value of nursing practice. To help nurses on both shifts, one NPA is scheduled from 10:30 am to 11:00 pm. The NPA focuses on the patients that are at highest risk for harm, identified through auditing and consultation with the bedside RN, charge RN, medical team, support staff, clinical nurse specialist, and nursing manager. A significant amount of the NPA’s time is also spent coaching and mentoring nurses, educating families, and reinforcing evidence-based practice. The time the NPA spends with each nurse also allows them to identify challenges that could prevent bedside RNs from taking their breaks. The NPA role went live in the second quarter of 2020. Quarter two of 2020 showed a decrease in the combined infection (CLABSI and MBI-LCBI) rate from quarter one (6.85 to 2.24). The combined infection rate has been contained between 3.5 and 4 since that time. A noteworthy benefit is that gaps in standard care have been significantly reduced in all cases of infection since the role was implemented. There have been no noted gaps in standard care in CLABSI events since July 2020. Tracking of outcome metrics is ongoing.