Background: Staff nurses of an acute care surgical unit reported their concern regarding various obstacles in completing patient admission process and meeting new patients’ care needs in a timely manner while maintaining quality care and safety for their previously assigned patients. These obstacles were simultaneous influx of direct admissions and transfers, especially at around change of shift and medication administration time, lack of team support, and high-acuity admissions or transfer patients with extensive needs and multiple orders. Delays in patient care and patient and staff dissatisfaction were the catalyst for the project.
Aim statement: In response to staff concern, the unit-based council introduced the concept of “SWARMING” the new admission. The swarming process was officially implemented in June 2018, with the objective of utilizing a team nursing approach to provide resources and support to the primary nurse and patient care technician when new admissions, incoming transfers, and post-operative patients arrived to the surgical unit. This collaborative approach also aimed to increase patient satisfaction by at least 20% by December 2018 and promote staff engagement.
Interventions: Swarming process was implemented as follows: • The health unit coordinator sends a mass message to Spectra Link phones of all staffs on duty “Patient’s room number – SWARM new admit is here” upon arrival of the admission or transfer. • Available staff members will come to the new admission to swarm and assist with various tasks to help settle the new patient. • The primary nurse and charge nurse will direct the swarming team and delegate tasks to other team members such as transferring the patient to the bed, paging physicians, setting up the IV pump, taking vital signs, obtaining blood glucose, obtaining a standing weight, orienting the patient to the unit, and so on. • In 2019, modifications to the initial interventions were made with the objective of improving efficiency by specifying certain tasks and responsibilities to swarming team members. • Primary nurse and/or charge nurse: receive the new patient, complete Epic admission database, perform skin checks, dual sign-off for required medications. • Nurse buddy: page the physician, start PIV as needed, set up IV pump, start IV fluids, obtain labs, or call phlebotomy. • Primary PCT: set up the room with admission supplies, assist with transferring patient from the stretcher/gurney to bed, obtain admission vital signs and a standing weight, set up blood pressure machine for frequent vital signs if needed. • PCT buddy: obtain blood glucose, apply sequential compression device, obtain a telemetry/pulse oximetry box.
Results: Based on feedbacks from nurses and patient care technicians (PCT) post-implementation, the swarming project was well received by majority of staff who reported feeling supported throughout admission process for new admits or transfers. Teamwork and morale were strengthened with swarming. According to leadership rounding, new admission patients feel cared for and appreciative of the whole team collaboration. The post-implementation Press-Ganey result in 2018 was favorable. Patient satisfaction scores soared up from 3% (pre-implementation in the second quarter) to 83% (post-implementation in third quarter) and 92% (post-implementation in fourth quarter).