A brief overview of the hospital
Recently, Sinai Hospital Baltimore became the first community/teaching hospital in Maryland to receive the American Nurses Credentialing Center’s Magnet designation for its excellence in nursing care.
It joined the 287 other hospitals in the country to receive this credential among more than 6000 eligible health organizations. It was established in 1886 by the Jewish community in Baltimore as a Hebrew Hospital and Asylum and has evolved to become a non-profit institution committed to quality patient care, research and teaching institution (Life Bridge Health, 2010).
Mission, vision and core values
The Sinai hospital was founded and is supported by the Jewish community and is committed to carrying out two major roles; providing high-quality and cost-sensitive health care services to the people of Baltimore and to provide high-quality medical education programs to undergraduates, graduate, other health professional practitioners, employees, and the wider community.
Its mission is to be sensitive to the needs of the patients especially Jews as well as its staff and maintains the Jews traditional values of excellence, community concern, and kindness (Life Bridge Health, 2010).
The vision of the hospital is to emerge as a model of comprehensive health care providers in the country through strengthening its Jewish heritage, outstanding clinical strength, and its record of service.
Number of beds and services provided
The Sinai Hospital Baltimore has the capacity of 491 Acute-care beds, 335 of them being for medical and surgical care, 23 obstetric, 57 are for rehabilitation, 21 NICU, 31 for pediatric care, and 24 for psychiatric care as of the year 2010 according to (Life Bridge Health, 2010).
The hospital offers a wide array of services, both in-patient and out-patient, in several departments which include emergency medicine, urology, pediatrics, pathology, orthopedics, physical medicine and rehabilitation, radiology, radiation oncology, surgery, psychiatry, oral and maxillofacial surgery and dentistry, ophthalmology, obstetrics and gynecology, neurosurgery and medicine (Life Bridge Health, 2010).
It also served around 25,952 adult patients, 2,291 births, 212 NICU, 73,847 emergency visits, 70,893 outpatient clinic visits, 10,552 same-day surgical visits and 3,918 VSP visits in 2010 alone according to ( (Life Bridge Health, 2010) in its 12 centers of excellence.
Sinai Hospital and the Magnet Model
Sinai Hospital always endeavors to apply the five components of the Magnet Model in every project it undertakes. This ensures that nurses in direct care services are fully involved in projects that affect their practice areas. A recent example of how Magnet model components are applied is outlined in the bedside medication administration process (Bolton & Goodenough, 2003).
In 2003, the Sinai hospital was dedicated to ensuring secure administration of medication to its patients. This was supposed to be automated by the use of robots to fill and deliver medications to patients to eliminate human errors in the process. The automation of the process, however, was met with challenges as the next step in automation, which was barcode reading, could not be supported by the change.
The chief nurse, together with the hospital leadership, was committed to transforming the process of medication administration in the hospital. This process was interdisciplinary as it involved the physicians, pharmacy and nursing, information services, facilities maintenance, capital improvements, and respiratory therapy departments, and the direct-care nurses were involved throughout the process.
This collaboration between stakeholders in transformational leadership was geared to promoting change, growth, and evolution with the nursing profession (Faust, 2011).
There were focus group debates held among nurses with the aim of identifying the most critical components in medication administration; this was to ensure that the registered nurses (RNs) were involved in the direct care as well as secure medication administration. The results of the discussions created criteria for identifying the products that will help meet the goals of this project. This research, together with that from the internet and literature resulted in a list from which the best storage options were chosen.
The manufacturers or vendors of these products held a demonstration of these with the RNs and other stakeholders from which each attendee was to use and evaluate each model of the storage options. From the evaluation of the attendees, two models were listed, and further evaluation sessions were done where the NetLock cabinet by Cygnus, Inc was chosen as the best. In choosing the locking system for the cabinets, the same composition of direct-care nurses and stakeholders was used for feedback.
From the options provided by Cygnus, Inc vendor, Isonas PowerNet Reader security device was chosen. The Ethernet was used to power the new medication cabinets, this simplified access by the RNs as they could just swap their employees badges. This eliminated the requirement for keys and access codes and further tightened the security by tracking access patterns for increased medication security (Laschinger & Wong, 2007).
The component where change would improve organizations outcome
To improve further, the outcome of the safe medication administration process, the exemplary nursing practice component of the magnet model should be changed. This should include a pilot project by installing the new cabinets in an inpatient unit in the hospital, which should be identified by the RNs and stakeholders.
The pilot project should last one month and should be in use in the chosen inpatient unit as the others get installations for the same. This will help identify any changes required and the problems that may arise in the use of the cabinets by those who will be using them to inform the installation in the rest of the units (American Nurse Credentialing Center, 2008).
The pilot project should create communication tools that will allow the nurses to make inquiries, voice their concerns, and generally real-time feedback between the users and the installation team.
After the pilot project and during the implementation of the next phases of the project, RNs should be involved to support their practice improvement. This should be done by allowing the RNs and the nursing manager complete control of their work schedules.
In the placement of medication cabinets in each unit, RNs, nursing manager and the pharmacy stakeholders should be involved to determine which position is the best where nurses could access computers at the bedside and also in isolation room in places marked by the nurses themselves.
At this point, the stakeholders should set date and time for the commencement of the project when all the systems ‘go live.’ Their involvement is important to allow them to consider their staffing needs, their workflow, and infrastructure support where information services department comes in (Malloch & Porter-O’Grady, 2010).
Since this is a massive project, I recommend that a few units at a time “go live” but with the consultation of all stakeholders. First, the units scheduled to “go live” should meet with all partners and the nurse managers to plan for the commencement of the project for these units. They should then check the functioning and positioning of all the cabinets and how the system is working with the employee budges. Another important task at this stage is to educate everyone using the cabinets on how they function and how to use them.
A feedback mechanism should be in place by this time to allow for communication on the process. This process is likely to take around six weeks, and after they start using the system feedback report on the findings should be used to inform the other units in installation (Bolton & Goodenough, 2003).
Another task for improving the practice of nurses in this project would be reporting the progress of the project to the existing patient-care board meetings every month to keep all stakeholders informed on the project. This creates a positive attitude towards the project and informs the units that are yet to implement the changes. This will ensure the implementation is smoother every time since stakeholders know what to expect (Laschinger & Wong, 2007).
The new cabinets will greatly motivate the RNs since they are more efficient, and their workflow will be much less, thereby increasing their time with patients for quality service. The patients will be positively affected by the changes and will feel better knowing that their medication security is highly guaranteed.
This change in medication cabinets will greatly support the next phase in improving medication safety, i.e., implementing bedside barcode. This should also follow the Magnet model components in assessment, implementation, and review of processes (Faust, 2011).
Systems affected by the proposed changes
The proposed changes in the success of the nursing performance in the improvement of safe medication process at the Sinai Hospital will affect several systems. The Nursing and pharmacy department of the hospital is at the core of the changes since they are the ones administering medications to patients. Human resources and information services department will be involved since the new cabinet changes are labor intensive and work schedules are bound to change, and new staff and training program will be required.
The finance unit of the hospital will be involved since a lot of investment is required for this project. The clinical engineering, facilities maintenance, and capital improvements are units that will partner with the involved departments in the implementation (Faust, 2011).
The top leaders of the Hospital would be informed first through including these changes in a strategic plan for the hospital. This makes sure that the proposal reaches the hospital’s board of directors and the funding for it outlines together with other future projects for the hospital.
Presenting a report to the hospitals Quality Council, which includes research on the same and recommendations will be another way since the council establishes annual goals, priority activities for the year, and allocates resources. Another way of presenting my proposal to the top leaders is through the Patient Care Council, which addresses quality patient care where medication safety process is part of the agenda (Bolton & Goodenough, 2003).
Conclusion
The Sinai hospital Baltimore mission is to provide health quality service to the people of Baltimore and quality education program for the students, staff, and other professionals. To do this, improving medication safety is a priority, and realizing this, the Hospital committed to improving medication safety in 2003. To do this, exemplary service from those involved in direct-care to patients is required. This project will take three years to implement and will be very successful since already a commitment from the top leadership has been made.
Adequate funding has already been committed also for the improvement of medication safety, and the staffs are responsive and adequate to start the project. This project has enabled me to explore the Magnet Model components and how health organizations go about incorporating it in their practice.
Reference List
American Nurse Credentialing Center. (2008). Magnet Model Compnents and Sources of Evidence: Magnetic Recognition Program. United States of America: American Nurse Credentialing Center.
Bolton, L., & Goodenough, A. (2003). A Magnet Nursing Service Approach to Nursing’s Role in Quality Imporvement. Nursing Administarion Quartely , 344-354.
Faust, B. (2011). Applying the Magnet Model to Improve Medication Safety. American Nurse Today , 123-136.
Laschinger, H., & Wong, C. (2007). A Profile of the Structure and Impact of Nursing Management in Canadian Hospitals. Canada: Canadian Nursing Leadership Study.
Life Bridge Health. (2010). Life Bridge Health Profile. Baltimore: Life Bridge Health.
Malloch, K., & Porter-O’Grady, T. (2010). Introduction to Evidence-Based Practicve in Nursing and Health Care. Jones and Barlett Publishers, LLC: United States of America.