In May 2016, Baptist North Mississippi Chief Nursing Officer Mark Ottens found himself tasked with a KATA to improve Training Within Industry (TWI) practices. “Thinking about practicing TWI better is a squishy goal, so we thought about how to get our arms around this one.”
Mark decided to find a project with measurable, real results and settled on the pre- and post-ambulatory care center (ACC) as a testing lab. “It’s a fairly closed environment with about 12 people, two TWI instructors and open Monday through Friday, so it was fairly contained.”
Then, his team began thinking about what an excellent patient experience in the ACC would look like. “Everyone who comes in gets an IV, so we looked at that. At that time, our patient experience was in the 3rd percentile rank for the question, “the skill of the nurse that started your IV.” Our hypothesis was “if we could change the IV success rate, we could improve that patient experience.”
He set a May 2017 goal of reaching 100 percent success rate on starting an IV on the first attempt. “We were at about 70 percent for first attempts on an IV when we began the project,” he said.
Considering nurses are trained in school to start an IV, his team first began searching for any existing information on Google, YouTube or any other source about starting an IV.
“You know what we found? There’s nothing out there with any detail. We began to wonder how people who have the same training could have such different results.” Even when they went to the nurses who had a 100 percent success rate, their responses were surprising.
“They didn’t know why they were better. They couldn’t tell us why they were successful.” And to further mystify the situation, the nurses’ experience ranged from three years to 20 years.
Mark’s team began filming IV start attempts with iPhones to observe the nurses who were most successful. “We began noticing many small details like the angle of the needle, how many fingers are used, how the skin was retracted.” Then, the team began training using TWI.
“We found that retraining those with experience was more difficult because of their muscle memory. We had to break habits to teach new ones.”
The process wasn’t immediately successful, but after just two months, the results were tangible. “Our IV success rate went up to 82 percent. Patients began to perceive an even greater skill with their nurse. Our score for patient experience went to the 90th percentile rank for ‘skill of the nurse that started your IV.'”
Today, Baptist North Mississippi reports patient experience at the 99th percentile rank for skill of the nurse, with a start rate on first attempt at 93 percent. In fact, Mark said his team will roll out the TWI training to the cardiac catheterization lab.
The KATA helped improve the TWI process. It also gave nurses a greater sense of confidence when starting an IV. “I heard people say they feel much more confident in their IV skills.”
Mark points to his team, Marci McCoy, Hannah Wilson and Nikki Griffin, for driving the KATA and TWI improvements. “They just kept saying ‘We’ll figure this out.’ I was just the cheerleader!”
The same team has gained national recognition and has been invited to speak in San Diego about their success. Visitors from other hospitals and universities have also observed the nurses at Baptist North Mississippi.