Structural Empowerment

Megan Carrigan, RN, at her DAISY Award celebration
Megan Carrigan, RN, at her DAISY Award celebration

Implementing the DAISY Award

In December 2019, Megan Carrigan, a nurse in the Mountain View Emergency Department, became El Camino Health's first DAISY Award recipient.

The DAISY Award for Extraordinary Nurses was created by Mark and Bonnie Barnes in memory of their late son Patrick. Patrick died at the age of 33 of complications of Idiopathic Thrombocytopenic Purpura. The Barnes family was so profoundly touched by the nursing care their son received during his illness they decided to create a way to thank nurses for the care they provide. They developed the DAISY Foundation in 1999 with one hospital, and there are now more than 4,000 hospitals participating in the program.

This is a monthly award, and nurses are nominated by patients and/or families for providing extraordinary care.



Addressing Alarm Fatigue in the Critical Care Unit (CCU)

Research indicates that 72% to 99% of alarms in critical care units are false alarms, which can create a situation in which alarms are ignored. Alarm fatigue is defined as a sensory overload that occurs when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarm sounds and increased numbers of missed alarms. There were more than 600 alarm related patient deaths between 2005 and 2012 in the U.S.

CCU nurse Kayline Martinez began work to address alarm fatigue in May 2019 by making recommendations for default alarm settings, based on evidence and industry best practices. In June 2019, Kayline began teaching the nurses about alarm fatigue concepts and the new recommended default alarm settings.

The new settings were implemented in August 2019. The average number of alarms in the CCU decreased from pre-implementation average of 20,000 per day to 3,500. Additionally, HCAHPS scores for "Quiet At Night" in the CCU increased from a pre-implementation mean score of 50 to a mean score of 80.2 post-implementation.

Kayline Martinez, RN, in the monitor room at El Camino Health's Mountain View Hospital
Kayline Martinez, RN, in the monitor room at El Camino Health's Mountain View Hospital

Jill Byrne, RN, assisting with skin to skin care in the Mountain View Hospital NICU
Jill Byrne, RN, assisting with skin to skin care in the Mountain View Hospital NICU

Neonatal Intensive Care Unit (NICU) "Out of The Box"

Skin to skin contact is a cornerstone of developmental and family-oriented care for very low birthweight and other infants separated from their parents and admitted to the NICU. Skin to skin contact provides the infant with stability of body temperature, cardio-respiratory rhythms, and oxygen saturation.

In early 2019, Arlene Fleming, a nurse in the Mountain View NICU, brought best practice recommendations for skin to skin contact she learned at a conference to the NICU. In April 2019, the NICU's Family Centered Care Committee created a sub-committee for environmental developmental care to develop this initiative, and named it "Out of The Box", referring to neonates spending time out of the incubator, in skin to skin contact with a parent.

The sub-committee created a process and education for parents. Nurses were educated on the process measures and goals that infants would be held by their parents within 48 hours of life, and that total Out of The Box time goal is 60 minutes per day.

Out of The Box was implemented in late June 2019. By November, total Out of The Box time increased from 35 minutes pre-implementation to an average of 78 minutes, and the length of stay in the NICU decreased 44%.

Graph of Average Skin to Skin Time for NICU Patients <35 Weeks