Exemplary Professional Practice

Critical Care originally started the peer recognition program, Critical Care Star award, as a way for the Critical Care department to recognize each other for going above and beyond for patients and/or each other. It is awarded from interdisciplinary team members to interdisciplinary team members. In 2024, it spread to ASU and PACU, as a way to recognize their interdisciplinary team members.

2024 STAR award recipients in Critical Care

Nick Avdienko, MSN, RN, CNL, SN II, CVICU

Dr. Jeff Gotts

Milan Shahi, BSN, RN, SN III, CVICU

Dr. Dustin See

Vic Ferraris, UA, CVICU

Adriel Macalintal, BSN, RN, ANM, CVICU

Jasmine Miyamoto, PCT, CVICU

Naran Phattharawittakorn, BSN, RN, CCRN, SN II, CVICU

Joan Lo, ADN, RN, CCRN, SN II, CVICU

Jemma Parayno, UA, ICU

Dr. John Alexander

2024 STAR award recipients in ASU and PACU

Amor Arcilla, ADN, RN, AMB-BC, SN IV, ASU

Josephine Canales, LVN, PACU

Heidi Lau, MSN,RN, SN IV

Narelle Lange, RN, SN II, PACU

Erik Tvede, BSN,RN, SN III, ASU

Unplanned Extubations (UEs) are the fourth-most common adverse event in the nation’s Neonatal Intensive Care Units (NICU) and can lead to airway trauma, bleeding, and cardiovascular collapse (Kambestad, 2019). Exposure to one or more UE is associated with a nearly one-week increase in the duration of mechanical ventilation, an additional 10 days in the hospital, and/or patient demise (Sadowski, 2004).

KP San Francisco’s NICU had 4 UEs occurred out of less than 300 total ventilator days in 2023, averaging a rate of 1.3 UE per 100 ventilator days, while the national benchmark for like units is <1 UE per 100 ventilator. In response, a multidisciplinary team worked to develop and implement a UE prevention bundle with the aim of reaching and maintaining the <1/100 UE rate goal for 2024.

After an apparent cause analysis (ACA) using the UE questionnaire of the 4 UE events, a multidisciplinary team identified the need to develop and implement a UE prevention bundle with the aim of reaching and maintaining the <1/100 UE rate goal. UE prevention practices across comparable NICUs in the region were compiled and a literature review of articles through PubMed, Cochrane, and CINAHL for bundle components was conducted. Findings support the implementation of a UE Prevention Bundle that consisted of 8 different pieces. A performance improvement plan using the Plan Do Study Act (PDSA) was developed to support bundle education, implementation, and ongoing compliance. The UE Prevention bundle was rolled out on March 1st, 2024. KPSFO has had 0 UE since bundle implementation and surpassed the goal of 1.0 UE per 100 ventilator days on November 1st, 2024.

On 4 Center, a medical-surgical telemetry unit at Kaiser Permanente San Francisco that specializes in caring for post-surgical patients, nurses know how important mobility is. Early mobilization increases functional capacity, decreases postoperative complications, and decreases length of stay, thereby enhancing patient safety during and after hospitalization. RNs perform a daily mobility assessment (Clinician Level of Function or CLOF) that provides a daily mobility goal for each patient.

Despite widespread awareness of the importance of early mobilization, 4 Center’s 2024 mobility data showed that independent walkers (patients with CLOF ≥38, or Mobility Group 6) were not meeting the regional mobility benchmark. That is when the 4 Center team developed the idea of piloting a project to give patients pedometers. A pedometer is an innovative wearable technology that tracks step count. Research shows that giving patients pedometers can increase physical activity, decrease sedentary behavior, and improve physical functioning.