For Nurses and Advanced Practice

A collaborative approach to measuring progress and identifying high priority areas

Unit-Based Clinical Leadership (UBCL) is a local inter-professional leadership model that promotes a multidisciplinary approach to quality and patient safety in patient care units and departments. The teams are made up of a nurse leader, clinical nurse education specialist, a physician (who practices on unit) and a quality and safety project manager who jointly determine and monitor progress on various quality and safety targets.

Routine meetings allow for the measurement of progress and identification of areas of high priority. A strengthened sense of partnership between physicians and nurses fosters a teamwork atmosphere where communication is enhanced across units.

Improved Quality and Patient Safety System-Wide

The success of UBCL is evident across Penn Medicine. At Penn Presbyterian Medical Center an Acute Care of Elders (ACE) unit worked with the emergency department to reduce its use of indwelling urinary catheters in elderly patients. With fewer catheterizations, the ACE unit significantly reduced its incidence of UTIs.

At the Hospital of the University of Pennsylvania Silverstein 11, Unit Based Clinical Leadership collaborated with the VTE "Performance Improvement In Action (PIAA)" team, to focus their efforts around VTE compliance, in particular, reducing missed and refused medication. Processes have changed as a result of this work including:

  • Ongoing MD and RN education
  • Day/night shift hand-off
  • Escalation activity across MD/provider and RN if and when missed or refused meds are captured
  • Interdisciplinary review and capture of VTE plan of care within the daily care coordination activity

One of the best examples of the work of UBCL at Pennsylvania Hospital is the Skin-to-Skin initiative in our Women’s Services Department. This initiative is a collaborative effort between all three Women’s Services in the area: Intensive Care Nursery, Labor and Delivery and the Post-Partum Units. This initiative was started in August 2011 and has shown an increase from 60% to a current rate of 97% since that time. Some of the numerous benefits for our patients include:

  • Higher breast feeding rates
  • Increased long-term success with breast feeding
  • Improved newborn thermoregulation
  • Improved newborn blood glucose stabilization
  • Improved maternal-child bonding

The UBCL concept was developed and championed by Victoria Rich, PhD, RN, FAAN, Penn Medicine CNE, and P.J. Brennan, MD, Penn Medicine CMO and senior vice president, and has now been implemented system-wide. It is a leadership model that has been nationally recognized as a successful method of accountability for quality care and patient safety.

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