Page 42 - Johns Hopkins Nursing Magazine Spring 2023 - Johns Hopkins School of Nursing

A Tested Tool Keeps Patients Safe
NEWS FROM JOHNS HOPKINS NURSING BY JOAN CRAMER In any hospital setting, some patients need constant From left, Alex Tsikerdanos, Emily Batie, Katherine Pontone,

observation. They might be disoriented or delirious,
suicidal, aggressive, unable to communicate, or simply
very young and can’t be left alone, so busy nurses often
elicit the assistance of patient safety attendants (PSAs),
to sit with those patients.

But as with many health care staffers today, PSAs are a Lucy Stewart, and Heather Watson of CORA.
When Stewart first proposed the tool, there was already
scarce resource. Nurses at The Johns Hopkins Hospital a work group talking about the issue, which resulted
who needed a PSA would call Intrastaff (the health in a community comprising stakeholders from every
system’s temporary staffing service) and negotiate specialty. At the same time, the Department of Nursing
for support. “The process wasn’t transparent, it was created its own supplemental staffing unit, which took
stressful and it could seem unfair,” says pediatric nurse over the role of assigning PSAs (as well as nurses and
educator Lucy Stewart. clinical technicians who float across the hospital). And
the hospital introduced a telesitter program, utilizing
Now, a PSA triage tool Stewart discovered in 2019— remote observers monitoring patients via screens from
as a bedside nurse in the hospital’s pediatric a centralized location.
anesthesia care unit working on her master’s degree
in health systems management—has been adapted, “As changes happen, we are always refining the tool,”
tested, and fine-tuned, and is being used successfully Batie explains. She also says the community couldn’t
throughout The Johns Hopkins Hospital. The have done its work without Alex Tsikerdanos, now a
40 Constant Observation Resource Assessment (CORA) is Johns Hopkins University senior systems engineer,
a tool nurses now use to put in a request for a PSA. It “who took all of our conceptions and put them into the
assesses each patient based on objective criteria and software system OnBase. ... Literally, the CORA was a
assigns a score based on the level of acuity or need. piece of paper, and we’d sit around at meetings saying,
‘Where can we fax this?’”
Because PSA availability is still limited, nurses don’t
always have their request filled, says Stewart. “But they Now, she says, the CORA has outgrown OnBase and is
know the process is objective and fair, and resources ready to be converted for use with the Johns Hopkins
are being allocated where they are needed most.” Epic medical records system. “It’s really a measure of
our success,” Batie says. “And it means leadership will
The CORA was based on a tool proven to work for brain have access to the data and a real-time picture of our
rehab patients at Mayo Clinic, Stewart says. Katherine patient population to better meet our staffing needs.”
Pontone, nursing coordinator for the Department of
Psychiatry and Behavioral Sciences, helped her adapt Watson’s team is continuing their research project,
JOHNS HOPKINS NURSING SPRING 2023 “There have been many moving parts,” Batie says. The next step, she says, is introducing the tool to the
which was abruptly interrupted by COVID-19. “Change
it to the specific needs of nurses and patients at The
Johns Hopkins Hospital. At Stewart’s request, Heather
is slow and sometimes challenging,” she says. “But the
tool has been shown to work.”
Watson, a nurse scientist at Johns Hopkins Medicine’s
Center for Nursing Inquiry, launched a research project
with her team to test the reliability and validity of the
tool. “You can’t just implement something and not
entire Johns Hopkins Health System. “We do a lot of
collaboration with our six affiliates, and they know
find out first if it works,” Watson says.
we have this tool, and they want it,” she says. “We’re
In fact, over the past four years, more than 40 people
just waiting for that final validity piece and then we
can share it, which is super exciting. But none of
have worked to bring the CORA to fruition, says
this would have happened if a bedside nurse hadn’t
Emily Batie, a project manager for the Department
introduced the idea.” ◼
of Nursing who has helped coordinate the process.