In the early 2000s, Betty Irene Moore experienced a life-changing moment. While in the hospital she was accidentally given a medication that could have cost her life – and it could have been prevented. Around this same time, there was growing national attention to patient safety in hospitals. The Institute of Medicine issued its 1999 landmark report, To err is human: building a safer health system, on the alarming frequency of harm to patients in hospitals. On the heels of her personal experiences, coupled with the significance of the IOM report, Betty, and our board of trustees, set a vision for the foundation to improve the quality and safety of patient care in the San Francisco Bay Area. In late 2003, the Betty Irene Moore Nursing Initiative was born.
To improve the quality and safety of care, the initiative focused on those responsible for delivering the majority of it: nurses. Ninety-five percent of the care people receive comes from nurses and as Betty shares in this video addressing quality improvement, “you have to depend on your nurses.”
The opportunities to improve care with nurse education and empowerment were many. The foundation began by understanding the areas that needed the most attention and where it could have the greatest impact. Data from San Francisco Bay Area hospitals confirmed there was a need to focus on preventable medical harms, such as hospital-acquired infections and medication errors. Additionally, few national and local quality improvement and leadership development programs existed for training nurses. This landscape made the environment ripe for the foundation to play a role in empowering frontline RNs as leaders implementing evidence-based patient safety practices at the bedside. Specific strategies were laid out, including:
- Build a large, well-prepared nursing workforce
- Strengthen the leadership skills of nurses and other frontline clinicians to implement evidence-based practices
- Improve a patient’s transition from acute care hospitals to home or other care settings
Over the course of 12 years the foundation partnered with all adult acute care hospitals in the San Francisco Bay Area and greater Sacramento to improve patient safety — 53 hospitals in total. This included academic medical centers, public and community hospitals and hospitals within systems such as Dignity Health, Kaiser Permanente and Sutter Health.
“The Betty Irene Moore Nursing Initiative did more to advance the quality of care through nursing in the Bay Area than any other single effort,” said Judith G. Berg, MS, RN, executive director, HealthImpact (formerly the California Institute for Nursing & Health Care).
By 2014, 83 percent of San Francisco Bay Area hospitals substantially improved outcomes across 17 clinical areas. Some of the results include:
- 78 percent of hospitals reduced central line-associated bloodstream infection rates to near zero;
- 75 percent reduced sepsis mortality rates by an average of 37 percent;
- 62 percent reduced hospital-acquired pressure ulcer incidence by an average of 41 percent; and
- 62 percent reduced ventilator-acquired pneumonia incidence to the zero zone.
Final aggregate results from Sacramento-area hospitals is still being compiled. Early project results are positive with all hospitals reducing sepsis mortality rates by at least 35 percent, with most having reduced sepsis mortality by more than 50 percent. Fifty percent of hospitals reduced preventable hospital-acquired venous thromboemboli to zero.
The most mature initiative-funded program in the area, the University of California, Davis Health System nurse champion program, also reduced C. difficile mortality by 53 percent and ventilator-acquired pneumonia rates by 57 percent.
The initiative also worked with all schools of nursing in the Bay Area and greater Sacramento to implement the Quality and Safety Education for Nurses initiative and helped five hospitals in Northern California achieve Magnet® status, a program that recognizes health care organizations for quality patient care, nursing excellence and innovations in professional nursing practice.
“Through this initiative, hospitals and schools of nursing developed robust partnerships to work together to improve nurse preparation for demanding and complex care environments,” added Berg. “A Nursing Education Plan for California was developed and accelerated progress in forging strong academic/service partnerships, academic progression, clinical faculty development, transition to practice programs for new graduate RNs and the use of simulation in both academic and practice settings – all focused on producing a nursing workforce well-prepared to improve health outcomes. The initiative’s body of work went way beyond its initial scope of the Bay Area to advance nursing across the nation.”
While the Betty Irene Moore Nursing Initiative closed at the end of 2015, it helped form the basis for an ongoing regional focus on quality improvement that continues today. You can read more in the final assessment and also see highlights in this infographic.