The Key Ingredients to Patient Safety Culture, Lori Stromness, RN, Intermountain Healthcare

The recipe for creating a culture of patient safety at any hospital is relatively simple, but it is by no means easy to pull off. The key ingredients are innovation,
initiative, collaboration, willingness to change, and buy-in from top to bottom. A Foley catheter team at Intermountain Healthcare Hospital, led by Registered Nurse Lori Stromness, perfectly illustrates how an innovative idea to reduce harm to patients can foster a culture of safety across multiple floors and become a replicable model for other medical providers, nationally and internationally.

Originally proposed by a pair of urologists at Intermountain, the Foley team launched in September of 2013 as a means of reducing the wait times for patients experiencing difficulties with their bladder catheters. (The name “Foley” derives from a common brand of catheter.) Addressing catheter-related problems is generally a nursing skill. However, when the floor nurses have a hard time inserting, changing, or irrigating a urinary catheter, a specialist often needs to be called in for a urology consult, often requiring the patient to wait with a full bladder for an extended period of time.

The Foley team at Intermountain, a top 10 finalist in PSMF’s 2016 Innovation Awards, was devised by the hospital’s urologists to fill in gaps in nurses’ training and experience in order to provide an effective, quick response to troubleshoot complications. Stromness wasn’t part of the initial formation of the Foley team, but as a long-time charge nurse in both the transplant and med surge units, she immediately saw the benefits and eagerly stepped in to take it over. By maintaining communication between the doctors, nurses, and the leadership of Intermountain, as well as by keeping up with the education of new members of the Foley team, she has helped the program at Intermountain take off.

“At our trauma 1 center, there used to be one to two urethral injuries a week from improper placement of catheters. Now urologists rarely see any injuries, which further decreases complications.”

The longer a patient must wait with a full bladder for assistance, the greater the risk for permanent bladder dysfunction. And with each failed attempt at placing a Foley catheter, there’s a corresponding increase in the risk of injury and acquiring a Catheter-Associated Urinary Tract Infections (CAUTI). By reducing wait times and the number of catheter placement attempts, Intermountain’s Foley team has not only contributed to the greatly reduced number of injuries, but also the rate of infections. And the resulting reduction in specialist consults also cuts healthcare costs for patients and their insurers.

Though Intermountain has a separate CAUTI team, the two teams work together synergistically to support each other, amplifying the healthcare provider’s culture of safety. For example, when Stromness’s Foley teams go to other floors, they have that department’s nurses come into the patient room to educate and show them what they’re doing.

“Ideally we could teach ourselves out of a job by increasing the other nurses’ knowledge and proficiency. And that way it becomes a team effort throughout the whole hospital.”

Based on her first-hand experience, Stromness recognizes that safety isn’t about just one person doing something. “We’re not going to improve the safety culture with just one person taking the responsibility. It has to be everybody working together for it to really work.”

Patient safety is part of why Stromness became a nurse in the first place, because she hated the idea of anything ever happening to someone she loves and not knowing what to do about it. “Safety in general is the motivation behind why I do a lot of things.”

Stromness is always on the lookout for new avenues to expand the process’s use beyond Intermountain. For the past five years, she has gone on an annual humanitarian medical mission trip to Uganda. During a recent mission, she spoke with a urologist on the trip about the Foley team, thereby introducing the concept to both him, so he could take it back to his hospital in Kansas City, and to the hospital in Uganda.

To help expand the process globally, Stromness has created two standard works documents: one for large urban hospitals to implement a Foley team, like the one at Intermountain, and one for rural facilities that are too small for an actual team. Thanks to its minimal startup and maintenance costs, the Foley team process can be adapted to any healthcare system—from small to large, simple to complex. She has already shared it with other international humanitarian mission groups to take it to other places, in addition to Uganda.

She also anticipates that her continuing education toward an acute care nurse practitioner doctorate degree will put her in an even better position to share the Foley team idea with more hospitals.

“As part of my doctorate program, I am going to implement this at another hospital and track the data. Showing its benefits at other hospitals can give the process more credibility for other hospitals that may want to adopt it.”

Though Intermountain wasn’t the first healthcare system to implement a Foley team, Stromness feels Intermountain had the right collaboration between doctors and nurses and other floors to make it work. And that’s the part she’d especially like to share with others to ensure a successful expansion.


Additional Resources

To learn more about Patient Safety Movement’s Actionable Patient Safety Solutions (APSS), click here

Go more in-depth about the CAUTI APSS.

More information on healthcare-associated infections, view here.