- Email: [email protected]
Connecting the Dots: Finding What Matters Most to Patients and Families
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and Post Op area as a resource for consistent hand off communication. Education was completed during in-services, individual learning occurred, and sign in sheets were collected to ensure the same education was provided to all staff. Statement of Successful Practice: The nursing staff successfully demonstrated competency in using the tool as a guide for consistent communication and completing the education. The tool was uploaded to the information website and orientation packet for new employees. Auditing is ongoing by Shared Governance Council Members. Implications for Advancing the Practice of Perianesthesia Nursing: In the spirit of lifelong learning, our nursing team constantly seeks knowledge to improve nursing practice. Using Evidenced Based Practice to develop ways to improve communication during transitions contributes to increased patient safety, quality, and satisfaction.
COMMUNICATION HANDOFF TOOL IMPROVING PATIENT SAFETY AND PATIENT OR READINESS Team Leader: Darlene Berghaier, BSN RN CMSRN Virtua Hospital, Voorhees, New Jersey Team Members: Bernadette Drumm, RN, Colleen St John, BSN RN, Jennifer L. Sulzner, BSN RN OCN CAPA
Background Information: Nurses in the pre-admission testing (PAT) and the surgical prep area (SPA) identified a problem with communication that affects patient safety and readiness for the operating room (OR). The current practice in our organization is for PAT to be the initial contact for the patient. The PAT nurses are then able to identify areas of concern which could impact the SPA admission process and result in OR delays or cancellations. Objectives of Project: There was a lack of standardization that was identified when relaying information between the PAT and SPA nurses. The object of the project was to develop a concise communication tool that met the needs of both departments and would ensure patient safety. A well-developed standard operation procedure (SOP) would allow the SPA nurses to determine the appropriate plan of care for the patient on the day of surgery. All aspects of this project affect patient readiness for OR procedures. Process of Implementation: A literature review was performed through Pub Med. Collaboration between the two shared governance teams led to the creation of a communication handoff tool. The shared governance teams of PAT and SPA emailed a sample tool to the nurses of both units with an explanation of the rationale and the planned implementation date. A joint shared governance meeting was held for feedback from the staff to evaluate the components of the original tool and to finalize any suggested changes. Once the tool was finalized, we determined a time line for staff education and roll out dates. Statement of Successful Practice: The outcomes to date include; staff accountability, improve patient safety with clear and concise communication, create a standard of process, cultivate an environment of teamwork, and improve nurse satisfaction.
Note: All abstracts are printed as received from the authors.
ASPAN NATIONAL CONFERENCE ABSTRACTS Implications for Advancing the Practice of Perianesthesia Nursing: A standardization of the communication tool improves patient outcomes and decreases errors.
RECOVERY ROOM PATIENT REPORT CARD: AN EFFECTIVE COMMUNICATION TOOL Team Leaders: Audrey McFadden, BSN RN CPAN, Precy Dsouza, MSN RN PCCN Virtua Hospital, Voorhees Division Voorhees, New Jersey Team Members: Priscilla Kane, RN CPAN, Deborah Larosa, RN BSN Overview: Due to the Anesthetic effects, Patients are unable to remember the first stage of Recovery. The challenging aspect of Perianesthesia Nursing is to provide continuous communication with family and patients during recovery. This gap was reflected on the Press Ganey scores. The shared Governance Council explored ways of bridging the communication gap in the continuity of care in the recovery room. On doing a literature review on best Practices from JOPAN, the unit came up with a creative approach of preparing a recovery room patient report card. Purpose: The recovery Room report card was created as a communication tool for patients and their families and would serve as a tangible reminder of their PACU experience which most often cannot be recalled and thus help in improving patient satisfaction as reflected on the Press Ganey scores. Process of Implementation: The Recovery room patient report card was prepared which included the name of the primary care nurse, the condition of the patient on arrival, pain status in the recovery room, post op nausea and measures employed for safety and comfort. All the perioperative Nurses were educated about the report card. The nurse in phase 2 ensured the recovery room report card was sent along with the discharge instructions. The feedback was collected during the 24 hour post op phone call and in the Press Ganey scores. Significance of the finding: After 1 month of data collection the feedback on the 24 hour post op phone call was that the Recovery room report card was a good brief update and it did help them to recollect their time in the recovery room. There was an improvement in the Press Ganey scores. Implications for perianesthesia nurses and future research: The project helped to communicate the patient needs which were identified and met in the phase I of recovery room to the patients and their families. The use of the report card serves as an effective method to communicate about the patient stay in the recovery room which enhances and promotes a therapeutic patient and family centered surgical experience. This improves patient satisfaction and Perception of care.
CONNECTING THE DOTS: FINDING WHAT MATTERS MOST TO PATIENTS AND FAMILIES Team Leaders: Anita Norton, MSN RN CPNP, Sheri Hall, BSN RN Children’s Hospital of Wisconsin, Milwaukee, Wisconsin Background Information: The landscape of healthcare is changing, and customers have choices in their healthcare decisions. Now, more than ever, the patient/family experience has
ASPAN NATIONAL CONFERENCE ABSTRACTS become a top priority in many organizations. Despite reports of excellent clinical care, customer satisfaction scores were continuously lower than the perceived level of service. Perioperative care can feel fragmented as most outpatients will have a minimum of four nurses during their surgical journey. During an initiative to streamline our nursing handoff processes, an addition was made to ask the patients and families in the pre-operative phase of care what matters most to them that day. Objectives of Project: Focus on what matters most to patients/families Make a personal connection with patients/families during a hectic time Demonstrate consistency in communication throughout the four phases of care Improve our patient/family satisfaction scores Process of Implementation: This staff-driven initiative was included with the implementation of a revised handoff tool in the electronic health record. Education occurred during unit staff meetings and leadership rounding, and audits are ongoing to measure compliance and sustainability. Nurses in the preoperative phase ask the question and document responses in the sticky note, which populates the handoff tool. The response is discussed in each phase of care during hand-off, as well as addressed once the patient and family have been reunited. Statement of Successful Practice: Recognizing what matters most to patients and their families throughout the surgical care continuum has improved the overall patient satisfaction rating, as well as the percentage of families who would recommend our facility to others. Staff have found value in the responses, providers have had positive comments about the process, and families have expressed appreciation of the question during post-operative phone calls. Implications for Advancing the Practice of Perianesthesia Nursing: Perianesthesia nurses are able to influence the experience and satisfaction of our patients and families. Through caring, advocacy and collaboration, nurses can positively impact the perioperative patient/family experience.
IMPROVING HANDOFF Team Leader: Kristy Ratcliff, RN The Christ Hospital, Cincinnati, Ohio Team Members: Stacy Bond, BSN, Mark Scherer, RN, Jessica Meyers, RN, Cassie Koop, RN, Joyce Burke, BSN CPAN NEA-BC Background Information: PACU was requested to implement Phase I recovery for Transcatheter Aortic Valve Replacement (TAVR) recovery. Collaboration between the PACU and the Cardiovascular Step Down Unit (CVSU) resulted in face to face handoff expediting patient throughput and safety. The CVSU staff come to PACU, receive report and take the patient to their room. With this success we surveyed both units to move forward and implement for all patients going to CVSU. Objectives of Project: The goal of this project is to improve patient safety, throughput efficiency, and communication with other units by implementing face to face hand off. For the purpose of this project we decided to focus on the CVSU.
Note: All abstracts are printed as received from the authors.
e21
Process of Implementation: A satisfaction survey was developed to identify barriers among the PACU staff and the receiving units. These surveys were passed out to all PACU nurses and to all CVSU nurses. We then asked that the receiving unit’s nurse come to PACU when the patient was ready to transport. Bedside report was given and an opportunity for questions from receiving nurse was provided. This was a one-month trial. We then repeated the satisfaction survey to get feedback on the success of this project. Statement of Successful Practice: Requiring face to face report improved communication between the sending and receiving units. The improved communication resulted in decreased hold time in PACU, and a verbalized sense of security for the patient. The ability to review vital signs, incision sites, and plan of care together increased patient safety. Implications for Advancing the Practice of Perianesthesia Nursing: By implementing the face-to-face hand off, we are able to ensure proper communication, improve patient safety, improve patient and staff satisfaction, and decrease hold time in PACU.
IMPROVING COMMUNICATION WITH FAMILY FOR POST ANESTHESIA PATIENTS Team Leader: Dianne Morgan, BSN RN CPAN Salem Health, Salem, Oregon Team Members: Richard DeArmond, BSN RN CMSRN, Clinical Informatics Coordinator, Nancy Dunn, MS RN, Clinical Excellence Coordinator Background Information: The Post- Anesthesia Care Unit (PACU) received patient and family complaints because of lack of updates and notification of the patient being transferred to an inpatient bed, leaving the family in the lobby waiting to see their family member or receive an update. Objectives of Project: Create a standard to update and notify patient families of patient transfer, then patient family complaints will decrease and patient family satisfaction will increase as indicated by the patient satisfaction survey data related to the question, “information given to family.” Process of Implementation: Role clarity. The person transferring the patient to the inpatient bed will be responsible to notify family of transfer. Collaborate with informatics to create and icon to reflect on the Epic status board indicating the patient had been in PACU for 2 hours, providing a visual reminder for the RN to update waiting families. The 60 “ flat screen previously used for OR scheduling, was repurposed to display the EPIC status board providing a large view, so all staff in PACU can notify other RN’s in the department when the patient length of stay had reached 2 hours. Create standard documentation. Family notification space added to the Epic documentation flow sheet for ease of documentation. PACU RN’s given access to add “scripted” messages to the family status board in the waiting, room previously only used by the OR staff. Statement of Successful Practice: PACU is moving in the right direction; focusing in improving communication with families and creating a system to support the workflow. Since we started this work there have been no patient family complaints of being forgotten in the lobby.
and Post Op area as a resource for consistent hand off communication. Education was completed during in-services, individual learning occurred, and sign in sheets were collected to ensure the same education was provided to all staff. Statement of Successful Practice: The nursing staff successfully demonstrated competency in using the tool as a guide for consistent communication and completing the education. The tool was uploaded to the information website and orientation packet for new employees. Auditing is ongoing by Shared Governance Council Members. Implications for Advancing the Practice of Perianesthesia Nursing: In the spirit of lifelong learning, our nursing team constantly seeks knowledge to improve nursing practice. Using Evidenced Based Practice to develop ways to improve communication during transitions contributes to increased patient safety, quality, and satisfaction.
COMMUNICATION HANDOFF TOOL IMPROVING PATIENT SAFETY AND PATIENT OR READINESS Team Leader: Darlene Berghaier, BSN RN CMSRN Virtua Hospital, Voorhees, New Jersey Team Members: Bernadette Drumm, RN, Colleen St John, BSN RN, Jennifer L. Sulzner, BSN RN OCN CAPA
Background Information: Nurses in the pre-admission testing (PAT) and the surgical prep area (SPA) identified a problem with communication that affects patient safety and readiness for the operating room (OR). The current practice in our organization is for PAT to be the initial contact for the patient. The PAT nurses are then able to identify areas of concern which could impact the SPA admission process and result in OR delays or cancellations. Objectives of Project: There was a lack of standardization that was identified when relaying information between the PAT and SPA nurses. The object of the project was to develop a concise communication tool that met the needs of both departments and would ensure patient safety. A well-developed standard operation procedure (SOP) would allow the SPA nurses to determine the appropriate plan of care for the patient on the day of surgery. All aspects of this project affect patient readiness for OR procedures. Process of Implementation: A literature review was performed through Pub Med. Collaboration between the two shared governance teams led to the creation of a communication handoff tool. The shared governance teams of PAT and SPA emailed a sample tool to the nurses of both units with an explanation of the rationale and the planned implementation date. A joint shared governance meeting was held for feedback from the staff to evaluate the components of the original tool and to finalize any suggested changes. Once the tool was finalized, we determined a time line for staff education and roll out dates. Statement of Successful Practice: The outcomes to date include; staff accountability, improve patient safety with clear and concise communication, create a standard of process, cultivate an environment of teamwork, and improve nurse satisfaction.
Note: All abstracts are printed as received from the authors.
ASPAN NATIONAL CONFERENCE ABSTRACTS Implications for Advancing the Practice of Perianesthesia Nursing: A standardization of the communication tool improves patient outcomes and decreases errors.
RECOVERY ROOM PATIENT REPORT CARD: AN EFFECTIVE COMMUNICATION TOOL Team Leaders: Audrey McFadden, BSN RN CPAN, Precy Dsouza, MSN RN PCCN Virtua Hospital, Voorhees Division Voorhees, New Jersey Team Members: Priscilla Kane, RN CPAN, Deborah Larosa, RN BSN Overview: Due to the Anesthetic effects, Patients are unable to remember the first stage of Recovery. The challenging aspect of Perianesthesia Nursing is to provide continuous communication with family and patients during recovery. This gap was reflected on the Press Ganey scores. The shared Governance Council explored ways of bridging the communication gap in the continuity of care in the recovery room. On doing a literature review on best Practices from JOPAN, the unit came up with a creative approach of preparing a recovery room patient report card. Purpose: The recovery Room report card was created as a communication tool for patients and their families and would serve as a tangible reminder of their PACU experience which most often cannot be recalled and thus help in improving patient satisfaction as reflected on the Press Ganey scores. Process of Implementation: The Recovery room patient report card was prepared which included the name of the primary care nurse, the condition of the patient on arrival, pain status in the recovery room, post op nausea and measures employed for safety and comfort. All the perioperative Nurses were educated about the report card. The nurse in phase 2 ensured the recovery room report card was sent along with the discharge instructions. The feedback was collected during the 24 hour post op phone call and in the Press Ganey scores. Significance of the finding: After 1 month of data collection the feedback on the 24 hour post op phone call was that the Recovery room report card was a good brief update and it did help them to recollect their time in the recovery room. There was an improvement in the Press Ganey scores. Implications for perianesthesia nurses and future research: The project helped to communicate the patient needs which were identified and met in the phase I of recovery room to the patients and their families. The use of the report card serves as an effective method to communicate about the patient stay in the recovery room which enhances and promotes a therapeutic patient and family centered surgical experience. This improves patient satisfaction and Perception of care.
CONNECTING THE DOTS: FINDING WHAT MATTERS MOST TO PATIENTS AND FAMILIES Team Leaders: Anita Norton, MSN RN CPNP, Sheri Hall, BSN RN Children’s Hospital of Wisconsin, Milwaukee, Wisconsin Background Information: The landscape of healthcare is changing, and customers have choices in their healthcare decisions. Now, more than ever, the patient/family experience has
ASPAN NATIONAL CONFERENCE ABSTRACTS become a top priority in many organizations. Despite reports of excellent clinical care, customer satisfaction scores were continuously lower than the perceived level of service. Perioperative care can feel fragmented as most outpatients will have a minimum of four nurses during their surgical journey. During an initiative to streamline our nursing handoff processes, an addition was made to ask the patients and families in the pre-operative phase of care what matters most to them that day. Objectives of Project: Focus on what matters most to patients/families Make a personal connection with patients/families during a hectic time Demonstrate consistency in communication throughout the four phases of care Improve our patient/family satisfaction scores Process of Implementation: This staff-driven initiative was included with the implementation of a revised handoff tool in the electronic health record. Education occurred during unit staff meetings and leadership rounding, and audits are ongoing to measure compliance and sustainability. Nurses in the preoperative phase ask the question and document responses in the sticky note, which populates the handoff tool. The response is discussed in each phase of care during hand-off, as well as addressed once the patient and family have been reunited. Statement of Successful Practice: Recognizing what matters most to patients and their families throughout the surgical care continuum has improved the overall patient satisfaction rating, as well as the percentage of families who would recommend our facility to others. Staff have found value in the responses, providers have had positive comments about the process, and families have expressed appreciation of the question during post-operative phone calls. Implications for Advancing the Practice of Perianesthesia Nursing: Perianesthesia nurses are able to influence the experience and satisfaction of our patients and families. Through caring, advocacy and collaboration, nurses can positively impact the perioperative patient/family experience.
IMPROVING HANDOFF Team Leader: Kristy Ratcliff, RN The Christ Hospital, Cincinnati, Ohio Team Members: Stacy Bond, BSN, Mark Scherer, RN, Jessica Meyers, RN, Cassie Koop, RN, Joyce Burke, BSN CPAN NEA-BC Background Information: PACU was requested to implement Phase I recovery for Transcatheter Aortic Valve Replacement (TAVR) recovery. Collaboration between the PACU and the Cardiovascular Step Down Unit (CVSU) resulted in face to face handoff expediting patient throughput and safety. The CVSU staff come to PACU, receive report and take the patient to their room. With this success we surveyed both units to move forward and implement for all patients going to CVSU. Objectives of Project: The goal of this project is to improve patient safety, throughput efficiency, and communication with other units by implementing face to face hand off. For the purpose of this project we decided to focus on the CVSU.
Note: All abstracts are printed as received from the authors.
e21
Process of Implementation: A satisfaction survey was developed to identify barriers among the PACU staff and the receiving units. These surveys were passed out to all PACU nurses and to all CVSU nurses. We then asked that the receiving unit’s nurse come to PACU when the patient was ready to transport. Bedside report was given and an opportunity for questions from receiving nurse was provided. This was a one-month trial. We then repeated the satisfaction survey to get feedback on the success of this project. Statement of Successful Practice: Requiring face to face report improved communication between the sending and receiving units. The improved communication resulted in decreased hold time in PACU, and a verbalized sense of security for the patient. The ability to review vital signs, incision sites, and plan of care together increased patient safety. Implications for Advancing the Practice of Perianesthesia Nursing: By implementing the face-to-face hand off, we are able to ensure proper communication, improve patient safety, improve patient and staff satisfaction, and decrease hold time in PACU.
IMPROVING COMMUNICATION WITH FAMILY FOR POST ANESTHESIA PATIENTS Team Leader: Dianne Morgan, BSN RN CPAN Salem Health, Salem, Oregon Team Members: Richard DeArmond, BSN RN CMSRN, Clinical Informatics Coordinator, Nancy Dunn, MS RN, Clinical Excellence Coordinator Background Information: The Post- Anesthesia Care Unit (PACU) received patient and family complaints because of lack of updates and notification of the patient being transferred to an inpatient bed, leaving the family in the lobby waiting to see their family member or receive an update. Objectives of Project: Create a standard to update and notify patient families of patient transfer, then patient family complaints will decrease and patient family satisfaction will increase as indicated by the patient satisfaction survey data related to the question, “information given to family.” Process of Implementation: Role clarity. The person transferring the patient to the inpatient bed will be responsible to notify family of transfer. Collaborate with informatics to create and icon to reflect on the Epic status board indicating the patient had been in PACU for 2 hours, providing a visual reminder for the RN to update waiting families. The 60 “ flat screen previously used for OR scheduling, was repurposed to display the EPIC status board providing a large view, so all staff in PACU can notify other RN’s in the department when the patient length of stay had reached 2 hours. Create standard documentation. Family notification space added to the Epic documentation flow sheet for ease of documentation. PACU RN’s given access to add “scripted” messages to the family status board in the waiting, room previously only used by the OR staff. Statement of Successful Practice: PACU is moving in the right direction; focusing in improving communication with families and creating a system to support the workflow. Since we started this work there have been no patient family complaints of being forgotten in the lobby.