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GE Brings Pain Scores to Life, Improving Post Discharge Pain Assessment Electronic Documentation
ASPAN NATIONAL CONFERENCE ABSTRACTS improvement. The objectives of the focus group were to improve efficiency of the user, to increase staff scanning compliance scores and to monitor potential delay of patient throughput in PACU. Implementation of change included staff education and training, effective collaboration and continuous dialogue between pharmacy, informatics and PACU staff. The presence of pharmacist in the PACU played significant role in promoting efficiency in physician order verification turnaround time process. Data gathered from July 2011 through May 2012 showed improvement in overall PACU scanning compliance, achieving .90% threshold in medication and patient scanning scores. In addition, the OR holds improved from 54 as baseline to , 10 per month. Leadership support and staff involvement played crucial roles in sustaining process improvement related to medication administration workflow in PACU.
USING EVIDENCE-BASED PRACTICE TO IMPLEMENT STANDARDIZED ANESTHESIA-TOPACU HANDOFF TOOL AND IMPROVE PACU STAFF SATISFACTION Team Leader: Regina Hoefner-Notz, MS, RN; Clinical Manager Children’s Hospital Colorado, Aurora, CO Mary Wintz, MS, RN, Quality Specialist, Jackie Sammons, BSN, RN, PACU Staff RN, Scott Markowitz, MD, Associate Professor, University of Colorado
Identification of the problem-Overview: Children’s Hospital Colorado uses the SBAR format for standardized communication throughout its facilities. There was no standardization of PACU specific information delineated within the SBAR framework. This sometimes led to inefficient or incomplete handoff reports. In turn, unnecessary time was spent on follow-up phone calls required to clarify information or request orders. A wealth of literature exists providing evidence that standardization of handoff content leads to safer patient care, fewer care failures, and improved staff satisfaction. EBP Question/Purpose: Will developing a specialized, standardized anesthesia-to-PACU RN handoff tool improve patient safety, as well as staff satisfaction with the transfer of care process? The purpose of this project was to use an interdisciplinary, evidence-based approach to develop an anesthesia-to-PACU RN handoff process that will improve staff satisfaction. Methods/Evidence: An interdisciplinary team from PACU nursing leadership, quality improvement, bedside PACU staff, and anesthesiology was formed to develop a standardized specialty tool for handoffs from anesthesia providers to PACU RNs. A literature search was performed using CINAHL, PubMed, and Google Scholar to identify existing tools and handoff processes that yielded evidence of best practices. Nine articles were chosen to substantiate the need for the development of a standardized tool in the PACU. The interdisciplinary handoff team developed an SBAR handoff report that included anesthesia and perioperative specific elements. Prior to implementation of this tool, a five-point Likert scale was used to evaluate staff satisfaction with the existing transfer process. The new handoff tool was then piloted for three months. All RN staff members randomly audited one handoff each month, rating their satisfaction with the transfer of care.
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Significance of Findings/Outcomes: Initial findings indicated an increase in use of the handoff tool, as well as an improvement in staff satisfaction. Two care failures occurred in the five month pilot. It is hypothesized that potential care failures are being prevented by diligence of the PACU staff. A new method for tracking potential care failures is being initiated in October 2012. Implications for perianesthesia nurses and future research: Analyzing results of the standardized handoff provided the basis for new questions: 1. Does standardization of handoff checklist decrease patient care omissions and errors? 2. Does surgeon participation in the handoff process improve patient safety?
GE BRINGS PAIN SCORES TO LIFE, IMPROVING POST DISCHARGE PAIN ASSESSMENT ELECTRONIC DOCUMENTATION Team Leader: Kathy Makary, BSN, RN, CAPA Summa Akron City Hospital, Akron, Ohio Team Member: Victoria Wells, MSN, RN, CAPA
Background Information related to the problem identification: First quarter 2012, post discharge phone call documentation was integrated to the Surgical Services electronic medical record. During review of audits, it was discovered that post discharge pain levels were higher than expected. After analyzing the data, a discrepancy was noted related to in-hospital and post discharge communication and documentation. Objectives of project: Review the post discharge pain intensity electronic documentation dataset Clarify and reeducate staff for standardization when collecting post discharge pain information Review ongoing audit after electronic documentation changes for success Process of implementation: The team leader collaborated with Surgical Services Information Specialist to make changes for consistent communication and documentation. Nurses were made aware of the initial audits and the reason standardization was important. Other initiatives included: Unit-based Education Council support, collaboration with the Patient and Family Education Coordinator to revise the Pain Education form, and discussion with Pre-testing to provide patients with this form pre-op. Statement of the successful practice: First half of 2012 post discharge phone call resulted in patient report of pain intensity . 4 on a zero to ten scales at 8.2%. After the review, clarification of dataset, and education of staff for standardization, the third quarter results are promising at 6.5%. Audits continue. Implications: A continued effort to reduce patient post discharge pain intensity report is in progress. PeriAnesthesia nurses have an important role in problem-solving and making appropriate recommendations for patient quality outcomes. Patients benefit from the involvement of the nurse.
USING EVIDENCE-BASED PRACTICE TO IMPLEMENT STANDARDIZED ANESTHESIA-TOPACU HANDOFF TOOL AND IMPROVE PACU STAFF SATISFACTION Team Leader: Regina Hoefner-Notz, MS, RN; Clinical Manager Children’s Hospital Colorado, Aurora, CO Mary Wintz, MS, RN, Quality Specialist, Jackie Sammons, BSN, RN, PACU Staff RN, Scott Markowitz, MD, Associate Professor, University of Colorado
Identification of the problem-Overview: Children’s Hospital Colorado uses the SBAR format for standardized communication throughout its facilities. There was no standardization of PACU specific information delineated within the SBAR framework. This sometimes led to inefficient or incomplete handoff reports. In turn, unnecessary time was spent on follow-up phone calls required to clarify information or request orders. A wealth of literature exists providing evidence that standardization of handoff content leads to safer patient care, fewer care failures, and improved staff satisfaction. EBP Question/Purpose: Will developing a specialized, standardized anesthesia-to-PACU RN handoff tool improve patient safety, as well as staff satisfaction with the transfer of care process? The purpose of this project was to use an interdisciplinary, evidence-based approach to develop an anesthesia-to-PACU RN handoff process that will improve staff satisfaction. Methods/Evidence: An interdisciplinary team from PACU nursing leadership, quality improvement, bedside PACU staff, and anesthesiology was formed to develop a standardized specialty tool for handoffs from anesthesia providers to PACU RNs. A literature search was performed using CINAHL, PubMed, and Google Scholar to identify existing tools and handoff processes that yielded evidence of best practices. Nine articles were chosen to substantiate the need for the development of a standardized tool in the PACU. The interdisciplinary handoff team developed an SBAR handoff report that included anesthesia and perioperative specific elements. Prior to implementation of this tool, a five-point Likert scale was used to evaluate staff satisfaction with the existing transfer process. The new handoff tool was then piloted for three months. All RN staff members randomly audited one handoff each month, rating their satisfaction with the transfer of care.
e3
Significance of Findings/Outcomes: Initial findings indicated an increase in use of the handoff tool, as well as an improvement in staff satisfaction. Two care failures occurred in the five month pilot. It is hypothesized that potential care failures are being prevented by diligence of the PACU staff. A new method for tracking potential care failures is being initiated in October 2012. Implications for perianesthesia nurses and future research: Analyzing results of the standardized handoff provided the basis for new questions: 1. Does standardization of handoff checklist decrease patient care omissions and errors? 2. Does surgeon participation in the handoff process improve patient safety?
GE BRINGS PAIN SCORES TO LIFE, IMPROVING POST DISCHARGE PAIN ASSESSMENT ELECTRONIC DOCUMENTATION Team Leader: Kathy Makary, BSN, RN, CAPA Summa Akron City Hospital, Akron, Ohio Team Member: Victoria Wells, MSN, RN, CAPA
Background Information related to the problem identification: First quarter 2012, post discharge phone call documentation was integrated to the Surgical Services electronic medical record. During review of audits, it was discovered that post discharge pain levels were higher than expected. After analyzing the data, a discrepancy was noted related to in-hospital and post discharge communication and documentation. Objectives of project: Review the post discharge pain intensity electronic documentation dataset Clarify and reeducate staff for standardization when collecting post discharge pain information Review ongoing audit after electronic documentation changes for success Process of implementation: The team leader collaborated with Surgical Services Information Specialist to make changes for consistent communication and documentation. Nurses were made aware of the initial audits and the reason standardization was important. Other initiatives included: Unit-based Education Council support, collaboration with the Patient and Family Education Coordinator to revise the Pain Education form, and discussion with Pre-testing to provide patients with this form pre-op. Statement of the successful practice: First half of 2012 post discharge phone call resulted in patient report of pain intensity . 4 on a zero to ten scales at 8.2%. After the review, clarification of dataset, and education of staff for standardization, the third quarter results are promising at 6.5%. Audits continue. Implications: A continued effort to reduce patient post discharge pain intensity report is in progress. PeriAnesthesia nurses have an important role in problem-solving and making appropriate recommendations for patient quality outcomes. Patients benefit from the involvement of the nurse.