- Email: [email protected]
PACU Gatekeeper Process
ANNUAL ASPAN CONFERENCE ABSTRACTS PACU GATEKEEPER PROCESS Jennifer Allen, MSQSM, RN, CPAN, Kellie M. Kline, BSN, RN, LT, NC, USN National Naval Medical Center, Bethesda, Maryland Background: The Operating Room has an 18 room capacity. On the average day, 14 rooms are scheduled. The holding room has a total of nine (9) spaces for preoperative preparation. Because of this variance in capacity, the Post Anesthesia Care Unit (PACU) is used for the first case overflow up to a maximum of five (5) patients. This is complicated with Operation Iraqi Freedom patients who require isolation precautions until cleared by cultures and can’t be placed in holding. Objectives: To develop a standardized process in the preoperative holding room assignments of patients overflowing into the PACU. Improve compliance with National Patient Safety Goals: Improve the effectiveness of communication among caregivers; and Reduce the risk of health care-associated infections. Process of Implementation: The Six Sigma DMAIC-R process improvement format was followed during this project. It consists of: Define; Measure; Analysis; Improvement; Control; and Results. Successful Practice: Success is measured with the preoperative patients being assigned to appropriate spaces for preoperative preparation. Positive Outcomes: Improved communication; transport staff stops, ask, and receive an assigned space; and clarification of Infection Control policies related to contact and droplet precautions in an open cohorted space. Implications: An opportunity to improve communication and patient outcomes. The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.
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COMPLIANCE WITH ANTIBIOTIC TIMING PRIOR TO SURGERY Lillian Bailey, RN, ANM, BSN, CAPA, Project Leader Meggie Kwan, RN, BSN, CAPA, Belma Miguel, RN, BSN, CAPA St. Luke’s Episcopal Hospital - Houston, Texas In partnership with The Surgical Care Improvement Project (SCIP) we were interested in the reduction of surgical site infections (SSIs) which account for 40% of all hospital acquired infections. Research shows that by reducing SSIs, hospitals on the average could recognize a savings of $3,152 and reduction in extended length of stay by seven days on each patient that develops an infection. The team saw opportunities to begin a new process within the neurosurgery and orthopedic services. The goals were to improve antibiotic timing compliance adhering to the SCIP guidelines. A committee was formed consisting of nursing, pharmacy, physicians, and infection control. Opportunities to improve antibiotic timing were discussed and a need to reeducate MD and staff were identified. An antibiotic protocol guideline was developed to guide physicians on what antibiotic to order and to alert nurses to call MDs if antibiotic is not ordered. Communication between the OR nurses and the preoperative nurses played a big role in the right timing of antibiotic administration. As a result the antibiotic timing on the neurosurgery and orthopedic cases is at 100% compliant and we aim to sustain compliance.
TEAMWORK BETWEEN PREADMISSION AND DAY SURGERY TO IMPROVE SURGERY ON-TIME START
TRAVELLING THE ROAD TO MEDICATION RECONCILIATION
Meggie Kwan, RN, BSN, CAPA, Project Leader; Marianne Pham, RN, CAPA; Belma Miguel, RN, BSN, CAPA; Lillian Bailey, RN, BSN, CAPA; Susan Lewis, RN, CNOR St. Luke’s Episcopal Hospital - Houston, Texas
Presenter: Tanya L. Spiering, BSN, RN, CPAN Clinical Practice Leader for PeriAnesthesia Services Bayhealth Medical Center Dover, DE.
Prior to the implementation of Continuous Improvement process in March 2007, the on-time readiness for surgery from DSC to the OR was 35%. One of the main reasons for the patient delay and cancellation was the incomplete and noncompliant charts. There were missing orders, missing H&P and missing test results, such as EKG or stress test, causing undue stress to the patients, staff and physicians. In order to improve on-time readiness for surgery we implemented the 5S/Workplace Organization (a LEAN Principle) throughout the department. The 5 S/ Workplace Organization refers to sift, sort, sweep, standardize and sustain. Both departments mapped out the processes, standards were created, roles and responsibilities were defined, and continuous improvement became a way of life for everyone. PAT and DSC along with ancillary departments involved met weekly to discuss problems and brainstorm on ways to improve the process. The staff from both departments aimed at streamlining processes improving the quality of care and product. Within 6 weeks of implementation we were able to decrease noncompliant charts to less than 1%. As a result, we improved on-time readiness for surgery from DSC to the OR from 35% to 99%.
Medication reconciliation has continued to be a challenge among health care organizations. It has been identified as an important aspect of patient safety by its inclusion among the Joint Commission’s Patient Safety Goals. Our facility decided to proceed on the journey to successful medication reconciliation two years ago by forming a multidisciplinary workgroup. This group consisted of a Pharmacist and nurses from every specialty with collaboration from physicians and other clinicians. The tool that evolved has simplified the process of medication reconciliation significantly and allowed for dissemination of gathered information at discharge. This has allowed our facility to show its commitment to the ever changing world of patient safety.
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COMPLIANCE WITH ANTIBIOTIC TIMING PRIOR TO SURGERY Lillian Bailey, RN, ANM, BSN, CAPA, Project Leader Meggie Kwan, RN, BSN, CAPA, Belma Miguel, RN, BSN, CAPA St. Luke’s Episcopal Hospital - Houston, Texas In partnership with The Surgical Care Improvement Project (SCIP) we were interested in the reduction of surgical site infections (SSIs) which account for 40% of all hospital acquired infections. Research shows that by reducing SSIs, hospitals on the average could recognize a savings of $3,152 and reduction in extended length of stay by seven days on each patient that develops an infection. The team saw opportunities to begin a new process within the neurosurgery and orthopedic services. The goals were to improve antibiotic timing compliance adhering to the SCIP guidelines. A committee was formed consisting of nursing, pharmacy, physicians, and infection control. Opportunities to improve antibiotic timing were discussed and a need to reeducate MD and staff were identified. An antibiotic protocol guideline was developed to guide physicians on what antibiotic to order and to alert nurses to call MDs if antibiotic is not ordered. Communication between the OR nurses and the preoperative nurses played a big role in the right timing of antibiotic administration. As a result the antibiotic timing on the neurosurgery and orthopedic cases is at 100% compliant and we aim to sustain compliance.
TEAMWORK BETWEEN PREADMISSION AND DAY SURGERY TO IMPROVE SURGERY ON-TIME START
TRAVELLING THE ROAD TO MEDICATION RECONCILIATION
Meggie Kwan, RN, BSN, CAPA, Project Leader; Marianne Pham, RN, CAPA; Belma Miguel, RN, BSN, CAPA; Lillian Bailey, RN, BSN, CAPA; Susan Lewis, RN, CNOR St. Luke’s Episcopal Hospital - Houston, Texas
Presenter: Tanya L. Spiering, BSN, RN, CPAN Clinical Practice Leader for PeriAnesthesia Services Bayhealth Medical Center Dover, DE.
Prior to the implementation of Continuous Improvement process in March 2007, the on-time readiness for surgery from DSC to the OR was 35%. One of the main reasons for the patient delay and cancellation was the incomplete and noncompliant charts. There were missing orders, missing H&P and missing test results, such as EKG or stress test, causing undue stress to the patients, staff and physicians. In order to improve on-time readiness for surgery we implemented the 5S/Workplace Organization (a LEAN Principle) throughout the department. The 5 S/ Workplace Organization refers to sift, sort, sweep, standardize and sustain. Both departments mapped out the processes, standards were created, roles and responsibilities were defined, and continuous improvement became a way of life for everyone. PAT and DSC along with ancillary departments involved met weekly to discuss problems and brainstorm on ways to improve the process. The staff from both departments aimed at streamlining processes improving the quality of care and product. Within 6 weeks of implementation we were able to decrease noncompliant charts to less than 1%. As a result, we improved on-time readiness for surgery from DSC to the OR from 35% to 99%.
Medication reconciliation has continued to be a challenge among health care organizations. It has been identified as an important aspect of patient safety by its inclusion among the Joint Commission’s Patient Safety Goals. Our facility decided to proceed on the journey to successful medication reconciliation two years ago by forming a multidisciplinary workgroup. This group consisted of a Pharmacist and nurses from every specialty with collaboration from physicians and other clinicians. The tool that evolved has simplified the process of medication reconciliation significantly and allowed for dissemination of gathered information at discharge. This has allowed our facility to show its commitment to the ever changing world of patient safety.