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Process Improvement: Creating New Anesthesia Guidelines
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RESOURCE ALERT e EMPOWERING STAFF WITH METRICS Team Leaders: Mark Sanders, MSN, RN, NEA-BC, Jeff Wilcox, RN-BC, CPAN Baylor Heart and Vascular Hospital, Dallas, Texas Team Members: Megan Linker, BSN, RN-BC, Jewel Johnson, PCT, Amanda Their, BSN, RN
BHVH was experiencing extended patient wait times from the Recovery Room to unit bed assignment. The delays lead to decreased patient and employee satisfaction as noted in our hospital surveys and BHVH Employee surveys. With the deployment of Teletracker, our system-wide bedtracking software, we could readily monitor bed assignment times and establish a metric for bed assignment.The staff were saying “we are hitting a ‘brick wall’ when trying to achieve established metric. They were dealing with competing priorities of other units. Our goal statement was to decrease the time from bed request (by the recovery room) to room assigned (by the units) to an average of 15 minutes. The “Resource Alert” was established e an email alert sent to all Team Leaders (directors, managers, and supervisors e including the president of the hospital) whenever it took longer than 15 minutes to receive a bed assignment after our “ready to move” function was initiated in Teletracker.The “Resource Alert” would alert the leadership in the building that help may be needed in the way of discharging patients, helping with a busy patient assignment that a nurse may have, or even just cleaning a room, in order to allow for the patient to move from Recovery to their hospital room. Within a few months, our metric was achieved, and staff and patient satisfaction increased noticeably.
PROCESS IMPROVEMENT: CREATING NEW ANESTHESIA GUIDELINES Team Leader: Tiffany N. Fields, RN, BSN Memorial Regional Medical Center, Mechanicsville, Virginia
Many errors within healthcare are caused by process failures, so it is important to adopt various process improvement techniques to identify inefficiencies and ineffective care. One major issue that hospital institutions should be concerned with is operating room cancellations and delays. Cancellations and delays can have significant negative financial implications on an institution, so it is viable that patients are assessed prior to surgery. The purpose of this project is the analysis and identification of ways to improve the preadmission testing process at Memorial Regional Medical Center. The primary goals of my clinical project are to increase the number of patients who come for a PAT visit by 10% and to decrease the amount of lab work and testing needed on the day of surgery. Preadmission testing visits provide a valuable means of centralizing patient medical information, thus allowing healthcare providers an opportunity to make changes in perioperative medical management. To improve the PAT process within this institution, I devel-
ASPAN NATIONAL CONFERENCE ABSTRACTS oped new anesthesia guidelines that were distributed to the institutions main surgery services. I met with the office manager and/or scheduler for each service, over an eight-week period, to educate staff on the purpose and use of the guidelines and the role they played in scheduling patients for a PAT visit prior to surgery. After the distribution of the new guidelines, data was collected through the auditing of PAT, Pre-op and OR charts to identify whether there had been an increase in patient visits prior to surgery and to identify whether DOS surgery lab work had decreased. After seven weeks of auditing charts, I have not seen a significant increase in PAT visits or a decrease in DOS lab work and tests. There are many implications for perianesthesia nursing within this process improvement project because preoperative evaluations can enhance patient safety and satisfaction, while reducing surgical complications. This project warrants further research due to its ability to improve the outcomes of all surgical patients.
CELEBRATE SUCCESSFUL PRACTICE ABSTRACTS: NURSE LIAISON
PACU LIASION ROLE: KEEPING FAMILIES UPDATED Team Leader: Joyce Burke, RN, BSN, CPAN The Christ Hospital, Cincinnati, Ohio Team Members: Sara Richart, RN, BSN, Tamera Bird, RN, BSN, CCRN, Kimberly Latham, RN, BSN, CCRN
Family Centered Care in the perioperative arena requires communication and updates throughout the perioperative process to alleviate patient and family anxiety as well as increase patient and family satisfaction. At our 550-bed community hospital Phase I PACU averages 90 cases per day. Our PACU goal for visitation and or family updates within 60 minutes of patient arrival to the PACU many times was being missed. Therefore a performance improvement taskforce was formed to identify barriers to improve family visitation and or communication; as well as ideas to overcome obstacles. The areas identified for success were time away from newly admitted patients, critical events of patients, as well interruption of nursing care at the bedside. A successful trial of assigning a role of Nurse Liaison was implemented with the objective to communicate and or provide limited visitation in the PACU for all loved ones within 45 minutes. This role was rotated among all RN’s to provide buy in, as well as a benefit of a new role from daily routine PACU nursing. As a result, positive successful outcomes included: 1) Improved patient and family communication, education and satisfaction. 2) Utilizing the Nurse Liaison as needed available help for critical issues. 3) Transitioning the role to PACU Liaison, including Patient Care Assistants, allowing flexibility in staffing needs. This performance improvement project advances the practice of perianesthesia nursing for improved patient family centered care, communication and education.
RESOURCE ALERT e EMPOWERING STAFF WITH METRICS Team Leaders: Mark Sanders, MSN, RN, NEA-BC, Jeff Wilcox, RN-BC, CPAN Baylor Heart and Vascular Hospital, Dallas, Texas Team Members: Megan Linker, BSN, RN-BC, Jewel Johnson, PCT, Amanda Their, BSN, RN
BHVH was experiencing extended patient wait times from the Recovery Room to unit bed assignment. The delays lead to decreased patient and employee satisfaction as noted in our hospital surveys and BHVH Employee surveys. With the deployment of Teletracker, our system-wide bedtracking software, we could readily monitor bed assignment times and establish a metric for bed assignment.The staff were saying “we are hitting a ‘brick wall’ when trying to achieve established metric. They were dealing with competing priorities of other units. Our goal statement was to decrease the time from bed request (by the recovery room) to room assigned (by the units) to an average of 15 minutes. The “Resource Alert” was established e an email alert sent to all Team Leaders (directors, managers, and supervisors e including the president of the hospital) whenever it took longer than 15 minutes to receive a bed assignment after our “ready to move” function was initiated in Teletracker.The “Resource Alert” would alert the leadership in the building that help may be needed in the way of discharging patients, helping with a busy patient assignment that a nurse may have, or even just cleaning a room, in order to allow for the patient to move from Recovery to their hospital room. Within a few months, our metric was achieved, and staff and patient satisfaction increased noticeably.
PROCESS IMPROVEMENT: CREATING NEW ANESTHESIA GUIDELINES Team Leader: Tiffany N. Fields, RN, BSN Memorial Regional Medical Center, Mechanicsville, Virginia
Many errors within healthcare are caused by process failures, so it is important to adopt various process improvement techniques to identify inefficiencies and ineffective care. One major issue that hospital institutions should be concerned with is operating room cancellations and delays. Cancellations and delays can have significant negative financial implications on an institution, so it is viable that patients are assessed prior to surgery. The purpose of this project is the analysis and identification of ways to improve the preadmission testing process at Memorial Regional Medical Center. The primary goals of my clinical project are to increase the number of patients who come for a PAT visit by 10% and to decrease the amount of lab work and testing needed on the day of surgery. Preadmission testing visits provide a valuable means of centralizing patient medical information, thus allowing healthcare providers an opportunity to make changes in perioperative medical management. To improve the PAT process within this institution, I devel-
ASPAN NATIONAL CONFERENCE ABSTRACTS oped new anesthesia guidelines that were distributed to the institutions main surgery services. I met with the office manager and/or scheduler for each service, over an eight-week period, to educate staff on the purpose and use of the guidelines and the role they played in scheduling patients for a PAT visit prior to surgery. After the distribution of the new guidelines, data was collected through the auditing of PAT, Pre-op and OR charts to identify whether there had been an increase in patient visits prior to surgery and to identify whether DOS surgery lab work had decreased. After seven weeks of auditing charts, I have not seen a significant increase in PAT visits or a decrease in DOS lab work and tests. There are many implications for perianesthesia nursing within this process improvement project because preoperative evaluations can enhance patient safety and satisfaction, while reducing surgical complications. This project warrants further research due to its ability to improve the outcomes of all surgical patients.
CELEBRATE SUCCESSFUL PRACTICE ABSTRACTS: NURSE LIAISON
PACU LIASION ROLE: KEEPING FAMILIES UPDATED Team Leader: Joyce Burke, RN, BSN, CPAN The Christ Hospital, Cincinnati, Ohio Team Members: Sara Richart, RN, BSN, Tamera Bird, RN, BSN, CCRN, Kimberly Latham, RN, BSN, CCRN
Family Centered Care in the perioperative arena requires communication and updates throughout the perioperative process to alleviate patient and family anxiety as well as increase patient and family satisfaction. At our 550-bed community hospital Phase I PACU averages 90 cases per day. Our PACU goal for visitation and or family updates within 60 minutes of patient arrival to the PACU many times was being missed. Therefore a performance improvement taskforce was formed to identify barriers to improve family visitation and or communication; as well as ideas to overcome obstacles. The areas identified for success were time away from newly admitted patients, critical events of patients, as well interruption of nursing care at the bedside. A successful trial of assigning a role of Nurse Liaison was implemented with the objective to communicate and or provide limited visitation in the PACU for all loved ones within 45 minutes. This role was rotated among all RN’s to provide buy in, as well as a benefit of a new role from daily routine PACU nursing. As a result, positive successful outcomes included: 1) Improved patient and family communication, education and satisfaction. 2) Utilizing the Nurse Liaison as needed available help for critical issues. 3) Transitioning the role to PACU Liaison, including Patient Care Assistants, allowing flexibility in staffing needs. This performance improvement project advances the practice of perianesthesia nursing for improved patient family centered care, communication and education.