(NURSING)Quality Improvement Initiative: Inefficiency in the Post Anesthesia Care Unit
J3SsY29
FPX6016_RamosJessica_Assessment2-1.pptxQuality Improvement Initiative: Inefficiency in the Post Anesthesia Care Unit
Jessica Ramos
MSN-FPX6016
July 12, 2021
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Objectives
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Overview of the issue
Objective/aim
Development of the project
Reflection of the value the practicum project has on my professional career path
Professional relationships developed during the project and the value of those relationships.
Overview of the Issue
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Literature Review
Unit Analysis
What we Know
There are numerous research studies that expose the effects of work interruptions in the acute care setting. So far, the literature has largely focused on work interruptions since nurses in the Post Anesthesia Care Unit (PACU) communicate through Electronic Health Record programs (EHR) to input medication errors, which ultimately affect patient safety. There is limited evidence relating to the type and scope of unit interruptions within the anesthesia care unit (PACU) setting.
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Analysis of Quality Improvement Initiative: Part 2
The Importance of the Quality Improvement Initiative
To increase patient outcomes in the PACU unit by decreasing interruptions of nurses in the unit.
Specific Implications of the Quality Improvement Initiative
Eliminate work interruptions and reinforce productivity.
Improve resources that allow for an environment free of interruptions.
Increase patient and staff satisfaction.
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The significance to the problem is that patient care and safety are being affected because of the interruptions. Most PACU nurses say that their jobs frequently or always involve multiple competing urgent priorities; therefore, interruptions are highly discouraged. Staff who feel frustrated when they are frequently interrupted during their work often get distracted and abandon their task; sometimes leading to medical errors. Research shows that it may take between 5 to 10 minutes for the nurse to refocus after interruptions (Bourgail, Johnson & Strauss, 2015).
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Objectives
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Objective # 1
To eliminate work interruptions and reinforce productivity.
Objective # 2
To improve resources that allow for an environment free of interruptions.
Objective # 3
To increase patient and staff satisfaction.
The initiative will evaluate the effectiveness of an education plan that details how the PACU will identify unnecessary distractions, how to remove the distractions, and how to eliminate them from future practice. For example, a method used in other high-critical areas in patient care that has proven to be successful at eliminating medical errors, is to limit the amount of people coming in or out of the PACU during critical periods, such as registration, documentation of medication, and emergence from anesthesia. Education about traffic limitations before starting surgery could be important in decreasing interruptions and the subsequent occurrence of error (Hopkinson & Jennings, 2015).
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Evaluation of the Quality Improvement Initiative
National Benchmarks Supporting the Quality Improvement Initiative
STANDARD I - All patients who have received general anesthesia, regional anesthesia or monitored anesthesia care shall receive appropriate postanesthesia management.
STANDARD II - Upon arrival in the PACU, the patient shall be re-evaluated and a verbal report provided to the responsible PACU nurse by the member of the anesthesia care team who accompanies the patient.
STANDARD IV - The patient’s condition shall be evaluated continually in the PACU.
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These standards apply to postanesthesia care in all locations. They are intended to encourage quality patient care, but cannot guarantee any specific patient outcome. They are subject to revision from time to time as warranted by the evolution of technology and practice.
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Analysis of the Benchmarks Related to the Quality Improvement Initiative
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The standards serve as a forum to provide strategic planning to improve efficiency of patient flow. The standards are designed to implement a program and standardized processes to help ensure the delivery of safe and effective patient care.
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To identify common work interruptions that interfere with efficiency.
To identify the resources needed to improve productivity and efficiency.
To provide an educational program that minimizes work interruptions and increases patient outcomes.
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Evaluation of the Quality Improvement Initiative
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The evaluation criteria is based on establishing coordination through the pre-procedure testing unit to ensure all required items and evaluations are completed by the medical staff without interruption.
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1. 2. 3. 4. A a ABOUT accepts ACCOMPANIED ACCOMPANIES accurate admission, all An an AND and ANESTHESIA Anesthesia anesthesia anesthesiologist. anesthetics, application APPROPRIATE appropriate ARRIVAL arrival as assessing assure at attention availability BE be BY by capable cardiopulmonary CARE Care care circulation, complications concerning CONDITION condition CONDITION. condition. consciousness CONTINUALLY coordination course delivery. discharge discharge. documented. DURING During during each employed encouraged EVALUATED facility for from General given III IN in Information initial intended intervals IS is IV KNOWLEDGEABLE labor level maintained. managing medical MEMBER member method methods monitored MONITORING monitoring not NURSE nurse nurse. nursing observed obstetrical OF of on oximetry oxygenation oxygenation, PACU PACU, PACU. Particular PATIENT patient PATIENT. patient. patients PATIENT’S patient’s period phase physician policy preoperative prior PROVIDED providing pulse quantitative RE-EVALUATED recovery recovery.* regional remain REPORT report responsibility RESPONSIBLE resuscitation scoring SHALL shall should STANDARD status such supervision SUPPORT surgical/anesthetic system TEAM Team temperature. THE The the There This time TO to transmitted TRANSPORT TRANSPORTED TREATED until UPON Use used vaginal ventilation, VERBAL was WHO whom WITH written complications concerning CONDITION condition CONDITION. condition. consciousness CONTINUALLY coordination course delivery. discharge discharge. documented. DURING During during each employed encouraged EVALUATED facility for from General given III IN in Information initial intended intervals IS is IV KNOWLEDGEABLE labor level maintained. managing medical MEMBER member method methods monitored MONITORING monitoring not NURSE nurse nurse. nursing observed obstetrical OF of on oximetry oxygenation oxygenation, PACU PACU, PACU. Particular PATIENT patient PATIENT. patient. patients complications concerning CONDITION condition CONDITION. condition. consciousness CONTINUALLY coordination course delivery. discharge discharge. documented. DURING During during each employed encouraged EVALUATED facility for from General given III IN in Information initial intended intervals IS is IV KNOWLEDGEABLE labor level maintained. managing medical MEMBER member method methods monitored MONITORING monitoring not NURSE nurse nurse. nursing observed obstetrical OF of on oximetry oxygenation oxygenation, PACU PACU, PACU. Particular PATIENT patient PATIENT. patient. patients complications concerning CONDITION condition CONDITION. condition. consciousness CONTINUALLY coordination course delivery. discharge discharge. documented. DURING During during each employed encouraged EVALUATED facility for from General given III IN in Information initial intended intervals IS is IV KNOWLEDGEABLE labor level maintained. managing medical MEMBER member method methods monitored MONITORING monitoring not NURSE nurse nurse. nursing observed obstetrical OF of on oximetry oxygenation oxygenation, PACU PACU, PACU. Particular PATIENT patient PATIENT. patient. patients complications concerning CONDITION condition CONDITION. condition. consciousness CONTINUALLY coordination course delivery. discharge discharge. documented. DURING During during each employed encouraged EVALUATED facility for from General given III IN in Information initial intended intervals IS is IV KNOWLEDGEABLE labor level maintained. managing medical MEMBER member method methods monitored MONITORING monitoring not NURSE nurse nurse. nursing observed obstetrical OF of on oximetry oxygenation oxygenation, PACU PACU, PACU. Particular PATIENT patient PATIENT. patient. patients
Critical Aspects of the Quality Improvement Initiative
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The post-anesthesia period is where patients are in a transition of monitoring that requires increased attention to detail, undivided attention, and enhanced critical thinking skills. In the intraoperative or procedure period, the Post Anesthesia Care nurse evaluates and manages the patient’s hemodynamic, analgesic and general ability to recover quickly and effectively (Bourgail, Johnson & Strauss, 2015). All these specialized tasks must be performed in an environment free of interruption and distractions.
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Interprofessional Team
Interprofessional Team Members Involved in the Quality Improvement Initiative
Physicians
Nurse Practitioners
Nurse Manager
PACU Nurses
Admissions/Discharge Staff
Team Member Perspectives
Decreased exposure to the effects of work interruptions in the acute care setting increase productivity.
Decreased potential for errors and ultimately increases patient outcomes.
Impact of Team Member Perspectives on the Quality Improvement Initiative
Getting on board with the initiative.
Participating and collaborating to increase patient outcomes.
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The team is comprised of physicians, nurse practitioners, nurse managers, PACU nurses, and admissions/discharge. The goal is to work together to decrease exposure to interruption that increases potential errors. The team must be educated on how the initiative will impact their job and productivity.
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Recommendations for the Future: Part 1
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An important recommendation is to create a sense of urgency. This recommendation develops a strategy to address feelings of emergency and understanding to the emotions of nurses who are not well informed or pleased with the present processes of the unit. Building a coalition helps to get the staff on board. The coalition will be formed by sending out a survey of interest to participate and the possible incentives to participation (e.g. request for time off, appreciation luncheon, gift cards). Using technology allows PACU nurses to communicate through wireless phone calls and messaging to operate with or without sound and vibration.
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Recommendations for the Future: Part 2
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The construction of nurse workstation barriers in the form of soft walls have been used in various clinical settings to isolate a workstation and limit traffic and distraction. Sustaining acceleration means bringing data of success to the unit, spread the word on results, seek input from nursing committee, obtain green light on project implementation.
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Questions
Thank you for participating today!
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References
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American Association of Colleges of Nursing (2016). About AACN. Retrieved from: http://www.aacn.nche.edu/about-aacn.
Bourgail, V., Johnson, M., & Strauss, M. (2015). Improving the medicine administration process by reducing interruptions. Journal of Healthcare Management, 57(6), 384-390.
Gupta, P. (2017). Leading innovation change - The Kotter way. International Journal of Innovation Science, 13(3), 141-150.
Hall, L. M., Ferguson-Paré, M., Peter, E., White, D., ... Hemingway, A. (2017). Going blank: Factors contributing to interruptions to nurses’ work and related outcomes. Journal of Nursing Management, 18, 1040-1047.
Hopkinson, S. G., & Jennings, B. M. (2015). Interruptions during nurses' work: A state-of-the science review. Research in Nursing & Health, 36(1), 38.
McLeod, M., Barber, N., & Franklin, B. D. (2015). Facilitators and barriers to safe medication administration to hospital inpatients: A mixed methods study of nurses’ medication administration processes and systems (the MAPS study). Plos ONE, 10(6), 1-20.
Mount Sinai Quarterly Report (2019). Quarterly Report – Quality Assurance: 2019 Second Quarter. Department of Risk Management, Mount Sinai.
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