787 Burn Resuscitation Critical Reflective Practice

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S228-S229
Author(s):  
Jennifer Schoonard ◽  
Jeanne Lee ◽  
Eli Strait ◽  
Jeremy Cabrera ◽  
Jen Garner
Keyword(s):  
Reflective Practice ◽  
Patient Outcomes ◽  
Interdisciplinary Teams ◽  
Communication Process ◽  
Team Members ◽  
Staff Members ◽  
Critical Reflective Practice ◽  
Trauma Bay ◽  
Burn Resuscitation ◽  
Parkland Formula

Abstract Introduction The Burn Resuscitation Critical Reflective Practice (CRP) was started as collaborative meetings to review 1st 48 hours of admission for burn resuscitations (resus) October 2018- July 2019. All multi- disciplinary teams were invited. The problem identified was on average burn resus patients (>20% TBSA) were being over resuscitated in 1st 24 hours of admission. The goals of the CRP were: 1) Decrease resus fluid in the 1st 24 hours; 2) Increase knowledge of the current fluid resus pathway; 3) Increase communication with interdisciplinary teams during the resus. Methods CRP initiated in October 2018. 6 CRPs were held October 2018- July 2019.The average ml/ KG/ TBSA prior to CRP from January 2017- September 2018 was 5.17ml/kg/TBSA (goal: < 4ml). Chart reviews were done to gather data from each resus (i.e. urine output, fluids, labs, events). Discussions held with staff involved in the 1st 24 hours of resus regarding any communication/process issues.Patient data was presented & staff members present would discuss questions/ issues that came up during the resus. Multi-disciplinary teams surveyed prior to CRP to assess comfort/competence with current resus pathway and communication. 46 surveys received prior to initiating CRP. After initiating CRP October 2018- July 2019, staff members that had attended >1 CRP were post-surveyed. Results January 2017- October 2018 average ml/ KG/ TBSA was 5.17ml/kg/TBSA. October 2018- July 2019 POST CRP implementation, the avg ml/ KG/ TBSA was 3.86 ml LR/ kg/ TBSA in 1st 24 hours of resus. 3 new practices were implemented 1) Decrease fluids by 200ml/hr (instead of 100) when UOP is >100/hr at least 2 hours into resus; 2) Double sign by 2 RNs required when calculating Parkland Formula; 3) Guideline created to guide communication between Burn RNs & trauma bay when burn resus arrives. Post- survey data showed increase in comfort communicating with physicians regarding resus & increase in comfort/confidence in calculating Parkland Formula. 2 additional subjective questions were added onto the post- CRP survey. Conclusions Fluids given in the 1st 24 hours decreased from 5.17 to 3.86 average ml/ kg/ TBSA post- CRP. 3 new practices were implemented as discussed in results. Staff felt more comfortable communicating with team & calculating Parkland formula. Staff had positive responses on the post- survey. Applicability of Research to Practice The monthly CRPs are to be continued to discuss all burn resus patients received during the prior month. Allows team members to continue to modify practice as needed by what’s learned through each CRP to help better our patient outcomes and decrease overall resus fluids.

Constructive Distributed Work: An Integrated Approach to Sustainable Collaboration and Research for Distributed Teams

2021 ◽  
pp. 105065192110214
Author(s):  
Michelle McMullin ◽  
Bradley Dilger
Keyword(s):  
Best Practices ◽  
Team Building ◽  
Three Dimensional ◽  
Integrated Approach ◽  
Interdisciplinary Teams ◽  
Digital Tools ◽  
Distributed Teams ◽  
Distributed Work ◽  
Team Members ◽  
Negative Impacts

Academic work increasingly involves creating digital tools with interdisciplinary teams distributed across institutions and roles. The negative impacts of distributed work are described at length in technical communication scholarship, but such impacts have not yet been realized in collaborative practices. By integrating attention to their core ethical principles, best practices, and work patterns, the authors are developing an ethical, sustainable approach to team building that they call constructive distributed work. This article describes their integrated approach, documents the best practices that guide their research team, and models the three-dimensional thinking that helps them develop sustainable digital tools and ensure the consistent professional development of all team members.

scholarly journals Digital Tools to Enhance Caregiver-Centered Communication

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 571-571
Author(s):  
Debra Parker Oliver
Keyword(s):  
Family Caregivers ◽  
Randomized Clinical Trials ◽  
Video Conferencing ◽  
Geographic Distance ◽  
Interdisciplinary Teams ◽  
Digital Tools ◽  
Team Members ◽  
Outcomes Of Care ◽  
Challenges And Opportunities ◽  
Episodes Of Care

Abstract While it is recognized that caregiver engagement can improve processes and outcomes of care in gerontology, there are barriers to caregiver centered communication, including limited resources for health systems to devote services specifically to families, geographic distance and lack of time. Digital tools such as social media platforms and video-conferencing introduce opportunities for remote and often asynchronous communication. In this presentation, we discuss findings from two randomized clinical trials that explored digital tools to empower family caregivers. In the first we examined ways to use video-conferencing to enable family caregivers to become virtual team members during hospice interdisciplinary teams, and in the second trial we examine the use of secret Facebook groups to meet informational and emotional needs of family caregivers during episodes of care that are often linked to increased social isolation and loneliness. We discuss challenges and opportunities in designing digital tools to facilitate caregiver engagement and empowerment.

scholarly journals Framing the difficulties resulting from implementing a Participatory Management Model in a public hospital

2012 ◽  
Vol 20 (6) ◽  
pp. 1142-1151 ◽  
Author(s):  
Andrea Bernardes ◽  
Greta Cummings ◽  
Yolanda Dora Martinez Évora ◽  
Carmen Silvia Gabriel
Keyword(s):  
Decision Making ◽  
Public Hospital ◽  
Communication Process ◽  
Management Model ◽  
Participatory Management ◽  
Bolman And Deal ◽  
Job Descriptions ◽  
Team Members ◽  
Decentralized Decision Making ◽  
Innovative Management

OBJECTIVE: This study aims to address difficulties reported by the nursing team during the process of changing the management model in a public hospital in Brazil. METHODS: This qualitative study used thematic content analysis as proposed by Bardin, and data were analyzed using the theoretical framework of Bolman and Deal. RESULTS: The vertical implementation of Participatory Management contradicted its underlying philosophy and thereby negatively influenced employee acceptance of the change. The decentralized structure of the Participatory Management Model was implemented but shared decision-making was only partially utilized. Despite facilitation of the communication process within the unit, more significant difficulties arose from lack of communication inter-unit. Values and principals need to be shared by teams, however, that will happens only if managers restructure accountabilities changing job descriptions of all team members. CONCLUSION: Innovative management models that depart from the premise of decentralized decision-making and increased communication encourage accountability, increased motivation and satisfaction, and contribute to improving the quality of care. The contribution of the study is that it describes the complexity of implementing an innovative management model, examines dissent and intentionally acknowledges the difficulties faced by employees in the organization.

Coordination Difficulties in the Management of Operation Theatre in Children Hospital Lahore.

2021 ◽  
Author(s):  
Taimoor Hassan ◽  
Sana Saeed ◽  
Muhammad Moazzam ◽  
Manan Sadiq ◽  
Sidra Siddique ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Sampling Technique ◽  
Descriptive Study ◽  
Teaching Program ◽  
Operation Theatre ◽  
Staff Members ◽  
Material Resources ◽  
Study Population ◽  
Quality Check ◽  
Leadership And Organization

An operation theatre is any facility within a hospital domain where the surgical procedures are carried out in a strict sterile cosmos. Management of the operation theatre requires the coordination of humane and material resources in such a way that surgery can be performed safely, efficiently and cost effectively.Objective: To identify the difficulties in coordination of operating room management and find out their solutions for better patient outcomes. Methods: This descriptive study was conducted in Main Operation Theatre of Children Hospital and Institute of Child Health Lahore. Data was collected by using Convenient Sampling Technique. This was a hospital-based study in which staff members of both genders were included. The study population divided into four strata; doctors (surgeons and anesthetists), nurses, operation theatre technicians and anesthesia technicians. A total of 51 cases were observed and checked by a checklist about coordination diffculties in the management of operation theatre. Results: A total of 51 cases were studied to determine the difficulties in management of operation theatre. 25.22% cases showed difficulty in proper management of Operation Theater. This result showed that there are still some difficulties like insufficient and old equipments, absence of proper sterilization, lack of proper leadership, work overload, no quality check of equipments, no teaching program, and unpunctuality of staff, improper timing and organization in the operation theater. Conclusions: There are many difficulties in management of operation theatre regarding staff members, equipments, timings and sterilization. A proper leadership and organization can sort out these problems.

scholarly journals Role of the Diabetes Educator in Inpatient Diabetes Management

2018 ◽  
Vol 45 (1) ◽  
pp. 60-65
Author(s):  
Keyword(s):  
Diabetes Management ◽  
Performance Outcomes ◽  
Interdisciplinary Teams ◽  
Family Education ◽  
Team Members ◽  
Diabetes Educator ◽  
And Performance ◽  
Inpatient Diabetes Management ◽  
Diabetes Educators

It is the position of American Association of Diabetes Educators (AADE) that all inpatient interdisciplinary teams include a diabetes educator to lead or support improvement efforts that affect patients hospitalized with diabetes or hyperglycemia. This not only encompasses patient and family education but education of interdisciplinary team members and achievement of diabetes-related organizational quality metrics and performance outcomes.

Abstract 105: Accuracy of Team Perception of Performance With Actual CPR Quality Metrics in Children

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Lynda Knight ◽  
Todd Sweberg ◽  
Pual Mullan ◽  
Anita Sen ◽  
Matthew Braga ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Language Processing ◽  
American Heart ◽  
Qualitative Content Analysis ◽  
Heart Association ◽  
Prospective Data ◽  
Team Members ◽  
Assessment Measure ◽  
Cpr Quality ◽  
Perception Of Performance

Background: American Heart Association (AHA) recommends high quality CPR to promote optimal patient outcomes. Few reports compare team members’ perceptions of CPR quality with quantitative CPR data during actual pediatric CPR. Hypothesis: Self-reported team perception of CPR performance will not meet quantitative CPR metrics using AHA BLS guideline criteria. Methods: Prospective data from an international pediatric (pediRES-Q) resuscitation collaborative from February 2016 to August 2017. A modified Team Emergency Assessment Measure framework for qualitative content analysis was used to assess data from “hot” debriefings (held soon after arrest) by language processing experts blinded to CPR data. Events without reported perception of CPR and quantitative CPR data were excluded. Comments regarding CPR perception were grouped as either Plus perceptions of performance (PPP) or Delta perceptions of performance (DPP). Grouped events were matched and compared to quantitative CPR data of chest compression (CC) fraction (CCF), rate, and depth as collected by CPR-recording defibrillators. Compliance with AHA BLS guidelines were defined as events with mean: CCF >60%, CC rate 100-120/min; and CC depth for infants <1yo, ~4 cm (3.6-4.4 cm.); children 1-18 yo, 5-≤6 cm. Results: Of 227 arrests, 108 (48%) hot debriefings were reported. Reported CPR perceptions with paired quantitative CPR data were available for 53/108 (49%) events; 32/53 (60%) PPP and 21/53 (39%) DPP. Event CPR metric summaries (median [IQR]) for PPP - CCF 0.87 [0.77, 0.93]; CC rate 116/min [108.5, 120]; CC depth age <1yo 2.35 [2.01, 3.0] cm; >1yr 4.2 [3.3, 5.05] cm. DPP - CCF 0.79 [0.69, 0.92]; CC rate 118/min [109,129]; CC depth < 1 yo 2.03 [1.95, 2.2] cm; >1yo 3.93 [3.3, 5.06] cm. PPP events, 28/32 (87%) met guideline criteria for CCF, 25/32 (78%) for CC rate; 6/32 (19%) for CC depth; and 4/32 (12%) met criteria for all 3 categories. For DPP events, 17/21 (80%) met guideline criteria for CCF; 15/21 (71%) for CC rate; and 3/21 (15%) for CC depth, and 2/21 (9%) met criteria for all 3 categories. Conclusions: Self-reported team perception of CPR quality does not match quantitative CPR metrics using AHA guideline criteria whether CPR was positively perceived or not, depth being main reason for non-compliance.

Organization and Structure of the Cardiothoracic Intensive Care Unit

2015 ◽  
pp. 86-104
Author(s):  
Michael H. Wall
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Cost Of Care ◽  
Team Members ◽  
Low Intensity

The purpose of this chapter is to emphasize and describe the team nature of critical care medicine in the Cardiothoracic Intensive Care Unit. The chapter will review the importance of various team members and discuss various staffing models (open vs closed, high intensity vs low intensity, etc.) on patient outcomes and cost. The chapter will also examine the roles of nurse practitioners and physician assistants (NP/PAs) in critical care, and will briefly review the growing role of the tele-ICU. Most studies support the concept that a multi-disciplinary ICU team, led by an intensivist, improves patient outcomes and decreases overall cost of care. The role of the tele-ICU and 24 hour in-house intensivist staffing in improving outcomes is controversial, and more research is needed in this area. Finally, a brief discussion of billing for critical care will be discussed.

Critical Reflective Practice, Critical Pedagogy, and Culturally Relevant Pedagogy

2020 ◽  
pp. 64-90
Keyword(s):  
Professional Development ◽  
Critical Pedagogy ◽  
Reflective Practice ◽  
Teacher Professional Development ◽  
Culturally Relevant Pedagogy ◽  
Culturally Relevant ◽  
Educational Challenges ◽  
Teacher Professional ◽  
Critical Reflective Practice ◽  
Relevant Pedagogy

This chapter describes the frameworks of critical pedagogy, culturally relevant pedagogy, and related experiences that teachers engage in as part of the authors' antiracist professional development work. Critical reflective practice is at the core of these pedagogical approaches and is central in offering effective antiracist teacher professional development, with these frameworks having the potential to help teachers become aware of the ways that institutional racism pervades schools and society and the ways we are all complicit in perpetuating racism; shift the focus of oppressive educational challenges from individuals—including self as teacher, parents, and students—to systems of oppression; support teachers to develop the knowledge and skills to advocate and take action for antiracist attitudes, policies, and practices, both in society and in their own classrooms; support teachers' antiracist teaching that positions students to develop as critical, antiracist, and engaged citizens; and ensure that teachers and schools recognize and support the optimal development of every child.

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