Abstract P857: Rapid Cycle Process Improvement During a Pandemic: Changing How Patients at Low Risk for Complications Are Monitored Post Intravenous Thrombolysis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michelle Whaley ◽  
Rebecca van Vliet ◽  
Leah Farrell ◽  
David Welcom
Keyword(s):  
Patient Safety ◽  
Critically Ill ◽  
Process Improvement ◽  
Nursing Staff ◽  
Intravenous Thrombolysis ◽  
Low Risk ◽  
Nursing Time ◽  
Improvement Project ◽  
Practice Nurses ◽  
Low Intensity

Background: During the initial emergence of the 2019 novel coronavirus (COVID-19) and the subsequent surge of patients requiring critical care, our Joint Commission certified thrombectomy-capable stroke center sought to utilize a low-intensity monitoring protocol in stable, post intravenous (IV) thrombolysis patients in our intensive care unit (ICU). The acuity level in our ICU jumped to an all-time high, with many critically ill COVID-19 patients. Our goal was simple, provide safe patient care, free up precious nursing time, and preserve the personal protective equipment supply. Purpose: The purpose of this study was to use a rapid cycle process improvement project to implement a low-intensity monitoring (LIM) protocol in stable, suspected stroke patients, who are deemed at low risk for complications, in the first twenty-four hours following IV thrombolysis. Methods: We utilized the Plan-Do-Study-Act (PDSA) model to implement this project. Collaboration between physician, nursing, and stroke program leaders occurred during the month of April 2020. Our new process utilized the O ptimal P ost T -pa I v M onitoring in I schemic ST roke (OPTIMIST) protocol. We continued to admit our post IV alteplase patients to the ICU, rather than a step-down unit, in order to accommodate the 3:1 patient to nurse ratio, ensure protocol adherence, and maximize patient safety with this high-risk medication. We used change of shift huddles to educate the ICU nursing staff over a two-week period. Stroke program advanced practice nurses were on-site to ensure compliance. Results: Since implementation of the new protocol, two IV alteplase patients have met protocol criteria; both remained stable throughout the twenty-four-hour LIM period. The protocol’s nursing ratio changes allowed the other, critically ill patients, to be staffed with traditional ICU ratios. Conclusion: Rapid cycle PI projects can be accomplished during times of extreme challenge, as evidenced during the COVID-19 pandemic. Nursing staff was able to adapt and even welcomed the change, while maintaining patient safety. Further study is needed to document the ongoing effect of this protocol.

scholarly journals Using Focused Laboratory Management and Quality Improvement Projects to Enhance Resident Training and Foster Scholarship

2017 ◽  
Vol 4 ◽  
pp. 237428951772215 ◽  
Author(s):  
Matthew D. Krasowski ◽  
Bradley A. Ford ◽  
J. Stacey Klutts ◽  
Chris S. Jensen ◽  
Angela S. Briggs ◽  
...  
Keyword(s):  
Medical Education ◽  
Patient Safety ◽  
Quality Improvement ◽  
Graduate Medical Education ◽  
Process Improvement ◽  
Laboratory Management ◽  
University Of Iowa ◽  
Improvement Project ◽  
Graduate Medical ◽  
Management Quality

Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output.

scholarly journals An Assessment of Flight Surgeon Confidence to Perform En Route Care

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 306-309
Author(s):  
Chad T Andicochea ◽  
James Wilson ◽  
Emily Raetz ◽  
Benjamin Walrath
Keyword(s):  
Critically Ill ◽  
Process Improvement ◽  
Ad Hoc ◽  
Search And Rescue ◽  
Critically Ill Patient ◽  
Convenience Sample ◽  
Improvement Project ◽  
Patient Transport ◽  
The Past ◽  
Survey Results

Abstract Introduction En Route Care (ERC) is often an ad hoc mission for the USN. In a review of 428 Navy patient transports, a Flight Surgeon (FS) was the sole provider or a member of crew in 118 of the transports. Naval FSs receive approximately 4 hours of didactic ERC training during their 24-week Naval FS course. Regardless, an FS may be caring for a critically ill patient in a helicopter. We conducted a survey to evaluate FS confidence in their ability to perform ERC and to establish their understanding of the training of Search and Rescue Medical Technicians (SMT). Materials and Methods A convenience sample of FSs completed a needs analysis survey as part of a process improvement project. Flight Surgeons surveyed were actively assigned or had been assigned within the past year to a squadron with Search and Rescue/MEDEVAC capabilities. Results A total of 25 surveys were completed. An average of 13 (range 0–100) patient transport missions were performed by the respondents. Twenty-five percent reported feeling confident in their ability to provide ERC without senior level direction, while 41% stated they would require direction. Nearly 70% of the FSs surveyed expressed “minimal” or less understanding of the training of the SMT. Conclusions Our survey results reveal most FSs are confident in neither their ability to perform ERC nor the ability of their hospital corpsman to provide care during patient movement.

scholarly journals P36 Numeta G13% preterm neonatal parenteral nutrition solution – a licensed all-in-one triple chamber, ready to use and terminally sterilised parenteral nutrition for preterm newborn infants

2020 ◽  
Vol 105 (9) ◽  
pp. e25-e25
Author(s):  
Mar Moreno ◽  
Kenny McCormick ◽  
Lindsey Macfarlane ◽  
Alexandra Scrivens
Keyword(s):  
Patient Safety ◽  
Parenteral Nutrition ◽  
Standard Deviation Score ◽  
British Association ◽  
List Type ◽  
Central Administration ◽  
Nursing Time ◽  
Perinatal Medicine ◽  
Improvement Project ◽  
Safety Alert

AimsWe aim to evaluate the efficacy and safety of Numeta G13%E preterm neonatal parenteral nutrition (PN) in our neonatal population.In September 2017 a National Patient Safety Alert (NPSA) highlighted the risk of harm to babies when lipid was mistakenly run at the rate intended for the aqueous component resulting in significant lipid overdose.Although we have worked to implement many of the alert’s recommendations, we feel we can avoid this risk further by using an all-in-one PN solution.1Numeta meets current nutritional guidelines as per British Association of Perinatal Medicine (BAPM) but this project allows comparison of outcomes important to both patient and service between those achieved with our current regimen and those with the all-in-one regimen.2MethodsWe carried out a quality improvement project from April 2018 to April 2019. We collected data from 330 babies in our neonatal unit during six months before (154 babies) and after (176 babies) the adoption of the all-in-one solution.Our previous PN regimen consisted of a ‘menu’ of aqueous bags (starter, maintenance, ‘light’ and bespoke) and a separate lipid solution. All of them were suitable for peripheral or central administration. Numeta came with similar choices: starter, maintenance -for central administration only- and ‘lite’ and Numeta peripheral, suitable for peripheral administration. Bespoke bags were also available if clinically indicated. We set out our desired outcomes and measured parameters accordingly:Patient outcomesMetabolic stability: electrolyte, glucose, bilirubin and lipid measurements summarised by the need to change from standard PN regimen and/or requirement for insulin.Fluid balance summarised by the lowest weight during the first two weeks of life and time taken to regain birth weight.Growth summarised by change of standard deviation score of weight and head circumference between birth and discharge or transfer back to local hospital.Liver tolerance of lipid solutions summarised by incidence of cholestasis (>25 μmol/l conjugated fraction of serum bilirubin)Days and type of PNSepsisService outcomesNursing time taken to prepare PNCostWastageAccess to productResultsAlthough we finished collecting the data in April 2019, we are still in the process of analysing it and evaluating the final results. There have been no cases of lipid overdose and our neonates (including the preterm ones) have so far tolerated well the new parenteral nutrition solution. Average nursing time preparing Numeta went down from 18.5 minutes to 8 minutes and comparison of cost came in favour of Numeta. PN wastage was higher with Numeta (4.7% Maintenance, 10% ‘light’, peripheral 50%) especially in the first month during the transition phase. There was no significant increase of bespoke bags when Numeta was introduced.ConclusionsIn summary, so far we have not identified significant clinical differences between the first six months of the project -using our old standardised nutrition regimen- and the last months -on the new all-in-one solution. We have continued with Numeta preterm solution on the basis of assumed safety.ReferencesRisk of severe harm and death from infusing total parenteral nutrition too rapidly in babies. NHS improvement patient safety alert September 2017.The Provision of Parenteral Nutrition within Neonatal Services – A Framework for Practice. British Association of Perinatal Medicine (BAPM) April 2016 www.bapm.org

Ergonomic Process Improvement for Mapping Risk and Identifying Key Interventions for Eliminating Injuries from Needles and Sharps in the OR

2020 ◽  
Vol 64 (1) ◽  
pp. 716-720
Author(s):  
Pramila Kalaga ◽  
Barbara Wolford ◽  
Matthew Mormino ◽  
Timothy Kingston ◽  
Julie Fedderson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Process Improvement ◽  
Injury Risk ◽  
Best Practice ◽  
Physical Workload ◽  
Physical Factors ◽  
Improvement Project ◽  
Targeted Interventions ◽  
Effective Interventions ◽  
Sharps Injury

The risk of a needle stick or sharps injury in the operating room (OR) is high due to conditions such as minimal physical protective measures, frequent transfer of sharps, and reliance on human attention and skill for injury avoidance. An ergonomic process improvement project was initiated at a large metro teaching hospital to identify ergonomic risk factors for these OR injuries. To maximize the engagement of the front- end users, an ergonomic process improvement (EPI) team was developed, consisting of representatives from participating OR teams, an employee health nurse and two ergonomists. Surveys, observations, and interviews were conducted to quantify injury risk for the OR teams, evaluate barriers to best practice adherence, and identify opportunities for targeted interventions. Risk mapping was completed for the surgeons, surgical techs and OR nurses identifying double gloving and safe passing zone as areas in need of improvement. Through observation and interviews, researchers identified physical factors relating to musculoskeletal pain and cognitive factors leading to distractions as safety risk concerns. The overall success of the EPI was the engagement of the OR teams and surgeons in the process of identifying risk factors and potential opportunities for ergonomic solutions related to cognitive workload, physical workload, teamwork, and work design for injury prevention. The risk factors identified will provide the basis for developing targeted, effective interventions for eliminating injuries from needles and sharps within the OR.

scholarly journals OR and ICU teams ‘running in parallel’ at the end of cardiothoracic surgery improves perceptions of handoff safety

2021 ◽  
Vol 10 (1) ◽  
pp. e001001
Author(s):  
Safraz Hamid ◽  
Frederic Joyce ◽  
Aaliya Burza ◽  
Billy Yang ◽  
Alexander Le ◽  
...  
Keyword(s):  
Patient Safety ◽  
Cardiac Surgery ◽  
Safety Culture ◽  
Positive Response ◽  
Improve Patient Safety ◽  
Health Care Research ◽  
Response Rates ◽  
Patient Safety Culture ◽  
Improvement Project ◽  
Surgery Patient

The transfer of a cardiac surgery patient from the operating room (OR) to the intensive care unit (ICU) is both a challenging process and a critical period for outcomes. Information transferred between these two teams—known as the ‘handoff’—has been a focus of efforts to improve patient safety. At our institution, staff have poor perceptions of handoff safety, as measured by low positive response rates to questions found in the Agency for Health Care Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS). In this quality improvement project, we developed a novel handoff protocol after cardiac surgery where we invited the ICU nurse and intensivist into the OR to receive a face-to-face handoff from the circulating nurse, observe the final 30 min of the case, and participate in the end-of-case debrief discussions. Our aim was to increase the positive response rates to handoff safety questions to meet or surpass the reported AHRQ national averages. We used plan, do, study, act cycles over the course of 123 surgical cases to test how our handoff protocol was leading to changes in perceptions of safety. After a 10-month period, we achieved our aim for four out of the five HSOPS questions assessing safety of handoff. Our results suggest that having an ICU team ‘run in parallel’ with the cardiac surgical team positively impacts safety culture.

Estimating performance from capabilities in business process improvement

2016 ◽  
Vol 22 (6) ◽  
pp. 1099-1117 ◽  
Author(s):  
Boyd A. Nicholds ◽  
John P.T. Mo
Keyword(s):  
Process Improvement ◽  
Business Process ◽  
Expected Improvement ◽  
Management Decision ◽  
Published Data ◽  
Performance Gain ◽  
Data Set ◽  
Business Process Improvement ◽  
Improvement Project ◽  
Content Type

Purpose The research indicates there is a positive link between the improvement capability of an organisation and the intensity of effort applied to a business process improvement (BPI) project or initiative. While a degree of stochastic variation in applied effort to any particular improvement project may be expected there is a clear need to quantify the causal relationship, to assist management decision, and to enhance the chance of achieving and sustaining the expected improvement targets. The paper aims to discuss these issues. Design/methodology/approach The paper presents a method to obtain the function that estimates the range of applicable effort an organisation can expect to be able to apply based on their current improvement capability. The method used analysed published data as well as regression analysis of new data points obtained from completed process improvement projects. Findings The level of effort available to be applied to a process improvement project can be expressed as a regression function expressing the possible range of achievable BPI performance within 90 per cent confidence limits. Research limitations/implications The data set applied by this research is limited due to constraints during the research project. A more accurate function can be obtained with more industry data. Practical implications When the described function is combined with a separate non-linear function of performance gain vs effort a model of performance gain for a process improvement project as a function of organisational improvement capability is obtained. The probability of success in achieving performance targets may be estimated for a process improvement project. Originality/value The method developed in this research is novel and unique and has the potential to be applied to assessing an organisation’s capability to manage change.

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