Improving Patient Safety through Standardization of the Hand-off Process for Post-operative Pediatric Cardiothoracic Patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/164214
Category:
Abstract
Type:
Presentation
Title:
Improving Patient Safety through Standardization of the Hand-off Process for Post-operative Pediatric Cardiothoracic Patients
Author(s):
Meliones, Jon; Mericle, Jane; Norman, Sharon
Author Details:
Jon Meliones, MD, MS, Duke University, Durham, North Carolina, USA, email: nacnsorg@nacns.org; Jane Mericle, BSN, MHS-CL; Sharon Norman, MSN, RN, CNS, CCRN
Abstract:
Purpose: Decrease variability in the hand-off process for post-operative pediatric cardiothoracic patients between the OR and PICU. Enhance communication between the OR and PICU team. Significance: Patient hand-offs from one team to another is a process vulnerable to errors. A commonly cited system failure involves communication errors during the hand-off process. Background/Design: The lack of information, teamwork, and inconsistency during hand-offs for pediatric cardiothoracic patients returning from the OR had been previously identified. Methods: Using the Six Sigma methodology and the DMAIC process (design, measure, analyze, improve and control) a multidisciplinary team was formed. This team consisted of PICU nurses, physicians, RTs, anesthesiologists and cardiothoracic surgeons. The team defined critical information/processes that were to occur during the hand-off process. An audit tool was created which documented the critical information to occur during the hand-off. Direct observation of 22 patient hand-offs were done using this audit tool, Data analysis was performed and presented to the team, after which performance improvements were made including prioritization of events on arrival to the PICU. Once the team was educated on the improvements, further audits were done by direct observation on another 129 pediatric cardiothoracic patients admitted to the PICU from the operating room. Findings: There were 22 patients in the initial group and 129 in the post-intervention group. There was a significant reduction in turnaround time (15.3 to 9.9 min; p<0.001) and lab draw time (13 to 2.6 min; p<0.001. There was also an improvement in CXRs done within our standard (60 vs. 94%; p<0.01) and on percent of patients on the bedside cardio-respiratory monitor within our standard (86 vs. 99%; p<0.01). Conclusions: The hand-off between the OR and PICU represents a vulnerable time. Development of a standardized hand-off process reduces variability, enhances team work and improves patient safety. Implications for Practice: To utilize Six sigma and the DMAIC methodology in evaluating the hand-off process for other surgical services being admitted to the PICU as well as PICU patients transferred to other acute care units.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2007
Conference Name:
CNS Outcomes: Ensuring Safety and Quality
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Phoenix, Arizona, USA
Description:
Conference theme: CNS Outcomes: Ensuring Safety and Quality, held February 28-March 1 in Phoenix, Arizona, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleImproving Patient Safety through Standardization of the Hand-off Process for Post-operative Pediatric Cardiothoracic Patientsen_GB
dc.contributor.authorMeliones, Jonen_US
dc.contributor.authorMericle, Janeen_US
dc.contributor.authorNorman, Sharonen_US
dc.author.detailsJon Meliones, MD, MS, Duke University, Durham, North Carolina, USA, email: nacnsorg@nacns.org; Jane Mericle, BSN, MHS-CL; Sharon Norman, MSN, RN, CNS, CCRNen_US
dc.identifier.urihttp://hdl.handle.net/10755/164214-
dc.description.abstractPurpose: Decrease variability in the hand-off process for post-operative pediatric cardiothoracic patients between the OR and PICU. Enhance communication between the OR and PICU team. Significance: Patient hand-offs from one team to another is a process vulnerable to errors. A commonly cited system failure involves communication errors during the hand-off process. Background/Design: The lack of information, teamwork, and inconsistency during hand-offs for pediatric cardiothoracic patients returning from the OR had been previously identified. Methods: Using the Six Sigma methodology and the DMAIC process (design, measure, analyze, improve and control) a multidisciplinary team was formed. This team consisted of PICU nurses, physicians, RTs, anesthesiologists and cardiothoracic surgeons. The team defined critical information/processes that were to occur during the hand-off process. An audit tool was created which documented the critical information to occur during the hand-off. Direct observation of 22 patient hand-offs were done using this audit tool, Data analysis was performed and presented to the team, after which performance improvements were made including prioritization of events on arrival to the PICU. Once the team was educated on the improvements, further audits were done by direct observation on another 129 pediatric cardiothoracic patients admitted to the PICU from the operating room. Findings: There were 22 patients in the initial group and 129 in the post-intervention group. There was a significant reduction in turnaround time (15.3 to 9.9 min; p<0.001) and lab draw time (13 to 2.6 min; p<0.001. There was also an improvement in CXRs done within our standard (60 vs. 94%; p<0.01) and on percent of patients on the bedside cardio-respiratory monitor within our standard (86 vs. 99%; p<0.01). Conclusions: The hand-off between the OR and PICU represents a vulnerable time. Development of a standardized hand-off process reduces variability, enhances team work and improves patient safety. Implications for Practice: To utilize Six sigma and the DMAIC methodology in evaluating the hand-off process for other surgical services being admitted to the PICU as well as PICU patients transferred to other acute care units.</td></tr></table>en_GB
dc.date.available2011-10-27T11:44:09Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:44:09Z-
dc.conference.date2007en_US
dc.conference.nameCNS Outcomes: Ensuring Safety and Qualityen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationPhoenix, Arizona, USAen_US
dc.descriptionConference theme: CNS Outcomes: Ensuring Safety and Quality, held February 28-March 1 in Phoenix, Arizona, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_US
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