Reducing Preventable Codes in the Inpatient Hematology Oncology Population...when you are more than ten minutes away from an ICU

2.50
Hdl Handle:
http://hdl.handle.net/10755/164973
Category:
Abstract
Type:
Presentation
Title:
Reducing Preventable Codes in the Inpatient Hematology Oncology Population...when you are more than ten minutes away from an ICU
Author(s):
Gobel, Barbara; Murphy, Patricia Jean; Schumacher, Mark; Weitzman, Sigmund
Author Details:
Barbara Gobel, RN, MS, AOCN, Oncology Clinical Nurse Specialist, Northwestern Memorial Hospital, Chicago, Illinois, USA, email: bgobel@nmh.org; Patricia Jean Murphy, RN, MS, MBA; Mark Schumacher, MBA; Sigmund Weitzman, MD
Abstract:
Clinical/Evidence Based Practice: Multiple barriers exist to proactively and safely transition clinically appropriate oncology patients to an ICU setting. Despite these barriers the oncology units transfer 5.43% of their patients to an ICU setting. In addition, these units experience preventable and true codes at a rate of 0.095 codes per transfer: about 2 codes per month. The Oncology Department moved to a new facility that has added physical distance (a 10 minute one way trip) to the list of transfer barriers. The purpose of this evidence-based practice project was to develop a protocol to more proactively identify and intervene on critically ill oncology patients and to decrease preventable and true codes by at least 33%. Low preventable code rates serve as a primary indicator for a safe and effective ICU transfer process. In researching tools for proactive identification of at-risk or septic patients we identified the modified early warning score (MEWS) and systemic inflammatory response syndrome (SIRS) criteria; both already in use in other areas of the hospital. The MEWS was chosen. This is the tool that our Rapid Response Team uses in their identification of critically ill patients. No studies had evaluated the MEWS or SIRS in the Hem/Onc population. We tested the tools using historical vitals/lab data from 31 cardiac or respiratory arrests and another 31 patients that did not code, transfer to the ICU or expire. We developed a Hematology/Oncology MEWS Sepsis Protocol that was interdisciplinary in nature. In the first 6 months since protocol implementation, the preventable code rate dropped 80% (statistically significant) from a baseline 0.60 codes/100 discharges to 0.11 codes/100 discharges. The Hem/Onc team now reviews every code in an interdisciplinary meeting and leverages a control plan to sustain results. In addition to reducing preventable codes we learned as a team about managing change: involve all key stakeholders from the beginning, create a common language, the Rapid Response Team is an invaluable resource, and long-term sustainability requires vigilance, measurement and follow-up. Working collaboratively, nursing is able to effect profound changes on a complex system of care.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2009
Conference Name:
34th Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
San Antonio, Texas, 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.titleReducing Preventable Codes in the Inpatient Hematology Oncology Population...when you are more than ten minutes away from an ICUen_GB
dc.contributor.authorGobel, Barbaraen_US
dc.contributor.authorMurphy, Patricia Jeanen_US
dc.contributor.authorSchumacher, Marken_US
dc.contributor.authorWeitzman, Sigmunden_US
dc.author.detailsBarbara Gobel, RN, MS, AOCN, Oncology Clinical Nurse Specialist, Northwestern Memorial Hospital, Chicago, Illinois, USA, email: bgobel@nmh.org; Patricia Jean Murphy, RN, MS, MBA; Mark Schumacher, MBA; Sigmund Weitzman, MDen_US
dc.identifier.urihttp://hdl.handle.net/10755/164973-
dc.description.abstractClinical/Evidence Based Practice: Multiple barriers exist to proactively and safely transition clinically appropriate oncology patients to an ICU setting. Despite these barriers the oncology units transfer 5.43% of their patients to an ICU setting. In addition, these units experience preventable and true codes at a rate of 0.095 codes per transfer: about 2 codes per month. The Oncology Department moved to a new facility that has added physical distance (a 10 minute one way trip) to the list of transfer barriers. The purpose of this evidence-based practice project was to develop a protocol to more proactively identify and intervene on critically ill oncology patients and to decrease preventable and true codes by at least 33%. Low preventable code rates serve as a primary indicator for a safe and effective ICU transfer process. In researching tools for proactive identification of at-risk or septic patients we identified the modified early warning score (MEWS) and systemic inflammatory response syndrome (SIRS) criteria; both already in use in other areas of the hospital. The MEWS was chosen. This is the tool that our Rapid Response Team uses in their identification of critically ill patients. No studies had evaluated the MEWS or SIRS in the Hem/Onc population. We tested the tools using historical vitals/lab data from 31 cardiac or respiratory arrests and another 31 patients that did not code, transfer to the ICU or expire. We developed a Hematology/Oncology MEWS Sepsis Protocol that was interdisciplinary in nature. In the first 6 months since protocol implementation, the preventable code rate dropped 80% (statistically significant) from a baseline 0.60 codes/100 discharges to 0.11 codes/100 discharges. The Hem/Onc team now reviews every code in an interdisciplinary meeting and leverages a control plan to sustain results. In addition to reducing preventable codes we learned as a team about managing change: involve all key stakeholders from the beginning, create a common language, the Rapid Response Team is an invaluable resource, and long-term sustainability requires vigilance, measurement and follow-up. Working collaboratively, nursing is able to effect profound changes on a complex system of care.en_GB
dc.date.available2011-10-27T12:10:17Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:10:17Z-
dc.conference.date2009en_US
dc.conference.name34th Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationSan Antonio, Texas, 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.-
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