Positive Thoughts, Positive Outcomes: Providing Feedback to Improve Patient Care

2.50
Hdl Handle:
http://hdl.handle.net/10755/306626
Category:
Abstract
Type:
Poster
Title:
Positive Thoughts, Positive Outcomes: Providing Feedback to Improve Patient Care
Author(s):
Sexton, Jessica
Lead Author STTI Affiliation:
Non-member
Author Details:
Jessica Sexton, BSN, RN, Jessica.sexton@childrens.harvard.edu
Abstract:

Evidence-based Practice Abstract

Purpose: Pediatric patients who present with fever and neutropenia to the Emergency Department are at high risk for developing fulminant sepsis. Decreasing time to first antibiotic administration has been shown to decrease the likelihood of mortality and morbidity within 24 hours of presentation. Based on findings from an extensive evidence-based practice search, multiple initiatives were put into place to decrease the time to first antibiotic administration in this patient population; however variability in practice continued to exist. The objective of this initiative was to decrease variability within the process by adding the strategy of nurse-driven positive reinforcement to physician and nursing.

Design: Pre-post test assessment.

Setting: A 44-bed Emergency Department level I trauma and referral center in an academic quarternary free-standing children’s hospital in the Northeast United States with an annual census of 60,000 patient visits.

Participants/Subjects: All patient presenting to the Emergency Department with an oncology diagnosis, fever of 38.5°C or 38°C twice within 24 hours and suspected or known neutropenia.

Methods: Starting in July 2011, written feedback was provided to nursing and physician staff after caring for a febrile oncology patient with suspected or known neutropenia. On average, 10 patients each month presented that met inclusion criteria. Data were collected on patient arrival time, antibiotic order time, antibiotic administration time and any other relative information related to the patient experience that could potentially affect administration time, (example, difficult intravenous access). Following each case review, a letter was sent to the nurse and physician staff that cared for the patient, as well as nursing and physician leadership. Those who met or exceeded the goal of 60 minutes (for known neutropenia), or 90 minutes (for suspected neutropenia) for initial antibiotic administration received a congratulatory letter. Those who did not meet the goal were praised for their efforts and asked to review the specified patient chart and provide feedback on process barriers and what would have been needed to achieve the goal. Data from staff feedback was then disseminated throughout the department regarding ways to improve the process.

Results/Outcomes: Staff time to generate and send the letters was estimated to be 15 minutes per month, demonstrating feasibility. The average time from ED arrival to antibiotic administration prior to the intervention was 61 minutes. Following the intervention, time to first antibiotic administration significantly decreased to an average of 51 minutes (p=0.0001).

Implications: Written positive feedback has resulted in improved first antibiotic dosing for febrile neutropenic, or suspected neutropenic oncology patients and decreased variability practice. A demanding healthcare environment and rising costs requires innovative ways to encourage change, improve service and achieve positive outcomes for patients and staff and this cost-effective, feasible intervention has been successful.

Keywords:
Positive reinforcement to improve patient care
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Center
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.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titlePositive Thoughts, Positive Outcomes: Providing Feedback to Improve Patient Careen_GB
dc.contributor.authorSexton, Jessicaen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsJessica Sexton, BSN, RN, Jessica.sexton@childrens.harvard.eduen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306626-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: Pediatric patients who present with fever and neutropenia to the Emergency Department are at high risk for developing fulminant sepsis. Decreasing time to first antibiotic administration has been shown to decrease the likelihood of mortality and morbidity within 24 hours of presentation. Based on findings from an extensive evidence-based practice search, multiple initiatives were put into place to decrease the time to first antibiotic administration in this patient population; however variability in practice continued to exist. The objective of this initiative was to decrease variability within the process by adding the strategy of nurse-driven positive reinforcement to physician and nursing.</p><p>Design: Pre-post test assessment.</p><p>Setting: A 44-bed Emergency Department level I trauma and referral center in an academic quarternary free-standing children’s hospital in the Northeast United States with an annual census of 60,000 patient visits.</p><p>Participants/Subjects: All patient presenting to the Emergency Department with an oncology diagnosis, fever of 38.5°C or 38°C twice within 24 hours and suspected or known neutropenia.</p><p>Methods: Starting in July 2011, written feedback was provided to nursing and physician staff after caring for a febrile oncology patient with suspected or known neutropenia. On average, 10 patients each month presented that met inclusion criteria. Data were collected on patient arrival time, antibiotic order time, antibiotic administration time and any other relative information related to the patient experience that could potentially affect administration time, (example, difficult intravenous access). Following each case review, a letter was sent to the nurse and physician staff that cared for the patient, as well as nursing and physician leadership. Those who met or exceeded the goal of 60 minutes (for known neutropenia), or 90 minutes (for suspected neutropenia) for initial antibiotic administration received a congratulatory letter. Those who did not meet the goal were praised for their efforts and asked to review the specified patient chart and provide feedback on process barriers and what would have been needed to achieve the goal. Data from staff feedback was then disseminated throughout the department regarding ways to improve the process.</p><p>Results/Outcomes: Staff time to generate and send the letters was estimated to be 15 minutes per month, demonstrating feasibility. The average time from ED arrival to antibiotic administration prior to the intervention was 61 minutes. Following the intervention, time to first antibiotic administration significantly decreased to an average of 51 minutes (p=0.0001).</p><p>Implications: Written positive feedback has resulted in improved first antibiotic dosing for febrile neutropenic, or suspected neutropenic oncology patients and decreased variability practice. A demanding healthcare environment and rising costs requires innovative ways to encourage change, improve service and achieve positive outcomes for patients and staff and this cost-effective, feasible intervention has been successful.</p>en_GB
dc.subjectPositive reinforcement to improve patient careen_GB
dc.date.available2013-12-09T17:00:56Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:56Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Centeren_GB
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.en_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.