Partnership Through Integration: Perianesthesia Policy Standardization

Introduction The interprofessional collaboration within the interdisciplinary team is the key concept necessary to provide safe high-quality care for burn patients. Nurses must be knowledgeable and confident in caring for burn patients, therefore resources must be available and easily accessible. The development and implementation of technology-based collaborative learning tools such as Burn Padlet is a quality improvement project developed to enhance providers’ and nurses’ understanding of workflow, standards of care, and the latest evidence-based clinical practice guidelines. Methods A pre-implementation qualitative survey was done to assess baseline knowledge and understanding of burn-related information, and the level of communication between teams. The results demonstrated a need for burn resources readily available within the service to promote standardization of care to all burn patients. The Burn Padlet is a comprehensive resource tool that was developed utilizing the evidence-based practice guidelines and standards of care from each interdisciplinary team’s department. The nursing staff’s input and the Burn Nurse Competency education were also incorporated into this Padlet to further improve the competency level of all nursing staff. Results The post-implementation results were obtained 6 months after the quality improvement project was initiated into practice. The findings suggest an increase in burn nurses’ knowledge of burn-related information, providers’ workflow, and communication between nursing staff and providers. Nursing staff stated that they have a better understanding of burn protocols, guidelines, and procedures. Staff also reported that the tool is useful in preventing communication barriers between nurses and providers. The goal of this project is to continue to further develop this tool to reflect the most current evidence-based practices in the burn patient population. Conclusions This quality improvement project has met the goals for patient care needs. The intended outcomes of this project include but are not limited to optimizing burn resuscitation, nutritional needs, mobility, wound care, post-op care, infection prevention, pain management, and the effective utilization of resources available. The Burn Trauma ICU and Med/Surg units also utilize the Padlet as a resource to meet the needs of their burn patients. Applicability of Research to Practice Research evidence has shown interprofessional collaboration has proven to reduce medical errors, promote safety culture, and improve patient outcomes. Nurses have a pivotal role in influencing innovation, collaboration, leading across the continuum of care, piloting new ideas, and expanding the accessibility and use of technology for hospital operations, and research. Therefore, the successful implementation of an innovative tool to improve interdisciplinary communication is an essential component to achieving patient satisfaction and quality patient care. Funding for the Study N/A

Aligning Healthcare Safety and Quality Competencies: Quality and Safety Education for Nurses (QSEN), The Joint Commission, and American Nurses Credentialing Center (ANCC) Magnet® Standards Crosswalk

In countries with public health system, hospital bed reductions and increasing social and medical frailty have led to the phenomenon of "outliers" or "outlying hospital in-patients." They are often medical patients who, because of unavailability of beds in their clinically appropriate ward, are admitted wherever unoccupied beds are. The present work is aimed to systematically review literature about quality and safety of care for patients admitted to clinically inappropriate wards. We performed a systematic review of studies investigating outliers, published in peer-reviewed journals with no time restrictions. Search and screening were conducted by two independent researchers (MLR and ER). Studies were considered potentially eligible for this systematic review if aimed to assess the quality and/or the safety of care for patients admitted to clinically inappropriate units. Our search was supplemented by a hand search of references of included studies. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. We collected 17 eligible papers and grouped them into six thematic categories. Despite their methodological limits, the included studies show increased trends in mortality and readmissions among outliers. Quality of care and patient safety are compromised as patients and health professionals declare and risk analysis displays. Reported solutions are often multicomponent, stress early discharge but have not been investigated in the control group. Published literature cannot definitely conclude on the quality and safety of care for patients admitted to clinically inappropriate wards. As they may represent a serious threat for quality and safety, and moreover often neglected and under valued, well-designed and powered prospective studies are urgently needed.

Recent reports in the lay and professional press document the failings of our patient care systems and have led to a multitude of suggestions for patient care quality and safety improvement initiatives. Given the complexity and range of services being offered, hospitals are launching numerous improvement initiatives in nearly all clinical care and support areas. This article describes a quality improvement framework, the "10 Rights," designed to help leaders better understand, organize, and prioritize patient care quality and safety issues and approaches. In addition to describing the framework, each Right is linked to 3 current national efforts at enhancing patient care quality and safety: the Joint Commission on Accreditation of Healthcare Organizations' National Patient Safety Goals, the National Quality Forum 30 Safe Practices, and the Centers for Medicare and Medicaid Services Hospital Quality Measures.

There are opportunities to improve quality and safety of care provided to adult patients. The Plummer Project of the Department of Medicine at the Mayo Clinic (Rochester, MN, USA) is an initiative to redesign outpatient practice. We used multidisciplinary teams to standardize the tasks essential to improve patient care. With the initiative to standardize the rooming process, patient care and safety improved with greater accuracy of the medication list. The standardization also improved physician efficiency because trained clinical assistants helped address the needs of the patient. Physicians were satisfied by the new process and the technology enhancements. Clinical assistants were also highly satisfied by the training process. The quality and safety of patient care can be significantly improved by practice redesign. This practice redesign was satisfying for all, especially the patients, physicians and support team in our practice.

The nurse's role in quality improvement and assurance is well established, but this is particularly true as hospitals engage in a culture of patient safety and view quality-related activities as important "safety checks." The role of the nurse in ensuring quality related to patient care and safety cannot be overstated. The achievement of quality and safety in patient care is the result of caregivers doing the right thing the right way the first time. Nurses serve as a critical link to the best quality health care organizations have to offer. This article describes four elements of a successful quality program in a large tertiary health care setting (alignment, collaboration, evidence-based practice, and excellence) and makes the connection between quality and safety in the provision of exemplary patient care. Three examples are provided that show how nurses and other members of the health care team grouped together as a governing council for quality (Performance Improvement Council) and at the bedside as direct caregivers in ensuring patient safety and quality patient care.

The sterile supply and equipment spaces in our ambulatory surgery center (ASC) currently are experiencing growing pains due to our success. We do not have enough space for the extra sterile supplies or equipment we acquired in the last two years. Therefore, we are looking into extra space in our office building for storing equipment, extra custom packs, and medical supplies. This space will be dedicated for storage and will not be in the ASC footprint; therefore, it mainly will be a warehouse area. Do any concerns exist for keeping product off site?As long as the organization meets the design requirements of the local authority and maintains the proper ventilation requirements for sterile storage, they will be considered compliant.What is required to be presented regarding X-ray equipment during a TJC survey?Typically, on day one of the survey, the surveyor will provide a list documents for review. Be sure to respond exactly as requested. Your medical equipment management plan, equipment inventory, and maintenance history records should always be ready for review. Because most records are now electronic, be sure that more than one person can run all your management reports. You want to avoid a citation for lack of documentation due to one person being unavailable.For several reasons, alternative equipment maintenance (AEM) is not being accepted at our facility to the extent that it should. For example, legal said “no way” because they are hesitant to depart from manufacturers' recommendations. This is not a valid or quantifiable reason. Some third-party companies see AEM as revenue reduction. What are your suggestions for changing this?A successful AEM program requires acceptance and “buy-in” from your key stakeholders. A data-driven proposal, including a risk assessment based on your historical services records or from another credible source, may help to support your argument. Your AEM strategy must not reduce safety and must be based on accepted practice standards. Your challenge is to prove this to key stakeholders with a defensible program.Why do TJC surveyors not follow the tracer methodology when end users report to a surveyor that “a device is broken and healthcare technology management (HTM) hasn't fixed it”? We have had several surveys where TJC surveyors are told a device is “broken” and that “it has been broken for a long time”; however, no surveyor has taken down the HTM control number for the device and either requested the repair history records or gone to the HTM department to ask questions specific to the repair of that device (e.g., Was a work request submitted? Was a work order created? What was the resolution?). Usually, the report is returned to leadership with a “finding” noted and a description along the lines of “the infusion pump in inpatient was reported as broken and not being repaired,” with no reference as to which one of the hundreds of portable infusion pumps was allegedly at issue. This prohibits HTM staff from appropriately researching and responding to the alleged problems and/or providing documentation regarding the allegation that the device is not being maintained/repaired.The tracer methodology is the process used during the on-site survey to analyze an organization's systems or processes for delivering safe, high-quality care by following an individual patient or resident through the organization's care process in the sequence experienced by each individual. Feedback received from staff is recorded as an observation of finding. Depending on the severity of the comment, the surveyor may or may not choose to investigate further. During the course of a survey, organizations may address the circumstances surrounding the discovery of an item that is out for repair.In this department, The Joint Commission (TJC) answers questions posed by AAMI members. Become part of the discussion by visiting www.aami.org/communities and joining AAMI's Joint Commission Discussion Group, which is open to all AAMI members. Some of the questions and answers may have been edited for space, style, and clarity.

This review examines current research on teamwork in highly dynamic domains of healthcare such as operating rooms, intensive care, emergency medicine, or trauma and resuscitation teams with a focus on aspects relevant to the quality and safety of patient care. Evidence from three main areas of research supports the relationship between teamwork and patient safety: (1) Studies investigating the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events. (2) Research focusing on healthcare providers' perceptions of teamwork demonstrated that (a) staff's perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care and (b) perceptions of teamwork and leadership style are associated with staff well-being, which may impact clinician' ability to provide safe patient care. (3) Observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork. In recent years, research using diverse methodological approaches has led to significant progress in team research in healthcare. The challenge for future research is to further develop and validate instruments for team performance assessment and to develop sound theoretical models of team performance in dynamic medical domains integrating evidence from all three areas of team research identified in this review. This will help to improve team training efforts and aid the design of clinical work systems supporting effective teamwork and safe patient care.

In this project, we sought to develop and implement pediatric anesthesia metrics into electronic health records (EHR) in a hospital setting to improve quality and safety of patient care. While there has been an upsurge in metric-driven health care, specific metrics catering to pediatric anesthesia remain lacking despite widespread use of EHR. The rapid proliferation and implementation of EHR presents opportunities to develop and implement metrics appropriate to local patient care, in this case pediatric anesthesia, with the strategic goal of enhancing quality and safety of patient care, while also delivering transparency in reporting of such metrics. Using a quasi-nominal consensus group design, we collected requirements from attending anesthesiologists using Agile methodology. Forty-five metrics addressing quality of care (e.g., induction experience, anesthesia delivery, unanticipated events, and postanesthetic care unit stay) and provider performance (e.g., bundle-compliance, collaboration, skills assurance) were developed. Implementation involved integration into the EHR followed by transition from PDF-based feedback to interactive Power BI (Microsoft Corporation, Redmond, WA, USA) dashboards. We introduced and implemented customized pediatric anesthesia metrics within an academic pediatric hospital; however, this framework is easily adaptable across multiple clinical specialties and institutions. In harnessing data-collecting and reporting properties of EHR, the metrics we describe provide insights that facilitate real-time monitoring and foster a culture of continuous learning in line with strategic goals of high-reliability organizations.

Understanding the complexity of working under time pressure in oncology nursing: A grounded theory study

<h3>Background</h3> Most existing centres for health technology assessment (HTA) are associated with payers or government agencies, and review and analyse emerging and costly technologies. Yet, such centres can exist within individual medical centres as well, and can use HTA methods locally to synthesise, disseminate and implement best clinical practices to improve the quality, safety and value of patient care. <h3>Objectives</h3> Describe the structure, processes and outcomes of a model of hospital-based HTA (HB-HTA) in the US, such that it can be applied elsewhere. <h3>Methods</h3> Our academic medical centre established the centre for Evidence-based Practice (CEP) in 2006. CEP synthesises guidelines and studies for clinical and administrative leaders to inform decision-making, integrates select syntheses into practice through clinical decision support (CDS), and provides education in evidence-based practice. Local utilisation and cost data are incorporated where appropriate. <h3>Results</h3> Nearly 200 evidence reports have been completed to date, and over 35 reports have been integrated into CDS. The median time from project opening to first draft is 4 weeks. CEP also contracts with external organisations such as the CDC and AHRQ on systematic reviews and guidelines. <h3>Discussion</h3> To complete reviews rapidly, we work closely with requestors to define the questions up front and limit the scope, use experienced analysts to perform high yield searches with single study reviews and extraction, and use best available evidence and existing guidelines and reviews. <h3>Implications for Guideline Developers/Users</h3> An HB-HTA centre can develop, adapt and implement guidelines locally to support a culture of evidence-based practice and decision-making.

Objective: To improve the safety and quality of patient care in hospitals by shaping clinical pathways throughout the patient journey.Study Setting: A risk model designed for healthcare organizations in the context of the challenges arising from comorbidity and other treatment-related complexities.Study Design: The core of the model is the patient and his intra-hospital journey, which is analyzed using a data-driven approach. The structure of a predictive model to support organizational and clinical decision-making activities is explained. Data relating to each step of the intra-hospital journey (from hospital admission to discharge) are extracted from clinical records.Principal Findings: The proposed approach is feasible and can be used effectively to improve safety and quality. It enables the evaluation of clinical risks at each step of the patient journey.Conclusion: Based on data from real cases, the model can record and calculate, over time, variables and behaviors that affect the safety and quality of healthcare organizations. This provides a greater understanding of healthcare processes and their complexity which can, in turn, advance research relating to clinical pathways and improve strategies adopted by organizations.

Accreditation demonstrates a hospital's real commitment to improving the safety and quality of patient care, ensuring that the service environment is safe and the hospital strives to reduce risks for patients and hospital staff. The purpose of this study was to determine the understanding of hospital accreditation for health students and hospital personnel. For this method of service, we use zoom webinars and target health students and hospital staff. Health students and hospital personnel understand and can carry out hospital accreditation to improve the safety and quality of patient care. Research can increase knowledge and understanding of hospital accreditation for health students and hospital staff.

The characteristics and factors associated with omitted nursing care in the intensive care unit: A cross-sectional study

Purpose: The Oncospace database aggregates treatment planning and clinical information about prior patients facilitating extraction of knowledge from prior courses of care. The goal is to use this knowledge to influence clinical decisions, quality and safety of care for new patients. Methods: The Oncospace website, built in C# and ASP.NET, accesses the MS SQLServer database for analysis. The data tables are designed to support patient geometry, targets and organs at risk (OAR) and their spatial relationships, dose distributions, toxicities, diagnosis and disease progression, chemotherapy and medications, laboratory values, patient histories and demographics. Data is collected directly from the treatment planning system and the oncology information system (OIS). Point of service data collection is facilitated with tablet (iPad) forms linked to the OIS. Results: Web pages have been built to answer the following: A) For a selected toxicity and OAR, display the dose volume histogram (DVH) and colorize them by the maximum toxicity grade of the patient while identifying a selected patients DVH B) For a selected OAR and percent volume (%V), find the lowest dose achieved from all patients whose %V is closer to the selected target volume? C) For a given diagnosis, toxicity and treatment, display the aggregate trend in toxicity from start of treatment (acute) through several year follow‐up (late)? Oncospace currently supports: and a full H&amp;N database, a multi‐institutional pancreatic stereotactic trial, and shape database for automated planning pancreas cancer. Conclusion: Oncospace can provide fast access to large amounts of data through complex queries designed to answer specific clinical questions to influence the safety and quality of care for new patients. This system can be used in the clinical setting to assess both plan quality and outcome expectations for new patients based on the data of prior patients. Funding for this research was provided by the Commonwealth Foundation, Elekta/IMPAC Medical Systems, Inc., Philips Radiation Oncology Sytems, and the Johns Hopkins University.