Standardizing ICU Nursing Shift Notes

The purpose of this project was to see if the standardization of a nursing shift note increased the communication of important patient information between nursing and provider teams. The attending physician in the cardiothoracic intensive care unit (CTICU) stated critical patient information between shifts was missing in handoffs and inconsistent nursing notes. Providers cannot easily read all forms of nursing documentation for a summary of what is pertinent to patients. It was hypothesized a standardized note for handoff would increase the information providers could review before rounds and decrease the omission of critical data. A review of the literature was done on handoff standards in critical care. Use of standardized handoff notes reported improved communication on patients’ overall plan, decreased adverse patient events and medical errors. CTICU providers and nurses gave input on critical pieces of handoff communication. A CNS was consulted on components to make the note usable in other ICUs. A template was developed in the electronic medical record for standardized handoff information. CTICU nurses were educated to use the template instead of unformatted progress notes. Initial compliance of template use was high and early reports from the provider team included improved communication, receiving more information, and improved patient care. Nurses reported satisfaction with ease of use. A standardized note improved communication between providers and nurses with consistent handoff information. This feasibility study has future implications in expanding the use of this note to other ICUs to formally collect data on its functionality, and impact on communication and patient care.https://scholar.rochesterregional.org/nursingresearchday_2023/1008/thumbnail.jp

Hand-off Tool Implementation in Post-Anesthesia Care

The issues surrounding the safety of patients and improving patient care outcomes in the pre-operative and post-operative environment, is one of ongoing focus and development. Post-operative, hand-off report is one aspect in the continuity of patient care that has affected patient outcomes. Clear, concise, and accurate communication concerning patients and their postoperative status is one way that providers and caregivers may ensure patient safety. There are many various organizations that emphasize the importance of clear, effective communication, in the form of a standardized hand-off tool to maximize patient safety. The purpose of the project was to standardize clear, concise, effective communication from post-anesthesia care. A hand-off tool was developed and implemented to assist in the standardizing process of post-anesthesia communication to intensive care and medical-surgical floors. A survey was used to evaluate the effectiveness and delivery of the hand-off tool. A power point presentation regarding the importance of the hand-off tool, and the results of the survey were shared with the anesthesia providers of the facility

Standardized Handoffs For Anesthesia Students

Communication between healthcare providers is an essential aspect of caring for patients. Effective communication is vital during the patient handoff process. The patient handoff process involves exchanging patient’s medical information between a provider currently caring for the patient and the provider assuming care of the patient. If the information exchanged during the handoff process is inaccurate or essential information is omitted, that could potentially lead to harmful consequences for the patient. Currently, no standardized handoff tool exists for student registered nurse anesthesia students (SRNAs) in clinical practicum at the local level one trauma center. The lack of a standardized handoff tool at this facility suggests an increased likelihood of communication errors during the handoff process. The purpose of this quality improvement project is to implement a standardized handoff tool called the AneSBAR tool that SRNA students can utilize in their practice to ensure proper and effective handoffs in the post-anesthesia care unit (PACU) and the intensive care unit (ICU). The inclusion criteria for the project are 2nd or 3rd-year SRNA students currently enrolled full-time in the local Certified Registered Nurse Anesthetist (CRNA) program. The quality improvement project will follow a Plan-Do-Study-Act (PDSA) model. Both qualitative and quantitative data will be collected to determine the impact of the standardized handoff tool. Data collected from surveys and simulations will determine if the PDSA cycle needs repeated or if the QI measure is ready for implementation

Assessing Workflow in the Postanesthesia Care Unit

The postanesthesia care unit (PACU) environment must function smoothly as a critical recovery area for monitoring of immediate postoperative patients. Timely responsiveness to complications is imperative to ensure patient safety. Following postanesthesia observation, a patient is discharged from the PACU to home or is admitted to the hospital. If this transition is delayed by excessive discharge times or poorly managed patient adverse events, it can cause major bottlenecks and issues with throughput for the perioperative setting. This project aims to study the present workflow in the PACU, identify gaps in the workflow and provide recommendations to perioperative leadership. Current PACU practices were observed using an assessment tool to establish the barriers to a streamlined PACU workflow at a large urban academic hospital. Reoccurring workflow gaps were determined and collected data was presented to perioperative leadership with recommendations

Evaluation of postsurgical patient handovers at the interface between the operating room and the pediatric intensive care unit

Postsurgical patient handovers are largely unstandardized task and error- prone if insufficient teamwork and unfavorable surrounding conditions occur in the clinical setting. The focus of our study was on postsurgical patient handovers from the operating room (OR) to the pediatric intensive care unit (PICU). We conducted a prospective intervention study to assess the impact of a checklist-based intervention on the completeness of patient information, equipment preparation and teamwork characteristics. A mixed methods research design with structured observations of handovers in the designated area and standardized provider self-reports through questionnaires were used for data collection. The results of the 31 patient handovers of the baseline study, with the resulting 103 ratings of involved providers were compared to the 30 handovers and 110 ratings of the follow-up study. During the baseline study, the non-standardized actual status of postsurgical patient handovers was assessed. Based on the results, an ideal-typical handover process was defined in multidisciplinary cooperation and the handover protocol developed, the influence of which was subsequently observed in the follow-up study. We witnessed an improvement in the completeness of technical equipment preparation prior to patient handovers. The presence of team members from pediatric surgery increased slightly, but patient handovers still took place without a representative of this professional group in more than half of the cases. There was an improvement in the attention levels of all team members involved. The strongest change in the handover process could be determined with the simultaneous presence of participating team members, with a doubling value compared to the baseline study. The results indicate the positive effect of standardization of the handover process on the efficiency of information exchange and teamwork

Quality of Care Improvement: A Process to Standardize Handoff Communication Between Anesthesia Providers and Post-Anesthesia Care Unit Nurses

Introduction: Transition of care is the process in which sending provider teams and receiving provider teams release the care of the patient from one provider team to the next utilizing a communication process. Review of the literature has identified several different protocols in place to systematize communication among providers, however, there is no standardized instrument or process that encompasses the post-anesthesia transfer of care process. Our project goal is to develop a standardized evidence-based handoff communication instrument to be utilized during the transition of care process between anesthesia care teams to the post-anesthesia care (PACU) teams to improve quality of care. Methods: Literature review was conducted to search for handoff instruments or protocols utilized during the post-operative communication period between anesthesia providers and post-anesthesia care nurses. Database searches included CINAHL, Medline, PubMed, Joanna Briggs Institute EBP database, HAPI, TRIP, ProQuest Dissertations, and Theses Global, and Cochrane Library. Seventeen studies met inclusion criteria. Directed content analysis was developed from the search, a potential handoff instrument was constructed and electronically sent to a panel of expert reviewers consisting of anesthesiologists, CRNAs, and PACU nurses. The expert reviewers were asked to rate each item of the handoff instrument using a 4-point rating scale. Two questions provided comment boxes for qualitative feedback. A standardized evidence-based handoff instrument to enhance the transfer of care process was reformulated based on expert provider feedback. Sample and Setting: Survey was sent electronically via email to 22 anesthesia providers and 11 post-anesthesia care nurses from a 175- bed hospital in southeastern Pennsylvania. Eleven anesthesia providers and six post-anesthesia care nurses completed the survey. Results: Content validity index was performed for each item in the survey. Content validity (I-CVI) greater than 0.79 was desirable for each item. Thirteen out of the 15 proposed items of the handoff instrument had I-CVIs greater than 0.79, with an S-CVI score of 0.88 indicating high content validity. Conclusion: Content validity scores for instrument items were deemed valid which aligned with the themes and categories collected from the literature. Overall, the polled providers agree that standardizing the transfer of care process will minimize communication errors and improve patient’s quality of care. Future cohorts can assist in the adoption of this handoff instrument as a standard of practice in this healthcare facility

Tecnologias de gestão visual em hospitais: uma revisão sistemática de literatura

Introdução: Gestão Visual (GV) é um conjunto de práticas que apoiam tomadas de decisão de processos e de melhorias organizacionais. No contexto hospitalar, a GV fornece um conjunto de alternativas que visam reduzir a complexidade desnecessária, aumentar a transparência dos processos, auxiliar na agilidade das decisões e na confiabilidade das informações. Objetivo: Identificar quais são as tecnologias mais utilizadas na GV de hospitais, tanto as práticas quanto as ferramentas. Métodos: Emprego da metodologia de pesquisa PRISMA. Dos 330 artigos encontrados, 40 textos foram examinados sob a perspectiva de: se é uma tecnologia que auxilia na prática da gestão visual; se é uma tecnologia associada a alguma ferramenta da gestão visual; qual o grau de controle da tecnologia quanto a adesão do usuário à prática/ferramenta e quais são os principais usuários e as principais dimensões de desempenho que envolve a tecnologia. Resultados: Práticas de GV estão mais comumente relacionadas com a filosofia lean de gestão e visam o desempenho da eficiência hospitalar. Exemplos são reuniões diárias, pensamento A3, trabalho padrão e mapeamento do fluxo de valor. Dispositivos visuais ajudam a reconhecer os erros, anormalidades e desperdícios, permitindo que medidas corretivas sejam tomadas rapidamente. Exemplos comuns são quadro brancos e posters, além de ferramentas baseadas no computador. Conclusões: Um ambiente hospitalar pode se beneficiar de tecnologias que envolvam práticas apoiadas por dispositivos visuais. Por exemplo, reuniões diárias frequentemente é apoiada por quadros brancos e planilhas computacionais.Introduction: Visual Management (VM) is a set of practices that support decisionmaking processes and organizational improvements. In the hospital context, VM provides a set of alternatives that aim to reduce unnecessary complexity, increase the transparency of processes, helps to speed up decisions and ensure information reliability. Objective: To identify the most used VM technologies in hospital, both practices and tools. Methods: Use of PRISMA methodology. Of the 330 articles found, 40 texts were examined from the perspective of: whether it is a technology that helps in the practice of VM; if it is a technology associated with some VM tool; what is the degree of technology control regarding the user's adherence to the practice/tool and which are the main users and the main performance dimensions involving the technology. Results: VM practices are most related to lean management philosophy and aim at hospital efficiency performance. Examples are daily meetings, A3 thinking, standard work, and value stream mapping. Visual devices help to recognize errors, abnormalities and waste, allowing corrective action to be taken quickly. Common examples are whiteboards and posters, as well as computer-based tools. Conclusions: A hospital environment can benefit from technologies that involve practices supported by visual devices. For example, daily meetings are often supported by whiteboards and computer spreadsheets

Método de análise de sistemas visuais em sistemas sócio-técnicos complexos : revelando e dando sentindo às interações ocultas

Sistemas Sócio-técnicos Complexos (SSC) são ambientes com grande quantidade e variedade de elementos em constante interação, cujos efeitos são não-lineares e imprevisíveis. O setor da saúde, assim como outros, são considerados SSC e possuem potencial para amplificar essa complexidade, devido a fatores como pressão de tempo, demanda irregular e combinação de tecnologias, tratamentos e perfis de pacientes. A Gestão Visual (GV) é uma estratégia para alcançar transparência de processos e assim diminuir a complexidade desnecessária e a complexidade percebida pelos usuários do espaço. A GV atua através de dois mecanismos: (i) dispositivos visuais (por exemplo, luzes de advertência, placas, demarcações no chão) e, (ii) ambiente construído (por exemplo, layout, iluminação, organização da área de trabalho e privacidade). Estes mecanismos podem ser agrupados de acordo com o objetivo das informações que eles passam, formando um Sistema Visual. O desempenho dos Sistemas Visuais provém do resultado de múltiplas interações entre os dispositivos visuais, o ambiente construído e as pessoas. Dentre essas interações, algumas podem estar ocultas aos olhos dos profissionais, o que dificulta a identificação fácil e rápida das funções associadas aos dispositivos visuais e ao ambiente construído, e a causa de variabilidades para conceber medidas de melhorias no sistema. Apesar do potencial da GV para auxiliar na gestão de SSC, a compreensão sobre Sistemas Visuais e suas interações ocultas é uma lacuna de conhecimento. A presente pesquisa tem por objetivo desenvolver um Método para Análise de Sistemas Visuais em SSC, que enfatize as implicações das interações ocultas. A Design Science Research foi a abordagem metodológica adotada e o estudo de caso foi desenvolvido em uma Unidade de Terapia Intensiva de um hospital universitário de grande porte. O método proposto apresenta-se como a principal contribuição desse trabalho e possui cinco etapas: (i) modelagem funcional do sistema; (ii) avaliação da GV existente; (iii) identificação de sistemas visuais; (iv) priorização de oportunidades de melhoria e (v) recomendações práticas. Os principais resultados incluem propostas para dar visibilidade às interações ocultas, como o protótipo de dispositivo visual iterativo desenvolvido; a associação dos dispositivos visuais e do ambiente construído com as funções realizadas; e a identificação de oportunidades de melhorias para os níveis de gestão estratégico, tático e operacional.Complex Sociotechnical Systems (CSS) are environments with a large number and variety of elements in constant interaction, in which the effects are non-linear and unpredictable. The health sector, as well as others, are considered SSC and have the potential to amplify this complexity, due to factors such as time pressure, irregular demand and combination of technologies, treatments and patient profiles. Visual Management (VM) is a strategy to achieve process transparency and thus reduce unnecessary complexity and perceived complexity by the space users. VM operates through two mechanisms: (i) visual devices (for example, warning lights, signs, demarcations on the floor) and, (ii) built environment (for example, layout, lighting, work area organization and privacy) . These mechanisms can be grouped according to the purpose of the information they pass, forming a Visual System. Visual Systems performance comes from the result of multiple interactions between visual devices, built environment and people. Among these interactions, some may be hidden from the professionals eyes, which makes it difficult to quickly and easily identify the functions associated with the visual devices and with the built environment, and to identify causes of variability to design measures for the system improvement. Despite the potential of GV to assist in the management of CSS, the understanding of Visual Systems and their hidden interactions is a knowledge gap. This research aims to develop a method for analyzing visual systems in SSC, which emphasizes the implications of hidden interactions. Design Science Research was the methodological approach adopted and the case study was developed in an Intensive Care Unit of a large university hospital. The proposed method presents itself as the main contribution of this work and has five stages: (i) system functional modeling; (ii) existing VM evaluation; (iii) visual systems identification; (iv) improvement opportunities prioritizing and (v) practical recommendations. The main results include proposals to give visibility to hidden interactions, such as the developed prototype of an iterative visual device; the association of visual devices and the built environment with the functions performed; and the identification of opportunities for improvement at the strategic, tactical and operational management levels