AORN Surgical Conference & Expo 2014 Poster Summary

Transcription

1 Poster Number: 117 Title: Porphyria Patient = Need for Innovative Care Abstract: A rare genetic disorder called Porphyria causes patients to have abnormal amounts of porphyrins or related chemicals build up in the body. As porphyrins strongly absorb light, these patients suffer blistering, burning and scarring when exposed to light. Porphyria can also lead to end stage liver disease requiring liver transplantation. That was the circumstance of our first surgical patient with cutaneous Porphyria, scheduled for living donor liver transplant. The room lights, overhead lights, surgeon headlights, even the bulb in the laryngoscope were dangerous for our patient and required special precautions to prevent injury. Research showed that filtered light protected the patient from injury and orange plastic sheets were used to cover all sources of light. The room was not the usual bright appearance of an Operating Room, but our patient left the O.R. with only what they expected.a new liver. Author(s): Karen B. Hammett, BSN, RN, CNOR

2 Poster Number: 118 Title: Standardizing Perioperative Handoff Communication Abstract: With the introduction of the electronic health record and its limited application to the intraoperative setting, challenges have been faced to meet the Joint Commission standard of hand-off communication. In the surgery department at Baylor Medical Center at Irving, a lack of a standardized process for hand-off communication was discovered. A team was constructed for a quality improvement project to address this issue and to utilize the electronic health record (EHR) in documenting that report was given and received. The team consisted mostly of operating room nurses and the post-anesthesia care unit (PACU) nurse supervisor. Baseline data was obtained from PACU nurses that consisted of frequency of verbal report, written report, whether or not the report was considered complete, and whether or not the receiver was allowed to ask questions. The aim was to have the intraoperative nurses increase the percentage of standardized and complete hand-off reports from 61.9% to 100% by July 2013 with the project starting in February A standardized hand-off tool and process was created and staff educated on documentation of communication hand-off in EHR. The hand-off tool was created using AORN recommendations. A flowsheet was discovered in the EHR to document hand-off communication to the receiving post-op care unit. The flowsheet was already being utilized by the PACU nurses and they were documenting receiving report from the anesthesia care provider only. Implementation of interventions began in early May. The operating room (OR) nurses began using the hand-off communication tool with every patient, which facilitated intraoperative and postoperative nurse-to-nurse verbal and written report which results in loss of minimal data. The OR nurses began documenting their hand-off communication in the EHR on the Pre/Post Procedure flowsheet, which was a completely new process for them. The PACU nurses began to document receiving report from the nurse as well as the anesthesia care provider on the same flowsheet. Audits and surveys were completed during implementation and continue to be done, albeit less frequently. At the end of the project, July 10, 2013, standardized complete hand-off reports occur 100% of the time, verbal reports occur 100% of the time up from 71.4%, written reports utilizing the hand-off tool occur 100% of the time up from 19% without a standardized form, and the receiving PACU nurse was allowed to ask questions 100% of the time up from 66.7%. Documentation of hand-off in EHR by the OR nurses increased from 38% on day 1 to 86% and continues to improve. The immediate post-op unit nurse documentation has increased from 46% to 90% with continued improvement. Presentations have been made to the hospital nursing leadership and the quality improvement committee, with a probable presentation to the Baylor Healthcare System OR Council. Efforts are being made to implement portions of this project in other units throughout the hospital and in OR departments throughout the Baylor Healthcare System. This project has huge implications for perioperative nursing in meeting a JC standard, especially with implementation of EHR and unknown application to the perioperative setting. JC has charged each facility in creating a standardized process for hand-off communication that is applicable to their department, facility, and resources. Author(s): Courtney Sheward, BSN, RN, CNOR This poster can be reviewed in the virtual gallery.

3 Poster Number: 119 Title: OR Passport - The Intraoperative Patient Armband Abstract: Baylor University Medical Center treats approximately 20,000 surgical patients yearly. Patient verification is a critical step in avoiding patient injury. Our patient safety/risk management department approached the OR about incidents involving mislabeled tissue and/or blood specimens. A multidisciplinary task force was formed to research the cause and eliminate future Wrong Blood in Tubes (WBITs) and Wrong Specimen in Containers (WSICs). Causes of mislabeling in the OR were identified. We often had patient labels in the OR from previous patients that were mistakenly used in labeling specimens. It became evident that we needed a process to verify patient labels against the patient's armband. During the intraoperative phase, the armband is often unavailable due to the positioning and draping of the patient. The OR PASSPORT was created to function as the intraoperative patient armband. The OR PASSPORT is generated during the patient interview. The patient verifies their name and birth date as the circulator checks both the patient's armband and a patient sticker. The sticker is attached to the OR PASSPORT, which serves as the patient's armband during surgery. All Ppatient labels for labs, specimens, blood, and critical lab read backs are verified with the OR PASSPORT. The backside of the OR PASSPORT includes a SBAR (situation, background, assessment, recommendation) checklist that is used during patient interviews and hand offs. A process and educational plan was implemented as we integrated the OR PASSPORT into practice. It has been modified based on staff surveys and audits. The OR PASSPORT has been successful in decreasing WBITs and WSICs, thus promoting patient safety. Author(s): Jennifer P. Duncan, BSN, RN, CNOR; Doug B. Robinson, RN, CNOR

4 Session Number: 5013 Poster Number: 120 Title: Collaboration Improves Innovative and Engaging Education Abstract: A CVICU (Cardiovascular Intensive Care Unit) assessment identified the need for increased comfort and knowledge during a mediastinal re-exploration in the CVICU after a Coronary Artery Bypass Graft procedure in the OR. Interdepartmental collaboration between an OR Educator and CVICU staff nurse exposed the need to identify and use instruments, maintain sterile technique and follow basic procedural steps to promote positive patient outcomes. An innovative and engaging strategy for learning was planned and implemented in the form of a mock mediastinal re-exploration. To prepare and implement the mock-ups, the challenges to overcome were securing instruments, supplies and internal defibrillator paddles for practice. Expenses were low due to our creative CVICU nurse who constructed a chest cavity from a plastic trash can in which one could actually place a sternal retractor! The learning activity enabled new CVICU nurses to gain increased comfort during this particular emergent situation. The mock scenarios were recorded on video clips and compiled into an interactional training video that was posted on you tube for training subsequent CVICU nurses. Perioperative nurses can impact beyond the OR by collaborating with other specialty nurses to promote safe passage of our patients through their hospitalization experience. Author(s): Margaret J. Hubbard, BSN, RN, CNOR This poster can be reviewed in the virtual gallery.

5 Poster Number: 121 Title: Perioperative Collaboration Achieves Best Patient Outcomes Abstract: Our Level I trauma Perioperative Services task force created an aim statement: To prevent and reduce Perioperative Hospital Acquired Pressure Ulcers (HAPUs) by 50% (from 4 in Fiscal Year 2012 to two or less) for Fiscal Year 2013, by raising awareness of causes, standardization of processes and education of staff. Our focus was on sacral pressure ulcers. This was a high goal to be achieved by nurses from four Perioperative areas: Day Hospital, Pre-operative, Intra-Operative, and Post-Operative units. Staff nurses, educators and risk managers all collaborated to achieve optimum patient outcomes. The result was achievement of the goal, only to find more work was to be done. We are now in the phase of examining more troubled areas to conquer. Author(s): Margaret J. Hubbard, BSN, RN, CNOR; Jane T. McDonald, BSN, RN

6 Session Number: 5013 Poster Number: 122 Title: Integrating Perioperative Nursing in a BSN Curriculum Abstract: This project describes the development and implementation of a clinical education innovation, the integration of perioperative nursing into a BSN curriculum, through a true academic-practice partnership between the University of St. Thomas School of Nursing (UST), Harris Health System (Harris Health) and the Association of perioperative Registered Nurses (AORN). A second objective of the project was to develop and evaluate a Nurse Preceptor Education program to prepare expert nurses to facilitate student clinical learning. Harris Health System nurse leaders were engaged from the beginning in developing the vision, mission, philosophy and curriculum for the new BSN program at UST. The partners agreed to utilize perioperative settings as the clinical site for the first required clinical course in the nursing major. Private foundation grant funding was obtained to support development of a Nurse Preceptor Education course, to prepare Harris Health perioperative nurses to function as clinical preceptors. UST and AORN entered into a pilot project, with nursing students given access to eight Periop 101: A Core Curriculum modules to prepare them for the perioperative setting. Periop 101: A Core Curriculum is an on-line program used to educate new perioperative nurses. It consists of 25 online learning modules delivered through AORN's e-learning platform. The UST and Harris Health also developed a clinical education program to educate preceptors on how to teach nursing students and included training on how to instruct, coach, and evaluate. This project also utilized Clinical Instructors. Clinical Instructors are highly expert nurses with advanced education and faculty qualifications. They accompany students to the clinical setting to help evaluate the students nursing care, provide expert consultation and role modeling, and assess their learning. Focus groups, interviews and written preceptor survey results suggest that the perioperative preceptorship was generally viewed positively by preceptors, students, and clinical instructors. The perioperative setting was deemed as a good initial learning experience for students, because they are exposed to basic, necessary skills and so many different clinical situations in a well-controlled environment. Preceptors worked effectively with the students and were confident in their skills as preceptors. The Clinical Instructors played a key role in helping the students maximize their learning experience and helping the preceptors understand how to work effectively with the students. Academic-practice partnerships are a critical key to facilitate nursing learning, strengthen practice and assist nursing in leading the change to advance health care in our communities. Author(s): Ann C. From, MSN, RN, CNOR This poster can be reviewed in the virtual gallery.

7 Session Number: 5013 Poster Number: 123 Title: Creating a Framework to Reduce IUSS Abstract: Immediate Use Steam Sterilization (IUSS) may put patients at increased risk for hospital acquired surgical site infections. Release of the revised IUSS standards in 2010 prompted a review of our practices and a determination that we were not compliant. High usage of IUSS increases production pressure on the team which could result in unnecessary work, incomplete cleaning and sterilization of instrumentation, failure to track IUSS to a specific patients and distractions removing the nurse from directly caring for the patient. An interdepartmental team facilitated by a senior management engineer was formed (nurses, surgical technologists and central processing technicians). Focusing on the ophthalmology service line which was the highest outlier, a methodology was developed and implemented which included analyzing trends, developing tools, standardizing kits and changing practice. Initially we found that the kit inventory was insufficient to support the surgical volume, kits were not standardized, kits contents were excessive and multiple kits had to be opened for a few instruments leading to care delays. As a result of this project the IUSS rate for Ophthalmology was reduced by an order of magnitude to below 5%. The process is being used to address IUSS practices across the service lines with similar results. Author(s): Charlotte L. Guglielmi, MA, BSN, RN, CNOR; Ross W. Simon, BA; Elena G. Canacari, RN, CNOR; Mary Francis Cedorchuk, BSN, RN, CNOR; Barbara L. Di Tullio, MA, BSN, RN; Debra Martinez

8 Poster Number: 124 Title: Job Safety Behavorial Observations Abstract: Healthcare workplaces are among the most hazardous in the nation. In 2010, health care employers reported 653,900 workplace injuries and illnesses, more than 152,000 more than the next most afflicted industry sector, manufacturing.1 A team at Beth Israel Deaconess Medical Center adapted a technique and tool used in industry, Job Safety Behavioral Observations, to make the hospital a safer place to work through observations of work performed and subsequent mitigation of hazards recognized. The observation tool was customized to address hazards unique to the healthcare environment such as sharps and use of a safe zone. The team identified critical safe behaviors and conditions in the OR using injury data, input from a staff survey, job safety analysis (JSA) and cause and effect analysis. The team piloted the process in the operating rooms, mitigating hazards that in the past led to musculoskeletal injuries, concussions, sharps related injuries and slip and fall injuries to OR staff, anesthesiologists and physicians. Results of this pilot in the OR have been successful in mitigating hazards. Next steps include spreading the learning and implementing the process in other areas of the hospital. 1Health Care, U.S. DEPARTMENT OF LABOR, OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, (viewed on June 3, 2012). Author(s): Charlotte L. Guglielmi, MA, BSN, RN, CNOR; Elena G. Canacari, RN, CNOR; Ross W. Simon, BA; Barbara L. Di Tullio, MA, BSN, RN; Lisa Foster, MS, ANP-BC

9 Poster Number: 125 Title: Predictive Model to Improve OR Efficiency Abstract: Achieving operational efficiency is a strategic priority for health care organizations today. Optimizing the elective surgical schedule and maximizing OR utilization are priorities in achieving the goal. The current surgical scheduling process has been essentially unchanged for over 30 years, resulting in a combination of limited access and suboptimal resource utilization. We formed a team with individuals from Anesthesia, OR nursing, OR scheduling, Department of Surgery, and Operations to address this issue with the goal of increasing OR access and improving perioperative resource utilization. Specifically, we developed a predictive OR demand model to forecast the expected elective case load for each OR day several weeks in advance. We have had success using the model to confirm out-of-block elective cases up to two weeks prior to the day of surgery rather than waiting until block release, which occurs four days in advance. These out-of-block case confirmations have generated improvements in patient satisfaction, staff planning, and resource utilization. Author(s): Charlotte L. Guglielmi, MA, BSN, RN, CNOR; Elena G. Canacari, RN, CNOR; Dorothy M. Sarno, MSN, RN; Ryan Graue, MS, MBA; Brett Simon, MD, PhD

10 Session Number: 5013 Poster Number: 126 Title: Perils, Pitfalls, and Progress: Determination of a Periop 101 Readiness Abstract: Purpose of Project: Evidence has shown by the year 2020, the RN workforce approaching retirement will reach critical levels. Specialty areas (OR, Perianesthesia, OB, Procedural areas) do not routinely recruit untrained nurses to fill vacancies. This project will identify barriers and possible methods to promote multidisciplinary, perioperative training programs for inexperienced staff on three campuses. Clinical Question: What are the key indicators that determine hospital readiness for implementation of a perioperative nursing succession program? Methodology: A standardized survey tool was developed to identify current staff buy-in, educational preparation, OR work history and institutional background regarding previous programs, need, planning and implementation of a recruitment and succession plan in hospital specialty areas. Results: Many hospitals have participated in the AORN Periop 101 Program, but published, nationwide utilization and retention rates are inconsistent. Existing grow-your-own perioperative programs may be insufficient to provide orientation and training of large groups of inexperienced nurses. Variables include: volume of new staff needed, length of training, orientation cost, resource availability, institutional culture. Perioperative Nursing Implications: Development of a standardized tool to determine feasibility of on-site implementation vs. collaborative endeavors (with neighboring facilities) to accomplish the planned staffing outcome. Author(s): Angela K. Walsh, MA, BSN, RN, CNOR; Nancy K. Giacomozzi, MEd, RN-BC, CNOR; Kristina M. McManus, MSN, RN, CNOR; Patricia Petrangelo, BSN, RN, CNOR; Alyson Shea This poster can be reviewed in the virtual gallery.