13.4 Provide three examples of interdisciplinary collaboration in which nurses have assumed a leadership role.

Transcription

1 13.4 Provide three examples of interdisciplinary collaboration in which nurses have assumed a leadership role. The planning and design process for the Building for the Third Century (B3C), the next major strategic facility on the main campus, began in It is slated to open in 2011 the 200 th anniversary of the MGH. Architects and programmers were selected and MGH executives, Chiefs of Service and planning staff confirmed data and projections, established connectivity requirements, set key room and space allocation guidelines, evaluated occupant options, and considered new approaches to procedural services that will allow for greater integration The new facility, which will be constructed from 2007 through 2011, will connect to both The Yawkey Center for Outpatient Care and the Main Hospital. It will provide up to 150 new private patient rooms and space for the Emergency Department, expanded imaging and surgical services, relocation of radiation oncology, and a new central sterile processing center. Seven user groups were formed to accomplish the more detailed planning: Emergency Department, Imaging, Radiation Oncology, Central Sterile, Level 0, Service Logistics, and Patient Beds. Each user group had executive sponsors. The groups were expected to work with the architects to complete a document providing an operations overview and a detailed room list with space allocations for each area so that concept schematics and floor configurations could be developed. The Chief Nurse and the Chief of Medicine were appointed executive sponsors of the Patient Beds workgroup. Once specific patient populations were defined for the inpatient beds, i.e, neuromedicine, neurosurgery and oncology, the Associate Chief Nurses for Medicine, Cardiac and Emergency Services and a neurologist were asked to co-lead a group of interdisciplinary workgroups that would determine more detailed design planning (attachment 13.4.a). Five workgroups were created to complete the work: Neuro Acute, Neuro ICU, Oncology/Medicine, Epilepsy, and Oncology/Pharmacy. A roster for Neuro Acute workgroup is included in attachment 13.4.b, demonstrating the membership from many disciplines and ancillary patient care services. The membership was chosen to ensure that the clinician s expertise and specific departmental needs were included in the process. The workgroups met several times (attachment 13.4.c) to determine the detailed specifics of the functional and space needs for the acute care and intensive care units. The design development included planning for patient rooms, interaction zones, space for family and staff, and the needed ancillary support services. 29

2 Several workgroup members made site visits to Northwestern and Komer Children's Hospital in Chicago and to Banner Estrella Hospital in Phoenix to assist in development of the designs. Once the detailed recommendations were complete, patient room mock-ups were created for both the acute unit and the ICU and made available for all staff to view and provide feedback. Based on this feedback, the building architects and programmers are currently finalizing specifications for the 150 inpatient rooms for B3C. The Bedside Technology Committee was established in 2004 as one component of MGH s Patient Safety Signature Initiatives. Interdisciplinary groups had already been established to plan for electronic medication administration, patient identification/ bar coding, and electronic documentation. The focus of the Bedside Technology Committee was on patient safety, harmprevention, medication error reduction, and support of clinician's work at the bedside. Very early on, the group identified infusion pumps as a priority and the Pump Steering Committee was established. Several forces came together to impact the decision to focus on infusion pumps. The 2004 Institute of Medicine report Keeping Patients Safe: Transforming the Work Environment of Nurses highlighted the safeguards that needed to be in the work environment to ensure safe patient care and encouraged process improvement that focused on medication administration. Infusion pump suppliers began to design and offer pumps with internal dose error reduction systems aimed at reducing programming errors and associate injuries to patients. At the same time, there was dissatisfaction with some of the infusion pumps being used at MGH and there was a need to increase the number of pumps. By 2005 major payors were even discussing a requirement for these types of infusion pumps in contract negotiations. The Pump Steering Committee is co-chaired by the Associate Chief Nurse for Perioperative Nursing Services and the Director for Patient Care Services Systems improvement. The interdisciplinary membership of the committee is included as attachment 13.4.d. The initial goals of the group were to assess the current technology and benefits of infusion pumps, refine drug libraries, promote practice standardization, and collaborate with the Positive ID Committee and the Electronic Medication Administration Process Committee to ensure interfaces of the technology. In 2004, the Pump Steering Committee worked to identify the specific requirements for pumps with the dose error reduction systems, referred to as Smart pumps. Toward this end, they 30

3 created a white paper with a Buyer s Guide of Product Requirements. The following five Must Have requirements were identified: 1. Ability to house dosing guidance and dose error reduction tracking system via a drug library (DL) that would reflects the institution's standardized practice. This library must have sufficient capability to be able to handle the entire formulary in all care areas. 2. A clearly articulated strategy for transition to a pump that has upgrade-ability for automated drug identification and patient-specific auto-programming. 3. A PC based Drug Library Editor software program for Drug Library data set management and validation. 4. A clearly articulated connectivity strategy for data transfer. 5. Vendor participation and collaboration. They also identified the three major types of infusion pumps as microinfusion/syringe pumps for high priority medications, pain management pumps (e.g., patient controlled analgesia and epidural infusions), and high volume infusion pumps. The committee focused on each type of pump, one at a time, based on the priority of perceived clinical needs. In 2005, two types of syringe pumps that met the must have criteria were trialed. A selection was made based on clinician feedback. From September through November 2005, 1410 new smart syringe pumps were deployed in the all of the intensive care units, operating rooms, and obstetrical areas. In 2006, the group focused on pain management pumps. Unfortunately, there was a lack of robust technology in this area and no available products met the necessary criteria. One potential vendor with a pump with an internal drug library was awaiting FDA approval. A short-term plan was developed to purchase more of the pumps currently in use and to focus on large volume infusion pumps until the improved technology became available. In the Fall of 2006, Requests for Proposals for large volume infusion pumps were sent to five major vendors. Only one vendor was able to meet the requirements as well as be positioned for wireless technology and bar coding in the future. In February and March 2007, this pump was trialed over an eight-week period on two adult ICUs, five inpatient units, a subset of operating rooms and the cardiac catheterization laboratory. The one smart pump would replace pumps from four different vendors currently being used. Clinician feedback indicated an approval of 97% on post-trial surveys. 31

4 In April, a decision was made to purchase 2000 large volume smart pumps. The pumps were deployed hospital wide in August Attachment 13.4.e contains a portion of a News You Can Use from the Chief Nurse and attachment 13.4.f contains a portion of a From the Desktop from the Chief Executive Officer congratulating the team and staff on a successful implementation. To-date over 8 million dollars has been allocated to this project, and more will be requested in the Capital Budget process for fiscal year The Pump Steering Committee will return to the goal of changing to smart pain management pumps and then will coordinate upgrades to all existing pumps to provide wireless technology and bar coding capability. In the Pre-admission Testing Area (PATA), an interdisciplinary and interdepartmental team led by the PATA Nursing Director and Medical Directors implemented a telephone assessment program. The PATA team is made up of Staff Nurses, Nurse Practitioners, Anesthesiologists, Patient Care Associates and Operation Associates. Patients scheduled for a PATA visit are booked by the surgeon s office via an on-line booking program. The MGH PATA clinic is open five days a week and evaluates about 60 patients per day. Prior to the development of the phone program patients, undergoing elective surgery were evaluated in PATA approximately 30 days prior to surgery. Based on guidelines established by the Department of Anesthesia, patients underwent laboratory, radiology, or EKG testing and were assessed, evaluated and educated by nurses and anesthesiologists. Written nursing and anesthesia assessments were completed and patients received education and materials regarding what to expect in terms of their surgery and hospital visit. Patients who did not require testing often came in the day of surgery and the pre-operative assessments were completed at that time. A review of data in 2005 showed that 86% of inpatients but only 20% of outpatients undergoing elective surgery at MGH were being seen in PATA. Nursing and Anesthesiology were in agreement that the goal should be that all patients undergoing elective surgery should have an assessment completed in advance of their surgery. A phone assessment program would allow the PATA Staff Nurse to perform a preoperative assessment as well as educate patients and families to prepare them for a safe hospital experience. The PATA Nursing Director and Staff Nurses knew that the change process would involve a number of incremental steps. They reviewed the current patient population in PATA to determine if there were patients that could be safely screened without coming to the clinic. Staff Nurses 32

5 identified some patients who were being booked for the PATA visit by surgical offices that, based on the department of anesthesia guidelines, did not require a PATA visit. These patients were generally considered healthy by the anesthesia guidelines and did not require pre-operative testing. A triaging process was developed by the RN and MD staff to expedite these patient visits. This also allowed the Staff Nurses and Anesthesiologist an opportunity to confirm the identification of patients that would be appropriate for the phone program. The guidelines for phone program that were developed through this process are as follows: PATA Phone Program Guidelines Patients undergoing elective surgery requiring anesthesia Men 50 years or younger Women 50 years or younger Healthy no major medical problems Require no EKG No lab work required Must speak and understand English Patients must answer No to all responses on the trigger questionnaire The Nursing and Medical Directors, with support from the Associate Chief Nurses for Perioperative Services and the Department of Anesthesia, obtained support from Administration to proceed with the phone program. In late 2005, a task force with representatives from nursing, anesthesia, information systems, and the admitting department was created to design and implement the PATA phone assessment program. Task force members searched the literature related to phone assessment programs and conducted an electronic survey to learn how other hospitals were managing this process. The PATA Staff Nurses also collected data for a month to identify services or physician practices that were scheduling patients who did not require a PATA visit. This data assisted identifying a beginning target population for the phone program. The task force identified a step-by-step process that would begin in the surgeon s office and follow through till the day of surgery, focusing on what was required from each stakeholder to make the process work and be successful for the patient and staff. They also determined the contents of the screening tools for the surgical offices and RN assessments, developed the process for the RN interviews, and assured a designated office to conduct interviews. Task force members assisted with 33

6 the revision of the PATA on-line scheduling program so that office secretaries could book either a phone assessment or a PATA visit. The program was rolled out in Surgical offices now use the criteria to schedule appropriate patients for the phone program. The PATA Staff Nurse assigned to the phone program reviews the data and calls the patient within 30 days of surgery. Based on the information received in the phone interview, the assessment tool is completed by the PATA. The anesthesiologist scheduled in the PATA clinic reviews the phone interview assessments, and the information is filed for the day of surgery. The success of the PATA phone program has supported expansion of the program into the evening hours to better accommodate the needs of the surgical patients. An additional 1.5 RN FTEs were provided in fiscal year 2007 and another 1.0 RN FTE will be added in fiscal year 2008, in part to support the PATA phone program. In late 2005, an Advanced Clinician Staff Nurse and a designated team leader for the Orthopedic Surgery team in the Same Day Surgery Unit (SDSU) were asked to participate in the development of the Ambulatory Surgical Center (MGW-ASC), a center that was built off site in the MGH West building in Waltham, Massachusetts. She initially consulted on the architectural designs for sterile processing area, working to assure compliance with Department of Public Health regulations. In February 2006 she began to collaborate with the newly hired Nursing Director to plan for and develop technology, instrumentation and the necessary staff education for the Ambulatory Surgical Center. Together they established a process that would allow the orthopaedic surgeons to evaluate surgical instrumentation, kits and equipment. At MGH, many surgeons have custom instrument trays that contain their prefered surgical instruments. They also have preferences for equipment such as limb and joint positioners and surgical products (e.g., fixation). From the start it was recognized that since this was a much smaller operative site (i.e., four operating suites), this level of individualization would not be possible. With her vast knowledge of the physician preferences, this Staff Nurse contacted the various orthopaedic surgeons suggested some items that could be standardized for the MGW-ASC. She then worked with the MGH Same Day Surgery Unit to organize trials so that the surgeons could use the suggested instruments and equipment in the familiar environment and prior to making choices. Once the physical plant and was established, the MGW-ASC Nursing Director and SDSU Staff Nurses also worked together to develop an orientation program for Staff Nurses, Surgical 34

7 Technicians and OR Equipment Technician. Nursing competencies were standardized with MGH to establish common expectations for staff. The collaborative relationship between the MGH Staff Nurse, the MGW-ASC Nursing Director, and the orthopaedic surgeons was critical in the success of the center and supported MGH s strategic plan to promote our services in key areas of the surrounding community. 35

8 Attachment 13.4.a From: Gallivan, Theresa M., R.N. Sent: Thursday, January 12, :35 PM To: Annese, Christine Donahue, R.N.; Brinkley, Keith E.; Brown, John P.,Phs Is; Clapp, Margaret; Cooper, Jeffrey B.,Ph.D.; Daniels, Ann A; Donahue, Shawn P; Fahey, Jean, R.N.; Fidias, Panagiotis, M.D.; Fitzgerald, Ellen M., R.N.; Gallivan, Theresa M., R.N.; Galvin, Patricia; Gottbrecht, Kathleen T, R.N.; Guanci, Mary,Mgh Neuroscience, R.N.; Johnson, Elizabeth, MGH Nursing, R.N.; Kacmarek, Robert M.; Kennedy, Ann,M.,Mgh Nursing, R.N.; Koroshetz, Walter J.,M.D.; McAfee, Steven L.,M.D.; McDonnell, Theresa M.,N.P.; McElhinny, Michael; Mott, Mary, N.P.; Murphy, John C. Jr.,Mgh - Nursing, R.N.; Nelson, Jill E.,N.P., R.N.; Noga, James ; O'Day, Elizabeth Tucker; Palumbo, Denise S.; Perleberg, Keith, R.N.; Phipps, Marion A., R.N.; Raeke, Edward; Reardon, George; Rordorf, Guy,M.D.; Singhal, Aneesh B., Neurology; Somerville, Jacqueline A., R.N.; Sullivan, Michael, Mgh Pt Ot; Swearingen, Brooke,Md; Thurston, Melissa M.; Vega-Barachowitz, Carmen D.; Welsh, Carla; Wright, Paula J.,R.N. Cc: Bringhurst, Richard,M.D.; Chelf, Kimberly M; Cole, Waveney; Hanitchak, David J.; Ives Erickson, Jeanette, R.N.; Lassonde, Jennifer M.; Obrock-Wallace, Marian Kay; Ralston, Colleen M; Whitworth, Lindsay N. Subject: Building 2 Bed User Group Good Afternoon, Walter Koroshetz MD and I have been asked to co-lead the "user group" through the design process for the approximately 150 beds in Building 2. This work is sponsored by Jeanette Ives Erickson RN, Chief Nurse and Sr. VP for Patient Care Services and Rick Bringhurst MD, Sr. VP for Medicine. Clinical Operations Management for Building 2 is provided by Denise Palumbo RN, Administrative Director for Radiology and we will be working in close collaboration with MGH's Real Estate and Facilities Office, the architectural firm NBBJ out of New York, and various other experts and consultants. You are being requested to participate in this important and exciting work based on your specialization and expertise and we have reviewed requested membership with your respective supervisors /chiefs. It is confirmed that the beds will be dedicated to Medical Oncology and Neuroscience and there will be a combination of general and ICU beds. Please find attached a more generic space program that we have developed over the past months which offers an overview of standard space requirements and areas of priority as the service specific design process unfolds. Also find attached the meeting schedule. We thank you in advance for your participation and ask that you let Jennifer Lassonde know directly if you plan to send a designee so that we have an accurate and current participant list. Please also let us know if you have any questions or comments. 36

9 Attachment 13.4.b Neuro Acute Workgroup Members Emad Eskander, MD Aneesh Singhal, MD Ann Kennedy, RN Core Group: Department Physician team leader Physician team leader Nursing Director team leader Department Audrey Cohen Speech-Language Pathology Andrew Cole, MD Director MGH Epilepsy Service Jean Fahey, RN Clinical Nurse Specialist, EL 12 Shawn Farrell Adm Director - Neurology Patricia Galvin Operations Coordinator WH 12/ EL 12 Kara Houghton Chief Technologist Epilepsy Monitoring Unit Elizabeth Kafka Occupational Therapy Kathleen Lomuscio, RN Case Management Catherine Mackinaw, RN Staff Nurse Robert Martuza, MD Dept of Neurosurgery Cristina Matthews, RN Staff Nurse - White 12 Mary Mott, RN Nurse Practitioner - Neurology Christopher Ogilvy, MD Dept of Neurosurgery Kristin Parlman Physical Therapy Marion Phipps, RN Clinical Nurse Specialist, WH 12 Brooke Swearingen, MD Dept of Neurosurgery Jennifer Totten, RN Staff Nurse - Ell 12 Ancillary Support: Department Bill Banchiere Michael Bodock Meg Clapp Jeff Cooper Ann Daniels Shawn Donahue Kathleen Kelly Dan Kerls Ray Mitrano Ed Raeke Richard Turgeon Trish Volpe Environmental Services Pharmacy Pharmacy Biomedical Engineering Social Services Telecommunications Materials Management Systems Improvement (Furniture & Equipment) Pharmacy Materials Management Environmental Services Biomedical Engineering 37

10 Attachment 13.4.c Bed User Group - Meeting Schedule Date Meeting Time Location Round 2 July 21, 2006 Neuro Acute workgroup 7:30-9:00am Yawkey 2210 July 21, 2006 Neuro ICU workgroup 9:00-10:30am Yawkey 2210 July 21, 2006 Med /Oncology workgroup 10:30-12:00pm Yawkey 2210 Aug 1, 2006 Neuro Acute workgroup 8:00-9:30am Bulfinch 222 Aug 1, 2006 Epilepsy workgroup 9: am Bulfinch 222 Aug 3, 2006 Neuro ICU workgroup 12:00-1:30pm Bulfinch 225-A Aug 3, 2006 Med /Oncology workgroup 1:30-3:00pm Bulfinch 225-A Aug 3, 2006 Pharmacy/Oncology workgroup 3:00-4:00pm Bulfinch 225-A Round 3 Aug 14, 2006 Neuro ICU workgroup 8:30-10:00am Yawkey Aug 14, 2006 Neuro Acute workgroup 10:00-11:30am Yawkey Aug 14, 2006 Med /Oncology workgroup 11:30-1:00pm Yawkey Sept 5, 2006 Neuro Acute workgroup 8:00-9:30am Bulfinch 222 Sept 5, 2006 Epilepsy workgroup 9:30-10:30am Bulfinch 222 Sept 7, 2006 Neuro ICU workgroup 12:00-1:30pm Bulfinch 225-A Sept 7, 2006 Med /Oncology workgroup 1:30-3:00pm Bulfinch 225-A Sept 7, 2006 Pharmacy/Oncology workgroup 3:00-4:00pm Bulfinch 225-A Round 4 Sept 14, 2006 Med /Oncology workgroup 12:30-2:00pm Yawkey Sept 14, 2006 Neuro Acute workgroup 2:00-3:30pm Yawkey Sept 14, 2006 Neuro ICU workgroup 3:30-5:00pm Yawkey Sept 25, 2006 Neuro ICU workgroup 11:30-1:00pm Yawkey 4910 Sept 28, 2006 Neuro Acute workgroup 2:00-3:30pm Yawkey 4920 Sept 28, 2006 Epilepsy workgroup 3:30-4:30pm Yawkey 4920 Sept 29, 2006 Med /Oncology workgroup 9:00-10:30pm Bulfinch 225-A Sept 29, 2006 Pharmacy/Oncology workgroup 10:30-11:30pm Bulfinch 225-A Round 5 Oct 16, 2006 Neuro Acute workgroup 8:30-10:00am Yawkey 2210 Oct 16, 2006 Neuro ICU workgroup 10:00-11:30am Yawkey 2210 Oct 16, 2006 Med /Oncology workgroup 11:30-1:00pm Yawkey 2210 Oct 31, 2006 Neuro Acute workgroup 8:00-9:30am Bulfinch 225-A Oct 31, 2006 Epilepsy workgroup 9:30-10:30am Bulfinch 225-A Oct 31, 2006 Neuro ICU workgroup 11:00-12:30pm Bulfinch 225-A Oct 31, 2006 Med /Oncology workgroup 12:30-2:00pm Bulfinch 225-A Oct 31, 2006 Pharmacy/Oncology workgroup 2:00-3:00pm Bulfinch 225-A 38

11 Attachment 13.4.d Pump Steering Committee Membership Chairs Dawn, Tenney, RN Deorge Reardon Associate Chief Nurse, Perioperative Services Director, Patient Care Services Systems Improvement Members Joanne Emploti, RN Adele Keeley, RN Sheila Burke, RN Ed Raeke Grana, Jane, RN Ellen Kinnealey, RN Gayle Fishman, RN Margaret Clapp Ray Mitrano Hugh Flaherty Macdonald, Dennis Volpe, Patricia Clinical Nurse Specialist Nursing Director, Medical ICU Knight Nursing Center for Clinical and Professinal Development Director, Materials Management Partners Materials Managment Technology Specialist, Biomedical Technology Lab Technology Specialist, Biomedical Technology Lab Director, Pharmacy Pharmacy Analyst, Budget Office Manager, Corporate Contracts and Partners Purchasing Director, Biomedical Engineering 39

12 Attachment 13.4.e From News You Use from Jeanette Ives Erickson on August 29, Large volume pump conversion completed Last week -- with the deployment of 2,000 new large volume pumps -- we successfully completed our conversion to a new large volume pump -- the Sigma Spectrum. This replaces the 3M infusion pump, Abbott Acclaim, Sigma 8000 and Gemini pumps. The new Sigma pump has "SMART" technology and contains a drug library to help improve the administration of medication. Future upgrades include adding wireless capability to be able to update the drug library and download quality data, as well as adding barcode capability to improve medication safety. During the past month, Sigma staff trained 91% of our staff (2,920 nurses), either on their unit or in well-attended super user sessions. If you have not been trained on the new pump, please talk to your CNS. Many thanks to everyone for their support and efforts throughout the trial, selection process, education and conversion. 40

13 Attachment 13.4.f From the Desktop of... Peter L. Slavin, MD MGH President August 2007 Smart Infusion Pump Conversion Key Step in Improving Medication Safety During an extraordinary four-day period in mid-august, the MGH converted more than 2,000 largevolume intravenous infusion pumps to new smart pumps. Called the Sigma Spectrum, these smart pumps have built-in guidance systems to prevent over- and under-dosing of medication through an embedded electronic drug library that contains drug names, dosing units and limits for a broad range of intravenous medications. This technology significantly reduces the chance of a medication administration error. Replacing the older IV pumps with the new smart pumps across our patient care areas clearly was a major task in itself, but this effort was accompanied by an unprecedented educational initiative to ensure that the MGH nursing staff could take full advantage of the new technology. As the pumps were deployed, more than 2,900 members of the MGH nursing staff were trained in their safe use. The Sigma large-volume infusion pumps complement our smart syringe pumps, which are in all our ICUs and operating rooms. This pump upgrade is part of a comprehensive strategy to improve medication safety. We have already put in place computerized physician order entry with decision support to check for drug-drug interactions, unit dose packaging for medications and automated dispensing cabinets (OmniCells). The new Sigma pumps have the capacity for key upgrades for the future, including wireless technology and bar-coding capabilities. When the bar-coding system is fully implemented, it will provide another safety check, helping to ensure that the right medication in the drug library is administered to the right patient. The pumps also will interface with the electronic medication administration record and the electronic flow sheets coming soon. When these pieces are in place, we will have a robust, automated system to support the five rights of safe medication administration: right medication, right patient, right dose, right route and right time. I applaud the many MGHers who helped accomplish this crucial step forward in patient safety. Special thanks go to the leaders of this initiative, including George Reardon, Dan Kerls, Dawn Tenney, RN, Sheila Burke, RN, and Joanne Empoliti, RN, of Patient Care Services; Dennis MacDonald of PHS Contracting; Ed Raeke, Henry Coughlin, Kathy Kelly and Lisa Martino of Materials Management; and Tricia Volpe, Ellen Kinnealey, RN, Gayle Fishman and Caitlin Farneny of Biomedical Engineering. 41