children’s affinity group coaching webinar: improving safety for all pediatric patients tuesday,...
TRANSCRIPT
Children’s Affinity Group Coaching Webinar: Improving Safety for all Pediatric Patients
Tuesday, May 14, 201312:00 noon to 1:00 pm Central
Objectives
• Review opportunities to reduce harm for all pediatric patients
• Discuss specific strategies used to improve quality and safety
• Review lessons learned• Identify potential solutions for your
organization
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Welcome & Introductions
• Shannon McDonnell Woodford, MPH - HRET Program Manager
• Denise Remus, PhD, RN – Improvement Advisor, Cynosure Health
• Vicki Montgomery, MD, FCCM – Chief Women and Children’s Division of Patient Quality, Safety, and Clinical Innovation; Chief, Pediatric Critical Care Medicine, Kosair Children’s Hospital, KY
• Kelley Miller, RN, BSN, RNC – Charge Nurse NICU, Freeman Health System, Joplin, MO
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4https://www.facebook.com/EngledowArtPhotography
Kosair Children’s Hospital Who we are. . . • 22nd largest children’s hospital with 263 beds• Magnet designated hospital• University affiliated – University of Louisville School
of Medicine• 115,000 patient encounters/year• 1800 employees, 620 nurses• 70,000 patient days, 10,000 admissions, 60,000 ED
visits• 12,000 surgeries• 70,000 radiology cases• 1200 NICU and 1800 PICU admissions
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Creating Culture
• Good Catch– Of the month– Team of the Year– Rewards / Prizes– Let folks know what you are
doing with the safety reports
Hospital Acquired ConditionsClinical Innovation Teams
-MD-RN co-chairs-Multi-disciplinary teams
-Standardize the improvement tools-Mentor/coach for each team
-Clinical Analysis support-Measure baseline
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Pediatric Patient Safety – Opportunities to Improve
• Medication Safety• Impact of new EMR• Pediatric dosing• Bedside medication verification
• Tracking use, regular reporting to care areas• Formulary• Smart pumps and limiting choices• Weight only in kg• Minimal verbal orders
• Medication error with serious harm/death• Hand Hygiene – 5 Moments (WHO)
• Secret observers• Mislabeled specimens
Barriers and Solutions
Time for meetings
Metrics and Data Collection
Messaging, Creating importance
Scope creep-Charters, keeping each other focused-Definitions – stick to them
-Find somebody creative-Story telling-Graphs that are meaningful to folks at the bedside-Pick projects that are relevant, important to folks at the bedside
-Take the time to do it well-Surrogate measures when unable to easily and reliably measure what you want
-Utilize technology (teleconference, SKYPE, Facetime)-Pick a recurring time-Do as much work as possible during meetings
Examples of Messaging
-One every other day-Every event results in a child re-experiencing the procedure
-Mortality associated with a BSI in a critically ill child
Secure Airways For EveryoneThe SAFE ETTS Project
Sustaining change-Gather voice-Real time investigations-Share and learn
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Lessons Learned
• BE inclusive – include bedside staff• Include physicians, find physician champions• Message, message again, and then again
• Message fit the audience• Story telling is very powerful
• Talk safety every day. It will become important to everyone – eventually
• Make sure that every project is associated with a patient outcome metric – not just a measure of compliance with a regulation
Next Steps
• HAC teams – develop solutions, start trials (rapid cycle testing)
• Patient safety page, blog, newsletter
• Increase involvement of families and patients
• Medication Safety Oversight Board and sub-teams
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Freeman Health System Joplin, Missouri
Hospital Story – Who we are. . .
• Freeman Health System located in Joplin, Missouri• 517-bed, three-hospital system providing
comprehensive healthcare and behavioral health services
• Since the May 22, 2011, tornado, Freeman has responded to increased patient volumes by enhancing current services and opening new facilities to stay ahead of the needs of our community.
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Current Hospital Wide Success
• Elective Induction <39 Weeks• Pressure Ulcer• VTE• CLABSI• Primary C-section Reduction• VAP
Our NICU• Level 3: Providing total body cooling, nitric
oxide, PDA ligation, and area transport• Only NICU of its kind in the region• 24 beds• Average 300+ admissions each year
– 23+ weeks gestation upon admission– Transport services of 100 miles covering 4 states
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Pediatric Patient Safety – Opportunities to Improve
Our Aim: To decrease the number of CLABSIs by 50% in the Neonatal population by Dec 31, 2013
Background• Average Umbilical catheter 2-7 days• PICC 10-30 days• NNPs primarily insert lines and perform dressing
changes on an as needed basis
Process Reviewed• Insertion to Discontinued Time.
• Culture of the Unit – “What more can we do?” and “I don’t have time for anything else”
• Buy in from other departments – Showing that the whole does impact the one.
• Need for equipment – Restricted in cost and availability
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Barriers Encountered
Issues Found• Bedside RN attaching all lines to C. line fluids• No dedicated CL Cart• Differences between NNPs dressings• Breaks in C Line for piggy back changes• Concentration issues with fluids making PIV more
fragile and difficult to maintain patency• Inferior caps protecting tubing tips.• Lack of equipment• Supplies and supply amts in circulation that were no
longer needed
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Solutions Implemented
• Changed concentrations of fluids. Decreased need for C. Lines. CLdevice days decreased
• RX prepares all C. Line fluids under sterile hood
• Utilized locking cap to ensure sterility of tubing tips
• Eliminated individual Piggy Back tubing for each med- one tubing for all meds and stays connected, changed every 24hours
Solutions Implemented• Implemented enhanced piggy back tubing • Utilized savings ($3,000-4,000) from eliminating
supplies to purchase new equipment • “Scrub the Hub” campaign• Dressing education using “correct vs. incorrect”
dressings. Standardized dressing changes • Dedicated Central Line Cart with modified Bundle
Checklist• Changed awareness of insertion procedure to one of
surgical procedure• Educated ancillary departments
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Lessons Learned
• Not a fast process. Some of the easiest ideas are the hardest to implement
• Get support from unlikely places.• Tap into cost savings to obtain improved
equipment/supplies• Sell the changes as an improvement in
staff life. Don’t look to blame.• If you want changes to happen, you have
to be the example.• Don’t be afraid to ask and to ask again.
In the Beginning…
Where we are!
535 device line days since last CLABSI.535 device line days since last CLABSI.March 2012- May 2013, 1 CLABSI (23 wk infant with septic mother at birth) March 2012- May 2013, 1 CLABSI (23 wk infant with septic mother at birth)
Next Steps
• Looking at research to support closing the unit for fluid changes
• Altering fluid delivery times• RN audits on “Scrub the Hub”.• Changing all tubing to new tubing
with clave• Timers on cart to ensure proper
drying prep times.
Questions
Affinity Group – Collaboration Opportunities
• Join our dedicated LISTSERV!– Email [email protected] and request to be added to the
Children’s Affinity Group listserv
• Next webinar July 16th at 12pm Central• More events to be announced soon – stay
tuned!
• What questions or comments do you have about your affinity group or today’s webinar?
• Please remember to fill-out the evaluation. https://www.surveymonkey.com/s/XDQPHQW
Thank you!
Julie Zaura, Program ManagerPhone: 312-422-2614 Email: [email protected] | [email protected] Website: www.hret-hen.org
Q&A and Evaluation