TEAMwork Boards in the PICU

Lauren Smith, MSN, RN, CPPS Cara Gallegos, PhD, RN Bev Holland MSN, RN, NEA-BC

A little about us…

• The only Children’s Hospital in Idaho. • A recognized Magnet® designated organization. •  Beds

• 61 NICU Boise and 12 NICU Meridian • 39 medical-surgical

• 11 hematology-oncology • 13 PICU

All of our rooms are private with adequate area for family members to remain at the bedside.

The PICU Team

Darcie Ineck, BSN, RN Jim Percy RN, CCRN Lauren Smith, MSN, RN, CPPS

TEAMwork Boards

•  Concept developed by Dr. Michael Leonard and colleagues (2010).

•  Consists of three colored sections: red, yellow, and green.

•  Foster frequent problem solving via a visual management tool that supports identification and timely resolution of simple to complex problems.

5

Department Driven

Department Driven

Department Driven

Department Driven

Staff & Patient Safety

TIP Process Metrics

Service Quality

Productivity

Financial Performanc

e

Department and Org.

Goals

Why TEAMwork Boards

CEO

VP

Director

Manager

Supervisor/Lead

Front Line Staff

IMPROVED PROBLEM SOLVING (PROCESS STRUCTURED and ORGANIZED around TEAMwork)

After leadership has

set the strategic goals

Frontline staff Supervisor/Lead

Manager Director

VP CEO

Tactical/ Operational

Strategy & Direction

Patient 1st every time

The Pilot TEAMwork Board

Critical Medication IV Drips Current State

MD  writes  medication  order

RN  faxes  order  to  pharmacy

PharmD  views  via  Omnilink

PharmD  enters  order  on  pt  profile  in  Siemens

Generated  label  prints  in  IV  room

Medication  mixed  in  IV  room  

RN  verifies  order  in  MAK  (compare  to  MD  order)

Medication  delivered  via  STAT  tube  or  Omnicell  

fill

RN  receives/  collects  drip

RN  documents  med  admin  in  MAK

RN  spikes/  connects  &  primes  tubing RN  programs  IV  pump

RN  contacts  pharmacy  when  next  dose  needed  if  drug  not  ava/  can't  

find  in  dept

If  no  bolus  on  order,  call  MD

Content  of  MD  order  varies

Frequency  isn't    updated

Pharm  D's  vary  in  calc  of  vol  

STAT  tube   Verified  before  

confirmed

Verified,  but  incorrect

Meds  ava  in  dept  2  hrs  

Change  bag  to  syringe

Vary   in  VTBI  programVary   in  

tubing  use

Most  calls  are  urgent

Critical Medication IV Drips

MD  writes  medication  

order

RN  faxes  order  to  pharmacy

PharmD  views  via  Omnilink

PharmD  enters  order  on  pt  profile  in  Siemens

Generated  label  prints  in  

IV  room

Medication  mixed  in  IV  

room  

RN  verifies  order  in  MAK  (compare  to  MD  order)

Medication  available  in  

PICU

RN  receives/  collects  drip

RN  documents  med  admin  in  

MAK

RN  spikes/  connects  &  

primes  tubing

RN  programs  IV  pump

Before  next  dose  due,  RN  verifies  ava.  in  

PICU

Action:  Create  and  utilizestandard  MD  order  sets  for  critical  drips

Action:  ALL of  MD  order  will  be  entered  into  pt  profile

Action:  Frequency  calculation for  max  rate  and  max  bolus  (volume-­‐based)

Action:  STW for  "VerifyingCritical  Drip  Orders  in  MAK  

Action:  -­‐ Initial  fill  via  tube  or  already  ava.  in  Omnicell-­‐ Subseq.  doses   fill  ava.  in  PICU  2  hrs  before  due  (in  Omnicell or  patient  drawer)

Action:Standardize IV  tubing  for  critical  drips  (includes  quad  setup)

Action:STW  for  "IVPump  Program  for  Critical  Drips"

Future State

Standardized MD Orders

Results •  Promote employee engagement in continuous improvement

•  Promote continuous improvement as a daily activity

•  Consistent use of the red/yellow/green section to facilitate problem solving

•  Promote visual management, allowing anyone to quickly review performance in key areas

•  Minimal blank spots on board (information relevant to the department)

•  Provide structure for daily huddles

•  Daily huddles efficient way to update staff

Results

0%

10%

20%

30%

40%

50%

60%

Strongly Agree

Agree Neutral Disagree Strongly Disagree

The TEAMwork Board has Made a Positive Impact

POST

0%

5%

10%

15%

20%

25%

30%

Strongly Agree

Agree Neutral Disagree Strongly Disagree

My Ideas and Suggestions are Seriously Considered

PRE

POST

Patient Experience & Outcomes

Charge RN CPU Access

IV Line Labels

Nor

-Epi

Kits

Routine Med Availability Pr

int f

rom

Mos

aic

AD

MR

Os from

OR

18 Posted

10 Solved

Keys to Success

•  Ideas are encouraged, welcomed, and expected

•  Submitting ideas is simple

•  Evaluation of ideas is quick and effective

•  Feedback is timely, constructive, and informative

•  Implementation of ideas is rapid and smooth

•  Ideas are reviewed for additional potential

•  People are recognized and success is celebrated

•  Idea system performance is measured, reviewed,

and improved

Transforming a Culture

Allow time to integrate continuous improvement as a part of how we do our jobs.

Develop mutual trust and keep an open mind.

Actively participate. Be a problem solver.

Recognize the good work people do to identify

problems and correct mistakes.

Make a personal commitment to change and apply TEAMwork knowledge, skills, and tools into your daily

work activities.