1 / 24

Karla Abela, MSN, RN, CCRN-K Angela Stutts , MS, RN, CCRN-K Darlene Acorda, MSN, RN, CNE, CPNP

Keeping a pulse on the bedside: Ten years of Quality and safety rounds in the Pediatric Intensive Care unit. Karla Abela, MSN, RN, CCRN-K Angela Stutts , MS, RN, CCRN-K Darlene Acorda, MSN, RN, CNE, CPNP Anne Lam, MSN, RN, CPNP. objectives.

iboyles
Download Presentation

Karla Abela, MSN, RN, CCRN-K Angela Stutts , MS, RN, CCRN-K Darlene Acorda, MSN, RN, CNE, CPNP

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Keeping a pulse on the bedside: Ten years of Quality and safety rounds in the Pediatric Intensive Care unit Karla Abela, MSN, RN, CCRN-K Angela Stutts, MS, RN, CCRN-K Darlene Acorda, MSN, RN, CNE, CPNP Anne Lam, MSN, RN, CPNP

  2. objectives • Discuss the history of patient rounding in healthcare. • Describe the challenges of PICU patient rounding efforts pre-2008. • Discuss the evolution of PICU rounding over the past 10 years. • Describe the future direction of patient rounding in the PICU.

  3. History of patient safety rounds • To Err is Human (1999) report increased awareness of U.S. medical errors • Focus on patient safety culture • Walk rounds became a strategy to engage leaders directly with front-line providers • Aim was to show leader commitment to safety, foster trust and psychological safety, and provide support • Proactively address threats to patient safety (Weaver et al., 2016).

  4. Ahrq recommendations for patient safety rounds • Developed by Allan Frankel, MD • Objectives: • Increase awareness of safety issues by all clinicians • Make safety a high priority for leadership • Educate staff about patient safety concepts such as a “just culture” • Obtain information collected from staff about barriers to safety • Act, after analysis, on information collected from staff • Consistently give feedback to frontline providers and leadership on processes

  5. Picu rounds prior to 2008 • Medical rounds separate • Multidisciplinary rounds – lacked physicians, child life, respiratory, nursing • 3 days per week • No focus • Non-quality related • Addressing patient needs rather than assessing patients • No accountability piece

  6. PICU Clabsi Rates pre-2008 • FY 06: 2.78/1000 central-line days • FY 07: 2.05/1000 central-line days • FY 08: 12 CLABSIs in PICU

  7. Challenges and barriers pre-2008 • Lack of interest, not viewed as important • Getting providers on board • Dissemination of rounds to other units • Lack of data behind the value of rounds not established • Manual data collection

  8. The impact of nachri and ohio collaborative • Became part of NACHRI in 2008 • Attended conference related to CLABSI • Learned about bundles and checklists • Learned about 15/15 scrub and dry • Data related to interventions • Had an increased in CLABSI (12) • Officially tracked CLABSI rates in 2008 • Beginning of care bundles • Beginning of RCAs for CLABSI • Shifted to Ohio Collaborative in 2015

  9. Evolution over time Rounds focused on hospital acquired conditions and overall quality of care

  10. Current Quality and safety rounds • Occurs weekly • Covers PICU/TICU 9-12th floors • Involves a multidisciplinary group of nurse leaders, critical care providers, infection control, infectious disease providers • Targets patients at risk for hospital acquired conditions • Focuses on current gaps in practice and organizational initiatives (e.g. PPID, etc)

  11. Data collection and reporting • Reports generated daily for CLABSI and Hygiene • Review of patient lists by the clinical specialists to identify other risk factors • Findings on rounds recorded in RedCAPsoftware • Findings shared to staff at quarterly state of the unit (SOU) meetings

  12. CLABSI 2016-2019

  13. CLABSI Bundle Compliance

  14. Cauti 2016-2019

  15. Hand hygiene

  16. Gaps found through rounding • Barriers to proper PPID • Practice deviations from standards • Gaps in parent education • Practice-related misinformation • Gaps in provider education related to hospital standards

  17. Initiatives • Respiratory rounding • Skin/Surface rounds • Night Shift rounding • CLRN pilot • PPID • Pump audits

  18. Challenges • Number of beds • Increased acuity of patients • Physical geography • Parent/family involvement • Attendance • Staff awareness of rounding goals

  19. Lessons learned • Best way to find out what is actually happening at the bedside • Entire team focused on the same goal • Automation of reports saves time • Tracking outcomes is essential to value • Night shift rounds are critical • Culture change starts with leadership visibility and engagement at the bedside

  20. Future direction • Full automation of reports using the EMR • Inclusion of staff nurses in rounds • Rounding as part of every major initiative

More Related