Transcript Relocation of ORC to OR2 - USF Scholarship Repository

RELOCATION OF ORC TO OR2
Svetlana Schopp, RN, CNL Student
University of San Francisco
November 2014
Specific Aim
• Relocate ORC to OR2 on September 3rd, 2014
• Maintain safety & quality of patient care in new location
• Through effective interdisciplinary communication &
collaboration
• Create process standardization
Background
• Measure C
• GO bond, $98.5M
• Passed in 2007
• To fund upgrades for campus
• Women and Family Center
• New construction
• Seismically compliant
• Planned completion 2016
Supportive Data
•
•
•
•
– proactive identification of process failures (
Extended transport time
Communication among clinicians
STAT cesarean sections (C/S)
Staff education for STAT C/S
)
•
• STAT C/S during normal business hours (
)
• STAT C/S after hours, on weekends & holidays (
• Mobilizing patient to OR for C/S (
• C/S Process Algorithm (
)
)
)
Microsystem Status Relative to the Project
(
•
)
: skilled staff, continuity of care for C/S patients
: longer pt transport time, unfamiliar location for
•
OB staff
: improve communication, develop checklists for
standardization, increase efficiencies
: loss of an OR for 2 years
Literature Search
• Strategies – based on highest severity of outcome
• Decision to incision
• STAT cesarean section
• Standards & recommendations
• Databases
• CINHAL Complete
• PubMed
• Scopus
• EBSCOhost
Summary of Evidence
• Mooney, Ogrinc, & Steadman (2007)
• Effective teamwork & communication to shorten decision to incision
• deRegt, Marks, Joseph, & Malmgren (2009)
• Collaborative interdisciplinary approach & teamwork to shorten
decision to incision
• Bloom et al. (2006)
• Use sound clinical judgment to establish urgency in emergency
situations
• Nielsen et al. (2007)
• Teamwork training shortens decision to incision in emergency
Apply the Evidence
Effective teamwork
Effective
communication/collaboration
Sound clinical judgment
EBP
Maternal
&
Neonatal
Safety
Stakeholders
Business Case
• Patient transport to and from OR2: $10,271.2
•
•
•
•
(
)
Potential loss of OR revenue at $33.12 per minute
Potential for $$$ liability w/change in location
Cost of PPH carts & extra C/S instrument set $6,000
Cost of labor for CNL $16,000 (based on 220 hours)
Timeline
11/6/13
FMEA Team Mtgs
Evaluate RPNs
Develop/Edit Checklists
Algorithm to Mobilize C/S pt
Algorithms for Process/pt Flow
Extra Crash C/S Tray
Code Section Policy
PPH Carts x 2
Plan & Do Code Section Drills
Move ORC to OR2
Study & Adjust Process
11/6/14
11/6/15
Supportive Theory
• To become
motivated to
change
Unfreezing
Changing
• What needs
to be
changed
• To make
changes
permanent
Refreezing
Kurt Lewin’s Change Theory (1951)
Results/Outcomes
• As of November 16th, 2014:
• 26 C/S, 10 elective
• Have maintained safety & quality of patient care
• Delays on elective C/S
• Suction for newborn resuscitation
• Support person waiting area
• PPH & operative delivery
Recommendations
• Continue Plan-Do-Study-Act cycles
• Adjust practices as needed
• Improve efficiencies in elective C/S
• Standardize PPH & operative delivery processes
Clinical Nurse Leader (CNL) Role
• Master’s prepared nurse
• Not advanced practice
• Able to practice in any healthcare setting
• Focuses on:
• Quality improvement strategies
• Outcome based practice
• Interprofessional communication
• Care coordination
• Toolkit: FMEA, SWOT, PDSA, EBP, Summary Brief
Thank you!