Hospital: Grey Nuns Community Hospital
City: Edmonton, Alberta
Initiative: Breaking the barriers and improving communication and collaboration between staff, physicians and anesthesiologist

 

Overview:

Coming together and working together as a team is one of the core principles of our MOREOB Core team and is the basis we use every year when setting our goals. We identified communication and collaboration between the staff and physicians of Women's Health and anesthesiology as an area of focus for the past year. We had concerns brought to us by both the nursing staff and the anesthesiologists about the nurses role in assisting with intubations and patients needing anesthesia support in the OR. As it is a rare occurrence in our OR's, our RN's did not feel competent in their skills in this area.

We, the MOREOB Core team had been dealing with ongoing concerns about patient care orders and the need for clarification and consistency. This prompted the development of a pre-printed patient care order and collaboration between all involved parties. We made communication and collaboration between labour and delivery staff and anesthesiology our MOREOB goal.

Submission:

Coming together and working together as a team is one of the core principles of our MOREOB Core team and is the basis we use every year when setting our goals. We identified communication and collaboration between the staff and physicians of Women's Health and anesthesiology as an area of focus for the past year. We had concerns brought to us by both the nursing staff and the anesthesiologists about the nurses role in assisting with intubations and patients needing anesthesia support in the OR. As it is a rare occurrence in our OR's, our RN's did not feel competent in their skills in this area.

We, the MOREOB Core team had been dealing with ongoing concerns about patient care orders and the need for clarification and consistency. This prompted the development of a pre-printed patient care order and collaboration between all involved parties. We made communication and collaboration between labour and delivery staff and anesthesiology our MOREOB goal.

Following the simulation the anesthesiologists walked the nursing staff through the steps to assist them with intubation and how to best support them during this procedure.

The evaluations from the work shop were very positive. Many staff expressed an appreciation for both the education and the simulation .

The recommendations stemming from the workshops were taken to the MOREOB Core team, where they were discussed and system changes were made and implemented. One example was to have a blank chart note in the patients room to use in an emergency situation for ease of documentation, as we have an electronic medical record for our main charting purposes.

In addition to running the work shop we also selected 10 RN's that worked various shifts to spend a day in the Main OR buddied with an anesthesiologist Here they would refresh their skills in assisting with intubation, extubation and initial recovery following general anesthetic. This allowed the nurses to feel more comfortable and competent in this skill with these patients. It also allowed them experience different working environments and work together with other nurses and respiratory therapists from the Main OR.

This past fall we surveyed our nursing staff and the general response was that they feel much more comfortable and competent in assisting with general anesthesia situations.75% of the staff has had the opportunity to assist with an intubation in the past year.

Collaboration

One of the ongoing issues that we were dealing with as a MOREOB core team was ongoing concerns between pharmacy, the post partum unit and physicians with regards to patient orders following both and Epidural and Spinals. Different Anesthesiologist had different approaches and the orders varied and occasionally conflicted with the orders from the obstetricians and family physicians. A subcommittee was put together to work collaboratively to develop a pre-printed patient care order (PPCO) that would make the orders clear, consistent and easy to follow. The sub-committee was made up of representatives from Anesthesia, Obstetrics, Pharmacy, Post Partum, managers and educators. An individual PPCO was drafted for both Epidural and Spinal each. The process progressed well and the committee was able to come together and work out the details both big and small. In spite of the fact that everyone came from a different background, In the end everyone worked toward something that would be increase patient safety.

The PPCO was rolled out in draft form in August 2014 to be trialed. Education and support were provided to all staff. The PPCO draft has been used successfully and is now going to be finalized for continued use.

The PPCO has resulted in increased patient safety, timely medication administration and less need to clarify orders. This has led to less time spent away from the bedside dealing with medication administration issues for both nurses and physicians.

Summary:

We met our goal of improved collaboration and communication between the staff and physicians in Women's Health and anesthesiologists for increased patient safety. This work is ongoing, as we strive to maintain the improved collaboration and communication. We are taking the lessons learned from the process and applying them to other PPCO's we use. Our team, both staff and physicians have worked together through this process and the result is a stronger team and ultimately increased patient safety. It is only through coming together as a team and overcoming our barriers that we have achieved this success.