Process Improvement in Perianesthesia
Dominique Watt, MSN, MBA, RN, CNL and her team presented "Process Improvement in Perianesthesia" during the Monthly Managers Meeting in November 2021. Dominique and her team conducted a process improvement project covering the perianesthesia units (500P Pre-Post, 300P Pre-Post, and the Cath Pre/Post). Their dynamic team worked on:
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Reducing preop cycle times for second and subsequent cases
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A dot phrase to standardize consents
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Perianesthesia on time starts and "go sticker"
Thank you to their process improvement team members!
Anh Hoang
Lisa Newton
Jon Villagracia
Paolo Montenegro
Kristen Martin
Sheena Thamban
Eddah General
Molly Rodriguez
Bridget Bergstrom
Liz Roney
Priya Prasad
Shivneel Sen Z
ahirah Aziz
Elise Scoggins
Shalisha Grace Maddela
Wendy Prigge
Sam Wald
A Multidisciplinary Approach to Falls Prevention
A collaborative effort led by Perianesthesia SLC members and Interventional Platform's Nursing Quality Team
-Submitted by Frances Liu, BSN, PCCN, MPA, Clinical Nurse III
Four perioperative units in an academic medical center joined efforts to reduce falls across the Stanford Health Care Interventional Platform.
This was a nurse-driven project, partnering with Nursing Quality, PeriAnesthesia Shared Leadership Council, Guest Services, Information Technology, Patient Education and Service Excellence/Patient Experience. The team sought input from literature searches, historic fall data analysis, A3 development, surveys, and multidisciplinary discussions, to identify root causes and develop interventions.
Background
Data pulled from incident reports showed an increase in falls over several years: 2017 (n=8), 2018 (n=16), 2019 (n=20). The increase in falls prompted perioperative nurses to establish a fall prevention program tailored to the perioperative patients. This work aligns with AORN Guidelines for Perioperative Practice 6.11 on mobility and fall risk assessment. Though falls occur primarily in the postoperative phase of surgery, fall prevention measures start in the preoperative phase of care. Goal setting methodology across perioperative platforms included a 10% reduction of falls from 2019 (n=20) to 2020 (goal n=<18).
Participants
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Stella Ng, Quality Consultant
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Fang Liu, RN, BSN, PCCN, MPA, Clinical Nurse III
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Mikaela Kay RN, BSN, CNRN, Clinical Nurse II
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Madonna Taylor, RN, MSN, CCRN, WOCN, Clinical Nurse II
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Sarah Palmer, RN, BSN, CPAN, CAPA , Clinical Nurse II
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Luranna Frank, RN, BSN, CCRN, OCN, Clinical Nurse II, Interventional Platform Perianesthesia
Methods
Using data to drive root cause analysis, initiatives included creation of a perioperative falls workgroup, standardizing a patient fall checklist completed and reviewed during the preoperative period, electronic health record updates to include falls as a checklist item, fall prevention education videos, staff surveys, and standardizing practice and language. Education was the primary focus point to ensure standard work was both understood and improved. A new standard of work was developed for assisting patients with mobility in post-op, including a standard script for staff to encourage patient acceptance of the fall prevention initiative. In addition to patient education, the units also ensured that appropriate equipment for patient mobilization was readily available.
Results
Data collection included granular information about the four perioperative regions to scope effectiveness of initiatives. Overall in 2020, the target goal was successfully met across the four perioperative areas (2020, n=6 falls). Performance across all four areas met the target, resulting in patient safety. One area reduced falls from 2019 (n=6) to 2020 (n=0), and the 3 other areas had 2 falls in 2020 at each location.
Conclusion
Research shows that the implementation of multifactorial fall educational interventions reduces falls (DeSilva et al., 2019). Reworking and customizing fall prevention measures specific to the perioperative area helps reduce the number of falls in the postoperative phase of care. SHC's fall education materials included poster signage, an educational video, and direct nurse-to-patient education in the preoperative area. Patient education is the most effective measure to encourage patients to become active participants in preventing falls (Heng et al, 2020). The fall program aims to establish care standards in the perioperative areas and identify patient risk factors to prevent falls.
K7 Becomes an ACE Unit
On January 13, 2021, SHC celebrated the Grand Re-opening of K7 as the mobile Acute Care for Elders (ACE) unit. Acute Care for Elders units are specialized inpatient centers that promote healing and prevent hospitalization complications in acutely ill older adults. Over the past year, K7 nurses and interprofessionals led by Ann Mitchell, RN, CNS, Nannette Storr-Street, RN, AGCNS-BC, Ankur Bharija, MD, Matthew Mesias, MD, Marina Martin, MD, and Sandy Chan, LCSW, APHSW-C, supported by Stanford Geriatric Medicine Service, PCS Professional Practice, and SHC's membership in the Nurses Improving Care for Health-system Elders (NICHE) organization spent over 700 hours in education and training designed to optimize hospitalized older adults' care.
This impactful age-friendly health program is guided by the 4Ms:
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What Matters
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Mobility
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Medication
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Mentation
Other components of this program include interdisciplinary team rounds, nursing-driven screenings on admission, and proactive attention to geriatric-syndromes. This exceptional work received significant commendation and was published by the Institute for Healthcare Improvement entitled: "Age-Friendly Health Systems | Case Study: Stanford Health Care" Click here to read the full article.
