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Interprofessional collaboration and teamwork in health care organizations essay
Pillars of quality improvement
Quality improvement implementation
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Problem:
Early sepsis often goes undetected leading to increased mortality and cost.
CMS Sepsis Bundle compliance is publicly reported and non-compliance results in financial penalties.
At St. Vincent’s the symptoms of sepsis are underdiagnosed approximately 60% of the time.
Quality Improvement Methods: An Interprofessional Sepsis Workgroup was formed and using Lean Management principles gaps in sepsis care, identification of care delays, and time-wasting workflows were documented.
Based on the workflow assessment there is a need for interprofessional education, leverage of current staff, technology, and the development of a nurse-initiated protocol for sepsis.
Evidence:
Manual data abstraction revealed that approximately 60% of sepsis patients were treated in the established time-frame for
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Sepsis Education for providers, nurses, and allied health staff.
Develop an automated screening tool in the EHR to alert nurses and providers of potential sepsis
Develop algorithms, nurse-initiated protocols, and order sets to facilitate care interventions.
Engage the Rapid Response Team (RRT) RN’s to act as Sepsis Experts to assist staff and encourage best-practice.
Stock common antibiotics to the ED to prevent delays in administration.
Interprofessional Workgroup Collaboration:
The development of an Interprofessional Workgroup for Sepsis fostered collaborative practice.
The workgroup was motivated by the desire to improve after reviewing the Lean workflow assessment data.
The workgroup developed a sepsis algorithm that can be used to develop an alert in the EHR, a sepsis bundle order set, and sepsis education that would be provided house-wide for nurses, providers, and allied health
The guidelines’ first focus is the definition of sepsis, which makes sense, because there is no way to effectively treat sepsis without an accurate and categorical definition of the term. The guidelines define sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection”. Such systemic manifestations can include fever, tachypnea, AMS, WBC >12k, among others; these manifestations are listed in full in Table 1 of the guidelines. The definition for severe sepsis builds on to the definition of sepsis, bringing organ dysfunction and tissue hypoperfusion (oliguria, hypotension, elevated lactate) into the picture; full diagnostic criteria is listed in Table 2. The guidelines recommend that all
At this point, the sepsis bundle order set will be initiated. Within one hour the physician will perform an assessment, laboratory will draw labs and blood cultures, the assigned nurse will initiate fluid resuscitation, and broad spectrum antibiotics will be administered after the cultures are collected. Figure 1 provides a detailed summary of tasks to be completed within the first hour of SIRS indicator identification. Within three hours, fluid resuscitation will be completed, lactate levels are remeasured, and the assigned nurse documents volume status. Within six hours, vasopressors are initiated if hypotension is not responding to initial fluid resuscitation, and hydrocortisone is administered if indicated. A “Gold Alert” was required for the case patient as evidenced by elevated temperature of 38.3oC and white blood cell count of 23,200
Process Excellence in the emergency department is a team collaboration that has a focus of interest for improving quality of care for patients. Team collaboration in health care is recognized as a group of health care workers from different disciplines working together on a common goal. This particular “multidisciplinary” (Finkelman, 2012, p. 336) team meeting was a collaboration of team members that included: the Emergency Room (ER) Director, ER physicians, and ER nurses, ER Head Health Unit Coordinator, ER Business Manager, Senior Process Excellence Coordinator, Director of Information Management, and the Senior Marketing Specialist. This team’s purpose aims to organize a team approach to care for patients treated in the emergency department and focuses on the care approach that provides continuity of care to patients. This focus on the patient is aimed to provide not only a higher level of patient satisfaction, but also to improve professional satisfaction by developing approach by emergency room staff to provide care as team collaboration. This process excellence team has been meeting for over two years in hopes of this goal being reached. This paper aims to help the reader gain a better understanding of this specific team collaboration, the roles of its members, and the communication methods utilized.
Calls to outpatient areas such as radiology, rehab, and the hospital lobby are also on the rise, with family members, visitors, and employees being added, besides the inpatients, to the list of eligible Code Rescue calls for the ICU nurse to respond to. With Code Rescues involving a Stroke Alert, the ICU nurse must accompany the patient to the CT Scan area for a STAT CT of the brain, which takes the nurse away from their assigned patients for an even longer period of time based on the status of that patient. When a nurses take their break, another nurse is required to monitor those patients as well as take care of their own patient assignment. The attention given to the other patients is not considered to be extensive, basically “keeping an eye” on them until their nurse returns. This patient assignment could be at a safety risk if their nurse is also the one assigned to respond to Code Rescues at any time during the
Sepsis is defined as the body’s inflammatory response to an infection and can quickly lead to multiple organ failure and death. Early, goal-directed therapy using the sepsis resuscitation bundle introduced in the “Surviving Sepsis Campaign” is the treatment used throughout the world for sepsis treatment (Winterbottom 2012, pp 247). There are approximately one million cases of sepsis in the United States annually and deaths total more than prostate cancer, breast cancer, and HIV/AIDS combined. Also, more than one-fourth of patients that develop sepsis will develop it on a medical-surgical unit and severe sepsis is the most common cause of death among patients in non-coronary critical units (Bernstein 2013, pp 24-25).
Niemei, K., Geary, S., Quinn, B., Larrabee, M., & Brown, K. (2009). Implementation and evaluation of electronic clinical decision support for compliance with pneumonia and heart failure quality indicators. American Journal of Health-System Pharmacy, 389-397.
Turnock, C. (1994). Technology in Critical Care Nursing. In B. Millar, and P. Burnard. (Eds.) (1994). Critical Care Nursing. Caring for the Critically Ill Adult. London: Baillière Tindall.
Urden, L. D., K. M. Stacy, and M. E. Lough. Critical care nursing, diagnosis and management. Mosby Inc, 2010. eBook.
Vital improvement for patient safety has triggered an enormous amount of positive change in the healthcare system. There were “1.6 million adverse events each year that led to 180,000 deaths” (Liang & Mackey, 2011). In a review, avoidable errors led to $19.5 billion dollars in healthcare expenses (Liang & Mackey, 2011). The National Patient Safety Agency analyzed 425 deaths from acute care hospitals and found “15% of the deaths were related to unrecognized patient deterioration” (Higgins, Maries-Tillot, Quinton, & Richmond, 2008). This finding led to the Institute for Health Care Improvement’s promotion for the use of an early warning scoring system to assist with identifying deteriorating patients (Albert & Huesman, 2011).
Safe nurse-patient ratio is a complex issue debated on for many years. Due to inadequate staffing registered Nurses are faced with high patient ratios, and nurse burn out everyday. According to the American Nurses Association, “Massive Reductions in nursing budgets combined with, the challenges presented by a growing nursing shortage have resulted in fewer nurses working longer hours for sicker patients. This situation compromises care and contributes to the nursing shortage by creating an environment that drives nurses from the bedside”. (2012) Through the nursing process, the essential role of the Registered Nurse is to assess, diagnose, and plan based on outcomes, implement and evaluate the effectiveness of nursing care. However, it is not realistic to thoroughly implement these core guidelines in a safe and effective way, when you are
According to the Clinical Excellence Commission (2014), approximately 6,000 deaths per annum are caused by sepsis in Australia alone. These mortality figures are higher than breast cancer (2,864) and prostate cancer (3,235) combined (Cancer Australia, 2014). Despite advances in modern medicine and increased understanding of the need for timely recognition and intervention (Dellinger et al, 2013), sepsis remains the primary cause of death from infection worldwide (McClelland, 2014). Studies undertaken by The Sepsis Alliance (2014) and Schmidt et al, (2014) state that 40% of patients diagnosed with severe sepsis do not survive.
With patient safety always being the number one priority FTR is the worst case scenario for the hospitalized patient. In an article titled “Failure to Rescue: The Nurse’s Impact” from the Medsurg Nursing Journal author Garvey explains ways FTR can occur “including organizational failure, provider lack of knowledge and failure to realize clinical injury, lack of supervision, and failure to get advice.” Nurses are problem solvers by nature, they heal the sick and help save lives. FTR is a tragic experience for everyone involved. The recent surge in this happening across the country has given FTR cases widespread media coverage. Hospitals are trying to figure out what the root cause is and how they can be prevented. Fortunately, with the advancement of technology and extensive research many hospitals have developed action plans and procedures to help prevent the early warning signs from being
Within the Surviving Sepsis Campaign they introduced guidelines and bundles which may beused as the basis of a sepsis performance improvement program. The Guidelines were based around a six-point action plan (...
...s and measurement to decrease healthcare- associated infections. American Journal Of Infection Control, pp. S19-S25. doi:10.1016/j.ajic.2012.02.008.
There are many members of the inter-professional team, all of which are contributing to the healthcare of acute and critically ill patients. Every member of the team has had education and obtained a license of practice compatible to their level of knowledge (Prater, Fundamentals of Nursing, 2013). As a practical nurse you need to be mindful of your scope of practice in relation to registered nurses, certified nurses’ assistants and other healthcare professionals. With so many different people involved in the immediate care of a patient, there is always the possibility of a mix up. The purpose of this paper is to help differentiate between the roles of the healthcare staff, which will in turn help develop a knowledge base for prioritizing care;