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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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the Sepsis bundle. A majority of the fallouts were in the first three hours. The Lean workflow established, delays in recognition of sepsis, missed documentation, late interventions, and barriers to provide care. Change Strategy: To implement changes that will impact the improved care of sepsis patients the Interprofessional Sepsis Workgroup suggests the following strategy for change: Ask for support from the CNO and CMO for the needed changes to improve sepsis bundle compliance.
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
professionals. The workgroup agrees that since sepsis most often diagnosed in the ED, the triage RN should be one to initiate the sepsis bundle order set. This will document time-zero and facilitate care for the patient. The ED provider who participated on the workgroup suggested assigning an ED provider to the triage area for sepsis patients, once the order set for the sepsis bundle was initiated by the RN, the ED provider would be notified to see the patient The RRT RN’s agreed that they would be responsible for monitoring patients that qualified for the sepsis bundle. The Pharmacy representative agreed to stock a small stock of unknown source antibiotics that could be mixed and given by the RN would remove barriers and improve workflow. Project Benefits: Establishes an interprofessional workflow that is aligned with best-practice. Provides education, documentation, and a set standard of care for the interprofessional team. Leverage technology to alert the interprofessional team when there is a patient at risk for sepsis. Allows the ED triage nurse to document time zero for sepsis patients and initiate the sepsis bundle order set. Provides timely interventions for patients that present with sepsis. Improves sepsis bundle compliance. Uses the current RRT RN’s to act as sepsis experts or change agents to monitor bundle compliance and staff adoption of new workflows.
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.
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
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
Timeliness in medical care can be of the utmost importance. Letting things progress can result in a slippery circle, where a minor infection, untreated end up being life threatening. With increased damage caused by neglecting health care, or waiting on a health care provider, the physical damage, and costs associated increase, often exponentially.
CLABSIs are not confined to one unit of nursing care and there are many precipitating factors that may contribute to the development of a CLABSI. Often times these lines are placed in emergent situations in the emergency department (ED) and there may be a break in sterile technique. However a study conducted by Smith, Egger, Franklin, Harbrecht, and Richardson (2011) found a higher incidence of CLABSIs among intensive care unit (ICU) patients compared to those patients whose CLs were placed either in the ED or operating room (OR). This indicates further education for ICU s...
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
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.
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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.
“ Sepsis” according to the International Surviving Sepsis Campaign, is defined as the presence of infection together with systemic manifestations of infection (Dellinger et al., 2013) In todays modern society sepsis still accounts for 15% of maternal deaths a year worldwide (Dolea & Stein, 2003). Despite medical advances, aseptic technique, and antibiotic use, sepsis is the most common cause of direct maternal death in the UK. According to the CMACE report the maternal mortality rate increased from 0.85 deaths per 100,000 maternities in 2003–05 to 1.13 deaths in 2006–08 (Harper, 2011). Puerperal sepsis has a long history within obstetrics and midwifery, and yet despite this knowledge it has become, yet again, the leading cause of direct maternal death. Therefore due to the increased maternal mortality, I have chosen to focus on the care of a woman within ...
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;