Setting the Stage for Quality Improvement and Patient Safety . - - PowerPoint PPT Presentation

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Setting the Stage for Quality Improvement and Patient Safety . - - PowerPoint PPT Presentation

Jun 03, 2023 42 likes •252 views

Clinical Scene Investigation (CSI): Setting the Stage for Quality Improvement and Patient Safety . Charlene Cunningham, RN MSN, CCRN Meghan Fitzpatrick-Duggan, RN, BSN, Lauren M. Derrigo, RN, BSN, David Heitz, RRT-NPS, Marcia Macy, RN, CCRN,

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Clinical Scene Investigation (CSI): Setting the Stage for Quality Improvement and Patient Safety

.

Charlene Cunningham, RN MSN, CCRN Meghan Fitzpatrick-Duggan, RN, BSN, Lauren M. Derrigo, RN, BSN, David Heitz, RRT-NPS, Marcia Macy, RN, CCRN, Bonnie Miller, RN, BSN, CPN

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Children’s Healthcare of Atlanta

Traditional Patient Safety Education

  • Policies & Procedures
  • Practice Alerts
  • Accreditation standards
  • Audit Reports
  • Collaborative Reports

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Children’s Healthcare of Atlanta

How CSI came about…

  • The project is an adaptation of a competency

validation method developed by John F. Dixon, RN, MSN.

– 4 Criteria for Identification of What to Validate

  • New procedures, policies, initiatives
  • Change in procedures, policies, equipment
  • High Risk areas
  • Problematic areas

Wright (2005)

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Children’s Healthcare of Atlanta

Background

  • The staff of the Pediatric Intensive Care Unit (PICU) at

Children’s Healthcare of Atlanta, Egleston consists of 118 nurses and 28 respiratory therapists.

  • Annual competency validation is composed of 4 hours

self-guided education and 4 hours class education with skill verification for high-risk, low volume skills.

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Children’s Healthcare of Atlanta

CSI Objectives

Main Objectives

  • To validate the staff

member’s ability to recognize risks to patient safety in a clinical setting using a scene scenario and simulation environment

  • To Receive feedback from

staff re: CSI experience

  • Minimize impact on non-

productive time (NPT) Participant Objectives

  • Mandatory Participation
  • Complete in 15 minutes
  • Record a minimum of 10

patient safety risks/errors

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Children’s Healthcare of Atlanta

CSI in PICU

  • The PICU PS&Q

multidisciplinary team identified patient safety risks for ICU patients

– Incident reports – New or Modified clinical procedures or processes – PICU quality initiatives – New policies or standards that needed reinforcement

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Children’s Healthcare of Atlanta

Errors to find from 6 Categories:

General & Medication Safety Bloodstream Infection Prevention Equipment & Procedural Accuracy Ventilator- Associated Pneumonia Prevention Pressure Ulcer Prevention 2012: CAUTI Prevention

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Children’s Healthcare of Atlanta

Team Involvement

  • Pharmacy
  • EMR specialist
  • Medication Safety

Specialist

  • System Quality Team
  • Quality and Patient

Safety Council

  • Professional

Development Council

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Children’s Healthcare of Atlanta

Examples of Simulation

  • Planned 30 nursing and respiratory errors for CSI

– Non-occlusive CVL dressing – Intravenous line contamination – Endotracheal tube insecure – Medication and infusion drip errors – Mislabeled specimen – Patient identification errors – Inadequate pressure ulcer prevention – Clamped chest tube – Pressure line management errors – Inadequate ventilator-associated pneumonia prevention – Isolation protocol errors

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What our Detectives Found…

  • Ventilator-Associated

Pneumonia risk

– Fish-hook on ETT – Condensate drains to patient – No mouth care kits available

  • Biohazard Waste Disposal

Errors

  • CLABSI Risk:

– Dressing – Line Contamination

  • Pressure Ulcer Risk

– Syringe under patient

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Children’s Healthcare of Atlanta

Challenges for the Team

  • Staging the scene

– Completed by 11 council members within 2 hours: full council participation

  • Maintenance of scene integrity

– Council members assigned to refresh scene during scheduled clinical shifts

  • Avoiding unintentional errors

– Review scene after first 20 observations to remove distracters

  • Patient Census

– Planned program during historically lower census period to use an unoccupied patient room for the scene

  • Feedback to participants

– Professional Development Council received list of scene errors and developed rationale with policy citation – Each participant received a copy of errors staged by the team, rationale, and their original scorecard

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Children’s Healthcare of Atlanta

Results:

20 40 60 80 100 120 140 160 180 Total Participants RN RCP 2011 2012 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 2011 2012

Evaluation Return Rate

Return Rate

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Children’s Healthcare of Atlanta

Time to Complete CSI

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10 20 30 40 50 60 70 < 15 min < 30 min <45 1h 2011 2012

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Children’s Healthcare of Atlanta

Completion Occurred

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10 20 30 40 50 60 70 80 90 During shift Before/after Come in 2011 2012

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Children’s Healthcare of Atlanta

Non-Productive Time For Competency Validation

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100 200 300 400 500 600 700 800 900 1000 Number of RN/RCP Staff NPT RN-i Total RN-NPT (I & P) Annual CSI

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Children’s Healthcare of Atlanta

Comments

0% 10% 20% 30% 40% 50% 60% Very Valuable Neutral Somewhat Invaluable Completely invaluable

How Valuable Was This Experience?

  • “What was the most

valuable?”

– “Fun & educational” – “Discovering details” – “Helped me to think about preventing mistakes” – “Increased awareness of errors”

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Children’s Healthcare of Atlanta

  • “What was the least

valuable?”

– “Little time-consuming, but worth it” – “Only having 15 minutes” – “Trying to do it during a shift”

  • “What recommendations do

you have to improve the

  • verall experience of CSI?”

– “Teaching beforehand” – “Live Simulation” – “Let us know the number of things we are looking for” – “Not so many errors, maybe focus on specifics”

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Children’s Healthcare of Atlanta

Conclusions:

  • Overall, CSI was viewed as a valuable educational experience

by staff based on evaluation comments and feedback.

  • CSI required minimal non-productive time.
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Children’s Healthcare of Atlanta

Implications for Practice

  • Cost-effective method of staff competency verification

to recognize clinical errors in a patient environment

  • Project may be replicated for other patient care

areas with adaptations to their patient safety and quality improvement needs

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Children’s Healthcare of Atlanta

Acknowledgements

David Heitz, Lori Emilus, Sarah Piland, Meghan F. Duggan, Lauren Derrigo, Bonnie Miler, Kim May, Sally Morris, Susanne Hannada, Charlene Cunningham

PICU Professional Development Council

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Children’s Healthcare of Atlanta

Contact information:

Charlene Cunningham Daytime Phone: 404-785-6424 Fax: 404-785-6593 Email: Charlene.cunningham@choa.org Meghan Fitzpatrick Duggan Work phone: 404-785-6006 Email: Meghan.fitzpatrick@choa.org