by Sean Power
July 14, 2014
Over the past several months, members of the patient safety community have suggested that the Physician-Patient Alliance for Health and Safety (PPAHS) host a podcast to highlight current work in opioid safety, venous thromboembolism, and alarm fatigue.
We thought it was a great idea. We love presenting PPAHS stories at conferences and on our website, and there is so much progress being made in patient safety by others, we thought a podcast would be a perfect avenue to share those stories, too.
Plus, the audio format of the podcast offers a unique advantage. We know from our website statistics that many of our supporters read articles during the morning and evening. With a podcast, you can learn about progress in patient safety on your commute or at the gym by loading the podcasts on your phone or iPod for listening later.
The PPAHS Patient Safety Podcast
With that, we would like to introduce the PPAHS Patient Safety Podcast. The PPAHS Patient Safety Podcast explores safety issues at health care facilities across the United States.
Focusing on opioid safety (pain management), venous thromboembolism (blood clots), and alarm management (noise fatigue), the PPAHS Patient Safety Podcast offers in-depth interviews with thought leaders, researchers, patients, and health care professionals from the field to bring a diverse set of perspectives on patient safety issues.
We’re testing the format, so please do not be shy about offering feedback. Reach our Community Manager, Sean Power, by emailing him at smpower@ppahsorg.wpcomstaging.com, to offer your thoughts on how we can improve the podcast.
Sharon Butler, Clinical Nurse IV, Perioperative Services, Stanford University Medical Center is our first guest on the PPAHS Patient Safety Podcast.
Ms. Butler recently implemented an improvement project to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE) by applying sequential compression devices (SCD) during pre-op, since research literature has demonstrated that early initiation of SCD helps prevent DVT/PE.
Listen to the full recording here.
See below for show notes.
If you like what you hear, be sure to subscribe to our iTunes channel.
Show Notes: Sharon Butler, Innovation SCD Use in an Academic Perioperative Setting
Download the poster presentation here.
Overview of the Problem
- When should sequential compression devices be started to prevent deep vein thrombosis/pulmonary embolism?
- Quality improvement project at Stanford looked into the question.
- Literature review found that the crucial time to start SCD in relation to surgical patients is 24 hours before general, epidural or regional anesthesia was started.
- In today’s world of to-be-admits and day-of-admissions, that was not going to be possible.
- Instead of starting SCD in operating rooms, it would be started during pre-op areas for the to-be-admitted patient population.
Starting Point
- This project would have the greatest impact on the pre-op nurse, who instead of disconnecting the device when the patient left after the surgical procedure to go to their recovery unit (ICU or PACU), the machine would have to continue with the patient.
- It would not have much impact on the inter-op nurse.
- Only change for recovery room staff: needed to make sure machine was going with patient at discharge from recovery room.
- Focused on pre-op nurse education.
- Pre-op nurse has tremendous amount of paperwork since pre-op is point of entry for at least 75-90% of patients today.
- Asking them to do one more piece of paperwork was impedance to the whole project.
- Equipment posed another problem: needed enough machines in the hospital to have the hospital’s processing staff turn over the machine in order to have the machines ready for patients in the pre-op room as well as in the operating room.
- As far as OR is concerned, they elected to leave a machine in the OR. Sometimes because of layout of room and amount of equipment, it was easier for them to maintain a machine under the operating room bed and quickly change the patient over; proved to be a good solution for the OR nurses.
- Learning curve for the OR nurses and resident staff to get them in tune with process—get the nurses and resident staff to stop disconnecting the patient after the procedure.
- For PACU, it actually turned out to be a positive experience for the PACU because when the patient enters the recovery area, the focus is not on that aspect of care; the focus is on the blood pressure and stability of the patient.
- Encountered stumbling block with the machines; had to ask VP Nursing to get more machines.
- Before starting project, discovered that they only had two sizes of sleeves, which was inadequate for their needs.
- Between very busy nurses and not enough equipment, it was actually quite a struggle to get the whole project implemented.
Success Factors
- Sharing information.
- Champion within the pre-op area.
- Investigate problems and solve them quickly (lack of machine? knowledge deficit?)
- Used the Perioperative Research Council constantly to look at why isn’t the protocol being followed.
- It became a core measurement for nursing in the hospital—helped people understand how critical this problem is.
- Patients know about DVT because it is discussed a lot in relation to long airplane flights; used this example to educate patients.
Size and Scope of Project
- 60 patients in 21 operating rooms on busy days.
- 12 ambulatory ORs, who probably do 45-50 patients.
- 300 professional staff that was involved with patient care in relation to applying the SCD devices (surgical technical staff, registered nurses).
- Distribution center had to add delivery times to their schedule to make sure they had enough machines.
Outcomes
- Some high-risk patients receive different treatments so they have no hard data that shows direct correlation between workflow change and patient outcomes.
- Improvement project has impacted the way nurses apply SCD to patients.
- The earlier you start SCD, the better off you are.
- Some studies underway on this subject.
- Two nurses on perioperative research council identified a knowledge gap not only for the nurses but for the patients as well.
- Developed two teaching tools: one for the professionals and one for the patients.
Getting the Patient On Board
- Simple matter of education.
- While wrapping patient’s legs in the sleeves, nurse would use the airplane explanation.
- Education and communication critical.
- When people see the evidence it is much easier to get buy-in.
Next Steps
- Collect data verifying gut feeling on personnel adoption rate.
- Work with individual people realizing that the majority has changed their pattern of behavior.