NUR-45100-100 Technology Proposal Project-LG

By georgeangel226 | Updated: Feb. 5, 2023, 6:18 a.m.

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Standardizing and Enhancing the Pre-operative Checklist & Nursing Hand-off
The Power of All
Technology Proposal Project
Presented by Luis George ADN, RN
Background/Issue: 
As a high-reliability organization (HRO), we should always attempt to identify ways we can improve our patients and families experience.
Every month, we provide care to approximately 3,000 pediatric patients. This is about 85-90 patients per day. 
Often times, each nursing checklist and hand-off documents are misplaced, incorrect, or not individualized to the patients needs. 
Our Pre-op nurses are overloaded with several checklists, hand-offs, paging primary care providers, and verifying surgical consents while simultaneously expected to provide direct patient care. 
Why is this important? 
“Preoperative care is a critical, yet complex, time-sensitive process. Optimization of workflow is challenging for many reasons, including a lack of standard workflow analysis methods” (Zheng et. al., 2020, paras. 1). At our institution, there are multiple versions of preoperative nursing checklists and hand-off paper documents. This includes the emergency department (ED), acute care units, intensive care units (PICU, CCU, and NICU), and preop department. 
What are the advantages of using an electronic nursing checklist/hand-off?
Preoperative care standards are met.All interdisciplinary team members can visibly see the standardized checklist in EPIC.Increases communication between providers throughout the entire organization.Increases patient safety, and direct patient/family interaction and care time.Provide proper patient and family education regarding care or discharge instructionsContinuity of care
The advantages
 are endless!
What has research shown? 
A recent study was conducted to evaluate how effective electronic hand off checklists versus paper format. “Clinicians who reported using the checklist in at least two-thirds of their handoffs reported higher satisfaction with quality of communication at handoff (P = 0.003). An electronic checklist improved relay and retention of critical patient information and clinician communication at intraoperative handoff of care” (Agarwala et. al., 2015, paras. 5-6)
Another recent study was conducted at Northshore University Healthcare systems about incorporating an electronic checklist versus paper form. “Compliance increased from 48% (n = 167) to 92% (n = 1,037; P < .001) after the SSC was integrated into the electronic health record. A comparison between risk events in the pre- and post-rollout period showed a 32% decrease (P < .01). Hospital-wide indicators including length of stay and 30-day readmissions were lower. The World Health Organization SSC is a validated tool to increase patient safety and reduce intraoperative complications” (Gitelis et. al., 2017, paras. 3-4).

More Research
How can we get started? 
Partner with our EPIC vendor representative, nursing informatics specialists, acute care units,  intensive care units (CCU, NICU, PICU), emergency department, operating room, and pre-op department. For instance, nursing leadership, charge nurses, bedside nurses, clinicians , child life specialists, etc. 
Collaborate with team members to standardize and pilot an electronic version with EPIC. Provide EPIC education to all staff members after checklist is finalized.

Although each unit's checklist varies, went ahead and combined a few components from each unit. 
Our current workflow
Possible New Pre-operative Checklist Example
Both images are examples of what our new electronic nursing checklist and hand-off may look like. These are just starting examples.

The electronic checklist could help reduce the risk of error as well as increase our patient's safety. 
Example (continued)
What do you think we could add?

We can all make a difference. 
Are you up for the challenge? 
Any thoughts or questions?
Still have questions? No worries.

Contact: Luis George
Email: georg162@pnw.edu
References:
Agarwala, A. V., Firth, P. G., Albrecht, M. A., Warren, L., & Musch, G. (2015). An electronic checklist improves transfer and retention of critical information at intraoperative handoff of care. Anesthesia and analgesia, 120(1), 96–104. https://doi.org/10.1213/ANE.0000000000000506Gitelis, M. E., Kaczynski, A., Shear, T., Deshur, M., Beig, M., Sefa, M., Silverstein, J., & Ujiki, M. (2017). Increasing compliance with the World Health Organization Surgical Safety Checklist-A regional health system's experience. American journal of surgery, 214(1), 7–13. https://doi.org/10.1016/j.amjsurg.2016.07.024Zheng, L., Kaufman, D. R., Duncan, B. J., Furniss, S. K., Grando, A., Poterack, K. A., Miksch, T. A., Helmers, R. A., & Doebbeling, B. N. (2020). A Task-Analytic Framework Comparing Preoperative Electronic Health Record-Mediated Nursing Workflow in Different Settings. Computers, informatics, nursing: CIN, 38(6), 294–302. https://doi.org/10.1097/CIN.0000000000000588

NUR-45100-100 Technology Proposal Project-LG

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