Thursday, April 5, 2012

Using Technology and Standardized Work to Make Care Easier and More Reliable

Once again, GBMC clinical and non-clinical staff are collaborating across departments in an effort to put the patient first and make management and discharge of patients as efficient and effective as possible.

Recently, 55-inch and 40-inch monitors were installed at the nurse’s stations on units 35 (Acute Care for the Elderly) & 38 (Telemetry) in a LEAN/Kaizen discharge initiative being coordinated by Nursing Administration and MIS staff.  Soon, all inpatient units will have these screens, which display the patient teletracker data and replace the old wipeboard (which will now be used only during downtime).

Caring for patients efficiently requires a team effort. If it’s your daughter waiting for a bed in the emergency room, you want her to move as soon as possible to the floor. You want the team caring for her and her room to be ready. Coordination in a complex system is critical. It wasn’t so long ago that logs were kept on paper of which patient was where, which room was clean and which room needed to be cleaned. We then began keeping track in a computer database but we had a hard time giving up the paper logs.

The existence of both systems often meant that neither was correct. The hospital computer system would say that Mr. Smith was in room 3501 but the nurses on the floor knew that he had moved to 3510 and the erasable board on the wall documented this. Some people would update the computer before the whiteboard. This lack of standardized work and people believing that it was ok to do things the way that felt right to them was actually making the job of patient care harder. The nursing supervisor would see an empty bed in the computer but because the system was unreliable, she would have to call the floor to see if it were true. Think of all the added steps and rework!

Coordinating efforts is much easier with standardized work and the correct use of technology. The pharmacist can see from the pharmacy who has been discharged. The food service worker in the kitchen can see that a new patient has arrived. The accurate  information available in realtime plays an integral role in helping all members of a patient’s care team be on the same page. The new screens make the information more readily visible to the team and allow us to synchronize our efforts. For example, when transport moves a patient from the unit for testing elsewhere in the hospital (i.e. Interventional Radiology), the teletracker will show this so everyone involved with that patient’s care knows where he or she is.

I believe that the work of a nurse on a medical unit is among the hardest jobs there is.   We must make sure that we remove steps in the nurse’s work that are wasteful. Using technology, like the 55 inch monitors, and standardized documentation of patient movement is a step in this direction.

Maria Baxter, RN, Unit 35’s Clinical Unit Coordinator, agrees. “Now the information is updated in realtime making it much easier for the staff. Often the staff is so busy around the unit that the wipe boards just were not updated as often as they needed to be,” she said.

Do you have other ideas where using technology and standardized work in the hospital might improve operations?

Congratulations to Unit 35 Staff

I’d be remiss if I didn’t extend congratulations to the staff of Unit 35, who have gone a year without a Central- Line  Associated Blood Stream Infection (CLABSI).  At GBMC we are participating in a national collaborative called "CUSP Stop CLABSI" (Comprehensive Unit Based Safety Program). Along with U35's tremendous accomplishment, it is important to note that housewide, GBMC has gone 134 days without a central line associated bloodstream infection, our longest stretch since housewide surveillance began!  Great CLABSI prevention work has been happening on all patient care units and our patients are reaping the benefits. The CDC estimates 41,000 CLABSI cases occur in United States hospitals annually and these infections are serious and cause a variety of problems for the patient, so anything we can do to reduce and eliminate these incidents will keep our patients safer.

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