Volume 5
WHAT’Snew
Number 5
March 4, 2016
Pennsylvania Hospital
`` Cathcart nurses, Genalin Creticio BSN, RN CMSRN and Jennifer Cortese BSN, RN, easily locate supplies in the reorganized on-floor supply room.
PAH Nursing Tackles Supplies & Equipment Procurement Process Team evaluates process, storage layout and categorization to streamline efficiency and ensure easy access In late summer of 2014, Mary Del Guidice, RN, MSN, BS, CENP, chief nursing officer, was rounding with her staff and in typical fashion, concluded each meeting with one question: If you could change or improve one thing, what would it be?
INSIDE
The overwhelming response seemed to focus on the availability of and access to necessary supplies and equipment. During a single shift, PAH’s nursing staff relies on a diverse collection of items, from IV kits to batteries to commodes.
PAH Nursing Tackles Supplies & Equipment Procurement Process (cont’d).................................... 2
As a result of this feedback, a team of about 20 nurses and two outside consultants was assembled to evaluate the current process for procuring supplies and equipment throughout each shift. Typically, if something was not available on the floor, the nurse would either run to another floor to get it or call the Storeroom Department (SPD) to have it sent up.
Risk Assessment for Food and Nutrition Safety at PAH........................ 3
Overall, one of the biggest challenges was the time spent looking and waiting for supplies.
Red Phone Rings...Answer It!............. 3 PAH Department of Nursing Announces Sixth Annual Relationship-Based Care Awards..... 4 Heart Heroes are Celebrated at PAH...................................................... 4
“It could take up to a few hours to get something delivered from the store room,” said Deborah Drayton, RN, MSN, nurse manager of 5 Cathcart. “Often supplies or equipment would be brought to the floor on a dumbwaiter, would be left in a hallway or on a desk, and the nurse who needed it wouldn’t be aware it had been delivered. This added even more wait time to the process and we found it was not the most efficient system.” / / / Continued on page 2
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PAH Nursing Tackles Supplies & Equipment Procurement Process The team identified goals and objectives to fulfill during the evaluation, which included: • Improve overall efficiency of the supply and inventory turn-over process • Reduce total cost by streamlining supplies ordered and kept on each floor • Determine the correct level of unit inventory ensure supply was maintained at that level • Improve confidence in processes related to delivery of equipment and supplies • Reduce the number of special order calls • Track the number of special order calls made • Reduce time spent “hunting and gathering” by nursing staff • Provide educational program to increase competency in facilitation • Provide education to leaders and staff to demonstrate a new way to solve problems
In order to accomplish these goals, the group plotted the current method for requesting equipment and supplies using Post-It notes on the wall. Once it was presented visually, the need for change became increasingly more apparent. An “ideal state” line of communication was identified for most efficient access and delivery: supplies needed, request supplies, supplies received, supplies delivered. This allowed the team to create a new logical map and functional map which reduced communication redundancies and afforded nurses more time at the bedside. And, once a new line of communications and request process was outlined, the group reorganized, coded and labeled each floor’s supply room for ease of use. “Before, there were supplies everywhere will little rhyme or reason for placement,” Drayton said. “We went in and grouped similar supplies together, color coded labels and put the most used items closer to the door.”
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This seemed like a logical change to the staff, so the implementation was relatively easy for staff to adopt. The amount of supplies on each floor was also evaluated, inventory was checked, demand was tracked, and now the supply rooms on each floor better reflect the needs of those patients and staff. The color coding and relative grouping allows for quicker retrieval, and a master list of official supply names, color codes, and abbreviated names was created and given to the PAH store room to allow for more rapid identification and delivery of requested items. And taking the efficiency and process improvements one step further, now when an item is requested from the store room, the requestor’s name and patient name are taken and the item is delivered directly to the patient’s room with a confirmation of delivery being sent to the requestor. Following these changes, there was an immediate improvement. In December 2014, for instance, 12.9 percent of all supply or equipment needs on Cathcart 5 resulted in a call to the store room for that item. Since these changes, the number of supply request calls has been cut in half. And more dramatically on 7 Cathcart/ Preston, the calls dropped from 11.4 percent to 4.46 percent. The new procedures and organization tactics have been rolled out on Cathcart 4, 5, 6 and 7 as well as on 7 Preston with the ICU, 4 Widener and 6 Scheidt slated to rollout later this year.
responses to these changes have been overwhelmingly The positive,” said Drayton. “Our nurses are getting more time at the bedside and our patients are getting what they need more quickly.
Risk Assessment for Food and Nutrition Safety at PAH From care plans to room accommodations, patient safety is paramount at Pennsylvanian Hospital, and across the entire health system. In the 2015 fiscal year, the Patient Safety Director initiated a risk assessment to evaluate the current processes in the kitchen as way to continue ensuring that patients with documented food allergies receive meals in line with their dietary restrictions. To put it into perspective, anywhere from 270 to 300 patient meal trays are prepared during each meal time. Nearly 50 of those patient trays require a special meal as a result of dietary restrictions — that’s about 15 percent of the trays every meal! For three consecutive quarters, there were two events in each quarter where food allergens were delivered to a patient with a documented allergy. While this is a low occurrence — seven trays per 250,000 delivered — and no harm came to patients as a result, it is high-risk event. The risk assessment included a review of each allergy event by Food and Nutrition leadership and the Patient Safety Team came to the kitchen and completed observations by following a patient food tray from receipt of order in the diet office to delivery to the patient. The information was processed, mapped and validated with input from both Food & Nutrition and Safety. Opportunities were identified and immediate changes were implemented, including: • Supervisor tray check and sign receipt for all trays identified with a food allergy • The use of purple placemats for all meal trays with a patient allergy or dislike • Increased staff training for all new hires • New scripting for tray passers to review allergies with patients at the bedside at the time of tray delivery
The following recommendations are also being implemented: • Simulation at Food and Nutrition Safety annual skills fair for all tray passers • Allergy Test Trays • Capture days since last allergy event (Kitchen, Safety: DCI) • Formalize the Food and Nutrition Office scripting to hold tray for review if there is an event “As a result of these additional steps, specifically the new review scripting for tray passers, we were able to catch a potential allergy interaction before a tray was completed,” said Carolyn Tobin, director of Food & Nutrition and Environmental Services at PAH. “And, we’re happy to report that we’ve now gone more than 100 consecutive days without a food allergy related event.” The food and nutrition department worked tirelessly to ensure that the highest quality patient care and patient safety continues to be a priority at Pennsylvania Hospital. And to continue this effort, the food and nutrition team will host a simulation for those responsible for patient meals, including test runs and quizzes, to ensure each staffer is fully versed in the new safely process. Congratulations to the Food and Nutrition team for their work and dedication to patient safety!
RED PHONE RINGS….ANSWER IT! In keeping with PAH’s commitment to patient safety, the telemetry team has installed red emergency phones throughout the hospital to ensure rapid response in patient emergencies. Staff is being alerted and trained throughout the hospital, but the main message: If a red phone rings, answer it! When the call is answered, the patient in need will be identified by their room number and you will be instructed to send assistance. The instructions are able to be put into motion by all members of the staff, from nurses to food service workers to pharmacy personnel.
If a red phone rings, answer it! As always, the telemetry team will simultaneously send an alert to medical staff, but the red phones allow for an added layer of rapid response.
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PAH Department of Nursing Announces Sixth Annual Relationship-Based Care Awards Nominate a PAH nurse today! The Relationship-Based Care Awards were established to recognize clinicians throughout Pennsylvania Hospital whose practice reflects the tenets of Relationship-Based Care: Leadership, Teamwork, Professionalism, Care Delivery, Resources and Outcomes.
Any Pennsylvania Hospital team member, in the following categories, is eligible for nomination:
Relationship-Based Care is founded in the principle of organizing care around the needs and priorities of patients and their families in a caring, healing environment.
• C linical Nurse – Procedural/PACU/ DSU/PAT, Critical Care/ED/ICCU, Women’s Health, Operating Room/ Surgery Center, Med Surg/Resource Pool, Psychiatry/CRC/Hall Mercer, and Physician Practice/Ambulatory/ Infusion Center/IST
More information on eligibility and the nomination form can be found on the UPHS intranet, PAH homepage. Nominations will be accepted through Thursday March 17th and the winners will be honored at a Nurses Week celebration this May.
• Nursing Ancillary Staff • Nursing Team
Heart Heroes are Celebrated at PAH High five to the teams of Heart Heroes out there that work together to ensure that patients are cared for and comforted during every step of their journey. Our Cath team at Pennsylvania Hospital is an example of a group that delivers not only expert care to their patients, but is compassionate, patient and respectful. During complex cardiac procedures, having a team that works so well together is crucial. These are just a few of the many reasons that we are so lucky to have a team like this one: Dr. Eron Strum and nurses, Emma Cotter, Denise Curran and Therese Jones.
• Physician • I nter professional Team Member – Any Non-Nursing PAH employee • Advanced Practice Nurse • Clinical Practice Support • Nurse Leader – Clinical Director, Nurse Manager, NAC
WHAT’Snew EDITORIAL STAFF Abbey Anderson Editor Trissy Laurito Graphic Design Barry Ogburn Photography
ADMINISTRATION
Susan E. Phillips Senior Vice President, Public Affairs Holly Auer Director of Communications Sally Sapega Director of Internal Communications CONTACT WHAT’Snew at: Department of Communications Pennsylvania Hospital Philadelphia, PA 19106 phone: 215.349.4829 email: abbey.anderson@uphs.upenn.edu
PAH CARDIAC CATHETERIZATION TEAM 4
WHAT’Snew is published biweekly for PAH employees. Access WHAT’Snew online at news.PennMedicine.org/inside/whats-new.