Date of Award

Spring 6-6-2024

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chair

Cindy Dong

Faculty Reader

Cindy Dong

Faculty Reader

Bomin Shim

Executive Summary

Executive Summary

Background and Significance

Miscommunications during transitional periods of patient care can lead to medication errors, delays in care, patient harm, along with stress and burnout within the work environment (Appelbaum et al., 2022). From 2012 to 2017, approximately 1,744 deaths and a total of $1.7 billion in malpractice costs were related to a failure of communication between healthcare personnel (Joint Commission, 2017). Accurate, efficient, and effective policies and procedures within hospital organizations help keep both employees and patients safe (Halterman et al., 2019). Performing anesthesia in non-operating room (OR) locations poses distinct challenges compared with performing the procedures in the OR (Chang & Urman, 2016). At a large regional burn center (the agency) in the Pacific Northwest, wound care for burn patients is routinely performed as an anesthesia assisted procedure (AAP) throughout their hospitalization. Burn patients often have complex comorbidities and significant pain management challenges, complicating their interventional sedation procedures (Dimick et al., 1993).

Problem and Purpose Statement

There is a lack of evidence-based studies on whether standardized handoff processes for patient information and readiness for AAPs improves safety, efficiency, and patient and provider satisfaction. Standardized protocols such as communication and surgical safety checklists, have increased in healthcare settings in the last decade (Rakof et al., 2018). Although studies have dealt with the handoff process, few have focused on a readiness handoff checklist for non-OR sedation procedures, and even fewer involving burn patients. In 2022, the agency’s burn department program director performed audits of AAPs and determined that the process suffered delays and lacked consistent charting of the safety checklist that should occur prior to the start of an AAP. This project was a quality improvement (QI) project creating and implementing a standardized and collaborative electronic readiness handoff tool for burn patients requiring AAPs at the agency. Project aims: (1) develop a structured multidisciplinary readiness tool specific to burn patients requiring AAPs, and (2) examine the multidisciplinary team members’ perception of the communication effectiveness within the AAP process.

Methods

The design of this project was created by incorporating initial evaluation from creating a Fishbone Diagram, inspiration from The Social-Ecological Model, and overarching guidance from The IOWA Model. The QI project was ten weeks total: three weeks for pre-implementation survey, four weeks for implementation of the AAP readiness handoff tool, and three weeks for the post-implementation survey. The surveys were developed using the team functioning assessment tool (TFAT), a reliable and valid behavioral marker tool for assessing nontechnical skills that are critical to the success of hospital-based healthcare teams (Sutton et al., 2013). Education on the AAP readiness tool was provided by the primary investigator (PI) to burn center staff during staff meetings, and “just-in-time” education sessions using a step-by-step educational outline. For the intervention phase, the PI created a tool document specific to the patients’ scheduled for an AAP that day and disseminated the tool via Microsoft Teams for the providers and clinicians to input the patient specific data. All data collected was entered and analyzed using REDCap, a browser-based electronic data capture software designed for clinical and translational research databases. The qualitative answers to the pre- and post-implementation surveys were made quantitative using a 7-point Likert scale. Scores were broken down by role and tenure and compared by mean and standard deviation. A two-tailed paired t-test was performed on each of the averages by job role along with the overall average scores.

Results/Outcomes

The baseline measures were based on a voluntary response sample of 20 registered nurses (RNs), 11 non-OR anesthesia (NORA) providers, and seven burn providers, for a total n=38 respondents. Post-intervention, responses were received from eight RNs, six NORA providers, and three burn providers, for a total n=17 respondents (45% follow-up rate). Of the initial respondents, 22 participants (58%) indicated that they had been assisting with AAPs at the agency for more than four years. The overall perceived effectiveness of the AAP process increased by an average 0.86 points (14%) post-intervention (mean score), while overall satisfaction increased by 0.72 (12%). For perceived effectiveness, NORA providers showed the highest overall perception of improvement, at 1.08 points, with RNs averaging 0.84 and burn providers 0.46. Under the two-tailed paired t-test, all three results were significant to p < 0.015, with RNs and NORA providers significant to p < 0.001. The overall satisfaction increase was also non-negative; RNs reported the highest increase in satisfaction at 1.05, burn providers reporting an average of 0.76, and NORA providers reporting 0.53. The results suggest that a standardized and collaborative electronic readiness handoff tool for burn patients requiring AAPs at the agency improves the multidisciplinary team members’ perception of communication effectiveness. These findings echo the existing literature’s emphasis on using standardized communication tools in healthcare to improve communication and promote teamwork.

Sustainability

There are tentative plans to add the AAP readiness tool to the orientation packets for the burn department’s providers, nurses, and the NORA team. The burn department is exploring the potential of making the AAP readiness tool an educational resource or integrating it into the electronic charting system. Given that NORA procedures occur hospital-wide at the agency, and not only for burn patients, there is also an opportunity for the AAP readiness tool to be utilized by other departments. In the coming months, the intention is to submit the results of this QI project to medical journals focused on burn and anesthesia care. There is also potential to present the project results at the American Burn Association Conference in 2024. These efforts will continue to disseminate the results and insights gained from the QI project.

Implications for Practice

The vulnerability of burn patients and the current level of burnout and fatigue by healthcare staff have made the need for process improvement clear. The results of this project support a solution for improved patient outcomes in healthcare practices. Staff members who utilize the AAP readiness tool can expect improved time efficiency, enhanced safety, reduced burnout, and better communication – all of which align with leadership priorities. Furthermore, the QI project addresses gaps in the existing literature by demonstrating the positive impact of standardized readiness handoff tools in NORA procedures. This project contributes to the growing body of evidence supporting the adoption of standardized patient handoffs and pre-procedure checklists. On a broader scale, the QI project has the potential to influence health policy and systems by advocating for the integration of standardized communication tools into daily practice.

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