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Innovations in Performance Improvement and Quality in PPMC Emergency Department

This report outlines the Performance Improvement (PI) and Quality Improvement (QI) initiatives implemented at the PPMC Emergency Department led by Martin Manno and Allen Fasnacht. It highlights their multidisciplinary approach, emphasizing collaboration between nursing and medical staff, and adherence to evidence-based practices. Key focus areas include pain re-assessment, moderate sedation, and behavioral restraints. The report discusses mechanisms for identifying improvement opportunities, fostering leadership, and ensuring patient safety while setting quantifiable compliance goals.

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Innovations in Performance Improvement and Quality in PPMC Emergency Department

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  1. PPMCEmergency Department Performance and Quality Improvement Committee Martin Manno, Clinical Nurse SpecialistAllen Fasnacht, Nurse Manager January 3, 2008

  2. PI/QI Innovations in the ED at PPMC • Purpose/Objectives: • The terms “performance improvement” (PI) and “quality improvement: (QI) are used interchangeably • PI/QI provides a means to initiate, monitor and improve care delivered to patients in the Emergency Department • The PI/QI Plan and related processes allow for a systematic approach to focus on the aspects of care most critical to patient safety

  3. PI/QI Innovations in the ED at PPMC • Scope/Responsibilities: • PI/QI in the ED follows a multidisciplinary approach with a close collaborative relationship between the nursing staff, medical staff and others • The Shared Governance model in the ED will implement the PI/QI Plan through the ED Unit Leadership council • Performance Improvement and Quality • Evidence-Based Practice and Translational Research • Professional Development and Education • Leadership and Stewardship

  4. PI/QI Innovations in the ED at PPMC • Organization/Processes: • Priorities are identified by hospital and departmental leadership • All staff may have input regarding opportunities for improvement • Seek and clarify current knowledge of processes • Explore and understand root causes and failure modes • Apply the PDCA improvement cycle • Plan • Do • Check • Act

  5. Nursing PI/QI Focus • Focused Performance Areas • Pain Re-Assessment • Moderate Sedation • 1:1 Constant Observation • Restraints for Behavioral Management • Rationales • Patient safety risk • Frequency versus acuity • Problem prone

  6. Nursing PI/QI Focus • Sample Sizes: • Pain Re-Assessment: 70 charts/month • Moderate Sedation: 100% • Constant Observation: 100% • Restraints for Behavioral Management:100% • Quantifiable Metrics/Compliance Goals: • Pain Re-Assessment: 90% • Moderate Sedation: 100% • Constant Observation: 100% • Restraints for Behavioral Management:100%

  7. Indicators: Pain Re-Assessment • IV versus PO or other interventions • If no medication, why? • If medication was given, was it re-assessed timely? • If not reassessed, why? • EMTRAC and other enhancements

  8. Expanded EMTRAC Triage Pain Assessment

  9. Pain Tool for ED Rooms & Triage

  10. Indicators: Moderate Sedation • Flow sheet, consent, procedure & site verification form • Pre-sedation checklist and assessment • Procedure assessment • Personnel in room and Pause for Safety • Vital Signs and I/O • Signatures • Aldrete Scoring System • Patient Discharge Disposition • Recovery noted in nurses note • Moderate Sedation discharge instructions • Noted for follow-up by NP • Reversal agent used • Admitted

  11. Indicators: 1:1 Constant Observation • Safety Observation Record: • Constant Observation (1:1) • Suicide Precautions • Demographics: Age and gender • RN assessment: • Specifics (Cognitive, behavioral, motor, delirium) • Alternative interventions • MD order and nurse signature • CNA Documentation • RN documentation in EMTRAC • Includes suicide risk assessment

  12. Indicators: Restraints for Behavioral Management • Demographics: Age and gender • MD order/reorder • Progress Note: Restraint/Seclusion for Behavioral Management • Alternatives, interventions and evaluation documented • Release of restraints/seclusion • Debriefing and RN signature • Restraint and Seclusion Behavioral Observation record • Care criteria indicated • Staff and RN initials and signatures • RN documentation in EMTRAC • Includes suicide risk assessment

  13. Improvement Interventions • Continued reinforcement of pain re-assessment criteria • Implementation of pain tools in triage and patient rooms • Inservice regarding expectations for care of the patient receiving moderate sedation • Inservice regarding expectations for care of the patient requiring constant observation (1:1), suicide precautions or restraints for behavioral management • Communication of all results on the ED Performance Improvement bulletin board

  14. PI/QI Next Steps • How do we want to distribute the data collection responsibilities? • Which areas of focus do we distribute? • Do we assign project leaders? • Development of 2008 PI/QI Plan? • Other questions??????

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