Lessons learned from condition A (arrests) and condition C (respiratory event) episodes in the Radiology Department UNIVERSITY OF PITTSBURGH MEDICAL CENTER
Lessons Learned • The most at risk patient in the department was an inpatient, in a wheelchair, on oxygen (02). Unit patients came with a nurse, so they had closer supervision and fewer events. • Many of the wheelchair patients are from monitored units that go "off monitoring" during their trip to radiology and many have been only recently transferred from ICU's. Some were sent to radiology "on the way" to their new monitored stepdown unit from the ICU. • We needed to centralize inpatient reception, as there were several areas in which a patient in a wheelchair could be "parked" and forgotten.
Actions Taken • We formalized handoffs from nursing to transport to nursing of anyone on any sort of 02 • We initiated finger pulse ox to go on all patients on 02 • We initiated that all wheelchairs have a spare (full) 02 tank and that none ever reads below half. [There is apparently some drop in the actual delivery of 02 near the bottom of the tank.]
Transportation Department Statistics • Total of 72 fulltime and part time employees, including 15 employees from temporary services. • Average a total of 18,000+ transports per month. This number does not include SDS transports. • Transport in-patients and outpatients within the various buildings of the U.P.M.C. Oakland campus. These buildings include: PUH, MUH, Kaufman, Falk Clinic, EEI, and WPIC. • Transporters working an 8 hour shift walk more than 8 miles a day completing their assignments.
Oxygen TrainingRespiratory Care provided training classes for the Transportation Department on August 15, 2007 Education Included • Basic oxygen safety. • Proper oxygen flow levels specific to the oxygen delivery device • How the oxygen delivery device should fit the patient. • How to change a portable oxygen tank with a new tank and set the proper flow. • When it is appropriate to call a code.
Before & After T2R • Before - Transporters (Escorts) were staff who moved patients from point A to point B. We followed the same basic introductory, safety, and patient comfort criteria as today. We were just a means to get the patient where they had to go….We were the “Truck with Cargo”. At some destinations we just rang the “doorbell” and placed the patient’s chart in a chart holder and left the patient in the hallway. • After– Transporters now take responsibility for the patient’s safety during transport. We document that all safety and comfort needs are met before we begin our transport. We ensure that we put the patient into another’s care before leaving the patient at their destination…..Hand-off…..Not Drop-off.