Medicine and Health Sciences Commons^™

Transition To Adult Care For Bleeding Disorders: Building A Multidisciplinary Tool, Leslie Larson, Ekaterina Funk, Dana Grass, Felicia Munster, Eric Larsen, Louise Baca, Glen Roy, Sara Artinyan

Operational Transformation

Youth with chronic illnesses often have poorer health outcomes after transitioning to adult care. Maine Health Bleeding Disorders is a Health Resources and Services Administration (HRSA) grant funded Hemophilia Treatment Center (HTC) that serves patients with congenital bleeding disorders. We provide multidisciplinary specialty care throughout the lifespan which includes pediatric and adult hematologists, family nurse practitioners, nurses, physical therapists, social worker, dietitian, genetic counselor, and research coordinator. In 2022, HRSA mandated all federally funded HTCs increase by 25 percent from baseline the number of individuals ages 12 to 26 years seen in a comprehensive clinic that have a health care …

Improving Access To Mainehealth Care At Home, Amanda Kunkel, Mhcah Intake Department, Mhcah Scheduling Department, Mhcah Clinical Leadership Team

Operational Transformation

It is known that there are capacity limitations at MaineHealth Care at Home caused by a decrease in staffing. This leads to limited availability of home health services to patients in the community and can also contribute to increased length of stay for patients in acute care hospitals. MaineHealth Care at Home needs a way to measure current capacity to accept referrals and improved systems for communicating with referral sources.

Team Engagement & Obstetrics Transformation Committee, Colette Dumais, Faye Weir, Lynn Willey, Kristen Heanssler, Brittany Babb, Suneela Nayak, Natalia Johnson, Rebecca Brookes, Obstetrics Transformation Committee,Maine Medical Center

Operational Transformation

Gallup defines employee engagement as the involvement and enthusiasm of employees in their work and workplace. Employee engagement helps to measure and manage employees' perspectives on the crucial elements of workplace culture. Based on over 50 years of employee engagement research, engagement employees produce better outcomes (better patient care) than other employees. Based on the unit survey, team members, with the support of local leaders, formed the Transformation Committee. This Committee was developed as a shared governance, team led model to address process improvement needs and create a culture of active engagement in problem solving.

Lean Daily Management: Keeping Quality And Safety At The Forefront During The Covid-19 Pandemic, Suneela Nayak, Ruth Hanselman, Natalia Johnson, Sydney Green

Operational Transformation

This storyboard describes how our Operational Excellence Platform pivoted to keep quality at the forefront of the Covid-19 response. Applying the Framework for Safe Effective and Reliable Care, we implemented the following innovations:

• Daily quality huddles became virtual, with 70-100 frontline leaders sharing alerts, announcements and celebrations
• Traditional Gemba Walks transformed into daily Executive Gemba Rounds visiting all care teams and focusing on patient and workforce safety.
• Patient and Workforce safety concerns were resolved real time and those requiring coordinated response were triaged to the Hospital Incident Command System (HICS) for accelerated action.

Innovative communication strategies were adopted to clarify …

Collaborative Strategies To Reduce Incomplete Operating Room Instruments Trays, Richard Neusch, Nicole Wagner, Colby Fike, Suneela Nayak

Operational Transformation

In an academic tertiary medical care center, the OR was receiving incomplete instrument trays. This issue became increasingly problematic in wasted staff time and cost to the institution.

Using a tracking system to generate a missing instrument report, baseline metrics were established. Reviewing each report, an interdepartmental team comprised of members of the OR and sterile processing departments, initiated a number of countermeasures.

Since the start of these countermeasures, there has been a reduction in the receipt of incomplete OR trays. Next steps include creating a tag process by which the OR instrument trays from one case would be kept …

Improving The Workflow And Partnership Between Registration And Clinical Staff In An Outpatient Urgent Care Center, Melissa Fairfield, Bailey Eells, Faye Collins, Joyce Cornish, Stephen Tyzik, Joy Moody, Wendy Osgood, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

An outpatient urgent care unit was experiencing challenges in balancing the need to register patients and delivering care in the timeliest manner as possible. Upon examination, it was found that delays were being experienced in patient triage and discharge that resulted in low patient satisfaction scores.

A team of providers was established to review all process steps and a quality improvement project was created to attain a goal of 100% of the time discharge would not be delayed due to incomplete registration.

Baseline metrics demonstrated current numbers of delayed discharges, median time from door to triage as well as door …

The Development And Implementation Of A Resource Nurse In The Float Pool: A Review Of The Literature And A Pilot Study Plan, Crystal M. Wiley

Interprofessional Research and Innovations Council

The Development and Implementation of a Resource Nurse in the Float Pool: A review of the Literature and a Pilot Study Plan.

Crystal M Wiley, BSN, RN, CMSRN

Background/Literature: It is pivotal that resources are available at the point of care allowing excellence in nursing care and exceptional outcomes. Currently, the staff have multiple resources to help with ethical dilemmas, patients who are unstable, and research. Discussion with leadership revealed a need for a support to busy units with a few newly hired staff and an interest in a resource nurse program to address these concerns and areas for improvement. …

Advanced Cardiovascular Life Support (Acls) And Obstetrical Critical Care (Ob Cc) Education For High Risk Labor And Delivery Nurses In Caring For Growing Population Of High Risk Patients, Tracey E. Mcmillan

Interprofessional Research and Innovations Council

Advanced Cardiovascular Life Support (ACLS) and Obstetrical Critical Care (OB CC) education for high risk Labor and Delivery nurses in caring for growing population of high risk patients

Tracey E. McMillan RNC, BSN

Clinical Nurse III

Labor and Delivery Unit Coordinator

BACKGROUND: Many studies show that an increasing number of pregnant women in the United States have chronic health conditions such as hypertension, diabetes, and chronic heart disease. The factors that place a pregnancy at risk can be divided into four categories: existing health conditions, age, lifestyle factors and conditions of pregnancy. The recent statistics from the Centers for Disease …

Improvement Of Chf Patients’ Fluid Restriction Education Through Self-Efficacy, Johanna Ruckey, William Fyler

Interprofessional Research and Innovations Council

Improvement of CHF patients’ fluid restriction education through self-efficacy

Johanna Ruckey RN and William Fyler BSN

Background: Dietary discretion through limited salt and fluid intake is an important aspect of heart failure (HF) management. Keeping accurate account of fluid intake has shown itself to be a difficult task, as both staff and patients often fail to do so on a fairly regular basis. Although staff are aware of a patient's fluid restrictions, there is a deficit in the patient's role in tracking their own intake. Patients often express confusion and frustration regarding their daily fluid intake, but also lack …

Did You Wash Your Hands?, Kelley Coyne

Interprofessional Research and Innovations Council

Did You Wash Your Hands?

Kelley Coyne, RN, OPD Maine Medical Center

Introduction: While there is great focus and education regarding the importance of hand hygiene among healthcare workers there appears to be less focus and education on the importance of patient’s hand hygiene. My observation, as a healthcare provider in pediatrics, is that patient’s compliance with hand hygiene is rare and it appears that there is a need to educate patients on the importance of hand hygiene. Hand Hygiene has the highest efficacy and is a cost effective measure for preventing infection. Researchers in London estimate that if everyone …

Increase Referrals To Medaccess At The Smhc Pharmacy, Sarah Jones, Kim Beaudoin

Southern Maine Health Care

Problem/Impact Statement: The MedAccess Program is losing referrals at point of sale in the SMHC Pharmacy.

Scope: Patients who are currently serviced by the SMHC Pharmacy that are uninsured or under insured and meet the % Federal Poverty Level for prescription assistance.

Reducing O Negative Blood Product Usage In A Tertiary Care Academic Medical Center, Wendy Weiler, Tracy Cook, Mmc Blood Bank, Mark Parker, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

MANAGEMENT OF O NEGATIVE BLOOD USE

O registered blood cells are the universal donor but it comprises only 7% of the blood supply. As a result, inappropriate use can result in shortages.

At an academic tertiary care medical center, a performance improvement goal was established that O negative blood cells would make up less than 12% of all blood type transfused by the end of their fiscal year.

A root cause analysis established reasons for the use of O negative blood cells. A number of countermeasures were initiated using the plan, do, study, act (PDSA) problem solving model. Using newly …

Patient Throughput Time In The Emergency Department: Can Obtaining Blood Specimens In A Pre-Hospital Setting Increase Timeliness?, Arielle Rancourt

Interprofessional Research and Innovations Council

Patient Throughput Time in the Emergency Department:

Can Obtaining Blood Specimens in a Pre-hospital Setting Increase Timeliness?

Arielle Rancourt RN

Abstract

The Emergency Department (ED) at Mid Coast Hospital currently follows a practice in obtaining blood specimens in-hospital by emergency department staff; this is done despite the ability of pre-hospital personnel to obtain specimens at the time of intravenous catheter insertions. Our current practice may not be the most effective and timely method. Studies showed that there was no increase in hemolysis of blood specimens drawn by Emergency Medical Services (EMS), and that laboratory results were received quicker when blood …

Statistical Forecasting Models Used To Predict Daily Patient Volumes In The Emergency Department: A Proposal For A Systematic Review, Jon White

Interprofessional Research and Innovations Council

Statistical Forecasting Models Used to Predict Daily Patient Volumes in the Emergency Department: A Proposal for a Systematic Review

Jon White, MS, BSN, RN, CCRN

Background: The existing and projected worldwide shortage of nurses requires numerous distinct solutions to prevent a healthcare crisis. Proposed solutions typically address the situation from different angles, including identifying ways to add new nurses to the workforce, or finding new ways to work with limited resources. This review examines the efficacy of forecasting demand in one area of the hospital, understanding the potential of its uses for short-term resource balancing and projection of need.

This …

Do Premature Babies Who Are Fed Thickened Liquids, Versus Those Fed Standard Feeds, Transition More Quickly To Full Oral Feeds? A Review Of Current Research And Evidence Based Practice, Donna J. Bisbee

Interprofessional Research and Innovations Council

Do Premature Babies who are fed Thickened Liquids, versus those fed standard feeds, transition more quickly to full oral feeds?

A Review of Current Research and Evidence Based Practice

Donna J. Bisbee, MA CCC-SLP, Speech Language Pathologist, MMC,

Department of Rehabilitation Medicine October, 2017

Background/literature : Babies born prematurely (prior to 37 weeks gestational age) experience a greater percentage of medical complications than full term babies. Chronic lung disease and gastro-esophageal reflux are particularly prevalent in this population and can contribute to delays and difficulties in learning to orally feed. Inability to efficiently and safely feed orally frequently contributes to …

Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic

Maine Medical Center

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less.

A root cause analysis identified several deficiencies to includelack of essential equipment, variations in

staff education and the absence of daily reminders.

Post KPI implementations, an overall decrease in the percentage of patients with poorly …

Aligning Opioid Prescribing Pathways, Andrea Lai, Outpatient Pharmacy, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Maine Medical Center

There is a drug epidemic sweeping the State of Maine and it continues to worsen each passing year. In 2017, the Maine legislature passed Public Law Chapter 488 to strengthen the controlled substance prescription monitoring program. An outpatient pharmacy, located in a large acute care hospital, created a performance improvement project to clarify opioid prescription and resolve any non-compliance with Chapter 488.

After a root cause analysis, several KPIs were established to include tracking the number of phone calls made by pharmacists to non-compliant providers to clarify scripts, provide one on one education and ultimately resolve non-compliance. Repeat offenders were …

Does Medication Safety And Diversion Education Improve Medication Securement Practices In Scu Compared To Current Practice?, Natasha R. Stankiewicz

Interprofessional Research and Innovations Council

Does medication safety and diversion education improve medication securement practices in SCU compared to current practice?

Abstract

Natasha R. Stankiewicz, MS, RN, NE-BC, CCRN-CMC

This safety quality improvement project began as newly hired SCU2 team members saw an opportunity to improve our medication safety practices and culture. The convenience of having certain medications directly available at bedside was priority. There was a lack of awareness and interest in securing medications within the department. However, the risk to our patients, families, visitors and colleagues when medications are left out, available and unsecured was apparent to new staff and others. Prior to …