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Slide 1
Slide 2
Theme Revving up for patient safety
Slide 3
PI-LDP The MRC Experience
Slide 4
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MRC Team Amanda Doty, RT(R) Gail Getzendaner, RN BSN Francine
Gory, MA CCC-SLP, CBIS Ryan Woodall, RRT RCP Advisors: MRC: Angela
Williams, RN BSN UMHS: Cindy Brooks, RN BSN
Brainstorming Got together as a group to choose a topic Lots of
ideas, hardest task to narrow down to reachable goal Needed
something that: Relevant to the entire group Would improve patient
safety Would be measurable
Slide 8
The Plan We would meet weekly (lunch meeting as time is
difficult to arrange) Travel time (3 1/2 hours each way to
Columbia) for brainstorming 1 st a project Aim Statement Before and
after surveys Policy Presentation
Slide 9
Project Focus Improving patient safety by ensuring a safe hand
off between disciplines when a patient leaves the unit for
radiology procedures.
Slide 10
Aim Statement We aim to improve the perceived percentage of
always completed patient handoff communication between selected
disciplines from 3% to 60% at the Missouri Rehabilitation Center by
January 28, 2010 to ensure patient safety.
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Addresses the safety needs of our patient population Meet the
needs of staff by improving communication Nursing Therapy Radiology
Demonstrate excellent service with our ancillary departments
Decreases potential costs by reducing errors and injuries Improved
patient identification, status changes, and identification of risk
factors Develop ment of PIT Stop form and hospital wide policy
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Timeline Aug 19, 2009 MRC team formed Aug 28 1 st meeting in
Columbia Sept 4 Aim Statement Draft Sept 28, 2009 Pre Survey Nov 16
PIT Stop Form Implemented Jan 19, 2009 Post Survey Feb 11, 2009
Final Aim Statement Feb 19, 2009Presentation in Columbia
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Narrowing it down Improve handoff between staff Lab Xray RT PT
OT ST RT Nsg H4 ICU H5 H5W H6 SBIU Improve handoff between staff
during procedures Lab Xray EKG Improve handoff between staff when
patient leaves the unit for Xray Xray
NeverOccasionallyHalf the time Almost Always AlwaysN/A 1. How
often is a handoff done before a procedure? 10 12 4 6 1 16 2. How
often is a handoff done after a procedure? 13 1 4 117 3. Do you
receive adequate information during handoffs? 9 10 3 6 3 18 4. Do
you feel like there is open communication between departments
during handoffs? 10 (42) 8 (43) 3 (11) 5 (21) 4 (9) 18 (69)
PreSurvey Results
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What information do you feel would be beneficial during
handoff? Any patient complaints? Medical information? Why the xray
is ordered? What is the patients diagnosis? Any precautions?
Functional level? Recent status changes? Isolation precautions?
Code status? Any problems during procedure? How did the patient
tolerate the procedure? Allergies (esp. contrast)? Fall/combative
alerts? Any family with the patient? How does the patient
communicate? When will results be available? Staff comments
included :
Do you receive adequate information during handoffs?
Slide 27
Do you feel like there is open communication between
departments during handoffs?
Slide 28
Return on Investment Patient Safety Benefits Improved
communication for patient safety Staff Satisfaction Increased staff
awareness of patient information
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Lessons Learned Start Small! Not able to implement a big task
all at once Include staff in planning process Allows staff buy-in
for performance improvement Obtaining valuable staff input Team
work and team motivation is needed in order to make process changes
Patient safety and process change can impact several areas
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In Summary As a team, we can make a difference for patient
safety and staff satisfaction This was a valuable project because
patient safety is an area that can always be improved Communication
is the KEY to patient safety Staff who recognize a need will be
more proactive in finding a solution Across the board staff felt
the need for improvement with communication during a patient
handoff.