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Qip Project

1) The document describes a microsystem assessment of a medical-surgical intensive care unit (MSICU) that identified impaired interdependence of the healthcare team related to role confusion and strain from a lack of debriefing after codes, rapid responses, and strokes. 2) The proposed intervention is to implement a post-code debriefing tool to allow for more reflective learning opportunities after high-stress clinical events in order to improve team cohesion. 3) Key outcomes that will be evaluated include administering a post-code stress scale at baseline and after the debriefing intervention to assess its impact on team functioning and caregiver well-being. If successful, the program aims to apply the debrief

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140 views14 pages

Qip Project

1) The document describes a microsystem assessment of a medical-surgical intensive care unit (MSICU) that identified impaired interdependence of the healthcare team related to role confusion and strain from a lack of debriefing after codes, rapid responses, and strokes. 2) The proposed intervention is to implement a post-code debriefing tool to allow for more reflective learning opportunities after high-stress clinical events in order to improve team cohesion. 3) Key outcomes that will be evaluated include administering a post-code stress scale at baseline and after the debriefing intervention to assess its impact on team functioning and caregiver well-being. If successful, the program aims to apply the debrief

Uploaded by

api-490662977
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Improving Interdependence of the

Healthcare Team
Andrew Chittaphong, Marco Stevens Cota,
Michael Manns, Ella Nanci, and Troy Schmidt
December 4th, 2019
Overview of Patient Care Delivery System
Northwest Medical Center - Tucson
• Medical-Surgical Intensive Care Unit (MSICU), a 20-bed unit
• Code team consists of respiratory therapists, staff RNs,
charge nurse, house supervisor, and unit physician.
• Focus:
• Impaired interdependence of healthcare team related to
role confusion and emotional strain due to a lack of
debriefing after codes, rapid-responses, and stroke events.
Microsystem Model: Leadership
MSICU Leadership
• Charge RN leads in a laissez-faire style
• “Little or no control, motivates by support… does not
criticize, disperses decision making throughout
group.”
• Little direction as long as protocols are followed and
adverse events prevented
• Unit director empowers RN staff to promote autonomy
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model: Organizational Culture
and Support
Unit Management
• ICU director acts through democratic leadership
• Directed through suggestions and guidance, emphasis is on we,
constructive criticism
• Unit-wide meetings held weekly during day shifts to identify
needs of the unit and improve unit resources
• ICU is used as IV team, Code Team, RST team, and Float Pool

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from


http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model: Patient/Staff Focus of
Healthcare Delivery
Culture and Work Roles Listening and Caring
• ICU director does new hires • Unit RN organizes care
for the unit • Education on medications, lines,
• Six months of onboarding for interventions, and plan of care
new nurses • Clear and concise bedside handoff
• Staff required to complete • Clustered and timely care
continuing education • Medication reconciliation
• Staff ratio 2:1
• Bonus based on annual review
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model: Interdependence of Care Team
Trust, Collaboration, and Shared Purpose
• Nurses trust each other to help with assignments
• Unit focused on interdisciplinary teamwork (RSTs,
chaplain, ENTs, social workers, etc.)
• House supervisor and physician run all codes
• Code tasks delegated to unit RNs

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from


http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model: Use of Information and
Healthcare Technology
Integration of Information
• Cerner EMR
• IT support, Medication database built-in
• Auto-populating charting
• Patients can ask for medical records
• Limited workstation-on-wheels located around the unit
• Facility-wide phones for all staff, number list available at all
nurse stations
• Updated alarm system (bedside monitors, bed alarms)
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model: Process for Healthcare
Delivery Improvement Activities
Process Improvement
• Unit nurses are encouraged to continue education
• High-skill nursing tasks require education and certification
• i.e. CRRT requires in-hospital CRRT certification before
care can be given
• Unit outcomes are audited and areas of concern are
emphasized
• Grand rounds and ICU manager huddle during day shift
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from
http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Microsystem Model: Staff Performance
Patterns
Performance Results
• Benchmarks on the unit are constantly monitored or audited
• End-of-month unit manager/charge RN meetings
• Charge RN distributes information down to unit RNs
• Benchmark results and quality indicators posted on information
boards positioned around the unit
• Yearly peer performance reviews

Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved from


http://clinicalmicrosystem.org/uploads/documents/microsystem_assessment.pdf
Specific Aspect Targeted for Improvement
Post-Code Debriefing
• Interdependence of healthcare team related to role
confusion and strain due to a lack of debriefing
post-code, rapid-response, and stroke events
• The use of a debriefing tool led to more code debriefs
• Reflective learning

Gillen, J., et al.. (2019). The impact of a fellow-driven debriefing program after pediatric cardiac
arrests. BMC Medical Education, 19(272), doi: 10.1186/s12909-019-1711-y
Kessler, D. O., Cheng, A., & Mullan, P. C. (2015). Debriefing in the emergency department after
clinical events: A practical guide. Annals of Emergency Medicine, 65(6), 690-698.
Integrative Nursing Principle
Integrative Nursing Principle #6
● “Integrative nursing focuses on the
health and wellbeing of caregivers
as well as those they serve.”
● Includes reflective practices such
as journaling and debriefing

Kreitzer, M. J. (2015). Integrative nursing: Application of principles across


clinical settings. Rambam Maimonides Medical Journal, 6(2). doi:
10.5041/RMMJ.10200
Project Timeline
Months
0-1 1-3 3-4 4-12 12+

Project Administer Education Begin Evaluate


planning and Post-Code on debriefing intervention
goal-setting Stress Scale; debriefing intervention outcomes
assessment intervention and data and apply
of baseline collection hospital wide
scores on unit
References
Gillen, J., Koncicki, M. L., Hough, R. F., Palumbo, K., Choudhury,
T., Daube, A., Patel, A., Chirico, A., Lin, C., Yalamanchi, S.,
Aponte-Patel, L., & Sen, A. I. (2019). The impact of a fellow-driven
debriefing program after pediatric cardiac arrests. BMC Medical
Education, 19(272), doi: 10.1186/s12909-019-1711-y
Johnson, J. K. (2001). Clinical microsystem assessment. Retrieved
from
http://clinicalmicrosystem.org/uploads/documents/microsystem_asse
ssment.pdf
References
Kessler, D. O., Cheng, A., & Mullan, P. C. (2015). Debriefing in the
emergency department after clinical events: A practical guide.
Annals of Emergency Medicine, 65(6), 690-698.
Kreitzer, M. J. (2015). Integrative nursing: Application of principles
across clinical settings. Rambam Maimonides Medical Journal,
6(2). doi: 10.5041/RMMJ.10200
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and
management functions in nursing: theory and application (9th ed).
Philadelphia: Wolters Kluwer Health.

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