QI Project Idea – Comments Encouraged!!!

Hi All,

As you are all interested in patient safety/QI, I wanted to run an idea by this very talented group and see if you had any thoughts/improvements/additional ideas.

Background: At the Washington DC VAMC there is minimal communication between the house staff and nursing staff, often the two groups don’t interact all day.  One of the biggest hurdles that residents feel they must overcome is being able identify which nurse is caring for their patients and how to get a hold of them.  The current work environment yields fractionated and adversarial relationships with the patient’s medical team, hindering a patient centered approach to treatment.

Aim: To improve communication between nursing staff and house staff with regards to patient care

Intervention: On day one of the rotation, all house staff will be taken to each medicine ward floor and introduced to the nursing staff.  Each team room will also be supplied with a list of the nurses responsible for each patient daily.  House staff will be told (as they currently are) that all orders should be ordered electronically and communicated verbally to the nursing staff.

Results/Outcomes: The primary outcome of the study will be time interval between electronically ordered STAT medications and time that patient receives aforementioned medication. This study can be a three part study. Part 1 will be retrospective, where we will look at data from the previous year (prior to having house staff meet the nurses and have posted nursing assignments in all team rooms).  Part 2 will be the current intervention and part 3, will be in September 2014 when the Washington DC VAMC transitions to a geographic hospital (one resident/intern for one ward for the entire month)

Conclusion: I suspect that the time to medication administration will decrease with each subsequent intervention as communication increases.  We can look at time to order, time to pharmacy receiving order, time for med to reach floor and admin . . .

Any thoughts on how to better this study would be much appreciated.  Do you think a survey of the nursing/house staff prior to the study would be beneficial? Any other outcomes that should be looked at?