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TEAMwork Boards in the PICU
Lauren Smith, MSN, RN, CPPS Cara Gallegos, PhD, RN Bev Holland MSN, RN, NEA-BC
A little about us…
• The only Children’s Hospital in Idaho. • A recognized Magnet® designated organization. • Beds
• 61 NICU Boise and 12 NICU Meridian • 39 medical-surgical
• 11 hematology-oncology • 13 PICU
All of our rooms are private with adequate area for family members to remain at the bedside.
The PICU Team
Darcie Ineck, BSN, RN Jim Percy RN, CCRN Lauren Smith, MSN, RN, CPPS
TEAMwork Boards
• Concept developed by Dr. Michael Leonard and colleagues (2010).
• Consists of three colored sections: red, yellow, and green.
• Foster frequent problem solving via a visual management tool that supports identification and timely resolution of simple to complex problems.
5
Department Driven
Department Driven
Department Driven
Department Driven
Staff & Patient Safety
TIP Process Metrics
Service Quality
Productivity
Financial Performanc
e
Department and Org.
Goals
Why TEAMwork Boards
CEO
VP
Director
Manager
Supervisor/Lead
Front Line Staff
IMPROVED PROBLEM SOLVING (PROCESS STRUCTURED and ORGANIZED around TEAMwork)
After leadership has
set the strategic goals
Frontline staff Supervisor/Lead
Manager Director
VP CEO
Tactical/ Operational
Strategy & Direction
Patient 1st every time
The Pilot TEAMwork Board
Critical Medication IV Drips Current State
MD writes medication order
RN faxes order to pharmacy
PharmD views via Omnilink
PharmD enters order on pt profile in Siemens
Generated label prints in IV room
Medication mixed in IV room
RN verifies order in MAK (compare to MD order)
Medication delivered via STAT tube or Omnicell
fill
RN receives/ collects drip
RN documents med admin in MAK
RN spikes/ connects & primes tubing RN programs IV pump
RN contacts pharmacy when next dose needed if drug not ava/ can't
find in dept
If no bolus on order, call MD
Content of MD order varies
Frequency isn't updated
Pharm D's vary in calc of vol
STAT tube Verified before
confirmed
Verified, but incorrect
Meds ava in dept 2 hrs
Change bag to syringe
Vary in VTBI programVary in
tubing use
Most calls are urgent
Critical Medication IV Drips
MD writes medication
order
RN faxes order to pharmacy
PharmD views via Omnilink
PharmD enters order on pt profile in Siemens
Generated label prints in
IV room
Medication mixed in IV
room
RN verifies order in MAK (compare to MD order)
Medication available in
PICU
RN receives/ collects drip
RN documents med admin in
MAK
RN spikes/ connects &
primes tubing
RN programs IV pump
Before next dose due, RN verifies ava. in
PICU
Action: Create and utilizestandard MD order sets for critical drips
Action: ALL of MD order will be entered into pt profile
Action: Frequency calculation for max rate and max bolus (volume-‐based)
Action: STW for "VerifyingCritical Drip Orders in MAK
Action: -‐ Initial fill via tube or already ava. in Omnicell-‐ Subseq. doses fill ava. in PICU 2 hrs before due (in Omnicell or patient drawer)
Action:Standardize IV tubing for critical drips (includes quad setup)
Action:STW for "IVPump Program for Critical Drips"
Future State
Standardized MD Orders
Results • Promote employee engagement in continuous improvement
• Promote continuous improvement as a daily activity
• Consistent use of the red/yellow/green section to facilitate problem solving
• Promote visual management, allowing anyone to quickly review performance in key areas
• Minimal blank spots on board (information relevant to the department)
• Provide structure for daily huddles
• Daily huddles efficient way to update staff
Results
0%
10%
20%
30%
40%
50%
60%
Strongly Agree
Agree Neutral Disagree Strongly Disagree
The TEAMwork Board has Made a Positive Impact
POST
0%
5%
10%
15%
20%
25%
30%
Strongly Agree
Agree Neutral Disagree Strongly Disagree
My Ideas and Suggestions are Seriously Considered
PRE
POST
Patient Experience & Outcomes
Charge RN CPU Access
IV Line Labels
Nor
-Epi
Kits
Routine Med Availability Pr
int f
rom
Mos
aic
AD
MR
Os from
OR
18 Posted
10 Solved
Keys to Success
• Ideas are encouraged, welcomed, and expected
• Submitting ideas is simple
• Evaluation of ideas is quick and effective
• Feedback is timely, constructive, and informative
• Implementation of ideas is rapid and smooth
• Ideas are reviewed for additional potential
• People are recognized and success is celebrated
• Idea system performance is measured, reviewed,
and improved
Transforming a Culture
Allow time to integrate continuous improvement as a part of how we do our jobs.
Develop mutual trust and keep an open mind.
Actively participate. Be a problem solver.
Recognize the good work people do to identify
problems and correct mistakes.
Make a personal commitment to change and apply TEAMwork knowledge, skills, and tools into your daily
work activities.