Relocation of ORC to OR2 Svetlana Schopp, RN, CNL Student University of San Francisco November 2014

Specific Aim Relocate ORC to OR2 on September 3rd, 2014 Maintain safety & quality of patient care in new location Through effective interdisciplinary communication & collaboration Create process standardization

Background Measure C Women and Family Center GO bond, $98.5M Passed in 2007 To fund upgrades for campus Women and Family Center New construction Seismically compliant Planned completion 2016

Supportive Data FMEA – proactive identification of process failures (Appendix A) Extended transport time Communication among clinicians STAT cesarean sections (C/S) Staff education for STAT C/S Process Flow Charts STAT C/S during normal business hours (Appendix B) STAT C/S after hours, on weekends & holidays (Appendix C) Mobilizing patient to OR for C/S (Appendix D) C/S Process Algorithm (Appendix E)

Microsystem Status Relative to the Project SWOT Analysis (Appendix F) Internal Factors Strengths: skilled staff, continuity of care for C/S patients Weaknesses: longer pt transport time, unfamiliar location for OB staff External Factors Opportunities: improve communication, develop checklists for standardization, increase efficiencies Threats: loss of an OR for 2 years

Literature Search Strategies – based on highest severity of outcome Decision to incision STAT cesarean section Standards & recommendations Databases CINHAL Complete PubMed Scopus EBSCOhost

Summary of Evidence Mooney, Ogrinc, & Steadman (2007) Effective teamwork & communication to shorten decision to incision deRegt, Marks, Joseph, & Malmgren (2009) Collaborative interdisciplinary approach & teamwork to shorten decision to incision Bloom et al. (2006) Use sound clinical judgment to establish urgency in emergency situations Nielsen et al. (2007) Teamwork training shortens decision to incision in emergency

Apply the Evidence Maternal & Neonatal Safety Effective communication/collaboration Effective teamwork Sound clinical judgment EBP

Patients Stakeholders Anesthesiologists OB, OR, PAAS staff Obstetricians Pediatricians RTs Patients Definition of a stakeholder (engage audience) Who are the stakeholders in this process? (engage audience) Most important stakeholders? (patients) – (engage audience) SPD staff EVS staff PCTs

Business Case Patient transport to and from OR2: $10,271.2 (Appendix H) Potential loss of OR revenue at $33.12 per minute Potential for $$$ liability w/change in location Cost of PPH carts & extra C/S instrument set $6,000 Cost of labor for CNL $16,000 (based on 220 hours)

Timeline

Supportive Theory Unfreezing Changing Refreezing Kurt Lewin’s Change Theory (1951) To become motivated to change Unfreezing What needs to be changed Changing To make changes permanent Refreezing

Results/Outcomes As of November 16th, 2014: 26 C/S, 10 elective Have maintained safety & quality of patient care Delays on elective C/S Suction for newborn resuscitation Support person waiting area PPH & operative delivery

Recommendations Continue Plan-Do-Study-Act cycles Adjust practices as needed Improve efficiencies in elective C/S Standardize PPH & operative delivery processes

Clinical Nurse Leader (CNL) Role Master’s prepared nurse Not advanced practice Able to practice in any healthcare setting Focuses on: Quality improvement strategies Outcome based practice Interprofessional communication Care coordination Toolkit: FMEA, SWOT, PDSA, EBP, Summary Brief

Thank you!