1. Switching to Celsius Kimberly Montague RN, MSN Fishbone Diagram: Process Maps and Flowcharts: Global Aim: The global aim of this project is to improve patient outcomes by improving healthcare provider communication during patient transfer, shift report, and discharge. Reducing medical errors do to inaccurate translation of patient body temperature between Celsius and Fahrenheit during healthcare provider written and verbal communication within the microsystem. Specific Aim: The aim of this project is to accomplish clear and accurate patient body temperature reading and documenting exclusively in Celsius values. PDSA Ramps PDSAs Conclusions: Timeline: Acknowledgements : Janet Parr and Mercy Hospital Switch to Celsius Assess Make Change Facilitate Change Celsius only Fahrenheit & Celsius values are both accepted in the taking, communicating & documenting patient body temperatures within the microsystem. People Patients and Health care providers Surgical Services Department Equipment Changing all thermometers To read in Celsius only Methods Inform staff though: posters, meetings, and email of the switch to Celsius Strengths Standardized temperature collection Patient safety Weaknesses Staff resistance to a change additional training and support Threats Lack of motivation change is confusing change will slow down the efficiency Opportunities provide accuracy Improved time efficiency reduce confusion Inform & educate staff of the switch to Celsius Change equipment provide conversion charts Monitor change progress and support system change 10/2811/911/2012/112/5 Educate and inform staff at staff meeting of up coming switch to Celsius The switch to Celsius go live date Monitor and assess the progress of the switch (Survey) Informatics review of switch, assess macro- system readiness for switching to Celsius Starting the switch to Celsius process over again floor by floor in the hospital macro- system Environment Surgical Services: Pre-Op, OR, Post-Op, Same day surgery, & Endo Materials Posters Conversion charts Problem: SWOT Analysis: Switch to Celsius Educate Change ready plan change plan Celsius only Switch to Celsius Promote Change example Standardize Expand Celsius to all dept. Clinical Leadership Theme Enhanced patient safety through clear and accurate body temperature taking, reporting, and documenting, by all healthcare providers in the Celsius measurement structure within the microsystem. Plan Meet with Surgical Services/OR department heads Educate all healthcare staff to the upcoming change to Celsius. Meet with the head of anesthesiology, about the switch Change of the anesthesiology documenting paper forms to Celsius Make and disperse laminated conversion carts (Fahrenheit-Celsius) Make changes to the computer EMR Change all thermometers in the microsystem of Surgical Services to read in Celsius Do Make the switch to Celsius within the Surgical Services microsystem on 11/9/15. Study Take a Celsius readiness survey Assess the Celsius change patient care flow Take a post change survey of comfort with Celsius Assess the documenting Celsius efficiencies through informatics dept. Act Report project “Switch to Celsius” success to department heads Begin change steps with all department within the hospital macrosystem The switch to Celsius aids in clear care provider communication during shift change, during patient transfers, enhances patient flow, and care efficiencies that reduce hospital errors.

2. The objective of my project is to change the way the microsystem of the Operating Room Services (OR) takes and documents patient body temperature. Currently when a healthcare provider takes or documents a patient’s body temperature, it is left to the healthcare providers’ preference whether to use Fahrenheit or Celsius values. The goal of this project is to accomplish clear and accurate patient body temperature reading and documenting exclusively in Celsius values. Prepare the healthcare staff to the upcoming change to Celsius. Create laminated conversion tables to be posted at every computer and for all nurses’ tags for a reference guide. Continue to remind the staff that “Celsius is coming” through email, staff meetings, posters on bulletin board, and team huddle reminders. Communicate with the head of anesthesia to have him participate in the change project with his staff. Make paper-documenting changes for anesthesia. Change all the thermometers to read in Celsius only. A nurse survey was performed about the comfort level with Celsius, prior and post to the Switch to Celsius. 15 nurses were surveyed: Prior to the switch Very comfortable with Celsius 3 Somewhat comfortable with Celsius 2 Not comfortable with Celsius 10 Post switch Very comfortable with Celsius 10 Somewhat comfortable with Celsius 5 Not comfortable with Celsius 0 The Institute of Medicine (IOM) in hallmark reports (1999, 2001, and 2003) has highlighted human errors and financial burden caused by system failures in health care. The complexity and sophistication of today's healthcare environment led to a call for reform in both the education of healthcare professionals and health care delivery (American Association of Colleges of Nursing, 2007). Evaluating the success of my project of a Switch to Celsius was accomplished by running a random sample of the usage of Celsius documenting through the informatics dept. and through nurse surveys.

3. American Association of Colleges of Nursing. (2007). White paper on the education and role of the clinical nurse leaders. American Nurses Credentialing Center. (2005). Magnet recognition program instruction and application manual (2005). AACN. Godfrey, M. M., Headrick, L. A., et al. (2002). Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. Joint Commission Journal on Quality Improvement, 28, 472–493. Nelson, E. C., Batalden, P. B., Huber, T. P., Mohr, J. J., Godfrey, M. M., Headrick, L. A., et al. (2002). Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. Joint Commission Journal on Quality Improvement, 28, 472–493.