1. Nurse Physician Partnership In Management of Critically Ill Children
Ndidiamaka L Musa MD FCCM
Associate Prof, Department of Pediatrics, University of Washington.
Pediatric Cardiac Intensivist, Seattle Children’s Hospital.
John Adabie Appiah Head, PICU KATH
Medical Knowledge FIESTA 2016
Accra, Ghana

2. Objectives
Current State of affairs
Nurse training
Physician attitudes toward nurses
The patient is the focus
Team based approach

3. Crossing the quality chasm in resource limited settings
A young school-age boy with severe respiratory distress presented to the remote hospital. Previously, the boy had been seen by untrained private clinicians in the community three times over four days. At presentation to the hospital, the child was evaluated by a mid-level practitioner who provided an initial course of antibiotics. Despite the child's ill appearance, supportive treatment including intravenous fluids and supplemental oxygen were not provided until discussion with the Medical Director three hours later. Later that evening, the electric nebulizer and oxygen concentrator became unusable after the hospital lost power owing to a blackout of the public electric grid and malfunctioning of the hospital’s backup generator. The regulator for the backup oxygen canister could not be found. At this juncture, without the ability to provide oxygen, the medical team recommended transfer. The family did not agree to transfer due to the high costs of other regional health facilities (the facility provides free services). That evening, after not being examined for over two hours by on-call staff, the child was found unresponsive with a thready pulse. For over 10 minutes the midwife managing the ward did not know the procedure and the bag valve mask was not at the bedside. Following 15 minutes of unsuccessful resuscitation, the child was declared dead.

4. Highly complex environment
Healthy Work Environments, Nurse-Physician Communication and Patient Outcomes
By Milisa Manojlovich, RN, PhD, CCRN, and Barry DeCicco, MS (Statistics), MS (Industrial Engineering)
IOM estimated that as many as hospitalized patients die each year from medical errors.
Errors in the ICU occur at a reported rate as high as 1.7per patient per day.
Highly complex environment
Conclusion nurse physician communication reduced medication errors
Am J Crit Care November 2007 vol. 16 no

5. WHO Report 2008
In 2008 report recognized a patient can be harmed as a result of a variety of factors and that understanding these and devising solutions to eliminate or minimize them would result in improved patient care. Among critical factors identified as global research priorities in the area of patient safety is the reported lack of communication and coordination between providers.

6. The high incidence of medical errors that results in a lack of safe care within the existing system
Most people view medical mistakes as an individual provider issue rather than a failure in the process of delivering care within a complex delivery system.
Disruptive behavior
Issues of inter-professional collaborations
Kohn et al 2000
The Joint commission (TJC) cites “Improving the effectiveness of communication among care givers as Goal 2 among the National Patient Safety Goals

8. Convert a team of experts… to an expert team!

9. Team Training…building competence to Excellence!

10. John Adabie Appiah Head, PICU KATH
Nurse Physician Partnership in Managing Critically Ill Children a Paradigm Shift
John Adabie Appiah
Head, PICU KATH

11. Physician - Nurse collaboration = improved patient outcome

12. Collaboration
The situation of two or more people working together to create or achieve the same thing
Oxford English Dictionary
Synonyms: cooperation, alliance, partnership, concert, association, gang up synergy, harness, tandem

13. Challenges to collaboration
Background
Similar training
Different emphasis
Same goal/target – better patient outcome
Working together cannot be over emphasized in PICU

14. Aviation –for a successful Boeing airbus flight
Team approach
Aviation –for a successful Boeing airbus flight
Pilots
Hostess
Engineers on the ground
All too often we don’t such teamwork in healthcare system where we have been trained to work as
Doctors issuing orders
Nurses carrying out orders
Barely make contribution during patient evaluation

15. Getting it right from the beginning
Need to respect each ones role and unique attributes
Football team analogy
Defense
Offence
Need to train together to understand how each member will play out
During formative training in respective school med and nursing schools
More interaction as a team
During continuous professional training
Sharing common meetings

16. Shifting attitudes – intensive care units
DCH - KATH approach
Initiated subspecialty training of medical personnel
Doctors mostly sent out to train including Ped Critical Care
APFP
PICU emphasis
Physician nurse team work by adoption of SBAR approach and Red Zone
Combined ward rounds
Team approach to incidence reporting and review together
Had reduced our number of adverse events
Increased confidence in team members

17. Communication – SBAR approach
For efficient and effective information transfer
S – Situation
B – Background
A – Assessment
R – Recommendation

18. Reducing errors together
Red zone concept
Incidence reporting and evaluation together.