1. Using Lean to optimize clinical practice, staff satisfaction, and patient experience
Pediatric Perianesthesia Unit Project
Sara Woodbury MSW, PMP, LSSBB
Kristen Young MSN

2. What was the problem?
Too many pediatric patients were arriving in the OR without IV access established
WHY were pre-procedure IVs not placed?
No established standard for IV vs. mask induction
High anxiety of pediatric patients & families
Varying levels of staff expertise and confidence
Misperception about mask induction experience

3. How was the problem identified?
Nurse manager and anesthesiologist identified an opportunity to optimizing patient experience
Operational Excellence was asked to help
They wanted a framework for change—Lean

4. What were the goals? Establish & implement a standard of care
Patients ≥ 8 y/o to have IV insertion care bundle
Reduce defects (mask induction)
Baseline: 37%
Goal: 10%
Improve staff confidence and enhance skills
Optimize patient experience

5. What did they do?
An interprofessional team was sequestered for a 3-day Rapid Improvement Event

6. How did they do it? Mapped the current state Identified root causes
Developed countermeasures
Evaluated and selected high-value solutions
Managed the change with regular coaching and progress monitoring

7. How was the change managed?
Scripting for all staff
Daily Inter-team huddle
Change management
Leadership messaging
Daily support available
Weekly coaching from RIE leaders

8. What did the team implement?
Visual management to reduce interruptions
Flow of patients on white board
Signs for procedure in progress
Tactics to hard-wire the process
Peripheral IV order in EMR includes numbing cream
Comprehensive orientation to the new way
Periop nurses observe mask inductions
Brand the experience for all—the Lion’s Pledge

9. The Lion’s Pledge
A Therapeutic Approach to Pediatric Venipuncture MD

10. What else? 5S the Supply Drawers Implement care bundle
Use data to change par levels
Move all IV supplies to one drawer
Use picture to maintain proper order
Evaluate par levels periodically—change if needed
Implement care bundle
Numbing cream
Comfort positioning
Therapeutic distraction

11. Not-So-Comforting Position
Parent standing to the side, not engaged
Hovering over the patient
Patient forced to lie supine
No one engaged with the patient
Bed is too low, making it uncomfortable for staff inserting the IV
Leaning across patient

12. Comfort Position: Parent at Bedside
Parent engaged in support
Patient permitted to sit upright
Clinicians on separate side, at patient’s level
Patient engaged in distraction
Distractor on separate side

13. Comfort Positioning: Side Sitting
Parent as distractor, book on opposite side of clinicians
Clinicians on separate side, at patient’s level
Patient distracted & held by mother
Legs free to dangle

14. What were the results? Defects reduced—clinical practice optimized
Staff satisfaction improved
IV process is clear & easy to do
Baseline 14%
Post-RIE 85%
Patient experience enhanced
Weekly scheduled patients switched to IV induction
They’ve developed new coping skills
“I think I’ll have an easier time with lab draws now”

15. What was the impact? Patients Staff Organization
Patients and families asking for this care bundle when in other PSH care venues
“Frequent Flyers” ask for the “magic cream”
Staff
Increased skills and confidence with IV insertion
Expressed appreciate for a standard to follow
Organization
2017 Magnet surveyors recognized this interprofessional team and their framework for change
Differentiates our Children’s Hospital in the region

16. What questions do you have?

17. Thank you! We welcome your feedback…
Sara Woodbury
Kristen Young