Upfront

Coding the project in the language of Poetic License

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The Idea

PEWS is a validated tool for identifying patients at risk of deterioration. In room handoffs have been identified as resulting better outcomes. Currently handoff report for transfers from PICU are done by phone. Adding a joint PEWS assessment of the patient at the moment of transfer of care  from PICU RN to Acute Care RN  may provide several benefits.

The San Diego Consortium for Evidence Based Practice runs an annual Institute (the EBPI) for training nurses in use of Evidence Based Practice to improve Care and Outcomes. Examining the utility of PEWS as tool within the handoff process fits within the core strategy of the hospital for reducing patient harm. Developing a project with support of EBPI was approved.

The Benefits

  1. Decrease in the return of patients to PICU after transfer to Acute Care Units.
  2. Better Handoffs
    1. Identification and rectification of weakness or omission from the hand-off report.
    2. A matched understanding of the patient condition ( which will still be viewed through a different lens appropriate to the acute care unit)
    3. An early opportunity to address changes to patient care, RN patient assignment, or orders to optimize treatment and care according to patient condition.
    4. Improved understanding of the perspectives on patient care and the workflow of RNs between Critical and Acute Care Units.
  3. Real Time documentation of a basic patient assessment on arrival to acute care floor.

The PICO Question

Does using PEWS when patients are transferred from PICU to Acute Care Floors facilitate handoff communication between PICU and Acute Care nurses, resulting in increased nurse satisfaction with handoffs, and in decreased return of patients to PICU within 48 hours, compared with the usual method?

Project Tasks

– Development and Education

  1. Test Runs on the Joint Assessment Process
  2. Education on PEWS scoring – for PICU RNs
  3. Education on the Joint Assessment and documentation for  RNs in: PICU, Medical Rose, 4E, 3E, &hemOnc.
  4. individual surveys for – how’d it go for after transfer

– for Satisfaction Outcome Measure

  1. Pre-Intervention Surveys for RNs in: PICU, Medical Rose, MBU, 4E, 3E, &hemOnc.
  2. Post-Intervention Surveys for RNs in: PICU, Medical Rose, MBU, 4E, 3E, &hemOnc.

– for Return to PICU Outcome Measure

  1. baseline data for PICU admissions, transfers, and return to PICU
  2. Identify the changes in returns, or initial sends to PICU since initiation of PEWS
  3. collect data after intervention – figure out if anything changed significantly

Desired though not necessary to Dos

    li>Changes in Epic to simplify scoring of PEWS automatically
  • Changes to the Transfer Report to include a sign-off for completion of transfer