Perianesthesia Quality Improvement Council

Minutes
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Purpose: Bi-monthly Meeting Date: March 27, 2013
Present: Becky Wiseman, Kacie Sims, Gabrielle Shamsabadi, Barbara Krumbach, Chris Woodman, Lynne Ochoa,
Julie Altmix
Time: 14:15 1530
Absent: Location: AOP 2111
Guest(s): Raelyn Nicholson Chair: Nicole Babu

Next Scheduled Meeting: May 22, 2013 Recorder: Vivian Parry

AGENDA ITEM ISSUES/DISCUSSION ACTIONS
RELATIONSHIP TO
MAGNET COMPONENTS
Pre-op instructions
(Medications)

Chris Woodman/Valerie Watkins
Medical backing for nurse instruction
Current process reviewed by Becky and Chris; followed by
discussion
Becky has prior protocol


Develop protocol for PAT (pre-
anesthesia testing) clinic/program
Trial rollout scheduled for June
More information to follow

Exemplary Professional
Practice
POUR (Post Op Urinary
Retention)


Raelyn Nicholson

PowerPoint presentation Post OP Urinary Retention
o System standardization
o Signs and symptoms
o Measurement levels and barriers to measuring
o Focus on risk factors, i.e., patient safety issue
o Patient voiding before they going home
o Surgical/anesthesia focus
o Review current process
o Other area focus
Started in October
Audits results showing well received
Raelyn Nicholson distributed:
o Is patient at risk for POUR?
algorithm
o MD order set screen shot
Automatically selected
Raelyn pursuing education with
physicians
Has Risk Management and Quality
improvement recommendation
Contact Lynn Ochoa re GI current
practice
Develop into guideline for HUB
New Knowledge, Innovations,
and Improvements
Perianesthesia PSN trends

Jennifer Livingston/ Nicole Babu
Hospital wide:
Mislabeled blood samples i.e., initial(s) missing
More than one patient sample in a bag
Smeared writing
CNA cannot sign off
Outpt can be 2
nd
signoff on blood
RN able to sign off
Use ball point pens

Empirical Quality Outcomes
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AGENDA ITEM ISSUES/DISCUSSION ACTIONS
RELATIONSHIP TO
MAGNET COMPONENTS
Sleep Apnea

Barb Krumbach
Met with respiratory to discuss what is reasonable care plan
Periop guidelines for ASA published in October, 2013

Dr. Jamison is working on order set
Modifying guidelines
Exemplary Professional Practice
Discharge home/24 hour person
with patient

Becky Wiseman/ Nicole Babu



Discussion points:
Have surgery schedulers call in addition to preop call center
Reason to be in observation
Cancellations/Hospital loss/Increased Medicaid population
Discharge instructions to responsible adult
Joint commission requires patient discharged to responsible adult
Switch to first case
Case manager/social worker assignment
Sedated patient
Literary support
Evidence of after 24 hours safe
Home health to check on them
Nurse direction/responsibility/discharge paperwork i.e., signature
Track how often this occurs
Cost of keeping patient overnight
Discharge lounge availability/Four CVC beds
Met with Mary Anne Sherman
Julie will meet with Sue West to
discuss administrative support
Encourages SIs
Revise discharge instructions with
color to be noticeable
Hospital reviewing continuity of care



Exemplary Professional Practice
Pre-op /Perianesthesia
documentation

Jennifer Livingston


Tabled to next meeting

Exemplary Professional Practice
SSI bundles


Nicole Babu/ Jennifer Livingston

Carol Ruscin and Cathy Kleiner s roll out in 2012
Reinvigoration
Next bundle is surgical spine rolling out May 1
OBGYN slotted for late summer
Eventually all services to rollout
Roll out total joints bundle April 1
Product and PreOp order set is in
Barb doing education
Prioritized by NHSN
Gabby will notify her group
New Knowledge, Innovations, and
Improvements
Pediatric Policy

Chris Woodman
Comfortability with evidence banding patient and parent
Standardization/common practice
Discharge concerns
Need to do banding education
Nikki Bach wrote PreOp policy
Chris will check age criteria
Have Nikki come and report
Barb will look into policy match
New Knowledge, Innovations, and
Improvements
Hot topics/Misc






Perianesthesia Policy Process
Final approval goes to Ashleys guideline group as a clearing
house and gets posted on the PeriOp website i.e., blocks
utilization, anesthesia awareness, etc.



Code in parking lot taken to ED

Co-chair
Comes to QI committee first
PPPPC are last to review
guidelines/policies that affect other
areas in the hospital
Committee will own guidelines, etc
Look for guidelines/ policies, etc to
update for submission.
Check to see if code patient had
procedure done
Gabby will fill co-chair position
Exemplary Professional Practice