[PDF] 7/18/2016 1 BEDSIDE TELEMETRY MONITOR SCANNING





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7/18/2016

1

BEDSIDE TELEMETRY

MONITOR SCANNING

STEVEN MCPHERSON, BSN, RN

Lessons

LearnedSuccess

StorySETTING

23Bed

CombinedICU/PCU15Bed

SurgicalSpecialtyUnit

24Bed

MedicalSpecialtyUnit13Bed

ObservationUnit

Centralized

Monitoring

Station

Cardiac

Monitors

Cardiac

Monitors

Prefense

(VitalSigns)

Monitors

Prefense

(VitalSigns)

Monitors

Prefense

(VitalSigns)

Monitors

PROBLEM

FailureModeandEffects

Analysis

Monitors

added/removed without communication

Monitornever

calledinto centralstation

Wrongmonitor

onwrong patient

7/18/2016

2 IDEA

Barcode

scanning

Bedside

verification

Inventory

management

ASSIGNING

MONITORS

Physician

order generates notification

Monitor

scannedinto electronic intervention inEMR

Onespecific

monitorasset number assignedto eachpatientfor theirentirestay

ASSIGNINGMONITORS

ASSIGNING

MONITORS

7/18/2016

3

MONITOR

BROUGHTTO

BEDSIDE

CAPTURINGINFORMATION

LogisticalDataRepository

Scanning

Activity

Monitor

Channel/

Asset#

Demographics

Cardiac

Rhythm

Current

Orders

Inventory/

Handoff

Reports

Patient

REPORTS

Functions

•Handoff •Inventory •Discontinuation

Readiness

•Order

Management

Compliance

•Decrease

MonitoringErrors

•Acuity/Census

Trends

7/18/2016

4

DOWNSTREAMEFFECTS

ReportsGrantFacilityWideViewof

MonitoredPatients

PromoteChargeNurseAuditingand

ConversationswithPrimaryNurses

MonitorsDiscontinued

Faster/PatientsDowngraded

MoreTimelyReduceStaffTime

andEfforts 2013)

DecreaseDivert

HoursandEDHolds

100%Scanning

ComplianceAt

ControlCenter

100%

Immediateand

Routine

Bedside

Scanning

ChargeNurse

andLeadership

Auditingfor

Compliance

IdealFutureState

BreakdownsIn

Process

Staff

ResponsibilitiesDocumentation

Compliance

LackofAuditing

ScanningVersus

ManualEntry

Documentation

Accuracyand

Compliance

MoreStrict

Documentation

ParametersPatientSafety

Workarounds

7/18/2016

5

WORKAROUNDS

Amixedmethodstudy

performedata470Ͳbed

Midwesternacademic

tertiaryhospitalidentified

15workaroundtypes

performedbynurses duringbarcode medication administration.These workaroundsrelated directlytoonesformed aroundtelemetrymonitor scanning(Koppel,

Wetterneck,Telles,&

Karsh,2008)

Omission

ofProcess Steps

Unauthorized

ProcessSteps

Steps

Performed

Outof

Sequence

SCANNINGCOMPLIANCE

Original

Captured

Query

Entered

QueryVerified

Scanned

Scanneras

anInput

Device

Requested

ValueApparent

toEndͲUser

BedsideNot

Necessaryto

Complete

RequiredFields

GETTINGCREATIVE

BACKEDINTOACORNER

7/18/2016

6

BARRIERSTOEFFECTIVE

PROCESSES

LowStaff

Engagement

intheProcess andit'sEffect onthePatient

PrimaryNursesNotScanning

InitiallyandEveryShift

ChargeNursesNot

RoundingtoAudit

MonitorTechniciansNot

FollowingProperProcedure

Decreased

PatientSafety

relatedto

NonͲ

Compliance

FalseSenseofSecurity

HOWISTHISFIXED?

RealͲTime

Auditingand

Rounding

FormalNewHire

TrainingCaseStudies

PostedIdeal

Workflows

PERCEPTION

Piscotty,Lawrence,&Targosz,2013).

Beliefthat

theprocess increases patientsafety

Compliancewith

processsteps

PositiveOutcomesrelatedto

safety,reducedcosts,andpatient satisfaction

Lessons

LearnedSuccess

Story

7/18/2016

7

REFERENCES

barcodemedicationadministrationsystems:Theiroccurrences,causes,andthreats to 535
quotesdbs_dbs26.pdfusesText_32
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