Rapid Access for Patients Imminent Delivery (RAPID) Project

 

Best available evidence shows that the decision to delivery interval (DDI) and emergency caesarean section (CS) should be no more than 30-60 minutes if maternal or fetal compromise is to be prevented.

Bentley Health Service (BHS) identified delays in getting Category 1 and 2 patients to theatre for emergency CS. Audit results for Sept 2018 to February 2019, showed that 22 Category 2 patients were over the recommended 60 minutes DDI and two Category 1 patients were over the 30 minute DDI for an emergency CS.

Aim

To decrease DDI for Category 1 CS patients to less than 30 minutes and Category 2 CS patients to less than 60 minutes.

Method

Implementation of a comprehensive bundle of RAPID interventions included:

  • Staff education using high fidelity simulation scenarios and power point presentations with embedded procedural videos.
  • The development of a Standard Operational Procedure (SOP)
  • a dedicated flexible theatre
  • Assigned emergency theatre team in-hours
  • Introduction of new paging distribution group for Category 1 and 2 CS
  • Modifications to theatre infrastructure to create a ‘RAPID’ bay
  • Streamlined after hours communication processes.

 

Results

Overall

  • 31% (n=258) of births (pre/post) resulted in a C Section
  • 46% (n=52) required an ECS at pretest
  • 33% (n=47) required an ECS at posttest.

 

Category 1 Patients:

  • Average RAPID time from DDI to ECS was 35 mins
  • Only 1 ECS was required at pretest
  • 38% (n=3) of RAPID Cat 1 patients had a DDI < 30 mins.

 

Category 2 Patients:

  • Average RAPID time from DDI to ECS was 53 mins
  • 51% (n=20) of RAPID Cat 2 patients had a DDI < 60 mins

 

Conclusion

  • All intervention strategies were successfully implemented.
  • RAPID practice has now been established at BHS.
  • Cat 1 and 2 caesarean now seen as an emergency (call 55)
  • Results showed slight improvement from DDI to ECS but further embedding of RAPID is required.

Jude Cuff, Royal Perth Bentley Group, Perth WA. Judith.Cuff@health.wa.gov.au

Jo Cable, Royal Perth Bentley Group, Perth WA.  Jo.Cable@health.wa.gov.au

Erin Ashbolt, Royal Perth Bentley Group, Perth WA. Erin.Ashbolt@health.wa.gov.au

Does Immersive Medical Emergency Treatment Response Simulation Improve Self Efficacy?

A medical emergency team (MET) response requires an integrated and coordinated approach if optimal patient outcomes are to be achieved. Enhanced learning through simulation training has been used successfully to improve both technical and non-technical skills of clinical staff responding to medical emergency response scenarios.

Aim

The aim of this project was to evaluate the self-efficacy of inter-professional clinical staff who participated in a high fidelity simulation based MET response session.

 Methods

A posttest only design was used to evaluate the impact of high fidelity MET response simulations on confidence levels. In 2018, clinical staff from three hospitals participated in MET crisis resource management (CRM) training using immersive simulation. Data analysis consisted of descriptive statistics and ordinal logistic regression modelling.

Results

There were 326 participants, 58% (n=189) were medical officers and 42% (n=137) nurses. Self efficacy was rated using a five point Likert scale with regard to:

  • Managing a clinically deteriorating patient
  • Participants’ role in a MET response
  • Participants’ CRM knowledge
  • Participants’ technical skills
  • Applying non-technical skills such as leadership, communication etc in an emergency.

The MET CRM simulation outcomes showed significant associations with improvements observed in all five confidence measures. Findings showed that confidence levels for MET role response and CRM knowledge significantly improved amongst staff who reported lower levels of confidence prior to undertaking the MET CRM simulation (p-value < 0.001).

Conclusion

The findings from this study provide evidence that MET CRM simulation training greatly enhanced the self efficacy of clinical staff who participated in simulation training. In particular, strong positive effects were observed for participants’ self efficacy with regard to their MET role responsibilities and knowledge of crisis resource management principles.

Kylie Fawcett    Royal Perth Bentley Group, Perth WA Kylie.Fawcett@health.wa.gov.au

Phil Vlaskovsky  University of Western Australia Perth WA Philip.Vlaskovsky@uwa.edu.au

Jeanne Young Royal Perth Bentley Group Perth WA   Jeanne.Young@health.wa.gov.au

Two Person IV Medication Administration

nurses working with patient
Background:

This project aimed to evaluate the safety, efficiency and cost of a two person independent IV medication administration procedure to the bedside compared to current single person IV medication administration. A secondary objective was to capture the frequency of interruptions during the IV medication process.

Methods:
A randomised controlled design using direct observations at pre and posttest was undertaken to capture IV medication administration data on four clinical areas at a major public tertiary teaching hospital. Medication safety culture was also assessed along with the time taken to administer an IV medication and the frequency of interruptions during this process.

Results:
A total of 310 IV medications were observed being prepared and administered with a total of eight errors (3%) identified across both the intervention and controlled wards. Across both the intervention and controlled wards there were low numbers of IV medication errors observed which were further corroborated by low numbers of IV medication clinical incidents reported. Findings revealed that there was no conclusive evidence that using a two person IV administrative check to the bedside was any safer than using a single nurse administration.

Fifty four percent (n=167) of IV medication administrations were interrupted between 1 and five times, with a total of 305 interruptions observed. The top reasons for interruptions included; to discuss a patient (n=76; 26%) followed by a request from a patient or relative (n=46; 15.8%). Mean medication safety culture scores were positive indicating that staff regard medication safety as important. Timing of IV medication preparation and administration were collected with a mean time of 11 minutes required to prepare, check and administer IV medications in this sample of patients. To contextualised this finding, for every 100 IV medications administered the extra five minutes required to have a second nurse check the IV medication to the bedside equates to an additional 8 hours and 20 minutes of nursing time required.

Conclusion:
The safety net of double checking IV medications remains questionable with definitive findings as to the benefits of this procedure not able to be verified by this project. The reinforcement of independent rather than collaborative medication checking is warranted to ensure that medication checks are completely impartial to outside influences. Finally, any interruption during medication preparation and administration should be viewed as detrimental to patient safety. As such staff and patients need to be made aware of the fact that interruptions can lead to medication errors.

 

Comprehensive Care Making Health Care Delivery Safer

                                                  

The WA Nurses Memorial Charitable Trust has awarded $10,000 to the Comprehensive Care (CC) Project led by Dr Heather Kidd, Nursing Director Safety, Organisational Learning and Development at RPBG.

Comprehensive Care (CC) is a service innovation for the provision of continuous and collaborative care whereby patients, families and the health care team work in partnership to achieve the best possible health outcomes for the patient.

International studies of CC in the acute care setting found that CC:

  • improved patient satisfaction
  • improved shared decision making and goal setting
  • reduced length of stay
  • reduced hospital readmissions
  • reduced inpatient mortality
  • reduced hospital acquired complications (HACS).

Hospital Acquired Complications are identified as clinical complications that are significantly preventable and are a national priority area. Hospital Acquired Complications occur in 1 in 9 patients who attend Australian hospitals with the annual cost of  HAC in Australia is estimated at $4 Billion for public hospitals.

 

The CC Model Project aims to reduce not only HACs but mortality and readmissions by further integrating health care delivery across all professions. Specifically, this project aims to improve team work and communication, redesign workflow to reduce duplication and enhance patient involvement. The research project aims to commence in the new year and will continue till mid 2021.

 

 

 

Implementation of Visual Risk Alerts at Royal Perth Hospital (RPH).

RPH recognised that there were significant gaps in how the risk of patient aggression was communicated to staff, in particular those with limited or no access to patient documentation, electronic patient information systems or verbal handover.

The RPH Aggression Prevention and Intervention and Research portfolios undertook a study into systems that alert staff to the risk of patient aggression.  This study was supported by grants from the RPH ‘Foundation for Nursing Research’ and ‘Nursing Fellowship’.

One of the recommendations from the study was to introduce signage that would visually alert both clinical and non-clinical staff to the risk of aggression.

This has now been introduced, supported by a Standard Operating Procedure and Education

A recent survey has been undertaken to audit the visual alerts against the SOP and a further survey is planned to assess the effect of the alerts on the original identified staff groups.

In the interim, the feedback from staff has been very positive in enabling them to identify risk, ask for a verbal handover of the behaviour of concern and any triggers / relievers and precautions required.

Patricia Tibbett recipient of the John Curtin Medal 2019

The John Curtin Medal is named after the Right Honourable John Curtin, Prime Minister of Australia from 1741 to 1945, who is recognised as one of Australia’s greatest statesmen.

The medal is awarded by Curtin University to people who have exhibited John Curtin’s qualities of vision, leadership and community service and who have made a significant contribution in their chosen field. It is the University’s highest non-academic honour.

Patrica was recognised for her outstanding contribution to the  nursing profession and to health care delivery in Western Australia.

RPH Ex Trainees & Association Inaugural Travel Grant 2019 awarded to Jonathon Burcham RN

The RPH Ex-Trainees & Assoc. (Nurses who trained at Royal Perth Hospital before Universities educated nurses) have announced their Inaugural Travel Award.

The award will assist Jonathon Bucham RN to  attend the 2020 International Conference for Emergency Nurses in Queensland to present on sepsis research at RPH. Jonathon is keen to share his experiences with colleagues upon returning from the conference.

He is the Clinical Nurse Manager for the Centre for Clinical Research in Emergency Research; he is a member of the College of Emergency Nurses Australasia and a member of the EMHS sepsis Working Committee-responsible for the design and implementation of the EMHS sepsis pathway across Armadale and Royal Perth Hospitals.

Congratulations Jonathon.

 

Magic of Nursing and Midwifery

The magic of nursing and midwifery was celebrated at the Nursing and Midwifery Awards celebration at Royal Perth Hospital in November.

Congratulations to the following nurses and midwives that were acknowledged for their commitment to excellence in service, a commitment to delivering high-quality care to our patients and having a can-do attitude.

RPBG Nurse/Midwife of the Year – Amy Lee RN

Tom Sten Award-Doug Downes, EN

RPH ExTrainees Association Travel Grant– Jonathon Burcham

Graduate Transition Program Award: RPBG Graduate of the Year – Rhiannon Carpenter RN

SWEETest  Nurse – Supportive Work Environment, Education and Training: Fiona MacDonald NE

SWEETest Ward – Supportive Work Environment, Education and Training: Imaging Nurses-Ward of the Year

Congratulations again to our winners and finalists and thank you for the magic you bring each day to our staff and patients.

 

Latest News! Nursing Research Foundation Grant 2018 has been awarded

nurses working with patient

Congratulations Royal Perth Bentley Group – Amazing Nursing and Midwifery Care Project which is the recipient of the 2018 FNR Grant

The Foundation for Nursing Research (FNR) has awarded the Amazing Nursing and Midwifery Care Project a $10,000 grant. The principal researchers on the grant are Dr Heather Kidd (RN), Dr Lucia Gillman (RN), Ms Dori Lombardi (RN) and Ms Maha Rajagopal (RN).

The aim of this nursing research project is to enhance nursing care by standardising the delivery of nursing team work and implementing initiatives such as bedside handover, shift safety huddles, a no pass bell call protocol and intentional rounding.  The project will undertake a robust evaluation of these five core initiatives across the Royal Perth Bentley Group.

Dr Heather Kidd, Nursing Director of Organisational Learning & Development stated that,

“Nurses work in a dynamic and complex environment and team work is a critical component in the delivery of high quality, patient centred care. This FNR funding is critical to improving and evaluating the care we provide to our patients.”

Doreen McCarthy Grant

This inaugural joint funded grant between RPH Nursing Research Foundation and the RPH Medical Research Foundation has been awarded.

The successful research project is Hospital Discharge Stage 2. The team, led by Associate Professor Michelle Kelly, will built on the findings of the pilot programme. The Management Committee of the Nursing Foundation congratulates  the team on winning this  Grant.

Doreen McCarthy completed her nursing training at RPH 1958. She was appointed to the position of Director of Nursing at RPH in 1990. During her period of tenure as Director of Nursing, major changes in the administrative structure of the hospital were introduced. She participated in the establishment of the original East Metropolitan Area Health Service, and the introduction of the new divisional structure at RPH. Doreen also identified the need for the establishment of the Nursing Professorial position at RPH.

Prior to her time at RPH Doreen played a key state-wide role in the implementation of the current nursing career structure. This new structure emphasised, amongst others, the key role of the Clinical Nurse, Clinical Nurse specialist and the Nurse Researcher positions.

On leaving RPH in December 1994, Doreen under took consultancy work for the Health Department of W.A. In 1999 Doreen was approached by the Vice Chancellor of the University of Notre Dame to establish the School of Nursing at Notre Dame, where she was appointed the Professor of Nursing, undertaking the establishment and development of the new nursing