Improving Quality and Safety in the ICU through the Introduction of A Procedural Checklist and Pause
CCCF ePoster library. Paramalingam V. 10/02/17; 198180; 18 Disclosure(s)(s): no disclosure
Ms. Vasuki Paramalingam
Ms. Vasuki Paramalingam
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Improving Quality and Safety in the ICU through the Introduction of A Procedural Checklist and Pause

Paramalingam, Vasuki; Baker, Andrew; Hall, David; Swift, Shannon; Williams, Michelle; Every, Hillary; Greco, Pamela; Smith, Orla.

Critical Care Department, St. Michael’s Hospital, Toronto, Canada

Background: While bedside invasive procedures are common in the ICUs procedure numbers and complexity are increasing.
A survey was completed by interprofessional team members within the four ICUs (TNICU, MSICU, CVICU and CICU) post various procedures indicated the need for improvement.  Role clarification among the team members, variable involvement of the interprofessional team members, lack of communication among the team members, family involvement and update, equipment medication issues as well as anticipation for any adverse events were evident. 

Objective: To improve patient safety during the execution of bedside procedures performed in the Intensive Care Units (ICUs) by creating and implementing an interprofessional procedural checklist and pause.
The tool will focus on a standard approach to preparing patients, family, and teams and will be a communication aid to assist teams during bedside procedures. 

Learning Outcomes:
By the end of the session, critical care team will be able to:

  1. Understand the importance of interdisciplinary collaborating during a bedside procedure in the ICU

  2. Understand the importance of role clarification and closed loop communication during a procedure in the ICU

  3. Understand the importance of engaging the patient and family in the bedside procedure

Method: To develop and implement a procedural check list and pause, a quality improvement approach using plan-do-study-act (PDSA) cycles was taken with the following steps:

  1. Create an interprofessional collaborative learning working group with representatives from four ICUs

  2. Scan current state of procedures that are completed in the four ICU’s

  3. Identify the procedures within the ICUs

  4. Review literature

  5. Develop procedure checklist and pause

  6. Engage stakeholders outside of critical care department

  7. Pilot protocol in all ICUs using simulation

  8. Use a multipronged approach to engage staff and educate

  9. Implement the protocol in all ICUs

Results: A pre intervention was completed in the ICUs. An interprofessional collaborative learning group was formed and a phased approach to the problem was adopted using quality improvement principles. A procedural audit tool was completed by 70 clinicians during 39 procedures, with deficiencies identified before, during, and after the procedure. As a result, the need for a procedural checklist and pause was identified. Plan-do-study-act (PDSA) cycles were defined to develop, implement, and evaluate a procedural checklist and pause with stakeholder involvement.  There are fifteen identified procedures in the Critical Care Department that will be utilizing the procedural pause and checklist.

Conclusion and Next Steps:  Audits will be conducted to evaluate the success of implementation and a staff survey will be conducted 6 months post implementation in all four ICUs. The feasibility of the tool will be audited to determine the outcome of implementation and changes will be made to the tool as needed.

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