Abstract
Background:
Our Respiratory Quality Team identified five quality areas that offered the most opportunities for improvement in our respiratory department, based on monthly quality data, chart audits, staff survey, and incident reports (ONS). Our "fab five" areas needing improvement were the following: VAP/VAE (Ventilator Associated Pneumonia/Ventilator Associated Events), UE (Unplanned Extubations), TOC (Transfer of Care), PUP (Pressure Ulcer Prevention), and Trach cleaning/processing.
Methods:
The Carnival station learning opportunities were completed, followed by an interactive game for the staff member to participate in for a small prize: 1. Trach journey: steps for trach cleaning and returning trachs to patient bedside were reviewed due to several gaps in processing steps by respiratory therapist. 2. UE: focused on evidence-based practice to collaborate with nursing to focus on ETT placement. 3. PUP: an increase in pressure ulcers was identified this station focused on how to identify the different stages of pressure ulcers, documentation of pressure ulcers, and how to support the patient post ulcer acknowledgement. We also displayed the different devices and options for patients with pressure ulcers. 4. VAP/VAE: several gaps in RT EPIC documentation were identified and these learning opportunities were reviewed as well as a review of the definition of VAP/VAE. 5. TOC: Gaps in transfer of care were identified and were focus points at this carnival station, as well as a comprehensive review of TOC expectations for all RTs.
Results:
Per our quality data, chart audits, and ONS reports, our department improved in all five quality areas by the end of 2019. More importantly, we saw a decrease in our UE rates. Our UE rate per 100 vent days for 2019 was the best in Children's Healthcare of Atlanta history. In 2018, our UE rates in the NICU was 1.10, in 2019 it decreased to 0.77.
Conclusions:
This event was a huge success, with over 100 RTs (from all CHOA campuses), more than 20 SR RNs and 10 SR RN leaders in attendance. The decrease in UE was the best in CHOA history. There were vast improvements in PUP EPIC documentation. Additionally, the station that won "voted best station" was PUP. Our RT Quality committee plans to host this event again this summer, during our "down season", in an effort to gear up for "busy respiratory season" that typically starts at the end of August until the following spring.
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