Transforming Transplant Intensive Care Unit and Transplant Telemetry: A Leadership and Staff Collaboration
Embracing the words of John Wooden, a legendary coach, “The transplant units are in the midst of changes aimed at improving their work environment.” These changes are aimed at improving the ability to deliver excellence in patient care and patient satisfaction in the Transplant Intensive Care Unit (TICU). Change is not always quick and speedy, but as patient advocates transplant nurses are by nature tenacious and willing to do what is necessary to achieve better patient outcomes. The work of their implementation process and change begins with the collaboration of leadership and staff.
Michael Payne, administrative director, TICU and Transplant Telemetry, describes his unit as “staff-run!” He views his job as helping his staff gain what they need to make their jobs run smoothly. As evidence of this process, he explains multiple projects that his staff wanted to improve by making changes on the unit, and how each change was accomplished. Changes included the following:
Patient Folder for Transplant Patients:The idea for the patient folder originated as staff reviewed their patient satisfaction scores, and while they felt good about them, they wanted to improve them. During hospitalization, transplant patients are given multiple papers with important information on medications and physical therapy, making it difficult for patients to keep track of it. So staff thought of a nice way to organize patient paperwork by proposing a folder where the patient could keep track of all papers during their stay, and even after discharge. This was surely a “patient satisfier.” They even designed an additional page, requesting patients to take a survey expected to arrive in the mail. All great ideas require funding though, so Michael quickly went to the transplant marketing team and explained the idea. After presenting the great benefits of this idea, the team couldn’t agree more, and even funded the project.
Transplant Class: A course on transplant was another need the staff brought forward. Michael agreed that this was a need, and paid all staff nurses to attend a two-day course, partly designed and delivered by staff nurses from the unit. The budget expense was handled by making a scheduling adjustment. The outcome was a success.
VRE Surveillance:The staff reviewed their outcomes data and found that they had fallen behind in their compliance due to a shortage in staff. Staff decided that if they could have baggies and day shift would tape the swab to the door, then the night staff would know that it needed to be completed. Michael happily secured the additional baggies and encouraged this team effort to get the job done. One month later, the unit initiative brought VRE surveillance of ICU patients to 100%.
Transport Monitor: The Transport Monitor was on the other hand, a capital request, but seen as much needed by staff. This monitor is used anytime they move a patient, or if they take a “road trip.” It monitors Blood Pressure, Pulse O2, EKG, Arterial line BP, and CVP of the patient, but to get this expensive equipment, there is lots of “grueling paper work” involved. A capital request was required to get acquire the equipment. After the paperwork was filled out, the unit was rewarded with the capital purchase of a Transport Monitor which has increased nurse satisfaction and patient safety.
Supplies: Supplies are at the core of a staff nurses’ life. For each supply needed, staff had to enter codes to access the supply machine and push a button associated with each item to keep electronic par levels correct. Missteps in this computing led to inaccurate levels of supplies and staff continually running out of what they needed. The solution was the removal of the supply PYXIS machine and installation of shelving and a new lock on the outside door. The cost was minimal for an incredibly happy staff. Michael says, “In some cases you have to initiate the process before the staff can become part of the process.” In the case of removing the PYXIS, meeting with the director of central supplies to sell and negotiate the deal was essential. This took several meetings before they could come to the new agreement to abandon the system and start over. Change is not easy for anyone and when you are working with other departments, you must bring them in immediately and get them to understand. Once this was accomplished, Michael disappeared and the staff jumped into the re-design of the room and began to arrange supplies. They worked with central supplies to evaluate their list of items and found that par levels needed adjustments and some supplies were not needed. The staff with little or no coaching could take it from there.
The transplant nurses have embraced the process of change and improvement. Their patients are the obvious benefactors of their endeavors!