The Impact of a Multidisciplinary Quality Transformation Team on Patient Safety and Outcomes

Purpose:
The Quality Transformation Team facilitates the delivery of safe, high-quality, and cost-effective care that enhances the overall health and well-being of pediatric hematology and oncology patients and families, using evidence-based practice guidelines and improvement science methodologies.

Relevance/Significance:
Relate exemplary work environment practices to patient and nursing outcomes. The collaborative efforts of the group have resulted in a reduction of late first-case start times for PACU patients, revision of chemotherapy checklist that incorporates Pharmacy in the verification process, central line education classes for patients and families in the care of central lines at home, and a medication reconciliation project (in progress) to address new NDNQI requirements.

Strategy and Implementation:
1. PACU - to decrease delays in first case start time (1000, 1200 Thursdays), inpatients were scheduled for the first two cases to allow outpatients time to obtain labw ork and order chemotherapy. Lab opened at 0715 (vs 0800) to accommodate early lab draws. 2. Chemotherapy Checklist - effective March 2015, chemotherapy safety process involves 2-providers, 2-RNs, and 2-RPhs to verify chemotherapy (one provider writes/other verifies, two nurses independently verify, and two RPhs now independently verfiy (this was new)). 3. Central Line Education Classes - effective January 2015, patient/family education provided to patients with CLABSI/new central line to impact CLABSI rates and increase readiness for discharge. 4. Medication Reconciliation Project - process being finalized with implementation date in June. Group currently identifying metrics to accurately reflect medication reconciliation.

Evaluation:
1. PACU - 7% decrease in late first case start times (decrease in 2 minutes). 2. Chemotherapy Checklist - data analysis in progress. 3. Central Line Education - data analysis in progress. 4. Medication Reconciliation - TBD. Implementation scheduled for June 2015 with data analysis goal of September 2015 (FY end).

Implications for Practice:
1. Increase patient satisfaction (delays) and increase nurse efficiency (lunch, satisfaction). 2. Increase patient safety and satisfaction at the point of care. 3. Reduction in CLABSI rates and occurrence of serious safety events. 4. Improve patient safety and satisfaction.