The advisory committee called PICU Partners in Improving Quality and Measuring for Excellence (PIQME) was the governing body for the initiative. The multi-disciplinary group consisted of unit leaders as well as frontline staff and met monthly to review project progress based on 90-day goals, to address issues impeding progress, and to promote sharing of lessons learned.
The program team included individuals in the following roles: PICU medical director, PICU nurse manager, program manager, quality analyst, and family-centered care specialist. The team oversaw program activities by leading the development of 90-day goals and monitoring the action plan to achieve them. They were responsible for maintaining and monitoring the quality dashboard and alerting PIQME to concerns; providing guidance to the project teams; facilitating widespread communication regarding improvements and accomplishments; and planning for sustainability.
The program team developed and implemented a stakeholder communication plan to reach PICU staff and family advisors, faculty and staff in other clinical areas, senior leadership, and Dance Marathon. Forms of communication included monthly newsletters, announcements in internal publications, posters presented at UNC Health Care’s annual Quality Expo event, a “traveling roadshow” consisting of short presentations and Q&A sessions with various groups. We published a quarterly report which included our dashboard as well as a 2-page overview of highlights of the program, results, outcomes, and plans for the next quarter.
Front line staff members were appointed as project team leaders to ensure timely completion of objectives and report out at quarterly milestone meetings. Feedback was gathered from a larger group of frontline staff through electronic surveys.
Results & Lessons Learned
The communication strategies allowed efforts of the program to be more visible and impressed senior leaders, who regard the PICU dashboard as a high standard for the rest of the institution. The multi-disciplinary approach and inclusion of family advisors allowed for streamlined implementation.
Incentives and recognition were important aspects of the program. On a monthly basis, the names of individuals who had completed hand hygiene observations were read aloud at the advisory group meetings. The program management team sponsored contests for compliance with the Daily Goals Communication Sheets and for hand hygiene observations. We gave peer-nominated awards to individuals for performance during standardized rounds. Awards included free valet parking, vouchers for parking and food, and coffee mugs. When the PICU reached over a year without a ventilator-associated pneumonia (VAP), the Performance Improvement & Patient Safety department sponsored a pizza party for PICU staff and invited senior leaders to attend and recognize the staff. With grant funds, we printed large banners that read, “Thank you for 368 VAP-free days in the PICU” and posted them outside the PICU entrances. At the end of each project year, PICU staff, advisory group members, and senior leaders were invited to a celebratory meeting during which awards were presented and results displayed on posters.
Some of the lessons learned throughout the two years include the following.
- Although frontline staff members were included in the advisory group and project teams, we could have engaged them even more, particularly those already trained as Six Sigma Yellow Belts.
- It is difficult to keep new staff oriented to various quality and safety approaches and techniques, especially residents who rotate through the PICU on a monthly basis. Therefore, frequent education is needed with both resident physicians and nurses.
- With our institution’s patient and family-centered care program being newer in development, we had to limit our activities in this area after the grant period due to resource constraints.
With the purpose of sustaining efforts in mind, we tried a strategy called “safety stand-downs,” which entails discussions within multidisciplinary groups regarding safety concerns and action planning for preventing serious adverse events. The PICU leadership team held three 90-minute sessions and required all staff (physicians, nursing staff, and respiratory therapists) to attend one session. The agenda included a large group discussion with stories and examples of safety concerns and small group sessions focused on alarm fatigue/general room safety, patient advocacy and infection prevention, and communication/handoffs. Staff feedback was positive in terms of increasing awareness of safety concerns as well as being helpful/meaningful/useful overall. Staff appreciated the multidisciplinary approach and open discussion. The plan is to hold safety stand-downs on a quarterly basis.
Please note that quality and safety efforts related to research and publication, whether internally or externally sponsored, should be reviewed by an Institutional Review Board to ensure compliance with human ethics regulations.