117 - Reducing DDI Length of Emergency Delivery for Severely Sick Parturients via HFMEA Improvement Process
Description: Clinical Issue :Reducing DDI length of emergency delivery for severely sick parturientsDescription of team :We are from the operating room of Jiangsu Provincial People's Hospital, China. There are 8 members of the team.We are all nurses.Preparation and Planning:Our team separated the Decision-Delivery process into sub-processes based on different steps and different personnel in charge using the HFMEA tool, and analyzed the impact of each sub-process improvement on DDI, making quality improvement and establishing new processes targeting the key influencing factors. Through repeated exercises, operating room personnel can operate according to the process skillfully in real scenes and the DDI length was shortened.
Assessment: we got the following sub-processes via decomposing the Decision-Delivery process, and evaluate the time spent on improving these sub-processes in the first few emergency childbirth cases. Including: noticing the situation, making calls; informing nurses and in the operating room and anesthesiologists; the lying-in woman was transit into the operating room and moved to the operating table; connecting monitoring equipment and oxygen supply; introducing catheterization; opening neonatal heating equipment; opening instrument packages, opening disposable single packages; preparing syringes, extracting local anesthetics; connecting attractors or electric scalpel; total time length.Implementation:Our team made time statistics for each sub-process,through the analysis of HFMEA, we found that the efficiency can be significantly improved through three processes including opening disposable single packages, informing nurses and in the operating room and anesthesiologists, preparing syringes and extracting local anesthetics; we need to improve the above three processes through PDCA. And the details will be shown on the Poster .Outcome :After the improvement of the process, we conducted several multidisciplinary exercises and counted the time of the exercises, among which we found out the situation and called for 5 seconds; notified the nurses and anesthesiologists in the operating room for 5 seconds; pushed the pregnant women into the operating room and moved to the operating table for 44.5 seconds; connected monitoring equipment for 31.0 seconds; indwelled urinary catheterization for 39.5 seconds; opened the heating equipment for the newborn for 9.0 seconds; opened the instrument package. Open the disposable single package for 91.30 seconds; prepare the syringe and extract local anesthetics for 14.10 seconds; connect the suction or electric knife for 8.50 seconds; total time is 174.80 seconds.Implications for Perioperative Nursing :Through HFMEA, we clarified the preparation process of the emergency caesarean section, and ensured that our improvement can maximize the efficiency. We will explore how to apply this process to practical operation in the future.