174 - Improving Quality and Safety for Perioperative Services by Incorporating Quality Nurse Coordinator Role
Description: Issue: Due to multiple process improvement (PI) initiatives throughout Perioperative Services, the need for a position that can provide the coordination of our quality assurance performance improvement program, which includes all ancillary, nursing, and support areas, was identified. Preparation and Planning: The Nursing Director gained approval for a Perioperative Quality Nurse Coordinator (QA RN) position by presenting rationale to the Operations Committee. The rationale included needing help to monitor and participate in the PI initiatives for catheter-associated urinary tract infections (CAUTI), normothermia, surgical site infection reduction, pressure ulcer prevention and other PI initiatives within Perioperative Services. The QA RN would focus on high risk, high volume and problem prone areas; infection control practices, emergency preparedness, medical errors/adverse events and Joint Commission, Centers for Medicare and Medicaid Services, and Association of Perioperative Nurses compliance. The QA RN would also review and investigate all incident reports, which were presently being reviewed by the Operating Room (OR) Managers, taking up approximately 25-30 hours per week of their time. By reducing just one safety event per year (approximately $85,000 per event), the department would pay for this position. This individual would also function as the Laser Safety Specialist. Once approval was received for the position, a detailed job description was formulated. The position required a Bachelor’s in Nursing with at least two years of current OR nursing experience and a recommendation of having a Certified Nurse Operating Room (CNOR) certification and/or American Society of Perioperative-Anesthesia Nurses (ASPAN) certification. Implementation: Once the QA RN position was filled and implemented, we created organization and coordination for current PI initiatives and identified additional opportunities for improvement. The QA RN is a critical member of the OR Safety Steering Committee, working closely to review incident reports and recommend PI projects with key stakeholders. Current projects include: pressure ulcer prevention, CAUTI prevention, blood management and utilization, specimen handling, day of surgery cancellations, handoff communication, turnover time management and an OR cleaning improvement project. Outcomes and Nursing Implications: Implications include improved project management, improved data analysis, created opportunity for direct and immediate follow up with nursing staff and identification of new areas of improvement. The role has increased collaboration with other departments and staff such as Infection Prevention and Control, the Anesthesiology Department, Patient Safety Specialists, and PI Specialists. Since the QA RN position was implemented in April 2019, we’ve already seen decreases in our neurosurgical pressure injuries, specimen errors, and blood waste.