2009 OPEN FORUM Abstracts
IMPLEMENTING AN EVIDENCE-BASED, OUTCOMES DRIVEN, INTERDISCIPLINARY TEAM IN A RURAL, CRITICAL ACCESS HOSPITAL: THE IMPACT ON INTERDISCIPLINARY CHARTING
Kimberly J. Bennion1, Carri Aguiar1, Julie Ballard2,1, Ezra Segura1, Michele Ludlow1, Michelle Colledge1, Jenny Chambers1, Kathie Coleman1; 1Heber Valley Medical Center, Respiratory Care Services, Intermountain Healthcare, Heber City, UT; 2System Improvement, Primary Children’s Medical Center, Intermountain Healthcare, Salt Lake City, UT
Introduction:Heber Valley Medical Center (HVMC) is a 19-bed critical access hospital owned & operated by Intermountain Healthcare. Utah state law requires 2 licensed caregivers & a physician be present at newborn deliveries. With limited nursing (RN) resources,leadership piloted the use of respiratory therapists (RT) as the licensed caregiver specifically charged with the care of the newborn. RT was added during February 2008. An electronic charting program, StorkBytes (SB), was introduced to RNs during 2006 to promote timely, accurate documentation during labor. In 2007, it was noted RNs were occasionally utilizing paper forms & not SB. Discrepancies were also noted in the various data points that comprised the total APGAR<1> score which is an objective method of quantifying the newborn’s condition & for conveying information about the newborn’s overall status & response to resuscitation. A “Delivery Scratch Note” was also developed. While not part of the patient’s medical record, it is a paper tool utilized by both disciplines to coordinate scoring during deliveries. We sought to identify what if any impact a RT/RN team model & APGAR scoring standardization might have on the documentation of pt care.Method:Comparison data of all HVMC Live Births (LB) during 2007 & 2008 (post-RT & “Delivery Scratch Note” implementation) were identified via the corporate database. Initial inclusion criteria were: (1) LB occurring at HVMC defined by year,(2) mode of delivery, & (3) post-delivery status (inpatient or transfer for a higher level of care). Respectively, 256 & 252 total LB were initially identified for 2007 & 2008. Vaginal births were randomized for 2007 but not for 2008. A total of 372 charts for both years were included in the final review. Results: Outcomes are reported in Table One. Discussion: We did not note a statistically significant improvement in SB charting when comparing years; however, a statistically significant improvement in APGAR score discrepancy was noted with p < 0.005. The positive impact of a RT/RN team approach to pt care, clearly defined team member roles & the standardization of data collection/reporting cannot be overemphasized. Specific employees not complying with SB charting were provided with additional education. With the addition of RT, an Early Lung Recruitment guideline using continuous positive airway pressure was introduced. Outcomes are reported in a separate abstract. Sponsored Research - None
Table One: Birth Type/Post Delivery Status & Documentation
*APGAR scoring discrepancy defined as: variance between Storkbyte & hardcopy charting or individual elements that did not support the total score.
1American Academy of Pediatrics, Perinatal Continuing Education Program (PCEP)