The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

RESPIRATORY CARE AS A MICROSYSTEM: APPROACH TO ORGANISATIONAL VERBAL ORDER REDUCTION.

Susan Ferry, Raymond Matthews, Linda Napoli; Respiratory Care, The ChildrenÂ’s Hospital of Philadelphia, Philadelphia, PA

BACKGROUND: Organizational improvement relies upon local implementation of PDSA cycle tests. To spread change and engage respiratory therapists (RTs) in improvement processes, a designated quality improvement RT and analytics RT participated in multidisciplinary team to reduce verbal orders. METHODS: Automated data in the form of PYXIS medication delivery overrides and CPOE downloads of verbal order selection were aggregated and distributed by the Quality and Patient Safety Office to medical units, physician safety officer and RT leaders. Analytic RT specialist grouped data for RTs and communicated results to leadership team members and individuals who entered the verbal orders or made the PYXIS medication overrides. Follow up was done with every verbal order occurrence. Signs were posted and distributed to staff to educate about risk of verbal orders and what actions constitute a verbal order. Education on organizational policy for verbal order use and NPSG elements of performance for verbal order use. RESULTS: Department verbal order use followed organizational use of verbal orders. While RT verbal order use accounted for no more than 20% of all verbal orders, significant improvement resulted from RT reduction efforts. CONCLUSION: RT specific indicators lack benchmarks for practice improvement in error reduction. Automated data can lead departmental improvement without significant resource utilization for data collection. Alignment with organizational improvement plans can be applied to RT departments which practice by care area rather than geography like nursing and medical staff. Minor adjustments to implementation can be translated to our discipline. This model of local application to the RT discipline as a microsystem can be applied to other elements of CPOE or web based event reporting databases to save resources and apply rapid cycle improvement. Sponsored Research - None