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April 06, 2017

Reducing the Utilization of Continuous Observations for Safety Precautions

At the Business Transformation & Operational Excellence World Summit, more than 30 companies shared the story of their most successful Operational Excellence projects. Throughout the 2 day summit, our judges read through the presentations and spoke to the presenters, to determine a winner! We are proud to present the BTOES Insights community with the story of our Poster Board winner, The University of Pennsylvania Operations Improvement Department, courtesy of Kat Voetelink, ASQ CSSBB, Operations Improvement at the University. If you would like to take a closer look at the presentation, view the full-size presentation in all its glory here.

Reducing the Utilization of Continuous Observations for Safety Precautions

The Hospital of the University of Pennsylvania (HUP) is a 789 bed, Magnet-designated, adult, acute care hospital that is annually recognized as one of the nation’s best by the U.S. News & World Report in its Honor Roll of best hospitals. 

Continuous observations (1:1s) for safety precautions at HUP cost the hospital approximately $1.1 million annually.  In addition to the significant cost, safety 1:1s cause a resource strain when Clinical Nursing Assistants (CNAs) are pulled from daily clinical duties and patient care to cover safety 1:1s.  A project was initiated to reduce the utilization of continuous observations on 6 pilot units in fiscal year 2016.  The units involved in the pilot included general medicine, surgery, ICUs, and neurology (161 beds).

After measuring and analyzing the problem, the team determined that patients were remaining on continuous observation longer than clinically indicated.  The team developed a behavior tracking tool and a standardized process for reassessment every 4 hours.  The 4 hour reassessment is a check-in between the CNA and RN to determine the need for continuous observation based on the documented observed behaviors.  The Charge RN is notified of the need to continue, discontinue, or wean the patient from the safety 1:1 to coordinate resources.  A defined weaning process was also developed. 

Results showed a decrease of nearly 5,000 hours 12 months post-pilot, with an estimated cost savings of $142,000.  The average duration of each safety 1:1 was also decreased by nearly 8 hours, or 1 full CNA shift. 

Some challenges sustaining were identified due to CNAs from non-pilot units covering pilot unit safety 1:1s without training on the observation tool and process.  A phase 2 of the project is underway to operationalize the process in the new EMR system on the pilot units with an anticipated roll-out hospital wide by Fall2017. 

 

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 Download the full Winning Poster Presentation

Phase 1 Project Team

Team leader/facilitator: Kat Voetelink, ASQ CSSBB
Clinical lead: Heather Trout, BSN, RN, PCCN
Executive Sponsor:  Diane Leichter, MSN, RN, BCNA, CNRN
Champion: Teresa Murphy, MSN, RN
Team Members:  Mike Albright, Jamie Benson, Alexandra Cosan,  BSN, RN, Janelle Harris, BSN, RN, CMSRN, NE-BC,  Michael Newcomb, MSN, RN, Sebastian Ramagnano, RN, BSN, BS, Donnamarie Schuele

We are extremely grateful to Kat Voetelink of the University of Pennysylvania for sharing the poster with our online community.

 


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