Improving patient safety during intrahospital transportation of mechanically ventilated patients with critical illness

BMJ Open Quality

article

Shwu-Jen Lin¹  Chin-Yuan Tsan²  Mao-Yuan Su³  Chao-Ling Wu¹  Li-Chin Chen⁴  Hsiu-Jung Hsieh²  Wei-Ling Hsiao²  Jui-Chen Cheng¹  Yao-Wen Kuo¹  Jih-Shuin Jerng⁴  Huey-Dong Wu¹  Jui-Sheng Sun⁴ 

[1] Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics , National Taiwan University Hospital;Department of Nursing , National Taiwan University Hospital;Department of Radiology , National Taiwan University Hospital;Center for Quality Management , National Taiwan University Hospital;Department of Internal Medicine , National Taiwan University Hospital;Department of Orthopedic Surgery , National Taiwan University Hospital

关键词: critical care;    patient safety;    respite care;    team training;    transportation of patients;   

DOI  :  10.1136/bmjoq-2019-000698

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Aim Intrahospital transportation (IHT) of patients under mechanical ventilation (MV) significantly increases the risk of patient harm. A structured process performed by a well-prepared team with adequate communication among team members plays a vital role in enhancing patient safety during transportation.Design and implementation We conducted this quality improvement programme at the intensive care units of a university-affiliated medical centre, focusing on the care of patients under MV who received IHT for CT or MRI examinations. With the interventions based on the analysis finding of the IHT process by healthcare failure mode and effects analysis, we developed and implemented strategies to improve this process, including standardisation of the transportation process, enhancing equipment maintenance and strengthening the teamwork among the transportation teammates. In a subsequent cycle, we developed and implemented a new process with the practice of reminder-assisted briefing. The reminders were printed on cards with mnemonics including ‘VITAL’ (Vital signs, Infusions, Tubes, Alarms and Leave) attached to the transportation monitors for the intensive care unit nurses, ‘STOP’ (Secretions, Tubes, Oxygen and Power) attached to the transportation ventilators for the respiratory therapists and ‘STOP’ (Speak-out, Tubes, Others and Position) attached to the examination equipment for the radiology technicians. We compared the incidence of adverse events and completeness and correctness of the tasks deemed to be essential for effective teamwork before and after implementing the programme.Results The implementation of the programme significantly reduced the number and incidence of adverse events (1.08% vs 0.23%, p=0.01). Audits also showed improved teamwork during transportation as the team members showed increased completeness and correctness of the essential IHT tasks (80.8% vs 96.5%, p<0.001).Conclusion The implementation of reminder-assisted briefings significantly enhanced patient safety and teamwork behaviours during the IHT of mechanically ventilated patients with critical illness.

【 授权许可】

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