Adding a Visual Communication Tool to the Electronic Health Record to Prevent Pressure Injuries.

Health care organizations no longer receive reimbursement for stage 3, stage 4, and unstageable hospital-acquired pressure injuries, which are never events that require interdisciplinary collaboration to treat and prevent. Perioperative patients are at risk for developing pressure injuries that may not manifest until five or more days after surgery. This quality improvement project aimed to inform inpatient nursing and health care professionals of the potential areas of skin breakdown after surgery using an annotated image (AI) depicting intraoperative patient positioning. To gauge OR nurses' use of the AI, we tracked image addition to the patient records weekly from May 2018 to May 2019 and found an overall average participation rate of 80% to 90%. Adding the AI of surgical positioning and pressure points raised awareness of the potential for skin breakdown and became a valuable communication tool for the inpatient nurses who were providing postoperative care to prevent pressure injuries.

Nurses' Perceptions of Personal Communication Devices in the Perioperative Environment.

Personal communication devices (PCDs) support reliable information sharing between clinical personnel to ease workflow processes. Perioperative leaders at a major medical center conducted a long-term quality improvement project evaluating perioperative nurse perceptions regarding PCDs. Perioperative nurses completed two surveys and the investigators conducted an independent group t test (2-tailed) to test for differences in RN perceptions of PCDs from initial use during a pilot study and after the nurses had used the technology for four years. The authors also used qualitative content analysis to assess the qualitative items on the survey. The RNs noted that the PCDs were particularly beneficial when contacting team members for assistance and that response times improved. Overhead pages decreased from 125 per six-hour period to an average of less than one per six-hour period. The perioperative nurses' perceptions of the PCDs have improved four years after implementation.

Implementing a Cardiac Skills Orientation and Simulation Program.

Patients with cardiac morbidities admitted for cardiac surgical procedures require perioperative nurses with a high level of complex nursing skills. Orienting new cardiac team members takes commitment and perseverance in light of variable staffing levels, high-acuity patient populations, an active cardiac surgical schedule, and the unpredictability of scheduling patients undergoing cardiac transplantation. At an academic medical center in Boston, these issues presented opportunities to orient new staff members to the scrub person role, but hampered efforts to provide active learning opportunities in a safe environment. As a result, facility personnel created a program to increase new staff members' skills, confidence, and proficiency, while also increasing the number of staff members who were proficient at scrubbing complex cardiac procedures. To address the safe learning requirement, personnel designed a simulation program to provide scrubbing experience, decrease orientees' supervision time, and increase staff members' confidence in performing the scrub person role.