DESIGN FOR CHANGE 6
DESIGNFOR CHANGE CAPSTONE PROJECT
Theobjective of this project is to test within the context of residents,a methodology that is based on failure modes and effects analysis(FMEA) in order to improve after surgery pain management for olderpatients. This methodology will be adaptive to self empoweredlearning teams in addressing the threats they face in their worksetting. Error Reduction intervention Cycle will be implementedincluding FMEA survey that will provide perceptions of frequency andseriousness of different types of pain management errors. This willbe followed with meetings to agree on priorities and applicablesolutions to address the problem.
Thetrend in pain management has remained unsatisfactory despite effortsin technological advancement in medicine, worldwide campaign on theimportance of pain management as a routine process and enhancedapproaches of undertaking post operative pain treatment. Recenttrends indicate a severe trend among older patients. Ineffective painmanagement leads to physiological and psychological changes that havelong term effects on the quality of patients’ health in terms oflengthy stay in hospitals, constant readmissions and overall patientdissatisfaction. There exists a wide gap between what is ideallydelivered in the health care and what is proposed by the Institute ofMedicine. Deficiency in effective postoperative pain managementrequires critical attention in such areas as monitoring, assessmentwill enhance availability and familiarity of pain managementapproaches, team work, coordination, respecting the dignity andintegrity of patients, family and patient involvement, and systemicimprovement in treatment management.
Inthis design project, residents will be trained on practice basedlearning and how to improve their practice. Lack of awareness oftype, consequence and incidence of errors in postoperative caremanagement is one barrier of improving the quality of care. The mostcommonly used method in counting errors is voluntary reporting system(incident reporting) this leads to difficulty in underreporting (on5% of errors are reported while majority remain unknown). Whenindividuals result to error reporting, this fails to createunderstanding in the process and organization of care and as such itresults in blame and conflicts among the team. Failure mode andeffects analysis (FMEA) is a prospective approach that allowsinvolvement of all team members in prioritizing and identifying thenature of problems. This change approach is design to evoke and formself empowered learning teams that have common vision to help them inadapting. This approach will in turn help to generate informationabout vulnerabilities and use this information to enhance learningabout the vulnerabilities of pain management approach. In additionthe approaches will harness resources for responding to theseunpredictable pressures and finally create good teams for executingtasks (Naho et al, 2012).
Accordingto past studies (Judithet al, 2012),Failure mode and effects analysis (FMEA) has been found to be timeconsuming it is costly, requires good experience and practice and insome aspects deficiency in expertise and resources has been found topresent problems (even in a hospital set up, there are deficiency oftrained and quality personnel despite the requirement by the JointCommission (Jennifer et al, 2011). In addition, it has been foundthat FMEA only focuses on specific processes and thus can improve onlimited part. As such it is impossible for individual hospitals tolimit their improvement to such narrow approach at the expense ofother useful mechanisms of improving post operative pain management(Marian, 2011). In effort to overcome these problems and to maintainthe efficacy of FMEA, the new approach designed to be used willaddress broad overview of the problem of the postoperative painmanagement (Naho et al, 2012).
Inthis change design the traditional FMEA will remain unchangedinstead a safety enhancement measurement instrument will be used as apilot study -Patient Centered (SEMI-P). This a broad visual modelbased on health safety n principles which could be undertaken inemergency departments, home or community, patients on long-term careand for inpatient. The study involves assessment accurate collectionof data from medical records and laboratory results. The approachthen focuses on plan of medication, monitoring of appropriateinterventions, implementations, feedback from patients, family ordoctor. Finally a review and learning is done to enhance systemiclearning and evaluation without assigning blame. Questionnaires wouldbe prepared containing 153 failure modes but participants could addtheir list of failure modes as experienced in their work station.Using the SEMI-P, Staffs would be requested to give their perceptionsabout their working station (hospitals). A relative hazard matrixwould be used to transpose qualitative frequency and severity toquantitative values.
Implementand evaluate change
Interventionchange design would be applied on two post operative surgery floorsin urban teaching hospitals using the Error Reduction Interventioncycle (ERIC). The two units would be managed by a single nursingmanager and would involve all administrative staffs, nurses, surgicalattendants and surgical residents. The hospital quality committeewould approve the protocol. The implementation will then take thesesteps measuring baseline safety state-SEMI-P, Identify significantproblems, establish team based solutions and thenimplement thosesolutions (Margret, 2011).
Central Baptist Hospital, Lexington, Kentucky
University of Louisville School of Nursing, Louisville, Kentucky
Address correspondence to Judith A. Schreiber, PhD, RN, Central Baptist Hospital, 1740 Nicholasville Road, Lexington, KY 40503
JudithA. Schreber, Donita Cantrell, Krista A. Moe, Jeanie Hench, EmilyMcKinney, 2012, ‘ImprovingKnowledge, Assessment, and Attitudes Related to Pain Management:Evaluation of an Intervention,’Volume 15, Issue 2. Pg. 474-481.AmericanSociety for Pain Management Nursing. Published by Elsevier Inc,Accessed fromhttp://www.painmanagementnursing.org/article/S1524-9042(12)00188-9/abstract
MargretL. Zalon, 2011, ‘Mild, Moderate, and severe Pain in PatientsRecovering from Major Abdominal Surgery’ Volume 15, issue 2. Pge1-e12, AmericanSociety for Pain Management Nursing. Published by Elsevier Inc,Accessed from:http://www.painmanagementnursing.org/article/S1524-9042(12)00043-4/abstract
JenniferHehl, Deborah Dillion McDonald, 2011 ‘Older Adults’ communication during Ambulatory Medical Visits An Exploration ofCommunication Accommodation Theory’ Vol. 15, Issue 2, page466-473. AmericanSociety for Pain Management Nursing. Published by Elsevier Inc,Accessedfrom:http://www.painmanagementnursing.org/article/S1524-9042(12)00044-6/abstract
MarianWison, 2011, ‘Integratingthe concept of Pain Interference into pain management’Vol. 15, Issue 2, pg 499-505. AmericanSociety for Pain Management Nursing. Published by Elsevier Inc,Accessed from:http://www.painmanagementnursing.org/article/S1524-9042(11)00130-5/abstract
NahoAdachi, Minako Munesada, Noriko Yamada, Haruka Suzuki, AyanoFutohashi Takashi Shingeeda, 2012, ‘Effects of AromatherapyMessage on face down posture Related Pain After Vitrectomy Arandomized Controlled Trial, Vol. 15, Issue 2, AmericanSociety for Pain Management Nursing. Published by Elsevier Inc,Accessed from:http://www.painmanagementnursing.org/article/S1524-9042(12)00186-5/abstract