Nursing Update 2007 - 2008 - Yale-New Haven Hospital

Pediatrics streamlines
medication delivery
One of the challenges for nurses caring for pediatric
inpatients is to ensure that patients receive
the correct medications they need in a timely
manner. With a pharmacy department that fills
3,800 orders a day, the staff wanted to make the
process of medication dispensing and delivery as
efficient and timely as possible.
Kim Carter, R.N., patient service manager for
the School-age/Adolescent Unit, formed a committee
with Lorraine Lee, Pharmacy Services
manager for medication safety and regulatory
compliance, and members of both staffs. Last
June, the group dedicated one week to pioneering
a new medication delivery system using the
“Lean” process improvement tools, a manufacturing
process Toyota popularized and healthcare
systems—including YNHH—have used to
trim waste and inefficiencies in their processes.
They developed eight interventions and
launched them on the School-age/Adolescent
Unit. They standardized time windows for delivery
of various medications, now posted in the
unit’s medication room, and created a dedicated
area on the unit where all medications must be
delivered. The committee also redesigned the
medication room with a wall-mounted computer
nearby so staff can easily look up information
such as proper dosage and allergies.
Due to the work of this unique collaborative
committee, the School-age staff has seen
significant benefits in accuracy and efficiency
of medication delivery, and the new delivery
system interventions are being implemented in
all of YNHH’s pediatric units with eventual plans
for the adult units as well.
Simulators enhance
nurses’ learning
Since her arrival at the Yale-New Haven
Children’s Hospital last spring, Noelle has given
birth hundreds of times. A life-size mannequin,
Noelle can simulate the normal human birth
process and be programmed to mimic birth
complications. She comes complete with monitors
that display maternal, fetal and newborn
vital signs, and her simulation baby lets staff
know its health status by its color: a healthy
baby will be pink, while a baby experiencing
oxygen deficiency will turn blue.
“For nurses, the simulators are an excellent
training tool,” Cheryl Raab, R.N., perinatal
patient safety nurse, Performance Management,
says. “Simulators give our nurses the
opportunity to learn correct interventions in a
risk-free environment, and provide them with
information and feedback about their individual
performance.”
Raab is currently using Noelle to help train
nurses, physicians, midwives and PCAs from both
the Women’s Center and Labor and Birth, as well
as medical and midwifery students. Meanwhile, in
the Pediatric Emergency Department, SimBaby,
Yale-New Haven’s first interactive infant simulator,
is used to train emergency healthcare professionals
in the care of seriously ill infants.
Simulation has become such an important training
tool for nurses at YNHH that the hospital is
looking at a future simulation center in partnership
with Yale School of Medicine and Yale
School of Nursing.
Wireless phone service
speeds up care delivery
When Yale-New Haven Hospital equipped all
of its nurses and patient care associates with
“SpectraLink” wireless telephone service last
year, telephone tag and noise from front-desk
employees paging nurses became annoyances
of the past, and patient satisfaction scores rose
across the board.
Every nurse and patient care associate (PCA)
has a SpectraLink phone, which can be used
for two-way communication throughout the
hospital without the interference common with
high-powered cellular phones. Patients may
press the call button for assistance, or dial their
nurse or PCA directly. The wireless phones also
allow nurses to quickly connect with other staff
to discuss pertinent information, treatment
protocols, medication orders and time-sensitive
information.
“Equipping nurses and staff with wireless
phones turned out to be a very positive innovation
for caregivers,” said John Sward, R.N., patient
service manager of the General Medicine
Unit on 9-7, who trained nurses throughout
YNHH in the use of the phones. Nurses hear
about their patients’ needs more quickly and are
better able to set priorities and serve them, he
said. “The phones are speeding up the process
of caregiving and make communication easier
and quieter for everyone.”
Innovations can change the way nurses practice
in ways they don’t anticipate. For example,
using wireless phones has made nursing more
efficient in some ways. Now nurses don’t have
to leave the bedside of one patient to take a
phone call about another patient, and they
are able to stay with a patient in crisis while
communicating with the physician.”
— Sue Arbo-Givens, R.N., Patient Service Manager, Orthopedics
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