.PALS

Project Topic

Hand-offs/communication

Hospital Units

Heart Center Intensive Care Units (HCICU)

• Cardiac Intensive Care Unit – Ellison 9
• Cardiac Surgical Intensive Care Unit – Blake 8

CSI Participants

Michelle Crocker, BSN, RN
Kara Donovan, BSN, RN
Jennifer O’Malley, BSN, RN
John Teixeira, BSN, RN

Project Goals/Objectives

1. To achieve 80% compliance with an enhanced electronic health record (EHR) smart phrase
2. To improve satisfaction and safety results from HCICU handoff surveys 8%
3. To improve the quality of information contained in transfer notes

Project Outcomes

1. Achieved 84% compliance with an enhanced EHR smart phrase
2. Improved perception of safety regarding transfer process 12%
3. Improved satisfaction with transfer process 12%
4. Increased bed availability and allowed an average of 3.75 more cardiac surgical cases to be completed each month
5. These outcomes resulted in a potential annual fiscal impact of $1,857,150.

Project Overview

Historically, our two units didn’t interact much. As the management of heart failure changed to involve increased use of mechanical circulatory support, more similarities were noted in the patient populations in our units. This resulted in more frequent transfers of patients between the units.

Without any consistent or concise way to hand-off our patients, our units experienced significant dissatisfaction and safety concerns about the transfer process. We wanted to implement a change that would positively impact our patients and improve the satisfaction of the nurses we work with. We created a hand-off tool in our electronic health record – using the smart phrase PALS (Plan-Assessment-Line, drips and drains-Social/family) – that nurses could use with every transfer between our units. We also provided education and incentives as we implemented our project.

We were pleasantly surprised to see the positive impact our hand-off tool had in our units after six months of chart audits and survey results. Nurses reported feeling more satisfied and safer since implementation of the handoff tool. Morale in our unit improved and new friendships were developed across units. Going forward we hope to expand use of our handoff tool when transferring patients to step-down units. Our ultimate goal is to have our hand-off tool published beyond just our two units.

We were thrilled to see the average RASS score decrease. Use of continuous sedating medications, and PRN medications, as well as average ventilator days, also decreased. Patients reported feeling safe and comforted with the weighted blankets. Nurses reported patients experienced increased sleep and were able to extubate sooner with the use of the blankets.

We presented our project and results to a group of clinical nurse specialists, who would like to work together on development of a hospital-wide policy for the use of weighted blankets in the acute care setting, and to trial the blankets on a general medical unit, surgical unit and neurology unit. Additionally, we will be meeting with the Director of the Yvonne Munn Research Center at Mass General to hopefully further the research of weighted blankets in the acute care setting.