Introduction to Problem

In the world of perioperative services, there are multiple stages of care. Examples of phases of care include pre-op, intra-op, PACU, and second stage recovery. My organization currently has 32 functioning operating rooms. On a given day we average an upwards of 80 patients that trace through these phases of care. Due to the large volume of patients ,our PACU prints paper tags that are hang on the wall. The tags include the patients last name, first initial, operating room (OR) number, and surgical service. When the OR nurse calls report to PACU, the “tag”, as they are known to us, is removed from the wall and put under a sign that reads “called in”.  This seems unconventional seeing as though we have a brand-new state of the art flat screen status board on the wall right next to our tags. There has been poor adoption of the status board in the PACU.

Motives for Change

The challenges our unit faces regarding using the status board, rather than paper tags, is that there are so many patients in the OR that the screen has to flip to include all of the patients. In order to see all of the patients in the 32 rooms we would have to have size 6 font, which would be nearly impossible to see. The status board information needs to be filtered in some way to decrease clutter and become more effective. Secondly, more often than not there are between two and six patients calling report at one time, making it difficult to keep track of who is coming. It is critical that we keep track of the OR’s who have called report because we have fewer PACU spaces than OR’s. American Society of Perianesthesia Nursing (2017) recommends 1.5 to 2 PACU spaces per OR to safely care for patients and ensure the OR does not get backed up. Although we meet this recommendation, keep in mind that we are the only teaching institution in the state and the acuity of our patients  is high, therefore keeping us from moving our patients through the recovery room as fast as other PACU’s in the state. The process of hanging paper tags is outdated, exposes patient information, and is time consuming for our clerical staff. This communication process is definite need of evaluation.

Patient Privacy

Of the above difficulties exposing patient information is perhaps the most alarming. Anesthesia providers, surgeons, pharmacists, nursing assistants, nurses, radiology techs, clerks, patients, patient’s family members, respiratory therapists, and environmental services staff are exposed to these tags on a given day. The American Nurses Association (2015) supports the protection of patient privacy and confidentiality and believes it is key to gain trust between healthcare providers and patients. They also propose that keeping the professions commitment to patient advocacy and trust is essential in achieving quality care (American Nurses Association, 2015). Because quality of care is driving reimbursement it is extremely important that we consider these recommendations in our everyday encounters.

The American Nurses Associations beliefs align directly with the code of ethics, which are, “statements of the professionals’ values and beliefs, which are based on ethical principles” (Sewell, 2016).  In order to uphold the nursing code of ethics it is imperative that the code of ethics evolves as does the profession of nursing and technology.  Provision 3 of the nursing code of ethics addresses the nurse’s ethical responsibility to safeguard the patients right to privacy and confidentiality. Slate (2015) reports that trust between the patient and the patient’s safety could be compromised by unnecessary revelation of patient information. There is a misnomer that patients do not remember the recovery room, however, in our current state we are often holding patients in our PACU while waiting for a bed on the inpatient unit. This increased length of stay allows patients anesthetic to clear and patients do remember conversations, interactions, and visual scenes from the PACU. This also leads me to the question, if the patient is under the influence of anesthesia does that make it okay to talk about other patients and or display other patient’s healthcare information?

Plans for Change

In order to phase out the notorious patient tags we will need to work closely with our nursing informatics team to create a status board that is efficient, effective, and protective of patient information. The status board will need to be linked to our electronic health record (EHR) and as previously mentioned, filtered in some way to make the information more valuable. I propose that the only patients who show on this new status bored be the patients that are closing in the OR. To protect patient privacy OR numbers would replace the patients name. Patients name and birthdate are exchanged at bedside report by the anesthesia team as well as the surgical team, therefore it is not necessary to include the patients name on the status board. If absolutely necessary to prevent error perhaps the first three letters of the last name and first initial could replace the full name. There would have to be a button, check box, or link the nurse in the OR selects to signify this change of status. This will give the PACU nurses a general idea of how much time they should expect before the patient arrives. With this being said there would need to be education that takes place to make sure that the OR teams were estimating the appropriate time for closing. The charge nurse would then have to manage the status board to make sure that there weren’t too many patients finishing surgery at the same time.

Implementation

In review, this dated version of communication between the OR and PACU needs evaluation. Protection of patient information and improvement of efficiencies are the biggest areas of opportunity. With the help of nursing informatics and current technology, the development and implementation of a filtered status board that communicates only the OR’s that have called report to the PACU would be ideal. This filtered status bored would enable the charge nurse to plan PACU space for the incoming patients. In order to have adoption by staff it is important to involve the nursing informatics team in education of the staff. Having a nursing informatics rep on the unit the day the status board goes live to help trouble shoot would also be beneficial.

Review

In order to evaluate effectiveness of the status board implementation, patient safety net reports should be reviewed for any status board entries, as well as a follow up meeting with staff one month post implementation to review any concerns about the new technology or any opportunities for improvements. By in by staff is essential. As technology advances it is important that this process continues to be evaluated. Overall, this modern, efficient form of communication should be able to support the PACU allowing the removal of the tags containing patient information. All in all, upholding the values of the nursing code of ethics. This process improvement will preserve the patient provider trusting relationship leading to quality care and improvement of patient outcomes overall.

References:

American Nurses Association (2015). Privacy and confidentiality. Retrieved from http://www.nursingworld.org/DocumentVault/Position-Statements/Ethics-and-Human-Rights/Position-Statement-Privacy-and-Confidentiality.pdf

American Society of Perianesthesia Nursing (2017). Frequently asked questions. Retrieved from http://www.aspan.org/clinical-practice/faqs#4
Nonprofit Activism (2010). Confidentiality matters. Retrieved from https://www.youtube.com/watch?v=_ITU377uuJY

Sewell, J. (2014). Informatics and Nursing: Opportunities and Challenges (5^th ed.) Philadelphia,

PA: Wolters Kluwer

Slate, M. K. (2015). Nursing code of ethics. Retrieved from http://www.rn.org/courses/coursematerial-177.pdf

(2107, September). Paper based vs. electronic observation. Retrieved from https://www.earete.co.uk/paper-based-vs-electronic-eyfs-observations/

Responses:

Raenan- March 4th 2017 at 0753.

Annie- March 4th 2017 at 0826