Performance improvements
in pump programming

Sophie-Line Kettenbeil (left) and Erin Cook (third from right) with the team from 3 West Step Down, from left: Jackie Guingab, Diane Brault, Nurse Aida Ricafort, Specialized Nurse Practitioner in Cardiology Shannon Mc Namara, Marie-Claude Dumais, Nurses Emmanuelle Peyrel and Mélissa Colette, Nursing Education Consultant in Cardiac Surgery Tatiana Kudzman. The poster for highest compliance has adorned the wall in 3 West since it was created, as the unit’s team has scored highest in IV programming compliance in each of the three months since the poster program was launched in December.

Who would be an avid user of a library that offers neither books nor a place to sit and lounge?

Turns out, the JGH nurses are heading more and more often to this library, which is contained, curiously, within a few square inches: the IV pump library, that is.

To encourage ever-improving adherence to programming the IV pump’s medication library, the IV Optimization Committee launched a series of initiatives last fall, culminating in a poster campaign launched at the end of the year. Two posters have been circulating the hospital, each ‘hosted’ in a different unit for a month: one is awarded to the unit with the highest compliance of programming, the other, to the unit(s) that have recorded the greatest improvement in adherence.

“To promote change, we find it’s most effective to motivate staff by instilling pride through our poster publicity, rather than penalize those who don’t comply,” says IV Optimization Committee Co-Chair Sophie-Line Kettenbeil. “The posters have been very effective, because staff feel they are participating in a bit of healthy competition. Head nurses clamor for the poster, encouraging their team, ‘We can achieve this too!’.”

Since the program was launched six months ago, the overall compliance in pump programming hospital wide has jumped to 81.9 per cent, an improvement of 14.5 per cent. The committee reviews reports on each unit’s compliance and shares the results weekly with head nurses, nurse clinicians and nursing associate directors. “We also email the tally monthly to all the floors, citing the winner for most improved, but also enticing others: ‘such and such unit is not far behind, who will be next?’,” says Erin Cook, who co-chairs the committee with Ms. Kettenbeil.

The nurses of 3 West: poster children for compliance

The title for best adherence has as yet been claimed only by 3 West, where the poster has not budged for the three months the project has been running. Head Nurse of Step Down Diane Brault reflects on the team’s success. “The unit already had a strong adherence when I arrived as Head Nurse in January 2011, but I have a quality background, so I pushed for even further improvements,” she explains. “At any given time, there are thousands of areas in which we can improve, it’s a matter of identifying priorities. This is something I value, and it’s clear to my staff that it’s something I value. There’s no way around it, if the tool is there and it has an impact on patient safety, then it’s our duty to use it.”

Every week, the 3 West team reviews their adherence. Any dip in the results leads to a discussion. “Our nurses all want to use the library, if they are bypassing it, there is a reason,” says Ms. Brault. As an example, if the Pharmacy Department introduces a new antibiotic drug, it may simply not turn up on the machine because updates to the library are periodic, not daily.

“I share our adherence percentage, the team knows where we stand. Now we’re at 94.5 per cent. I say, ‘come on guys, let’s do 95 per cent’. I can push all I want but I’m not the one programming the pump, they have to be motivated to do it. Nurses have to understand its impact on patient safety.”

Three West Assistant Head Nurse Jackilyn Guingab, who has championed the library among her colleagues, notes, “It became a pride for our unit and a culture on the floor. We’ve found what works best is positive reinforcement. I always congratulate staff, but I tell them, ‘it’s a team effort, let’s work together, let’s work harder’.”

“A discreet little reminder whispered into a nurse’s ear to add the medication name,” has been a tactic of Assistant Head Nurse Marie-Claude Dumais, another champion on 3 West. “The few seconds that it takes to program the pump are nothing when measured against the safety it brings to our patients,” she adds.

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