What is the largest performance improvement project your department undertook this last year?
What is ...
Excellence Matters ACT I & ACT II patient flow project
100
Besides EXCELLENCE MATTERS, name at least 3 areas of performance improvement in the Emergency Department.
What is ...
(1) Blood culture contamination
(2) Core Measures - Stroke, AMI, AHF, SCIP, Pneumonia
(3) Patient Satisfaction
(4) Hand Hygiene
100
What is a "shift huddle"?
What is ...
Team huddles at beginning of shift. Charge RN covers important updates for the week.
100
Locate Restraints policy ...
What is ...
Policies & Procedures > Organizational Policies > Safety-Precautions > Restraints ...
100
How can you tell at a glance in PICIS which orders are PHYSICIAN APPROVED PROTOCOLS (pre-approved annually through Medical Executive Committee)?
What is ...
GREEN
200
What are the goals of that project?
What is ...
Length of Stay <180 minutes
LWBS < 2%
Bed Request to transfer to floor <30 minutes
ERP to transfer to floor <120 minutes
200
What is the goal for blood culture contaminations?
What is ...
<3%
200
Where do you go to review shift huddle content if you were off work the previous week or if you are a mid shift employee?
What is ...
Intranet > Departments > Emergency Services > ED Shift Huddle Content
200
Locate policy relating to Sedation
What is ...
Policies & Procedures > Organizational Policies > Medication > Sedation Analgesia ...
300
Name some things you changed to help reach those goals?
What is ...
(1) Zoning Teams
(2) SBAR/Report Process
(3) Visitors policy
(4) No foleys with OB ultrasounds
(5) Protocols updated
(6) No re-writing orders
(7) Immediate bed assignment for admissions
(8) Quick triage process - straight to room
etc....etc....etc.......
300
What can the Emergency Department do to help make sure we meet core measures for our pneumonia patients?
What is ...
Blood cultures and antibiotics on board within 6 hours of arrival
300
Where do you find ED staff meeting minutes?
What is ...
Intranet > Departments > Emergency Services > ED Staff Meeting Minutes
300
Locate Emergency Department Policy relating to Fetal Demise > 20 weeks gestation.
What is ...
Policies & Procedures > Departmental Policies > Emergency Services > ED Policies & Procedures > Obstetrical Emergencies: Fetal Demise ...
300
Can a nurse initiate protocols without a physician order?
What is ...
Our policy allows for a nurse to initiate protocols without a physician order in an emergency situation in which the physician is not immediately available. However, it is our practice that our nurses ALWAYS get approval from physician on duty to initiate protocol orders.
400
Where do you look to see how we did last week?
What is ...
(1) Shift huddles
(2) Bulletin board
(3) Intranet
400
What are our goals for Stroke TPA patients?
What is ...
10 minutes - exam and orders
25 minutes - CT scan complete
45 minutes - CT and labs resulted
1 hour - TPA started
400
How do front line staff share ideas/suggestions with leadership?
What is ...
Employee Empowerment Committee reviews staff suggestions monthly. Employees can track progress on bulletin board.
400
Locate the Emergency Department policy that contains danger zone vital signs.
What is ...
Policies & Procedures > Departmental Policies > Emergency Services > ED Policies & Procedures > Vital Signs
400
How often do you repeat nursing assessments?
What is ...
Every 2 hours at a minimum
500
Why is it so important to decrease length of stay and LWBS?
What is ...
If we have improved patient flow, we can see more patients and don't risk having sick patients sitting in the waiting room for long periods. Patients who leave without being seen are at high risk so we want to make sure we see them.
500
What are our goals for STEMI patients?
What is ...
EKG within 10 minutes
To Cath Lab within 30 minutes
500
How do you find out what staff are doing on hospital-wide committees?
What is ...
Monthly ED newsletter contains committee reports and other important updates
500
Where would you find the ESI 5-tier triage system guideline for the overdose/accidental ingestion patient?
What is ...
Policies & Procedures > Departmental Policies > Emergency Services > ED Policies & Procedures > Nursing Standard Overdose & Accidental Ingestion
500
How often do you round? How often do you repeat vital signs?
What is ...
We round hourly. We repeat a full set of vital signs every 2 hours at a minimum.