University of Colorado Hospital

Focus-PDCA
Performance Improvement Team Worksheet
Department Cardiac !lectrophysiolo"y Department Date #$%&$'#
Primary Contact Person Claire (utherford) (* !+tension ,%-,.
(F) Find a Process to Improve (name the process, describe the beginning and ending steps in
the process, name the customers served; state why it is important to work on this now).
/pportunity 0tatement
Patients who are scheduled to have an endocardial device placed such as a pacemaker
or implantable cardioverter defibrillator, a revision to an endocardial lead, or a venogram in
preparation for having a device placed are brought to the Electrophysiology ab (EP ab) for their
procedure. !hese patients have to have an "# on the same side as where their device will be
placed or the side where their device is already implanted. $t times, patients would be brought to
the EP ab with the incorrect side peripheral "#. !his can cause a mild delay to our cases starting
but there were times when there were significant delays for patients who were very difficult to
start an "# on.
Prior to bringing an inpatient to the Electrophysiology ab the EP nurses call the inpatient
nurse for report. %hen calling report the EP nurses ask that a device side peripheral "# be
placed in inpatients prior to coming to the EP ab (when they do not have a device side "#).
!here were &uestions regarding why this is necessary and if the floor nurse was busy it would
take time before the device side "# could be placed, again delaying our cases starting.
"f this process could be improved it would benefit patients, the nurses caring for these
patients pre'procedurally, the EP ab staff, and it would improve efficiency in the EP ab, in turn
decreasing cost.
Circle all that apply
Dimension of Performance (imensions of health care performance are those definable,
preferably measurable, attributes of the system that are related to its functioning to maintain,
restore, or improve health care.
' Efficiency ' )afety
' )taff )atisfaction ' Effectiveness
' Patient *enteredness ' *ontinuity
Prioriti1ation
' +igh ,isk ' +igh "mpact on Performance
- +igh #olume ' +igh Potential for "mprovement
- Problem Prone ' )upports *ritical )uccess -actors
- ow #olume ' Patient )afety

/ther........................................................................
(O) Organize a team that knows the process:
List Team Members:
!he team that knows the process is the Electrophysiology ab registered nurses, physicians, and
the EP ab nurse manager.
(C) Clarify the current knowledge
What do we know about the process?
Inpatient Process
Electrophysiology ab Physicians are consulted regarding inpatients who need a change
to their current device and/or leads or regarding patients who need a new device system placed.
!he EP ab Physicians place the device order, and orders for labs and 0P1 status for the day of
the procedure but not always for a device side "# to be placed. !he EP ab charge nurse
schedules the procedure but it has not consistently been their practice to check to see if the
patient has a device side "# when they look up the patient2s medical history and demographics.
Prior to the EP ab staff transporting the inpatient down to the EP ab they call the inpatient
nurse caring for the patient for report. $t that time the EP ab nurse usually verifies there is a
device side "#. "f there is not they either place an order for one to be placed or transport the
patient to the EP ab for the EP ab staff or anesthesia to place the device side peripheral "#.
/utpatient Process
Patients who are coming in from home for their device procedure come in the day of their
procedure to the Pre/Post (epartment. Pre'procedural orders are placed by the pre/post staff for
these patients. !he pre'procedural order set for devices has a check off bo3 to place a left arm "#
for all EP ab patients. !he ma4ority of patient devices are placed in the left chest but for those
patients who have or are to have a right side device'they need a right arm "#.
(U) nderstand sources of !ariation:
Why are we looking at this process? Why is the process not going the way planned?
"npatient2s brought to the lab for their device procedure do not always have a device side
"# which in turn delays our cases. %e had a case in 5anuary where we were unable to start a
device side "# and the patient was sent back to their inpatient room and their procedure was
rescheduled. !he patient was transported by two EP ab nurses from the floor to the lab on a
telemetry monitor, was in the EP ab for 67 minutes while anesthesia and EP ab nurses
attempted to start a device side "#, then the patient was transported back to their inpatient room
by EP ab nurses. !his was not efficient use of the EP ab staff or anesthesia2s time and this
was not optimal patient care. "f difficult peripheral "# placement could be addressed when
patients are in an inpatient unit there are various resources the inpatients can use including their
charge nurse or a resource nurse (resource nurses are all trained in ultrasound guided peripheral
"# insertion if needed).
(S) "elect the impro!ement:
!he first improvement selected was to revise the order set used by EP ab physicians to
include a device side "# order. !he second improvement choses was to educate inpatient nurses
and Pre/Post nurses regarding why a device side "# is needed prior to placing a patient2s device
or revising a patient2s leads. !he third improvement chosen was to revise the EP ab look up
sheet so a device side "# is verified when scheduling a patient2s device procedure. $ device side
"# can be ordered at this time in advance of the procedure if the patient does not have one
already.
(P) #lan the impro!ement:
" plan to make contact with the manager of the Pre/Post unit, 8acie )imms, as well as the
*ardiac "*9 and *ardiac Progressive *are 9nit2s manager, :aureen (;ialo, to determine if
teaching an in'service regarding device side "#2s would be appropriate. " plan to meet with (r.
%endy !;ou, an Electrophysiology Physician to discuss revising an inpatient order set for device
implants that includes an order for device side peripheral "# placement. " then plan to submit this
order set revision re&uest to Epic. " also plan to revise the EP ab2s inpatient look up sheet (with
the input of the EP ab charge nurse and relief charge nurses) to add a prompt to check where
an inpatient2s peripheral "# is located.
(D) $mplement the impro!ement:
"n'services were taught to Pre'Post, the *"*9, and the *P*9 at their 5une staff meetings
regarding why device side "#2s are important to EP ab procedures. $ meeting was held with (r.
!;ou and a plan was made for revising a current *ardiac Electrophysiology )ervice Pre'
Procedural order set to include a section for ordering a device side "#, including a hard stop and a
check off bo3 for which arm to place the peripheral "# in. !his re&uest for revision was sent to
Epic and contact was made with 5o$nn <oung to implement these changes through Epic. !he
inpatient look up sheet was edited and approved for use by the Electrophysiology :anager, (ena
8eilman. !he new look up sheet was put into use 5uly =
st
.
(C) Check the results:
Prior to the in'services done and a change to our look up process the overall percentage
of patients brought to the EP ab from 5anuary to 5une without a device side "# was =>? with a
range of =6?. $fter the interventions of education and a change to our look up process the
percentage of patients brought to the EP ab without a device side "# from 5uly =
st
to $ugust =@
th

was @?. !he change to the Epic order set has not been completed by Epic and therefore has not
been implemented at this time.
(A) %ct to hold the gain:
!he follow'up data for this pro4ect was only over A@ days, but the hope is that the trend of
low percentages of patients brought to the EP ab without a device side "# will continue. "n the
EP ab we can act to hold the gain through the education of our peer nurses working in inpatient
units, by recogni;ing when a device side "# needs placed in advance of a patient2s procedure,
and by implementing a revised order set that the EP Physicians can use to order a device side "#
in advance of a patient2s procedure.
(epeat PDCA as needed and maintain documentation in your department2