The Cost of Patient Education on a Post-Partum Unit in an Acute Care Setting

Four years post-implementation, an interactive patient care system is slated for decommissioning in two hospitals. A team of experts was tasked with evaluating whether to replace or remove the functionalities of this system and the cost associated with either. The largest effects noted were the financial burden and the patient education. The cost to substitute video education with nursing time spent in patient education was determined to not be cost-effective.

Releasing Operating Room Nursing Time to Care through the Reduction of Surgical Case Preparation Time: A Lean Six Sigma Pilot Study

Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to care within a peri-operative environment; this was achieved by collaborating with stakeholders to redesign the process for laparoscopic hernia surgical case preparation (set up) material. Across 128 laparoscopic hernia surgical cases, the pilot resulted in a 55% decrease in overall nursing time spent in gathering and preparing materials for laparoscopic hernia surgical cases, with a corresponding reduction in packaging waste. The major impact of releasing nursing time to care within busy Operating Room environments enabled nurses to focus on continuing to deliver high-quality care to their patients and reduce pressure expressed by the Operating Room nurses. The results have led to an ongoing review of other surgical procedures preparation to further release nursing time and will be of interest to perioperative teams internationally.

Rapid Assesment Analisis Beban Kerja Perawat Ruang Isolasi Rawat Inap Non ICU Covid-19 di Rumah Sakit Umum Daerah Cengkareng

Pada masa pandemi Covid-19, tenaga keperawatan merupakan profesi yang sangat dibutuhkan dalam penanganan pasien yang terkonfirmasi Covid-19. Untuk memenuhi kebutuhan jumlah tenaga perawat maka perlu dilakukan analisa beban kerja dan selanjutnya dapat dilakukan perhitungan kebutuhannya. Tujuan penelitian mendeskripsikan dan mengidentifikasi beban kerja perawat di ruang isolasi rawat inap non ICU pelayanan Covid-19 di RSUD Cengkareng yang merupakan salah satu rumah sakit rujukan Covid-19. Penelitian ini menggunakan metode kuantitatif dengan pendekatan observasional, data penelitian diambil melalui pengamatan langsung dan wawancara mendalam yang dilakukan selama kurun waktu 5 hari di ruang isolasi rawat inap non ICU. Perhitungan beban kerja menggunakan metode Ilyas, dimana informasi yang dihasilkan untuk mengambil keputusan dapat dipercaya karena setiap transaksi bisnis dapat diukur secara cepat dengan tingkat akurasi yang tinggi. Dengan menghitung beban kerja ini dapat memperkirakan kebutuhan tenaga perawat yang diperlukan dalam perencanaan sumber daya manusia. Hasil perhitungan yang didapatkan yaitu berdasarkan data pasien per-Desember 2020, jumlah pasien yang dirawat di ruang isolasi non ICU untuk pasien Covid-19 berjumlah 251 orang, sedangkan tenaga perawat yang terdiri dari perawat RSUD Cengkareng dan perawat relawan berjumlah 171 orang. Berdasarkan data tersebut, analisa beban kerja dengan metode Ilyas didapatkan nursing time perawat ruang isolasi non-ICU untuk pasien Covid-19 adalah 3,5 jam, dan perhitungan kebutuhan tenaga perawat sebesar 178 orang. Penambahan jumlah tenaga perawat di ruang isolasi rawat inap non ICU di RSUD Cengkareng masih dibutuhkan. Keywords: Workload analysis, Nurses Need, Ilyas Method.

Using Lean Six Sigma to Redesign the Supply Chain to the Operating Room Department of a Private Hospital to Reduce Associated Costs and Release Nursing Time to Care

Continuity of the supply chain is an integral element in the safe and timely delivery of health services. Lean Six Sigma (LSS), a continuous improvement approach, aims to drive efficiencies and standardisation in processes, and while well established in the manufacturing and supply chain industries, also has relevance in healthcare supply chain management. This study outlines the application of LSS tools and techniques within the supply chain of an Operating Room (OR) setting in a private hospital in Dublin, Ireland. A pre-/post-intervention design was employed following the Define, Measure, Analyse, Improve, Control (DMAIC) framework and applying LSS methodology to redesign the current process for stock management both within the OR storage area and within a pilot OR suite, through collaborative, inclusive, and participatory engagement with staff. A set of improvements were implemented to standardise and streamline the stock management in both areas. The main outcomes from the improvements implemented were an overall reduction in the value of stock held within the operating theatre by 17.7%, a reduction in the value of stock going out of date by 91.7%, and a reduction in the time spent by clinical staff preparing stock required for procedures by 45%, all demonstrating the effectiveness of LSS in healthcare supply chain management.

Therapeutic Effect Analysis of Plasma Bipolar Intelligent Electrotonic for Cystostomy in the Treatment of Senile Prostatic Hyperplasia

To solve prostatic hyperplasia in the elderly, a method of cystostomy with plasma bipolar resection was proposed. From January 2019 to March 2020, 42 patients with BPH who needed surgical treatment in the urological department were selected. Cystostomy was performed in bipolar TURP. The cystostomy group and robot group were divided into two groups. The surgical safety, surgical efficiency, complications, and nursing time between the two groups were compared. The results showed that the experimental and control groups’ RUV values were significantly lower than those before surgery. In comparison, the Qmax value was considerably higher than that before surgery. The difference was statistically significant ( P < 0.05 ), suggesting that the cystostomy group in bipolar TURP had more substantial improvement of dysuria, better recovery of detrusor function, and better prognosis. It was proved that, for BPH below 80 g, cystostomy could reduce the operation time, bladder irrigation time, catheter indwelling time, and postoperative hospital stay, improve the operation efficiency, and have the same effect on patients’ symptoms improvement, more excellent psychological support, and higher quality of life score. It is proved that plasma bipolar resection combined with cystostomy can effectively improve annual BPH surgery.

Analysis of the Effect of Intensive Care Based on Lean Nursing Intervention

In order to improve the effect of intensive care, this paper proposes a lean nursing intervention method and evaluates the lean nursing intervention through a controlled experiment. According to the actual situation of intensive care, this paper starts with the research from several aspects of patients’ ICU nursing time, patients’ satisfaction, patients’ pathological knowledge familiarity, patients’ autonomous nursing, and enthusiasm of patients and their families. Moreover, this paper collects and displays experimental results through mathematical statistics, gives patients lean management concepts and methods based on routine care, and finds that it has good management effects. Thus, lean management concepts and methods can effectively improve the anxiety state of critically ill patients, improve the patient’s knowledge of disease, and reduce adverse nursing events to improve patient nursing satisfaction, which is worthy of further promotion in the clinic.

ANALISA KEBUTUHAN TENAGA KEPERAWATAN (Studi Kasus di Puskesmas Kebonagung)

Nursing services is an integral part of medical services system, 60% of wokers at public health center (Pukesmas)are nurses and therefore the plan of nurses, especially in determining the number of personnel, should be well-considered in order to obtain effective and efficient staff so that number of woker fits the requiref standard.The objective of this research is yo find out the need for nurses based on the analysis of need for nurses inside and outside the building of Puskesmas Kebonagung Kabupaten DemakThis research is adescriptive case study using cross-sectional framework. This research was done in a week at Puskesmas Kebonagung with atotal sample of seven nurses. The method used in data collecting was distributing from of working list systematically to nurses at Puskesmas Kebonagung .The result of this research showed thed the working time used up by nurse for activities inside the building: productive time compared to non-productive time is 66.14% : 33.86 %. Working time outside the building of Puskesmas Kebonagung for Program Perkesmas took productive time compared to non-productive time of 66.96% : 24.40%; Program P2M took that of 81.83% : 18.17%; Program PKM took that of 73.34% : 26.66%; and program UKS had tis ratio of 78.60% : 21.40%.With an effective nursing time of 3.22 hours per patient per day, it will need 16 nursing wokers according to formula from Depkes (2002),according to Swansbrug (1996) it will need 14 workers,and from Hasibuan (2003) 13 workers are needed. This result showed that the number of needed nurses at Puskesmas Kebonagung should be uncreased. New 6 – 9 staff should be added to the previous nurses.

Innovative Partnership Between Intensive Care Unit Nurses and Therapists to Care for Patients With COVID-19

Background When patients with COVID-19 began presenting to hospitals in early 2020, medical professionals were unprepared to handle the severity of disease and the number of severely ill patients. Local Problem In response to critical needs of patients with COVID-19 and the threat of nurse burnout, a special operations team comprising physical and occupational therapists was convened to (1) provide help to intensive care unit nurses, (2) help therapists be productive, and (3) use therapists’ specialties for critical patients. Methods Two therapists teamed up each shift to work with every critical patient with COVID-19, performing numerous nursing and therapy activities. Activity frequency was documented by the therapists daily, and duration was estimated and data were summarized by nursing leadership. Results During the 9-week program, 35 critical patients with COVID-19 were included in the special operations program. During the program, the teams performed 10 activities, including prone positioning, turning, and mobilization, 1937 times with the patients with COVID-19. The partnership saved between 5 and 40 minutes of intensive care nurse time per activity, which resulted in a total of 677.2 hours of nursing time saved. Discussion Implementation of the special operations program had a positive impact on patients, nurses, and therapists. Patients benefited both clinically and socially from additional time with special operations teams. Nurses benefited from having help caring for critical patients, and therapists benefited from increased productivity during redeployment. Conclusion Deployment of nonnursing clinical staff could be an effective strategy to leverage available resources while maintaining clinical standards of care and reducing nursing burden during a pandemic or crisis surge.

Impacting Neonatal Patient Care: Reducing Needle Sticks, with an Extended Dwell Catheter

Highlights Abstract Background: The use and efficacy of extended dwell peripheral intravenous catheters (EPIVs) has been extensively described at scientific conferences and in recent literature. The ramifications of repeated needle sticks include damage to vessels and ultimately the need for more invasive and costly access devices, which clearly support the need for reliable forms of vascular access. Methods: This quality improvement project spanned 4 years, 2017 through 2020, and included 128 patients who required a peripherally inserted catheter as their primary or secondary access site for a prescribed therapy. The EPIV utilized was a 4-cm, 22-gauge catheter made of thermosensitive polyurethane inserted using the Seldinger technique. Results: Over the course of 4 years, 128 patients received an EPIV for 2 or more days, totaling 849 days of therapy. Total insertion attempts were 174 or an average of 1.4 per patient. An estimated number of short PIVs needed for 849 days would have been 404 with 1011 attempts. Resultant savings with EPIV are estimated to be $30,686. Conclusions: Reducing the number of patient peripheral intravenous attempts while extending the dwell time results in less patient trauma, reliable longer-term access, reduced infection risk, reduced supply usage, and savings in terms of nursing time. The ultimate result for preterm newborns is more efficient delivery of care with less cost.

Implementing a three-hourly feeding schedule in stable preterm infants to decrease maternal fatigue

BackgroundA three-hourly feeding schedule has been shown to be as safe as a two-hourly schedule in preterm neonates. It saves nursing time and may be less tiring for the mothers. However, tradition and apprehensions have prevented its wider acceptance. We used a quality improvement approach to implement a three-hourly feeding schedule in stable preterm infants >32 weeks postmenstrual age (PMA) in our unit through a series of plan–do–study–act (PDSA) cycles.MethodsAll preterm neonates >32 weeks PMA, who were on full enteral feeds and without any respiratory support were eligible. The key quantitative outcome was maternal fatigue score. Safety was assessed in terms of episodes of hypoglycaemia and feed intolerance. Qualitative experiences from nursing staff were captured. The volume of expressed breastmilk and requirement of formula feeds were also recorded. After recording baseline data on a two-hourly feeding schedule, four PDSA cycles were sequentially completed over 21 weeks. The results of each PDSA cycle informed the change strategy for the next cycle.ResultsIn the baseline phase, five neonates on a two-hourly schedule were studied. In PDSA cycles I, II, III and IV, a cumulative of 122 neonates were studied on a three-hourly schedule. There was a significant decrease in median maternal fatigue score (13 (IQR 8–23) to 3 (IQR 1–6); p=0.01)). Only one neonate had feed intolerance, while two had mild asymptomatic transient hypoglycaemia. Six (5%) neonates were shifted to two-hourly feeds temporarily due to transient reasons. Nursing staff felt mothers could devote more time to Kangaroo mother care. The volume of expressed breastmilk and requirement of formula feeds were not different from the three-hourly schedule.ConclusionsIt was possible to change the traditional two-hourly feeding schedule to three-hourly in stable preterm infants using a quality improvement approach, while objectively documenting its safety and benefits.