Lakeland Regional Medical Center
Lakeland, Florida
One Year....One Team
Front L to R:
Michael Semanco, PharmD
Pam Johnson, BSN, CCRN
Sharlet Cochran, MS, CNS-BC
Allison Johnson, BSN, CCRN
Carrie Ogilvie, MSN, CCRN
Back L to R:
Michael Kirsch, PharmD
Troy Batterton, PharmD
Dean Sandifer, MD
Rodney Bevis, RRT
Diana Mellichamp, RN, CCRN
Lauretta Hemlich, BSN, CCRN
Jackie Jordan, BSN, CCRN
Paul Alley, Chaplin
Remarkable Steps Toward Excellence!
The NBA’s original basketball dream team won the gold medal at the 1992 Olympics in because of the passion, skill and heart they brought to the game. Their average advantage for eight games was 44 points. They didn’t settle for just the win, they went after the largest possible margin seeking every opportunity to gain an advantage and to make each game, each moment individually and for the team, the best it could be. There were huge stakes. This fueled their desire to work together and to bring home the ultimate symbol of success, a gold medal.
In intensive care units (ICUs) around the world, the stakes are high every day. For those who commit their careers, hearts and skills to the care of the critically ill and injured and their families, passion and relentless attention to incremental improvement is crucial. Not unlike sports, hard work, application of evidence-based strategies and the dedication of every team member are what make the difference between good and great. At a hospital in lakeland, Florida a truly remarkable multiprofessional team comes together every day to provide the very best care possible in the critical care units. Could this also be a dream team? Here are some details:
In October 2007, Lakeland Regional Medical Center (LRMC) began a year-long journey to identify and address opportunities for change in the critical care unit via Paragon. After pre-assessment and a two-day site visit, one crucial area identified for improvement was early diagnosis and intervention for sepsis in the emergency department (ED) and on the hospital wards. Clinical performance improvement integrating the sepsis bundles in an 800-bed trauma hospital is a daunting task, but the team got back to applying the basics of quality improvement using rapid-cycle change and, with the help of Paragon coaches William A. Brock, MD, FCCM and Sarah L. Darwin, RN, MSN, the team was well on its way. Dr. Brock and Ms. Darwin had extensive experience with integrating the sepsis bundles at Sentara Health System and understood the barriers and strategies involved, so this match signaled good things to come.
During the Paragon pilot, 496 patients were screened for sepsis, with 310 patients meeting the criteria for and receiving the sepsis resuscitation bundle. Of those receiving the bundle, 62% met the goal of a ScvO2 >70%. This is one of the highest rates of compliance seen by the Surviving Sepsis Campaign. The ICU team worked collaboratively with the ED to implement processes to improve the early recognition and treatment of sepsis. This included alerting the medical ICU charge nurse to potentially septic patients, revisions of the screening/order sheet, education in the ED, and the development of an early goal-directed therapy (EGDT) cart with supplies.
In addition to sepsis, the team decided to seek help from their Paragon coaches to reduce ventilator-associated pneumonia (VAP). A spike in cases caused the team to re-examine processes and refocus on strategies that had been successful in the past. The team audited the compliance with the standards of care for the ventilated patient, such as ventilator bundling, glycemic control, meticulous oral care, and patient care during “road trips.” The team also engaged the bedside registered nurse and respiratory therapist to create processes that would improve compliance and raised awareness utilizing standardized communication tools during rounding, staff meetings, and huddles, as well as one-on-one conversations. The result was a 50% decrease in the VAP rate.
Assessments that were performed using the ICU REPORT Index™ tool in 2007, before the Paragon project began, and in 2008 upon completion show the following results:
The pre-assessment revealed that the team already had transformed the LRMC critical care unit into a high performing environment, so exponentially stellar results were not expected at the close of Paragon in 2008; however, as shown above left there were impressive improvements across the board. This is what high performance is really all about: seizing every opportunity to tweak practices and embrace evidence-based guidelines, consistently caring deeply about working relationships, and putting high reliability and safety at the forefront. With the patient at the center of all activities, every team can make improvements to enhance care no matter the magnitude. That extra bit of excellence can be tough to achieve but it is well worth the effort.
Two members of the LRMC critical care team have now become Paragon coaches. They are be prepared to share their expertise in a wide variety of areas from palliative care to sedation management and beyond. It is with great gratitude and congratulations that the SCCM Paragon committee and staff acknowledge LRMC for their “Olympic” performance. We look forward to hear of their many continued accomplishments in the future.
To read about LRMC’s latest patient-centered care unit, Palliative Care, visit: http://www.theledger.com/article/20081127/NEWS/811270404
