Title : Practicality and reality of research in the clinical workplace: The s.p.o.t. – resilient bundle of care
What makes a viable healthcare program? Ease? Practicability? Simplicity? Every study is designed with a purpose –either to prove, to make something better or to make a lasting change. However, no matter how promising a study is, if not maximized or applied correctly and diligently, it will die a natural death and remain in the nursing archives. In 2014, a simple project pioneered by a group of novice nurses paved the way in providing a more efficient mechanical ventilator weaning process to post open heart surgery patients in a tertiary hospital in the Philippines. This consisted of routine independent nursing interventions (Suctioning, Patient Stimulation, Oral Care and Turning) organized together into a set called “SPOT bundle of Care”. From then on up to present, this study has continuously made an impact in achieving safe and quality outcomes for Cardiovascular - PACU patients. Retrospective data gathering was utilized to check the extubation time of patients as well as their total time of stay in CVPACU after surgery. Baseline data from January - July 2013 reports thatonly 23 out of 47 patients (49%) were extubatedless than pre-determined 5-hour target. The absence of structured guidelines and clear interventions to prepare the patient for extubation and the lack of set threshold for early extubation has contributed greatly to patients being intubated longer than necessary posing higher risks and longer stay in CV-PACU. After implementation in August 2013, significant increase of 26% was noted wherein 62 out of 82 patients (75%)in the number of patients were safely extubated within set target. This also has been a significant factor for reducing the patient’s stay in CV-PACU, which improved from an average of >10 hours to <6 hours by end of 2016. Measures have been monitored throughout the years and have presented consistent positive outcomes with mean extubation time at 3:29 (2017) and 3:93 (2018) whereas total patient stay was shortened to mean of 4:53 (2017) and 5:34 (2018). The S.P.O.T. Bundle of Care provided a unique nursing component in line with current trend of fast track cardiac surgery protocols widely implemented in other international hospitals. As with other studies done in the clinical setting, ensuring viability amidst fast paced work flow, constant attrition of nurses, and working with a multidisciplinary care team has been a refining measure.From 2013 to present, the project’s impact in patient care and the whole CV-PACU workflow have been visible. Having organized hands-on nursing care procedures on board has made the care team more patientfocused and for new nurses to be easily familiarized with post-operative caring process. In an area where complexity is a norm, the practicality, organization and simplicity of quality improvement measures are keys to make a lasting impact. From several independent nursing interventions to a more organized bundle of care called S.P.O.T. came a strategy that makes a difference not just to nurses and the healthcare team but more so to the patients to whom we desire to provide the best quality care.
Take Away Notes:
• The project standardized the process and helped attain post-operative goals in a timely manner, leading to care delivered more consistently, reliably, safely, and in compliance with standards of practice. This project is a testimony that simple interventions when organized well through research strategies and right people management tools can effectively bring improvement and life changing effects to patients and in healthcare processes. But more than the data, its ability to thrive and continuously make an impact ever since its implementation show that simple and viable quality programs are possible. This presentation will also discuss the practicality and reality of research in the clinical workplace as the project was developed. This also aims to encourage new nurses to explore and be involved in more research and quality improvement projects where their potentials, passion and experience could be utilized; and for seasoned nurses to be more patient in guiding new generation of nurses to see the bigger picture of the healthcare process and systems which are gained through years of experience.