St. Mary's Health Centre
A major component of continuous quality improvement
SSM St. Mary's Health Centre, located in Richmond Heights, Missouri, is a member of SSM Health Care, the first-ever health care recipient of the Malcolm Baldrige National Quality Award, the nation's highest honor for quality. Driven by a mission of faith-based humanitarian service, St. Mary's is a major community teaching hospital affiliated with the Saint Louis University Department of Obstetrics and Gynecology.
The hospital's independent, accredited residency programme offers a structured, university-style training programme that includes third- and fourth- year medical students along with full-time faculty. Services at St. Mary's include comprehensive obstetrics and cardiology services, including high-risk obstetrics and open-heart surgery. The hospital also offers a wide variety of outpatient services and is licensed for 582 beds, employs 2,100 people and has more than 800 physicians on staff, representing all medical specialties. In 2004, Solucient ranked St. Mary's among the 100 top cardiovascular hospitals in the nation.
In 2003, an interdisciplinary team from St. Mary's Labour and Delivery, NICU, and Mother Baby Unit and SSM Health Care's Order Management/ Information Centre used their system-wide quality improvement model to pinpoint new methods for implementing a positive identification system for newborns and their mothers.
In the past, St. Mary's Health Care used a four-part handwritten identification method, which proved time consuming to assemble. The paperwork was often illegible, with limited space to capture all the necessary information that tied patients to other vital healthcare data including medical record numbers, lab requisitions, and pharmacy labels. As a result, nurses spent a considerable amount of time verifying identification by comparing face sheets, order sheets, and armbands prior to any procedure or medication administration.
Once the collaborative team identified the major issues with the old system, they decided that the new identification method would need to address and accomplish several mandates. First, it must improve patient safety by including all necessary identifiers and ensure legibility. It needed to provide process automation by generating barcoded wristbands upon registration and at the time of birth. Enhanced patient comfort and employee satisfaction were also requirements. Just as important, the new solution must support a way to create appropriate size- and skin- friendly bands for premature babies.
According to Janice Schmitz, RN an on-site Order Management Specialist at St. Mary's Health Centre, the assembled team put forth an organized plan. It included the development of a skin-friendly, quality band, and an entire build that included start-to-finish dates and resource assignments on each significant task.
The plan "began with the SSM HealthCare Information Centre sending developed pieces of the project to begin testing on-site. LaserBand's labor and delivery wristbands which include parent and infant wristbands and infant tags were physically taken up to the units and run through the printers to make sure every piece worked properly. Unit personnel would then provide immediate feedback on the tested piece, and the LaserBand 2 infant wristbands were trialed on a select group of babies."
To gather the most relevant and timely feedback, the team collected surveys from nurses and other users of the new barcoded wristband products and processes. The survey metrics asked the following questions:
- Ability to scan the barcoded wristband on an infant
- Legibility of the wristbands
- Ease of application of the wristbands
- Comfort of the wristband against the baby's skin
- Ability of the wristband to become small enough for premature infants
Survey results indicated that the nine-digit CODE 128 bar code needed to be changed from a horizontal to vertical layout to provide a flatter surface for scanning. Results also showed that the wrist-wrap baby wristband construction stood out as the preferred assembly option.
With the initial testing and survey results complete, the hospital moved forward with standardising the change and packaging the process for facility-wide deployment. According to Paul Borgsmiller, Order Management Product Specialist for the SSM Health Care Information Centre, "Once the project was identified, the team knew they wanted to standardize the new identification system so that it could be used throughout the rest of SSM Health Care."
A critical step was to educate the staff to use the new barcoded wristband process. Beth Moore, RN, MSN, Clinical Educator-NICU, and Pat Birk, RNC, BSN, Clinical Educator-Mother Baby Unit, agree that education was the key to success on this project. Along with process flow charts, printed guides were posted at each unit station and included step-by-step instructions on generating the LaserBand 2 forms in the software programme including printing and loading the product into the printer. Additionally, every nurse was given a one-on-one assembly and application demonstration, and was required to do a return demonstration to the educator.