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San Leandro ICU staff team up to improve procedure process

“I wish I had a list of everything you needed so I didn’t have to keep going in and out of the patient room.”  What San Leandro ICU nurse manager, Sandi Kaur, MSN, RN, said as a light joke to her physician colleague, Jasper Ip, MD, instead became a light bulb moment. 

Now known to ICU care team members as the Procedural Optimization Project, communication has improved in preparation for procedures such as bronchoscopy, percutaneous tracheostomy, line placement, chest tube placement, and paracentesis because of Kaur’s informal comment. Each procedure has a workflow outlining specific details for the ordering physician such as a list of supplies and preferred patient positioning.  

The order also includes a procedure time, which allows nurses to prep everything in advance. “Just like you would see in the operating room or interventional radiology, everything is in place in the room, and the patient is prepped and ready before the doctor arrives,” said Kaur 

“It takes away all the guess work and is especially helpful for nurses who might not be as familiar with the process,” said Llewlyn Lagmay, BSN, RN, CCRN, Staff Nurse III.   

“Efficient is the best way to describe it. Bedside and procedural nurses know what to expect and can plan their day accordingly, and similarly our physician partners can manage multiple procedures a day while balancing their clinical duties – and it’s all seamless for the patient,” added Kaur.   

Additionally, the new process minimizes deviations in standard practice and improves patient care. “When procedures are done more efficiently, it’s less stress and discomfort to the patient,” added Lagmay. 

Consistency of practice between providers improves safety as well as quality. To ensure all nurses are familiar with the new process, a special procedural optimization station is set up on skills day, so all nurses are familiar with the process, as well as receiving one-on-one education.  

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