Using a Lean Six Sigma Approach to Yield Sustained Pressure Ulcer Prevention for Complex Critical Care Patients

Donovan, Elizabeth A; Manta, Christine; Goldsack, Jennifer C.; Collins, Michelle

doi:10.1097/nna.0000000000000291

Cited by 14 publications

(15 citation statements)

References 19 publications

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“…In a study to reduce the rate of occurrence of pressure ulcers, Donovan et al describe interdisciplinary ward rounding and use of integrated documentation and interdisciplinary rounding checklists as antecedents to situational awareness. “By discussing risk and skin integrity during interdisciplinary rounds and by having patient skin condition documented in a single location, our initiative ensured that all providers were aware of the status of patients” ([ 38 ]:46). …”

Section: Resultsmentioning

confidence: 99%

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Team interventions in acute hospital contexts: a systematic search of the literature using realist synthesis

Cunningham

Ward

Brún

et al. 2018

BMC Health Serv Res

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BackgroundResearch on team effectiveness in healthcare has focussed on whether effective teams yield positive outcomes for patients and on the effectiveness of team interventions to improve performance. Limited understanding exists of what works for whom within an effective team, or how and why the context in which the team operates enables team members both as individuals and as a collective to enact behaviours that promote positive outcomes.MethodsThis realist synthesis of the literature explores the relationship between team interventions, underlying teamwork mechanisms generated by those interventions, and the resultant impact on patient outcomes in an acute hospital context. A systematic search of five healthcare and healthcare management academic databases: PubMed, PsychINFO, CINAHL, ABInform, Emerald Management and three grey literature databases: ERIC, OpenDOAR and Open Grey was undertaken. Five experts in the field were also contacted to source relevant literature. Using PRISMA guidelines, relevant studies published between January 2006 and January 2017 were systematically searched by a team of three people. Drawing on realist methodology, data were synthesised using context, mechanism and outcome configurations as the unit of analysis to identify enablers and barriers to effective team interventions.ResultsOut of 3347 papers retrieved, 18 were included in the final synthesis. From these, five contextual enablers were identified: an inter-disciplinary focus and flattened hierarchy; effective communication; leadership support and alignment of team goals with organisational goals; credibility of intervention; and appropriate team composition with physician involvement. Ten recurring mechanisms were identified, the most frequently occurring of which was shared responsibility.ConclusionsThe advantage of using realist synthesis to extrapolate data from the literature is that it considers the context and mechanisms that will impact effectiveness of healthcare team interventions. This methodological approach provides a different perspective to other types of syntheses and offers insight as to why certain contextual elements may yield more success than others. Findings therefore tend to have more practical implications. Specificity of detail in terms of how external drivers impact on healthcare team interventions was limited in the articles extracted for analysis. This broader perspective is therefore an important consideration for future research.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3331-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…“By discussing risk and skin integrity during interdisciplinary rounds and by having patient skin condition documented in a single location, our initiative ensured that all providers were aware of the status of patients” ([ 38 ]:46).…”

Section: Resultsmentioning

confidence: 99%

Team interventions in acute hospital contexts: a systematic search of the literature using realist synthesis

Cunningham

Ward

Brún

et al. 2018

BMC Health Serv Res

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“…Mostly nurses, some by dedicated team 7(7) Ballard et al, 2008;Coyer et al, 2015;Donovan et al, 2016 ;Gage, 2015;Hiser et al, 2006;Loudet et al, 2017;Tayyib et al, 2015 *We used a modified implementation strategy classification system (Leeman et al, 2017); PI: pressure injury; PIP: pressure injury prevention Baldelli and Paciella, 2008;Ballard et al, 2008;Coyer et al, 2015;de Laat et al, 2007;Donovan et al, 2016 ;Gage, 2015 ;Hiser et al, 2006;Loudet et al, 2017;Richardson et al, 2017 New protocols Interdisciplinary team 1(1) Hiser et al, 2006 Adding new equipment Hospital 2(2) Donovan et al, 2016;Hiser et al, 2006 Using technology in decision making Team leaders 1(1) Loudetet al, 2017 Reminder system Dedicated team or bedside nurses 6(5) Baldelli andPaciella,2008;Coyeretal., 2015;Elliott et al, 2008Gill, 2015Tayyib et al, 2015 Communication and education checklist Multidisciplinary team and dedicated PIP team 2(2) Donovan et al, 2016;Wolverton et al, 2004 Capacity building strategies…”

Section: Implementation Strategiesmentioning

confidence: 99%

“…Integration strategies included standardising and improving documentation (in most papers), using reminder systems (six papers), clarification of roles (Azuh et al, 2016), establishing new structures such as new teams and new roles on pressure injury prevention (10 papers), pressure injury prevention protocol development (Hiser et al, 2006), adding new pressure injury prevention equipment to hospital product list (Donovan et al, 2016, Hiser et al, 2006, and developing/using technology such as smartphone apps to manage pressure injury management decisions (Loudet et al, 2017). Some of these strategies were carried out by project team members and bedside nurses, however, most of the papers did not specify who enacted the strategies.…”

Section: No Information 1(0) Gage 2015mentioning

confidence: 99%

The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review

Lin

Song

et al. 2020

International Journal of Nursing Studies

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“…Implementasi six sigma dilakukan dengan cara membuat project-project perbaikan atau peningkatan kualitas kinerja melalui siklus Define, Measure, Analyze, Improve, Control (DMAIC). Metodologi six sigma sudah banyak diterapkan dalam bidang kesehatan antara lain penerapan metode six sigma dapat mengurangi risiko infeksi terkait kesehatan di bagian bedah (1) , menurunkan angka kejadian decubitus dari 4,4% menjadi 2,8% (6) , mengurangi angka kejadian infeksi aliran darah primer atau Central Line Associated Blood Stream Infection (CLABSI) di bawah standar nasional (3) , dan efektif dalam mengurangi jumlah hari rawat inap dan menurunkan jumlah pasien yang terkena HAIs (1) . Tujuan dari systematic review ini adalah untuk memeriksa bukti yang ada tentang penerapan metode six sigma dalam mencegah dan menurunkan kejadian infeksi di rumah sakit sehingga akan memberikan dampak yang positif bagi pasien maupun rumah sakit itu sendiri.…”

Section: Pendahuluanunclassified

Penerapan Metode Six Sigma dalam Pencegahan dan Pengendalian Infeksi di Rumah Sakit: A Systematic Review

Waluyo

Sholihin

Permana

et al. 2019

JPKSF

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Background: Prevention and control of infections is a priority in the current health sector, and prevention of infection is an indicator of the quality of services provided. Purpose: to examine the available evidence about the application of the Six Sigma method in the prevention and control of infections in hospitals. Method: The database used to identify suitable articles obtained from Scopus, Pubmed, Ebscohost and Summon was limited to the last 5 years of publication from 2014 to 2019, English, and fulltext articles. The literature review used the keyword "Six Sigma, Prevention Infection". In searching articles used "AND". Only 8 articles met the inclusion criteria. This review was from these 8 articles. Results: The application of the six sigma method provided a variety of benefits. Prevention and Reduction of decubitus ulcer infection, Central Line Related Blood Flow Infection, Surgical Site Infection, Ventilator Related Pneumonia, reduced the incidence of health related infections, reduced length of stay, increased health protection, reduced treatment costs and improved patient safety. Conclusion: the six sigma method is effective in preventing and controlling infection in hospitals. Recommendation: hospitals apply this method for approval and control of infection. Keywords: six sigma; infection; hospital ABSTRAK Latar belakang: Pencegahan dan pengendalian infeksi menjadi prioritas bidang kesehatan saat ini, dan mengurangi kejadian infeksi merupakan salah satu indikator kualitas layanan yang diberikan. Tujuan: untuk menguji bukti yang ada tentang penerapan metode six sigma dalam pencegahan maupun pengendalian kejadian infeksi di rumah sakit. Metode: database digunakan untuk mengidentifikasi artikel yang sesuai diperoleh dari Scopus, Pubmed, Ebscohost dan Summon terbatas untuk publikasi 5 tahun terakhir dari 2014 hingga 2019, bahasa inggris, dan fulltex article. Tinjauan literatur menggunakan kata kunci “ Six Sigma, Prevention Infection”. Dalam pencarian artikel menggunakan "AND". Hanya 8 artikel yang memenuhi kriteria inklusi. Ulasan ini berasal dari 8 artikel tersebut. Hasil: penerapan metode six sigma memberikan manfaat yang beragam. Pencegahan dan penurunan kejadian infeksi ulkus decubitus, Central Line Associated Blood Stream Infection, Surgical Site Infection, Ventilator Associated Pneumonia, menurunkan kejadian healthcare associated infections, mengurangi lama hari rawat, meningkatkan kepatuhan kebersihan tangan, mengurangi biaya perawatan dan meningkatkan keselamatan pasien. Simpulan: metode six sigma efektif mencegah dan mengendalikan infeksi di rumah sakit. Saran: rumah sakit menerapkan metode ini untuk pencegahan dan pengendalian infeksi Kata kunci: six sigma; infeksi; rumah sakit

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Using a Lean Six Sigma Approach to Yield Sustained Pressure Ulcer Prevention for Complex Critical Care Patients

Abstract: The program significantly reduced UAPU rates in high-risk populations. LSS methodologies are a sustainable approach to reducing hospital-acquired conditions that should be broadly tested and implemented.

Cited by 14 publications

References 19 publications

Team interventions in acute hospital contexts: a systematic search of the literature using realist synthesis

Team interventions in acute hospital contexts: a systematic search of the literature using realist synthesis

The effectiveness of multicomponent pressure injury prevention programs in adult intensive care patients: A systematic review

Penerapan Metode Six Sigma dalam Pencegahan dan Pengendalian Infeksi di Rumah Sakit: A Systematic Review

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