Through the Shared Nursing Leadership Council Critical Care Clinical Forum (CCCF), clinical nurses have been working on improving processes for transporting critically ill patients to the MRI environment. The collaboration between intensive care unit (ICU) and radiology nurses began in the fall of 2018 in response to ongoing communication breakdown, challenging transports, and dissatisfaction between the nurses when preparing and transporting patients to the MRI environment.
The nurses in the critical care units and the radiology nurses in the Magnetic Resonance Imaging (MRI) setting agreed the transport was difficult and time-consuming; the transport process required a team approach to successfully identify improvements. The ongoing partnership supported by unit leaders has led to the implementation of numerous process changes leading to increased satisfaction between the PICU and Radiology nurses and improved efficiency of preparation and safe transport of critically ill patients to the MRI suite. The idea of the clinical nurses working as a team with the same goal is a natural outcome of Shared Nursing Leadership (SNL), however, it takes commitment and mutual respect to reach the result. The team approached this Process Improvement work with quality listening and sharing to understand how the two diversely different nursing areas function independently and interdependently. The conversations were not easy but definitely ended positively. Anecdotally, the experience of the PICU patients and PICU nurses has improved.
An example of this was brought to CCFC's attention by Dan Brown, a PICU nurse who had a positive experience with MRI in September 2019. An intubated critical patient with 8 drips needed to have an MRI. PICU nurse Dan reported it took only 15 minutes to transfer the patient from the PICU bed to MRI stretcher to MRI scanner. Dan reported this process was smooth; greatly due to flawless communication, coordination, and assistance from the MRI team prior to transporting the patient to the MRI setting.
Iris Cabading BSN, RN, CPN is an MRI charge nurse and she reported, "As one of the MRI charge nurses, we have experienced positive outcomes from the collaborative work of the CCCF team. The critical care transfers to the MRI department can be stressful for the nurses caring for the patient and the patients needing this exam. The nurses must plan this transport efficiently to include the transfer of numerous medication drips and monitoring/ventilation equipment to MRI safe equipment... the patients must be out of their ICU environments for long periods. In order to help lessen the stress of our fellow ICU team members, the need for intervention, communication, and proper education was addressed during our CCCF meetings. Improved teamwork with our critical care colleagues resulted in improved patient safety with increased preparation in the ICU setting, which resulted in less time in the MRI environment and increased nurse satisfaction. We continue to experience unforeseen delays in MRI; however, the ICU team responds much more positively than ever before. We believe this is directly related to the MRI-ICU nurse collaboration and teamwork".
The CCCF members have found positive outcomes to smooth the process for the transfer of the patients and positive attitudes from our nurse colleagues. Improved processes from the MRI nursing team include 1. The MRI updated SBAR tool 2. The RN tool kit utilized during the pre-exam visits to the ICU setting 3. Sharing 'real-time' knowledge and expectations of the MRI experience while in the ICU, and 4. Participating in medication transfer and education with the MRI infusions pumps in the ICU setting. The radiology new graduate nurses have contributed to this initiative, as their change projects focused on standardizing the preparation process of the ICU patients with the newly developed MRI checklist and Just in Time tool.
The dissemination of information from this small group of nurses to the many colleagues in their respective departments and units has contributed to the success of the improvement in this process. As facilitators of this group, we are extremely proud of the collaborative spirit in which the PICU and radiology nurses worked tirelessly and with mutual respect and understanding the expertise of their colleagues to improve this complicated process. Their compassion for their colleagues and understanding of unforeseen delays, steadfast commitment to patient safety, and willingness to connect with each other embodies not only our core values at Children's National Hospital but also the spirit of Shared Nursing Leadership.