Hearing a Mayday called on a pediatric unit is very stressful for all staff involved. Nurses on the pediatric unit at Lexington Medical Center (LMC) in West Columbia, S.C., have implemented a quality-improvement initiative that alleviates some of the anxiety and stress in pediatric code situations.
In February 2005, a few of the pediatric staff attended a workshop titled Sick Kids Crashing Kids. The speaker addressed the Academy of Pediatrics recommendation that any child who enters a hospital system be given an identification bracelet to match the appropriate drawer of the Braslow pediatric emergency cart. The drawers of the cart are color-coded to contain the proper equipment for specific weight groups.
At LMC, there is a Braslow cart on the pediatric unit, in the emergency department, and in the operating room.
Nurses who attended the workshop and the pediatric unit-based practice committee at LMC discussed developing a system to identify patients with the proper drawers of the cart.
The decision was made to recommend developing some type of color-coded method of identification. The committee presented the recommendation to the Nursing Leadership Council (NLC).
With overwhelming approval from the NLC, the pediatrics unit began working on the plan to identify patients by their weights corresponding with the Braslow cart drawers.
A PDCA (plan, do, check, and act) process improvement method was used for this project. The planning stage entailed researching the products available for purchase.
The nurses researched different ideas, such as color-coded magnets to place on doors and color-coded tape for charts, but they decided to pursue color-coded bracelets. The search for bracelets that match the colors on the Braslow cart was time-consuming. The nurses reviewed several bunches of sample bracelets before they found matches and bought them.
During the do stage, the nurses wrote a procedure for staff to follow. They developed a form to monitor compliance and check for problems. They provided orientation for staff members and distributed memorandums to supervisors notifying them of the trial that was under way.
They devised a graph with weights in both pounds and kilograms and the corresponding bracelet color the pediatric patient should have placed on his or her arm or leg. In an effort to ensure correct drawers were opened in an emergency, they taped a sample of each bracelet on the corresponding drawer on the Braslow cart.
During the check phase, two problems were identified. First, the patients being admitted to the pediatric unit from the ED were arriving with colored bracelets already in place, but the bracelets were not weight-based. The ED was using color-coded bracelets as part of its triage function to identify where the patient should be seen. The nurse managers from pediatrics and the ED met and the problem was resolved. The ED discontinued using the colored bracelets.
Second, there were patients who fell out of the weight range provided by the Braslow cart. Some fell below the lowest weight or above the highest weight provided by the cart. To reduce confusion, the unit ordered special bracelets to identify these patients. After a search was conducted, two styles were chosen and the staff was oriented about when to use the new bracelets.
Compliance monitors revealed 100% compliance in the placement of the correct bracelets on patients.
The act stage involved formalizing the procedure and presenting the results to the NLC. The unit developed a PowerPoint presentation describing the steps they took to implement this process improvement. The chair of the unit-based practice committee and the care manager of pediatrics gave the presentation at an NLC meeting.
As a result of this process improvement, the ED and the anesthesiology department are looking into using color-coded braclets, too. The idea has been presented to representatives from both areas and the pediatrics unit committee stands ready and willing to assist in the implementation process throughout the LMC system.
Fortunately, there has not been a pediatric code since the execution of the new system. However, the staff is secure knowing it can save precious time if and when the next Mayday strikes the unit.
Susie Pippin, RNC, BSN, BC, is a pediatric unit staff nurse at Lexington Medical Center. Nydia Harter, RN, MSN, CNAA, BC, is director of nursing and women and children services.