Date of Graduation

Fall 12-12-2014

Document Type

Project

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Melissa Vandeveer, PNP, CNL, PhD

Second Advisor

Janet Van Gelder, RN, DNP, NEA-BC

Abstract

The goal of this Clinical Nurse Leader (CNL) internship project was to maintain safety and quality of care of obstetric (OB) patients undergoing Cesarean Sections (C/S) after operating room for cesarean sections (ORC) is relocated from obstetric unit to the main operating room (OR). The microsystem will accomplish this through effective teamwork, clear interdisciplinary communication, collaboration, and standardization of processes involved. The institution is a not for profit rural health care facility and is a designated Critical Access Hospital; it is located in Northern California. A general obligation bond was passed in 2007 to fund seismic upgrades. Old OB unit was housed in one of the oldest buildings on campus; new seismically compliant unit is being built from the ground up. Supportive data for the projects was collected through Failure Modes and Effects Analysis (FMEA) and process map flowcharts. Strengths, weaknesses, opportunities, and treats (SWOT) analysis of the microsystem was also performed. Relevant stakeholders were included in process development and continuous evaluation upon implementation. Literature review of evidence-based practice (EBP) reviewed decision to incision times and attainability of the 30 minute standard. Kurt Lewin’s Change Theory of unfreezing, moving, and refreezing provided foundation to support this process change. The entire process from planning to implementation, and evaluation is 16 months. The process was implemented on September 3rd, 2014. Clinicians have maintained quality and safety of patient care of obstetric patients undergoing cesarean sections in the new location. Plan do study act (PDSA) cycles have been used to continually monitor and modify process to ensure safety and quality of care.