Project Scope and Plan (PSP) General Information: Project name: Contrast Dye Reaction Protocol. Project Manager Name: Erin Burdi

Transcription

1 Project Scope and Plan (PSP) General Information: Project name: Contrast Dye Reaction Protocol Project Manager Name: Erin Burdi Site: Radiology Department at Spectrum Health Hospital. Location: Grand Rapids, MI A. Project Overview: Describe the product or service of the project, the reason project will be undertaken, and the purpose of the project. Discuss the problem or opportunity this project addresses. Include the quality and safety issue this project will address. Support with current evidence-based practice literature or data specific to the project. I currently work as a Radiology Nurse in the interventional radiology (IR) holding room at Spectrum Health Hospital. As radiology professionals, it is our commitment to our clients and interdisciplinary team members within the facility to provide safe and quality patient care for inpatient and outpatients seeking testing and procedural services that we provide. There are numerous nursing responsibilities in this department. One of the responsibilities of an IR Holding Room RN is to act as an initial responder to patients experiencing an intravenous (IV) contrast reaction. IV contrast dye is used frequently in many of the tests performed in the radiology department at Spectrum Health; computerized tomography (CT), magnetic resonance imaging (MRI), IR arteriogram, and pyelograms, are just a few. While contrast reactions are rare, the severity of a reaction can range from mild (skin rash, itching, nausea and vomiting) to severe and life threatening reactions (arrhythmias, hypotension, overt bronchospasm, pulmonary edema, seizure, syncope, and possibly death) (Singh & Daftary, 2008). Reactions typically occur within 20 minutes of the contrast dye injection and are independent of the amount of contrast given. In fact, less than 1ml of contrast can cause a severe life-threatening reaction (Siddiqi & Lin, 2011). A project opportunity that I have identified in my department is the lack of an official protocol or algorithm published for Radiology health care professionals to follow when a contrast reaction occurs. There is currently a roughly drafted protocol in progress written by Dr. Larson. However, the draft has not been reviewed by radiology staff in the department and has been in progress for some time. I feel that because of the potential threat that these reactions pose to patients within our care, it is an important patient safety measure to have an established protocol and a posted algorithm for staff in the Radiology Department to follow as soon as possible. These tools would provide staff with evidence-based resources to quickly and efficiently identify and treat contrast

2 reactions. The project team for developing a Contrast Reaction Protocol for the radiology department at Spectrum Health will include myself and representatives from each modality in the radiology department: CT, MRI, Fluoroscopy, and IR. Together, I feel that we can establish a well-rounded, comprehensive, evidence-based protocol and compose an effective algorithm for IV contrast reactions. B. Project Goal(s): Describe the project goal(s) using SMART (specific, measurable, and accurate and agreed to, realistic, and time bound) formula. These goals will be used to measure and Determine the project s success at its conclusion. The project goal for my team is three-fold: the revision of the current draft of Dr. Larson s protocol, development of a visual algorithm to accompany this protocol, and presentation of our project information in at the Radiology Shared Leadership meeting by November 30 th C. Project Objectives/Deliverables: List the specific items or services that must be produced in Order to fulfill the goal of the project. Objectives/deliverables should be measurable results, Measurable outcomes or specific products or services. List and number in a logical order to Complete the project. 1. Project manager will identify and meet with potential stakeholders and ask for their project participation by September 8 th, Assemble project team of representatives from each modality (CT, MRI, X-ray, radiology education, and IR Holding room) by September 13, Determine date and time for November Shared Leadership meeting for project presentation by week of September 19 th, Project Manager will obtain and copies of Dr. Larson s draft of reaction protocol to project team by September 19 th, Meet with project team to review and discuss current draft of Dr. Larson s reaction protocol and team recommendations by October 7 th, Meet with project team to begin development of a visible contrast reaction algorithm by October 14 th, Establish a final draft of contrast reaction algorithm by October 28 th, 2011.

3 8. Dr. Larson and stakeholders copies of revised reaction protocol (with team suggestions and recommendations) and final draft of contrast reaction algorithm by week of October 31 st, Present Contrast Reaction Protocol and Algorithm to Radiology Shared Leadership Committee by November 30 th, D. Comprehensive List of Project Requirements/Activities/Tasks: List by corresponding Objective the necessary specifications of the objective/deliverable. Example 1.1, 1.2, 1.3, 1.4, etc This is a breakdown of the objectives/deliverables into their most basic components. Consider This the action plan of the project. 1. Project manager will identify and meet with potential stakeholders to discuss project and ask for their participation by September 8 th, Identify potential stakeholders for project Learn utilization of Microsoft Outlook and Scheduler software stakeholder s project purpose and set-up meeting time for using Microsoft Office by August 30 th, Assemble project team of representatives from each modality (CT, MRI, X-ray, radiology education, and IR Holding room) by September 13, Select five project team members (one from each radiology modality) to participate in team project team members project purpose and details. 3. Determine date and time for November Shared Leadership meeting for project presentation by week of September 19 th, Contact Renae Crozier RN, department representative, to determine date and time of November Shared Leadership meeting and have her submit project to be added to meeting agenda by September 19 th. 4. Project Manager will obtain and copies of Dr. Larson s draft of reaction protocol to project team by September 19 th, team members using Microsoft Outlook a request to review and make written suggestions and rationales to attached copy of Reaction Protocol Personally review Reaction Protocol 4.3. Research best practice for managing contrast reactions.

4 5. Meet with project team to review and discuss current draft of Dr. Larson s Contrast Reaction Protocol and team recommendations by October 7 th, Schedule team meeting using Microsoft Scheduler for week of October 7 th Review as a group Dr. Larson s Contrast Reaction Protocol and discuss each team member s suggestions and rationales Finalize a revised version of Contrast Reaction Protocol to submit to Dr. Larson. 6. Meet with project team to begin development of a Contrast Reaction Algorithm by October 14 th, Schedule team meeting using Microsoft Scheduler for week of October 14 th Prepare rough draft of Reaction algorithm for team review and discussion using Microsoft Word team rough draft of Contrast Reaction Algorithm and explain purpose of next meeting. 7. Establish a final draft of Contrast Reaction Algorithm by October 28 th, Revise and finalize draft of Reaction Algorithm incorporating team recommendations using Microsoft Word. 8. Dr. Larson and stakeholders copies of revised reaction protocol (with team suggestions and recommendations) and final draft of contrast reaction algorithm by week of October 31 st, Compose detailing team project purpose and goals to Dr. Larson Attach copies of revised protocol and reaction algorithm to for Dr. Larson to review. 9. Present Contrast Reaction Protocol and Algorithm to Radiology Shared Leadership Meeting by November 30 th, Prepare power point presentation detailing the team project Familiarize myself with software and technology needed to run presentation Make copies of revised protocol and finalized algorithm to hand out to staff Provide opportunities for staff questions and concerns.

5 E. Timeline: Identify time estimates by hours for each objective/deliverable in hours. These are estimates only and will be updated as project progresses. 1. Project manager will identify and meet with potential stakeholders to discuss project and ask for their participation by September 8 th, a. Estimated time to complete objective 5 hours (includes time to compose, edit, and send to stakeholders, learn Microsoft Outlook and Scheduler software, schedule meeting time and place, prepare agenda and documents for meeting, and commence 30 minute meeting with shareholders scheduled for September 8 th ). 2. Assemble project team of representatives from each modality (CT, MRI, X-ray, radiology education, and IR Holding room) by September 13, a. Estimated time to complete objective 4-5 hours. (Includes time spent discussing with stakeholders their choice of project representative, composing, editing, and ing each project team member.) 3. Determine and set-up Shared Leadership meeting times for project presentation by week of September 19 th, a. Estimated time to complete objective 3 hours. (Includes time spent in contacting and exchange with Renae Crozier meeting time for month of November, preparation and submission of project plan for agenda approval). 4. Project Manager will obtain and copies of Dr. Larson s draft of reaction protocol to project team by September 19 th, a. Estimated time to complete objective hours. (Includes time spent composing explanation of meeting purpose to team members, locating and attaching copy of protocol, personally reviewing protocol and researching best practice on management of contrast reaction literature). 5. Meet with project team to review and discuss current draft of Dr. Larson s reaction protocol and team recommendations by October 7 th, a. Estimated time to complete objective 15 hours. (Includes time spent scheduling meeting time and place, reviewing protocol and suggestions with team members at the meeting, and finalizing revised protocol for submission to Dr. Larson). 6. Meet with project team to begin development of a visible contrast reaction algorithm by October 14 th, 2011.

6 a. Estimated time to complete objective hours. (Includes time spent scheduling meeting time and place, learning how to compose an algorithm using Microsoft Word, preparing rough draft of algorithm, and meeting with team to review and revise rough draft). 7. Establish a final draft of Contrast Reaction Algorithm by October 28 th, a. Estimated time to complete objective 8-10 hours. (Includes time spent on revision and finalizing algorithm draft incorporating team suggestions). 8. Dr. Larson and stakeholders final copies of revised Reaction Protocol (with team suggestions and recommendations) and final draft of Contrast Reaction Algorithm by week of October 31 st, a. Estimated time to complete objective 3 hours. (Includes time spent composing s to Dr. Larson and stakeholders, attaching final drafts). 9. Present Contrast Reaction Protocol and Algorithm to Radiology Shared Leadership Committee by November 30 th, a. Estimated time to complete objective hours. (Includes time spent preparing power point presentation, preparation of project agenda documents, review of presentation with Jim Laforge & Renae Crozier, making possible revisions, making copies, familiarizing myself with software and technology needed for presentation, and presenting information at meeting). F. Assumptions & Constraints: Identify all project assumptions and constraints. Assumptions Contrast Reaction Project gets approval from Radiology stakeholders and management by specified date. Team members from each radiology modality who have the time and interest in the project can be selected by specified date. Team manager can review current protocol, research best practice literature for contrast reaction management, and develop a rough algorithm by specified dates. Team members can meet and engage in topics selected during specified times. Meeting rooms are available during specified times. Team manager can efficiently utilize technology and software to schedule meetings, communicate with team members, develop protocol and algorithm, and present information to staff by specified dates. Project presentation is approved for November Shared Leadership meeting agenda

7 There are no computer or technology breakdowns or snafu s through-out project term. Dr. Larson, stakeholders, and radiology staff accept and utilize protocol revision and reaction algorithm. Constraints Project does not get approval from management and stakeholders. Scheduling conflicts with team members for meetings. Time availability for team members to complete review of protocol and make suggestions. Meeting times and room availability. Project does not meet approval for Shared Leadership Meeting. G. Success Criteria: Provide the value of the project. Why is this project important and of what benefit it is? What impact will it have on client care and client outcomes including aspects related to quality and safety? How will you know if the project was a success? Support with evidence-based literature or nursing data. The development and implementation of a universal evidence-based contrast reaction protocol for the Radiology Department will improve health care outcomes by providing staff with the education and resources necessary to quickly and effectively assess and manage a contrast reaction. This protocol would aid radiology staff with the assessment of appropriateness of test requiring contrast administration, identifying patients at high risk for a reaction and those who have had a previous reaction, and whether the patient has received prophylactic treatment. A posted reaction algorithm would provide staff with a quick visual response tool in the event of a contrast reaction. Many contrast reactions are considered to be mild to moderate with recommended treatment focus on symptom management with antihistamines, bronchodilators, and corticosteroids (MedlinePlus, 2011). However, there are cases of life-threatening anaphylactic reactions that would require quick and aggressive intervention by staff. According to Namasivayam, Kalra, Torres, and Small (2006): Prompt recognition and treatment are invaluable in blunting an adverse response of a patient to contrast media, and may prevent a reaction from becoming severe, or even life-threatening. Knowledge, training, and preparation are crucial for appropriate and effective therapy in the event of an adverse reaction. Radiologists and their staff need to review the treatment algorithms regularly so that each can accomplish his or her role. (p. 214)

8 The establishment of a Contrast Reaction Protocol and algorithm management would provide decreased patient time to treatment, there-by improving quality of care and patient safety outcomes. Project success would be determined through the acceptance and publication of a Contrast Reaction Protocol and Algorithm following the project presentation in November. Indicators of success would include each modality having a readily available copy of the protocol and a posted copy of the developed algorithm in clear sight. Utilization of the protocol and algorithm by staff during a contrast reaction would also be indication that this project has been successful. H. Signatures: (no electronic signatures) Project Manager Nurse Manager/Supervisor/ Phone: (616) Doreen.Marcinek@Spectrum-health.org

9 References MedlinePlus. (2011, August 11). Drug allergies. MedlinePlus. Retrieved from Namasivayam, S., Kalra, M.K., Torres, W.E., & Small, W.C. (2006). Adverse reactions to intravenous iodinated contrast media: A primer for radiologists. Emergency Radiology 12, Retrieved from Saddiqi, N. H., & Lin, E. C. (2011, April 20). Contrast medium reactions. Medscape Reference. Retrieved from Singh, J., & Daftary, A. (2008, June). Iodinated contrast media and their adverse reactions. Journal of Nuclear Medicine Technology, 36(2), doi: /jnmt

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