Maria Luisa L. Cardinez, RN; Edward B. Medrano, RN; Dana Shae Cordova, RN;
and Rafael Vasquez, RN
St. Luke’s Medical Center Quezon City

Background of the Study
In pediatric clients, patient safety and satisfaction are two of the key indicators of quality care. They require a special level of skill, because they are vulnerable to medication errors (due to the unique drug computations) and harm particularly IV infiltrations since they sometimes cannot communicate how they feel when discomfort arises. Moreover, when nurses take care of pediatric patients, they actually have to “take care” as well of the parents and other watchers---the family as a whole.

The team, recognized the need to come up with an intervention using an organized process of “Bedside Admission Orientation, Bedside Handoff Shift Utilization, and Nurse Bedside Handing-off” Training to improve Key Result Areas (KRA) particularly on reducing the number of medication errors (Process Efficiency), increasing patient satisfaction ratings (Great Patient Experience), reducing the IV infiltration rates (Good Clinical Outcomes).

Utilizing a Lean-Six Sigma Approach, the nurses implemented a bedside shift report with patients and their families participating in the hand-off.  These measures provide opportunity for incoming nurse to meet the patient and their family at the very beginning of the shift while the outgoing bedside nurse ends his shift, hence decreases family anxiety and feelings of "abandonment" during change of shift.  It is likewise an opportunity to educate the caregivers, involve them in the care of the IV lines and other safety precautions, and validate the outgoing nurse’s assessment on the IV site, labels and current IVF. The medication error rate, IV infiltration rate, patient satisfaction data were collected before and after the implementation of the project. 

After the implementation of the project, there was a decrease in the medication error rate as well as a decrease in IV Infiltration rate but an increase in the patient satisfaction.  Through exchange of information and provision of health education, this initiative serves as early interception or prevention of errors and improves teamwork and relationship.