34 - Optimizing Picklists and Preference Cards: A Recipe for Success

Description: Background
Like a recipe for a baker, picklists and preference cards are essential to surgery preparedness. They can be used by orientees learning their way in an OR and can be used by veteran staff rotating through a service they do not work in often. At Memorial Sloan Kettering Cancer Center (MSK), picklists and preference cards are currently maintained by team leads in the electronic health record (EHR). Several challenges exist with this current system. These challenges led the team to review their current process and brainstorm ideas for improvements.

Description of team
The team undertaking this project consists of nurse leaders, clinical nurse managers, and service team leads.

Prep and plan/Implementation (process)
A survey sent to staff focused on the current preference card workflow highlighted several issues. First, preference cards could only be accessed from within a patient's surgery log, with no way to search or view a card outside of the editing portion of the EHR. This made it difficult for staff to review and prepare for future cases, often leading to staff members printing cards daily or holding on to outdated versions. Additionally, when the EHR was down, there was no way to access the cards. A third issue identified was the inability to customize cards to meet the specific needs of a service. For example, pictures of setups, links to resources, and other items that cannot be added to the preference card located within the EHR. Lastly, several services are moving towards standardized preference cards with surgeon exceptions listed within. This method simplifies updates for team leads by having only one card per surgery. However, in the current EHR, preference cards are listed by surgeon and require individual updates. A time-consuming process for the team leads.

Outcome
A review of the survey results allowed the team to have a better understanding of what was truly needed. The decision was made to move the preference cards into a shared, cloud-based platform. This new approach offers significant advantages: it allows for easier access for team leads to edit cards and provides the flexibility to customize each card to meet service specific needs. More importantly, it enables staff to access the platform in a multitude of ways, allowing for teaching opportunities and staff preparedness.

Implications for periop nursing
Evolving technology provides an opportunity for increasing efficiency and preparedness for cases. Combining technology along with an understanding of staff needs, is an integral part of providing safe patient care.