This document describes the implementation of TEAMwork boards in the pediatric intensive care unit (PICU) at a children's hospital. The TEAMwork boards were developed to foster frequent problem solving and timely resolution of issues using a visual tool with red, yellow, and green sections. An example problem around critical medication IV drips was presented, showing the current state challenges and proposed future state improvements. Survey results found the boards had a positive impact and staff felt their ideas were considered. The boards promoted continuous improvement and engagement. Keys to their success included encouraging idea submission and feedback, and recognizing contributions.

1. TEAMwork Boards
in the PICU
Lauren Smith, MSN, RN, CPPS
Cara Gallegos, PhD, RN
Bev Holland MSN, RN, NEA-BC

2. A little about us…
• The only Children’s Hospital in Idaho.
• A recognized Magnet® designated organization.
• Beds
• 61 NICU Boise and 12 NICU Meridian
• 39 medical-surgical
• 11 hematology-oncology
• 13 PICU
All of our rooms are private with adequate area for family members to
remain at the bedside.

3. The PICU Team
Darcie Ineck, BSN, RN
Jim Percy RN, CCRN
Lauren Smith, MSN, RN, CPPS

4. TEAMwork Boards
• Concept developed by Dr. Michael
Leonard and colleagues (2010).
• Consists of three colored sections: red,
yellow, and green.
• Foster frequent problem solving via a
visual management tool that supports
identification and timely resolution of
simple to complex problems.

5. 5
Department
Driven
Department
Driven
Department
Driven
Department
Driven
Staff &
Patient
Safety
TIP
Process
Metrics
Service
Quality
Productivit
y
Financial
Performanc
e
Department
and Org.
Goals

6. Why TEAMwork Boards
CEO
VP
Director
Manager
Supervisor/Lead
Front Line Staff
IMPROVED PROBLEM
SOLVING
(PROCESS STRUCTURED and
ORGANIZED around TEAMwork)
After
leadership has
set the
strategic goals
Frontline staff
Supervisor/Lead
Manager
Director
VP
CEO
Tactical/
Operational
Strategy &
Direction
Patient 1st every time

7. The Pilot TEAMwork Board

8. Critical Medication IV Drips
Current State
MD
writes
medication
order
RN
faxes
order
to
pharmacy
PharmD
views
via
Omnilink
PharmD
enters
order
on
pt
profile
in
Siemens
Generated
label
prints
in
IV
room
Medication
mixed
in
IV
room
RN
verifies
order
in
MAK
(compare
to
MD
order)
Medication
delivered
via
STAT
tube
or
Omnicell
fill
RN
receives/
collects
drip
RN
documents
med
admin
in
MAK
RN
spikes/
connects
&
primes
tubing
RN
programs
IV
pump
RN
contacts
pharmacy
when
next
dose
needed
if
drug
not
ava/
can't
find
in
dept
If
no
bolus
on
order,
call
MD
Content
of
MD
order
varies
Frequency
isn't
updated
Pharm
D's
vary
in
calc
of
vol
STAT
tube
Verified
before
confirmed
Verified,
but
incorrect
Meds
ava
in
dept
2
hrs
Change
bag
to
syringe
Vary
in
VTBI
programVary
in
tubing
use
Most
calls
are
urgent

9. Critical Medication IV Drips
MD
writes
medication
order
RN
faxes
order
to
pharmacy
PharmD
views
via
Omnilink
PharmD
enters
order
on
pt
profile
in
Siemens
Generated
label
prints
in
IV
room
Medication
mixed
in
IV
room
RN
verifies
order
in
MAK
(compare
to
MD
order)
Medication
available
in
PICU
RN
receives/
collects
drip
RN
documents
med
admin
in
MAK
RN
spikes/
connects
&
primes
tubing
RN
programs
IV
pump
Before
next
dose
due,
RN
verifies
ava.
in
PICU
Action:
Create
and
utilize
standard
MD
order
sets
for
critical
drips
Action:
ALL of
MD
order
will
be
entered
into
pt
profile
Action:
Frequency
calculation for
max
rate
and
max
bolus
(volume-­‐based)
Action:
STW for
"Verifying
Critical
Drip
Orders
in
MAK
Action:
-­‐ Initial
fill
via
tube
or
already
ava.
in
Omnicell
-­‐ Subseq.
doses
fill
ava.
in
PICU
2
hrs
before
due
(in
Omnicell or
patient
drawer)
Action:
Standardize IV
tubing
for
critical
drips
(includes
quad
setup)
Action:
STW
for
"IV
Pump
Program
for
Critical
Drips"
Future State

10. Standardized MD Orders

11. Results
• Promote employee engagement in continuous improvement
• Promote continuous improvement as a daily activity
• Consistent use of the red/yellow/green section to
facilitate problem solving
• Promote visual management, allowing anyone to quickly review
performance in key areas
• Minimal blank spots on board (information relevant to the
department)
• Provide structure for daily huddles
• Daily huddles efficient way to update staff

12. Results
0%
10%
20%
30%
40%
50%
60%
Strongly
Agree
Agree Neutral Disagree Strongly
Disagree
The TEAMwork Board has Made
a Positive Impact
POST
0%
5%
10%
15%
20%
25%
30%
Strongly
Agree
Agree Neutral Disagree Strongly
Disagree
My Ideas and Suggestions are
Seriously Considered
PRE
POST

13. Patient
Experience
& Outcomes
Charge RN CPU Access
IV Line Labels
Nor-EpiKits
Routine Med Availability
PrintfromMosaic
ADMROsfromOR
18
Posted
10
Solved

14. Keys to Success
• Ideas are encouraged, welcomed, and expected
• Submitting ideas is simple
• Evaluation of ideas is quick and effective
• Feedback is timely, constructive, and informative
• Implementation of ideas is rapid and smooth
• Ideas are reviewed for additional potential
• People are recognized and success is celebrated
• Idea system performance is measured, reviewed,
and improved

15. Transforming a Culture
Allow time to integrate continuous improvement as a
part of how we do our jobs.
Develop mutual trust and keep an open mind.
Actively participate. Be a problem solver.
Recognize the good work people do to identify
problems and correct mistakes.
Make a personal commitment to change and apply
TEAMwork knowledge, skills, and tools into your daily
work activities.