Background/significance: The ambulatory care setting faces specific challenges when responding to medical emergencies: infrequent events, lack of standardized medical emergency plans, and inconsistent inclusion of nursing leadership in planning/oversight.

Objectives: To increase percentage of practices with approved emergency plans. To increase staff awareness of plans through formal involvement of nursing, medical, and administrative leadership.

Implementation: In 2017, the Ambulatory Care Medical Emergency Response Committee launched a medical emergency improvement project using PDSA approach. In 2020, AMERC relaunched project using data from newly completed hierarchical mapping of all locations to reassess number of practices without emergency plans. An evidence-based emergency plan toolkit was developed to guide clinicians in creating/updating plans using standardized format with new requirement for nursing and administrative sign-off along with medical director.

Performance improvement outcome: In 2020, we completed mapping of location/contact data for 442 practices. In 2021, this data was used with 2017 project data, to identify practices requiring intial or updated plans. Mapping provided ability to accurately track compliance and supports next steps in ongoing improvements. To date, outreach competed to 81% of practices and 57 % have approved plans. Using tracer data, staff awareness of emergency plan improved from 60% in 2020 to 76% in Q1 2021.

Implications for nursing practice: Nurses are well positioned to lead safety initiatives in the ambulatory care setting and are crucial stakeholders in design and implementation of medical emergency plans. By ensuring nurse participation through required nursing, administrative and medical leadership sign-off, we seek to determine if this will improve staff knowledge of medical emergency plans and later, if all components are implemented. This sets a model for future QI work using the leadership triad approach.

Julia Edmondson MSN, RN, FNP-BC

Clinical Operations Program Manager, Massachusetts General Hospital

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