Transcript hourly rounding - Vancouver Island Health Authority

What’s up with all this change?!
Feel the ENERGY
A Johnny Lightning Bolt Presentation
Global Focus On Education In Our Little Part
Of The Universe
Wait ‘til
Johnny
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Lightning
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Bolt flashes
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you
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R.O.P.
S.W.I.
V.I.P.
IHEP4
O.M.G.!!
Accreditation
The force driving the creation of
ROPs
“an external peer review process to
assess and improve the services they
provide to their patients and clients
based on standards of excellence.”
“comprehensive international
literature reviews, field experts and
front line workers provide input”
It’s like how you may need…
a driver’s license
nurses certification
IV certification
CPR certification
Without these you cannot perform
those functions. Same goes for
VIHA
We are all VIHA
ROPs – required organizational
practices
Goals that VIHA,Canada and in fact many
other countries use to develop and grow thus
identifying best practices for patient safety.
Seems like a big obstacle in the way of
getting on with the care of the patient.
Ignore it??
It ain’t goin’ anywhere!!
Hulk out and move it
away
Remember?...It ain’t goin’ anywhere. We may
not like change but there is no escaping it.
Required is the key word. Just like required
to do vitals, promote mobility and have a
break. These have become must do’s for VIHA.
Depends on how you look
at it…
Quality & Safety
Obstacle or
part of the
path??!!?
System Wide Initiatives
Solutions For Patient Care Development
Problem
ROPs
35 of them in 6 groupings called
Quality and Safety Goals
1.
2.
3.
4.
5.
6.
Communication
Infection prevention and control
Culture of safety
Risk assessment
Medication management
Worklife/Workforce
Solution
SWIs
VIHA puzzled and puzzled until it could puzzle no more.
???
What could we create?
What blow could we make?
Be proactive and don’t trust fate
For quality care
For the patient’s sake.
-2 Client identifiers for procedures
-Hand hygiene education and compliance
-Falls prevention (hourly rounding)
-Medication reconciliation on admit & DC
-Violence prevention & MSIP training
Developmentally Explosive
Initiatives
So………….. now you see why we have to initiate these initiatives.
Hand hygiene education, compliance and surveillance.
Infection Control
The white boards at the sides of the beds.
Communication
Huddles
Communication
Hourly rounding
Patient Safety
Violence prevention training
Worklife/Workforce
Musculoskeletal injury prevention
Worklife/Workforce
New discharge follow up appointment sheets
Communication
Post-op assessment sheet
Communication
Daltaparin teaching sheet
Communication
When do we get started?
We already have as you may have guessed…
So what do we do next?
Well….we already dipped our toes
in the water with the VIP rounds
and now it is slightly changed, it is
to become a standard.
Just like vitals, mobilization, etc.
ROP Number one
Culture of Safety
• Staff Safety and Injury Prevention in all work
processes
• Hourly care rounds
• Supporting patient safety through the work of
the Infection Prevention and Control SWI.
(hand hygiene, outbreak management, prudent
antibiotic use.)
Quality Question 1
Does the Vancouver Island Health Authority have a
disclosure process and policy? How does the
policy and process support patients, families and
staff members?
Yes Absolutely, Look on the
Safety board for the policy. It is
also online
http://apps.viha.ca/pnp/pdf/9.2.
1Disclosure_Policy_vxxx2.pdf
SUPPORT
Prompt information+
Respect for patients’ right to be informed
=Maintenance of trust
The policy gives instructions to the health care
team about how to deal with Adverse Events as
they happen. Who to contact, what to chart,
how to communicate and what resources are
available.
Additionally, the situations are analyzed
individually and globally in an effort to improve
care quality.
Quality Question 2
What do you do to report an incident?
For patient safety incidents, use
the Incident Report Form.
Patient Safety Learning System
is on the way (online reporting)
For staff incidents, use the Call
Centre number located at the
main desk.
1-877-347-8442
Quality Question 3
Are you aware that VIHA provides regular reports on
client safety to appropriate authorities?
Reporting System = Learning System
All in the interests of patient safety
Yes a quality committee which receives
quarterly reports on patient safety from
the incident reporting system. These
reports will be produced more quickly and
effectively as the Patient Safety Learning
System is implemented.
Quality Question 4
What safety related proactive quality related activities
have we been involved with and how is this information
shared with the health care team?
CDMR is the answer. It is the driving
force behind the soon to be reinitiated
hourly rounding and it is responsible for a
lot of the changes in the recent past,
present and future. There is a CDMR
binder on the unit to peruse the changes.
Quality Question 5
What is your role in ensuring client safety?
Pretty much everything you do is
ensuring client safety.
Hand hygiene, C.Difficile management, swabbing
changes and infection control updates have got
bacteria on the run through evidence based
practice updates.
Almost all the changes lately are
centered around patient safety and
being elder friendly…
Think about it…
•Infusion pump training.
•Verification processes are in place for high risk
activities like insulin, PCA/Epidural changes,
blood administration, etc.
•2 client identifiers for any procedures or
services.
•Falls prevention – assessments, mobilization
techniques, rounding, history, family info., home
checks, mobility aids, etc.
•Transition point transfer of information
admit, DC, kardex, report checklist, huddles
•Reconciliation of medications at transition
points (pharmanet, history, patient, family,
doctor, etc.)
•Informing the client and family about their
role in promoting safety. They will often
provide information crucial to preventing
adverse events.
Woodinchanowit!!!!
The lightning bolts of change
are all around us!!!!!!
We are re-engaging and initiating hourly rounding.
We have to…..Hourly rounding is a SWI that will not
go AWI er..I mean AWAY.
But Johnny we already do that. We are in the
client rooms more than hourly. We are proud of
our nursing practice and consider ourselves
excellent professional nurses providing optimum
care in a hospital setting.
I Agree but we need to formalize this.
Oops I mean “must” formalize this.
Hourly
Rounds
•
•
•
•
•
Call light reduction
Falls reduction
Better communication
Increased patient satisfaction
Increased staff and patient safety
We have to
make our lives perhaps a little easier and the
client care perhaps a little safer. The research is
there, it’s multinational and best practice.
Besides you do it already.
Let’s Just Get It Documented
We have several ROPs that have
been addressed using a SWI.
HOURLY
ROUNDING
We respect your good care and
nursing practice and most of all….we will
Keep
It
Simple
Sugar
LET’S MAKE THIS EASY TO…
SWALLOW.
We are required to do hourly rounds
We do this sort of already so now we
make it formal.
Easy
The rounds have various components
No worries… we’ll be going over that
next. IHEP4 is the key.
GAYLE
I
Easier
There must be documentation of
these rounds.
A dedicated row on the flowsheet or
notation on the caremaps does the
trick.
Easiest
C’mon I’ll
show you!!
IHEP4
There’s an easier way?!

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
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Ask about comfort/ positioning:
Do you have any pain/ may I help you change position?
Offer non-pharmalogical and other pain relief if applicable.
Before leaving, as always, ask: ‘Is there anything else you need right now?’
Oh…remember to introduce yourself.
Do you need to use the commode/ washroom? (assist if needed)
Check IV intake -IV (rate, solution, site) if applicable (as usual)
Ensure fluids are in reach, and encourage or assist with intake
Review daily goals
Ensure bed is in lowest position, brakes are on and the required side rails
are up.
 Ensure there are no fluids or objects on the floor that would lead to a fall
I remembered all of those checks with just
remembering
. Know Why?
I’m also a nurse who takes pride in quality care.
Most of it comes naturally . I had to remember
the last P. Proactive. Remember
“ The key to best practice”
not IHOP
IHEP4
IHEP4 It’s easy
Here is the relative size and ease of reading for the revised reminder
card.
We honor your expertise and experience. You know all of
these things. You don’t have to carry it around…but do what you
always do. That includes self-assessment of your practice. Take the
IHEP4 challenge and see if you do what the yellow card says we need
to do.
If you’re not familiar then maybe it would be wise to carry the card
Yup..for flow sheets that’s
it
CAN’TCHA FEEL THE LOVE
•
Proactive
Positioning
Potty
Pain Assessment
Environment Check
Hydration Check
Introduce Self
Halloo…I’m Prudence
Pennypacker and I
would have to concur
that these are the
steps necessary to
effective hourly rounds
In summary
ROPs have compelled us to change.
The engines which drive the change are SWIs
CDMR is a SWI
Hourly rounding is a SWI and is now a standard of care.
We gotta do hourly rounds formally. IHEP4
We gotta document this in the chart.
Remember that boulder?
Turns out the dynamite
could only move the rock.
Good thing too…………..
Good thing the SWIs just moved
the boulder
We
need
these
ROPs
to
bridge
the gap.
Bridge the
void
between
health
care
provider
and health
care
receiver
Consider yourself flashed