Transcript EP1-D - Antepartum Patient Centered Model Training Materials

Patient Centered Care Model
Antepartum Unit – 9 Prentice
Training Guide
Antepartum Nursing PCCM Training
Patient Centered Care Model
Antepartum Unit – 9 Prentice
Why is this important? – Mission and Vision
The Antepartum Patient Centered Care Model provides a healing environment centered around trust, compassion, and the incorporation of patients’
individual needs. The goal is to ensure healthy outcomes for mothers and infants.
The Model provides nurses with critical thinking skills and creates a culture of seamless communication among members of the health care team.
What are we trying to accomplish? – Goals
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Increase communication of the multidisciplinary team in achieving a collaborative plan of care
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Increase the patient’s involvement in goal setting with the multidisciplinary team
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Include the patient in shift to shift RN handoffs
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Ensure timely and accurate interpretation of non stress tests
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Ensure serial and structured nursing observation of patients
What is our responsibility? – Expectations
•
Each team member is accountable for his/her role and assigned responsibility
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Nurses and physicians will collaborate daily with the patient/family and the multidisciplinary team to develop an individualized plan of care and
adapt it as necessary
•
A team approach will be used to achieve individualized care goals for each patient
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Patient satisfaction will increase through consistent patient involvement in establishing goals
•
Staff satisfaction will increase through coordination of care and enhanced communication within the health care team
•
Patient care staff will have a goal of hourly rounds on assigned patients
Adoption of this model requires a shift in culture towards more critical thinking, flexibility to adapt to individual patient needs,
and communication with all members of the care team.
Everyone is Responsible
For Every Patient
Everyday
Antepartum Nursing PCCM Training
Patient Centered Care Model
Antepartum Unit – 9 Prentice
What is involved? – Components of the Model
In-Room Shift Report
Purpose
Serial Rounds
Whiteboard Documentation
Safety Huddles
• Increase patient involvement
in goal-setting and plan of
care discussions
• Include the patient in shift-toshift RN handoffs
• Ensure serial and structured nursing
observation of patients (goal is to conduct
hourly rounds on assigned patients)
• Manage pain effectively
• Communicate plan of care with
patient and next shift
• Reduce patient need to call for
staff by proactively interpreting
care needs
• Address all patients that
are of highest risk and
validate plan of care
• Ensure maternal and
fetal safety
1.
Observation Criteria:
≥ 20 weeks gestation
1. Preterm labor / PROM / Vaginal
bleeding
1. Translate the plan of care onto
the white board with all areas
complete by end of report.
2. It is important to include plans
related to pain, scheduled
tests, and medications
3. Communicate directly with the
patient and family every shift
4. Include specific requests made
by the patient to engage them
in their plan of care
5. Documentation should include:
1. Safety huddles will
occur once per shift (or
more frequently as
determined by CC)
2. Focus on patients:
2.
3.
4.
Execution
5.
RN will introduce patient to
oncoming RN
RN will review history, plan
of care, scheduled tests,
specific shift/daily goals, and
medications
Protocol checks (e.g. DVT
checks for patient on bedrest)
RN will review with patient
notifications to report to the
RN, e.g., increasing pain,
contractions, vaginal
bleeding, leakage of fluid,
nausea or vomiting and/or
anything unusual
RN will review any required
MD notifications
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–
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2.
Increasing pain in abdomen or back
Contractions
Vaginal bleeding
Leakage of fluid
Pre-eclampsia
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–
–
–
–
Above symptoms
Headache
Blurred vision (‘floaters’)
Epigastric pain
Elevated blood pressures
< 20 weeks gestation
1. Hyperemisis or Diabetes
–
–
–
–
Pain
Bleeding
Nausea / Vomiting
Symptoms of hyper- or hypo-glycemia
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•
•
•
•
•
•
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Room #
Date
MD name
RN name (phone / next time for
rounds)
Tests/Procedures
Daily Activity
Daily Goal
Medications
Interdisciplinary Rounds help to facilitate execution of the Antepartum Patient Centered Care Model
– With special needs
– At increased risk for
change in status or
transfer to L&D
– With any changes in
condition
– Safety huddles will
occur once per shift
(or more frequently
as determined by CC)
3. Notify L&D of any
potential patients that
may be transferred
Antepartum Nursing PCCM Training
Patient Centered Care Model
Antepartum Unit – 9 Prentice
How does this impact me? – A Day in the Life of an Antepartum Nurse
Day Shift RN
Time
Night Shift RN
Activity
Time
Activity
7:30 AM
RN-to-RN in-room shift report
7:30 PM
RN-to-RN in-room report
8:00 AM
Round on assigned patients
8:00 PM
Round on assigned patients
9:00 AM
Round on assigned patients
9:00 PM
Round on assigned patients
10:00 AM
Round on assigned patients
10:00 PM
Attend Safety Huddle
11:00 AM
Round on assigned patients
Attend Interdisciplinary Rounds (Mon, Thu)
Round on assigned patients (Tue, Wed, Fri)
11:00 PM
11:30 AM
Round on assigned patients
Set expectations with patient for nightly rounds (e.g.
if patient is sleeping, conduct rounds without
disturbing patient)
12:00 PM
Attend Safety Huddle (Mon, Thu)
Round on assigned patients (Tue, Wed, Fri)
12:00 AM
Round on assigned patients
(interact with patient as needed and/or requested)
12:30 PM
Round on assigned patients
1:00 AM
Round on assigned patients
(interact with patient as needed and/or requested)
1:00 PM
Round on assigned patients
2:00 AM
1:30 PM
Round on assigned patients (Mon, Thu)
Attend Interdisciplinary Rounds (Tue, Wed, Fri)
Round on assigned patients
(interact with patient as needed and/or requested)
3:00 AM
2:00 PM
Round on assigned patients (Mon, Thu)
Attend Safety Huddle (Tue, Wed, Fri)
Round on assigned patients
(interact with patient as needed and/or requested)
3:00 PM
Round on assigned patients
4:00 AM
Round on assigned patients
(interact with patient as needed and/or requested)
4:00 PM
Round on assigned patients
5:00 AM
Round on assigned patients
(interact with patient as needed and/or requested)
5:00 PM
Round on assigned patients
6:00 PM
Round on assigned patients
6:00 AM
Round on assigned patients
(interact with patient as needed and/or requested)
7:00 PM
Round on assigned patients
Prepare whiteboards and SBARs for next shift
7:00 AM
Round on assigned patients
Prepare whiteboards and SBARs for next shift
7:30 PM
RN-to-RN in-room report
7:30 AM
RN-to-RN in-room shift report
8:00 PM
Complete other nursing activities
8:00 AM
Complete other nursing activities
Antepartum Nursing PCCM Training
Patient Centered Care Model
Antepartum Unit – 9 Prentice
Revised NST Review and Communication Process
NST order
placed by
MD
NST
performed by
primary RN
NST reviewed
by primary RN
NST reviewed
by charge RN
Reactive
NST?
NST placed in bin for
Attending sign-off by
following day
Y
N
Expectations
• All NSTs will be reviewed by the primary RN and charge RN
− If charge RN is unavailable for review, staff educator or other senior
RN can provide secondary review
− Primary RN and charge RN reviews must be documented in QS
 Reactive NSTs (defined below) will be placed in bin for MD review
by the following day
− If MD disagrees with “reactive” definition of NST, feedback will be
given to the RN team during interdisciplinary rounds
− If NST result shows anything other than “reactive”, NST must be
reviewed by a physician immediately
 MD review of all non-reactive NSTs will follow a defined escalation
process based on MD availability to review NST result within 1
hour
− The Unit Attending is the final source for escalation and must review
NST within allowable timeframe
− If NST performed on 9S, MD can pull up strip electronically and use
paper strip as back-up
− If NST performed on 9N, RN will provide paper strip for review
− All plan of care changes based on review of non-reactive NST must
be communicated back to RN by MD
 All NST sign-off and final results will be completed by MD in
PowerChart
What is a “Reactive” NST?
• Defined as 2 accelerations in 20 minutes
− ≥ 32 weeks: abrupt increase in FHR of ≥ 15 beats x 15 seconds
− < 32 weeks: abrupt increase in FHR of ≥ 10 beats x 10 seconds*
*If prior NST demonstrated accelerations ≥ 15 beats per minute, all subsequent NSTs
must meet 15 x 15 criteria.
High-risk OB
resident
notified
OB
resident
available?
Pager: 5-5334 (or web page)
Y
N
3rd
4th
or
year
L&D resident
notified
3rd / 4th year
resident
available?
N
Antepartum
Attending
notified
Pager: 5-2975 (or web page)
Phone: 2-2030 (R3) / 2-2031 (R4)
Y
NST results reviewed/
signed-off within 1 hour;
plan of care updated
ONLY
Mon-Fri,
8am – 5pm:
See MFM call
schedule to
webpage
Antepartum
Attending
available?
Y
MD communicates
sign-off / plan of care
changes to RN
N
L&D Unit
Attending
notified
Y
Phone: 2-2032
Pager: 5-6458 (or web page)
Antepartum Nursing PCCM Training
Patient Centered Care Model
Antepartum Unit – 9 Prentice
Frequently Asked Questions
Q: How is this different from how I have been caring for my patients?
A: The components of this model are not new concepts. Many of them are interventions that simply stopped happening over the course of time. In this new Patient
Centered Care Model, you are still responsible for the care of patients who are assigned to you (complete assessments, administer medications, carry out orders or
procedures, record vitals, etc.), but you will also have the support and insight of your peers to help you care for your patients.
Q: What are the benefits of adopting this new model of care?
A: The Patient Centered Care Model will allow for a more structured use of your time and will decrease interruptions in your daily work schedule. Studies show that
hourly rounding delivers quality clinical outcomes, decreases the number of call lights, and takes much less of a nurse’s time when faced with higher acuity patients.
Whiteboard documentation and in-room shift report allow for nurses to communicate the plan of care not only to their peers, but also the patient and her family.
This direct contact with patients engages them in their care and helps to improve patient satisfaction.
Safety huddles allow for each member of the care team to know who the high risk patients are, and provide a forum for education and support.
You have already seen the tremendous benefit of improved nurse-physician communication and collaboration during Interdisciplinary Rounds. This model will only
enhance the changes we have seen in our practice.
Q: Is this new model really going to work?
A: Yes. The concepts and components of the model have been proven at many other institutions like NMH, and the model has been customized specifically for this
Antepartum unit. You are an essential part of the model and your ability to adapt and be flexible to change will help to make this a success. Additionally, this model
shouldn’t be viewed as something you are being told to do; it should be something you want to do and that you believe is the right thing to do for the patient.
This is a work in progress. It may not be perfect the first time around, but with your input and ideas, we can continue to make it better and easier.
Q: Am I going to have enough time during my shift to accomplish everything?
A: The model was designed with you in mind. It is a structured approach to your daily activities and job function, and therefore should make it easier for you to work
effectively during your shift. That being said, you are part of a care team that works together; if for some reason you feel overwhelmed, do not hesitate to pull in
your CC, Staff Educator, or fellow Staff Nurse to help you with patient rounds or other patient care activities.
Q: Does in-room shift report violate a patient’s right to privacy?
A: Face-to-face handoff communication (or report) is a National Patient Safety Goal set by The Joint Commission. It is important to conduct yourself professionally
and respect a patient’s right to confidentiality. All of our patients have private rooms on the Antepartum unit, so the conversation during in-room shift report will not
be heard by anyone other than the patient and the nurses caring for her. If there is a visitor or family member in the patient’s room, it is always appropriate to ask
the patient whether or not they want the other person in the room during shift report.