Transcript Document

Involving Patients in Performance Improvement
March 26, 2014
Panelists
• Downey Medical Center NICU: Trav Ichinose,
member of parent advisory council, Sarah Koshy,
management co-lead and Marnie Morales, labor colead
• San Diego Medical Center Direct Observation Unit:
Sheryl Almendrez, management co-lead
• Largo, Maryland, Urgent Care: Donna Fraser, labor
co-lead
Special Guest
Hannah King
Director
Unit-Based Teams Service Quality
A Few Logistics
• To minimize noise, attendees have been muted
upon entry
• Please use the chat box at the lower left of your
screen to type in questions and comments
• Link to slides and audio will be posted to the LMP
website
• Link and resources will be emailed to today’s
attendees later today
Why Are Patients Falling?
Pat helped us understand the
underlying reasons “why”
Schmid
score alone
Patient’s
use of call
light (lack
of)
Bed
placement
What did
not prevent
falls
Toileting
approaches
Fall
protocols
(bed alarms,
identifiers)
Most falls (86%) were from
patients mobilizing unassisted
• From independent to
dependent
• Embarrassed to ask for
help and wearing a gown
Identifying
patients as
high risk for
falls
• Environment is not familiar,
can be disorienting
• Older people frequently
use bathroom at night – its dark
NICU UBT & Parent Advisory Council
Downey Medical Center
UBT PARTNERING WITH NICU
PARENT ADVISORY COUNCIL
• MISSION: Improve care design by partnering
with all caregivers and giving a voice to the
premature baby and family
– Communicate patient needs and concerns
– Help review and design policies and
procedures
– Encourage family involvement
and information seeking
– Strengthen communication
TRADITIONAL NICU SHIFT
CHANGE REPORT
Advisory Council Identified These Issues:
– process of shift change report varied
greatly
– Staff-centered versus patient-centered
– Visiting hours excluded parents from
shift change
– Concerns about HIPAA
NKE+ DESIGN AND
IMPLEMENTATION
• Designed and Role Played Shift Change
Reports
– Staff role played with UBT and Advisory
Council members and identified gaps
• Participated in Video Ethnography
– Videos made discussing benefits of attending
shift change, demonstrating
what it would look like
– Used as staff education tool
NKE+ COMPOSITE TOP
SERVICE SCORE
Combined Nurse Knowledge Exchange
Results
100
95
90
85
80
75
70
65
60
55
50
81
84
86
74
3rd Quarter 4rth Quarter 1st Quarter 2nd Quarter
2012
2012
2013
2013
QUALITY THROUGH PARENT
PARTNERSHIPS
•
•
•
•
Enhancing Patient and Family Focus
Influencing Perception of Quality Care
Customer Satisfaction
Continued Improvement
and Staff Empowerment
• Collaboration and
Shared Commitment
Urgent Care Department
Largo, Maryland (Mid-Atlantic States)
Largo and Camp Springs Urgent
Care/Critical Decision Unit
Name
Title/Classification/Union
Donna Fraser
Labor Co-Lead, RN (lead)
Felina Cephas
LPN
Abraham Abban
RN, Clinical Operations
Manager, Management Co-Lead
Abagail Nowlin
Lead Nurse, RN
Maria Chiu
Lead Nurse, RN
Paulette Harding
UFCW Shop Steward/ RN
Gary Campbell
Director, sponsor
Urgent Care projects needing
member input
• Triage wait
– Starts when member checks in
– Finishes when the first vital sign is entered
• Provider wait
– Starts when vital signs are entered
– Finishes when provider opens the encounter
• From exam room to finish
– Starts when provider opens the encounter
– Finishes when AVS is printed
– Varies greatly by whether patient requires lab or x-ray
A member as part of your UBT:
What does it look like?
Together we can make things better!
Our Best Practices
• Team approach: one doctor, a nurse and an
Urgent Care tech make up a team and work
together to manage patients assigned to doctor
• Daily huddles: cycle time data was shared
monthly with the entire UBT
• Cycle Time: keep below 100 minutes for Largo
and Camp Springs Urgent Care centers
What are We Doing Now?
Active Projects
Focus on Member Service:
“Treat Every Patient Like Family”
• Shift “champions”
• Proactive care: Mammos, Paps, blood sugar, LDL
ordered or done in Urgent Care
• Patient safety: Name bands on every patient
Definitive Observation Unit
San Diego Medical Center
Patient Involvement in
Committees
• Patient/Family Care Council (PFCC) started in 2012.
• Service Excellence Team-Council members meet every 3rd
Tuesday for two hours
• Wanted to know inpatient patient perspective and ways to
improve our patient care experience.
– Improvements include discharge paperwork for patients
and thank you cards
• Frank Hagg - Staff Nurse Council (PFCC representative)
• Susan Mahler, PhD - invited to Unit Based Teams (PFCC
representative).
Patient Involvement in UBTs
• DOU UBT staff were very interested in inviting a committee member
from PFCC to monthly meetings.
• UBT wanted to know how would staff would feel to hear the “Real
Truth” (patient’s perspective of care experience)
• Everyone “thinks” they are doing okay. Patients have a different
perspective.
• DOU UBT wanted to know ways to improve Patient Care Experience
through the perception of the patient
• Question staff and UBT had for PFCC member: “What does Nurse
Communication mean to you?”
• Answer: “Competency is expected. Quality Care is parallel to the
courtesy and respect given to the patients during hospitalization.”
Current DOU UBT Projects
Current Projects with Susan Mahler, PhD.
Overall Score
• Staff to introduce themselves every time they enter the patient’s room.
Nurse Communication
• MD/RN Collaboration
• Commonly used medications in the DOU/Possible Side Effects
Staff Responsiveness
• Ask patients what “timely manner” means to them.
Pain Control
• During rounding, talk about pain control and what the patient does at home for pain.
Discussion
• Why did you want to involve a patient in your performance
improvement effort?
• What barriers did you face? How did other UBT members
react? How did you overcome these barriers?
• What results did you achieve?
• How do you think having a patient voice in the project affected
what you came up with?
• What is your advice to other UBTs that would like to try this?
Special Guest
Hannah King
Director
Unit-Based Teams Service Quality