[PDF] - CUSP Communication & Teamwork Tools PDF Document

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7/18/2011 1 Welcome to CUSP Communication & Teamwork Tools Coaching Call 2

The session will begin shortly. To access the audio for the session, Dial: 800-977-8002, Participant code 083842#. The materials for this coaching call can be downloaded from the CUSP Communication & Teamwork Tools password-protected web page. Directions for how to access this web page can be found on each of the coaching call meeting notices (appointments) sent to you. The phone lines will be open during the presentation. Please keep your phone

n mute unless you are asking a question. If you do not have a mute function
n your phone, you can press *6 to mute your phone (and *6 again to unmute

if you want to ask a question). PLEASE DO NOT PUT YOUR PHONE ON HOLD!!! If you experience any problems, please call Marilyn Nichols at the MOCPS office at 573-636-1014, ext 221 or mnichols@mocps.org.

CUSP Communication & Teamwork Tools

Pat Posa RN, BSN, MSA Kimberly O’Brien, MHA System Performance Improvement Leader Project Manager

St. Joseph Mercy Health System

Missouri Center for Patient Safety Ann Arbor, MI Jefferson City, MO patposa@comcast.net kobrien@mocps.org

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Documents/Resources for this Session

(All can downloaded from the CUSP Communication & Teamwork Tools password-protected web site. Detailed instructions are located on each of the coaching call meeting notices/appointments emailed to you by Kimberly O’Brien)

1. This PowerPoint presentation
2. Monthly Team Leader Checklist
3. Sample Agenda for July CUSP Team Meeting
4. SJMHS Huddle Process
5. Learning from a Defect Tool
6. Video Samples of MDR and Huddles
7. An audio file recording of this session will be posted
n the password-protected web page following the

call

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CUSP Communication & Teamwork Tools

Project Organization

Monthly coaching calls will be held every third Tuesday

f the month, from 12-1pm (beginning on 6/21/2011)

Six coaching calls Coaching calls will be recorded Facilitated by Pat Posa, RN, BSN, MSA Team leaders will be provided agendas and materials for monthly unit team meetings (can be modified) Project deliverables: At end of 6 months, each unit will have implemented multidisciplinary rounds and/or huddles, and solved at least one defect

Submit Case Summary from Learning from a Defect Tool to MOCPS by November 30, 2011

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Agenda

Implementing Multidisciplinary Rounds with Daily Goals Structured Huddles: questions and view samples Learn from a defect—status of identifying defect Identify next steps Answer questions

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CUSP Communication & Teamwork Tools Interventions

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A strategy to assemble the patient care team members to

review important patient care and safety issues and improve collaboration on the overall plan of care for the patient

Improve communication among care team and family

members regarding the patient’s plan of care

Goals should be specific and measurable
Documented where all care team members have access
Checklist used during rounds prompts caregivers to focus on

what needs to be accomplished that day to safely move the patient closer to transfer out of the ICU or discharge home

Measure effectiveness of rounds—team dynamics,

communication, quality measure compliance, LOS

Multidisciplinary Rounds with Daily Goals – What is it?

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Should be done in ICUs and all units in hospital
Hard initiative to implement, especially if you have an open unit

and/or no intensivists or in non-ICU area Standardize the structure and process for all units Benefits seen even if physician can not attend consistently or at all Second rounds should be done in afternoon—include at least physician and bedside nurse Evaluate if goals for day have been met; readjust if necessary Identify if patient can be discharged (or transferred ) the next day and if so, what needs to be accomplished

Focused first on defining daily goals and recording those either on the

white board in the room or on a sheet of paper

Then standardize rounds—who should attend and what is discussed
Implemented checklist or nursing objective card

Multidisciplinary Rounds with Daily Goals

Challenges and Opportunities

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Spectrum of MDR

Community hospital with all private practice physicians or hospitalists ICU Non-ICU University affiliated teaching hospital—ICUs with dedicated intensivists

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Multidisciplinary Rounds with Daily Goals Steps to Implementation

1. Commitment by all that MDR with daily goals is a strategy

that will be implemented to improve communication and patient outcomes

2. CUSP team takes on initiative—identify if there are any

additional team members needed

3. Evaluate current rounding process

These steps you should have completed !!

4. Identify gaps between current process and what you want it

to look like

5. Define the standard work of rounds, roles and

responsibilities of each member and develop checklist and goal process

6. Define metrics to evaluate MDR

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Current State Assessment

What is the state of rounds on your unit? (summarize the survey results)

Describe unit structure (i.e. ICU, non-ICU, open unit, closed unit, intensivist, hospitalist) How often are rounds held? Who usually attends rounds? What are the roles of each member? Where do rounds usually take place? Is their a defined structure/process for rounds? If so what is it? Or does it depend on who is running them? How have rounds made a difference during the past year in improving the performance on your unit? What is the major barrier for multidisciplinary round implementation on your unit?

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Multidisciplinary Rounds with Daily Goals Steps to Implementation

4. Identify gaps between current process and what you want it

to look like

5. Define the standard work of rounds, roles and

responsibilities of each member and develop checklist and goal process

6. Define metrics to evaluate MDR

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Future State

What Multidisciplinary Rounds should look like?

Video samples Defined and agreed upon purpose and goals for MDR with Daily Goals Consistent time, members, member roles and structure to rounds Defined checklist and daily goal documentation

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Standardized Work Paradigm

Old Paradigm - I know you’ll be able to figure it out.

Just get it done the best way you can.

New Paradigm - In order to have consistent results

we must do things the same way every time.

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Standard Work System

Standardized Work is a system for achieving a stable baseline for a process in order to systematically improve it. Standardized Work Systems are the basis for Continuous Improvement.

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MDR with DG Action Plan

Task Responsibility Due Date Obtain executive buy-in Define members of rounds and their roles Define time of day and frequency Structure of rounds: Review of systems (or major issues) Define components of checklist Time for each patient Documentation: What is documented in medical record daily goal—where is it documented? Define metrics and evaluation process

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Who?

Physician

Team leader: guide rounds, ensure follow defined process, elicit input from all members, summarizes define daily goal

Resident:

Present patient in system format Place orders in computer during rounds Document note in chart

Bedside nurse

Provide clinical information, current patient status, changes over previous 24hrs, patient or family concerns/issues (if not present on rounds)

Case manager/social work

Could function as leader if physician not present Oversee discussion of discharge planning Define patient/family concerns/issues

Charge nurse/CNS/CNL

Function in leader role if designated and physician not present

Others

Pharmacist, respiratory therapy, PT/OT, pastoral care, palliative care

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Structure of MDR

Time of day Frequency Process for each patient

Checklist

Documenting

Which pieces of rounds? Daily goal

Define daily goal follow up process

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Daily Goal Sheet (continued)

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Nursing Card

(see Document 7 of the Coaching Call 1 materials – SJMHS Interdisciplinary Rounds Checklist)

VAP Delirium Sepsis

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http://www.youtube.com/watch?v=PKN8a8bL rSI&feature=email Remember . . . This is an example of MDR with DG with a physician present during rounding. There are also models of effective rounding without a physician present, as discussed in Coaching Call 1

Video Example:

MDR with Daily Goals at Kaiser Permanente

(on YouTube)

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Enable teams to have frequent but short briefings so that they can stay informed, review work, make plans, and move ahead rapidly. Allow fuller participation of front-line staff and bedside caregivers, who often find it impossible to get away for the conventional hour-long improvement team meetings. They keep momentum going, as teams are able to meet more frequently.

Structured Huddles

Use this strategy to begin to recovery immediately from defects---IE: falls, sepsis and daily to focus on unit outcomes

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Huddles

View sample videos What questions do you have?

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Components

Metric 1: Quality/Safety Metric 2: Patient Satisfaction Metric 3: Operations Daily Critical Communications Information Ideas in Motion

How to do it?

Beginning or mid shift 5 minutes Lead by member of unit leadership team

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SICU Huddle Board

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General Surgery Huddle Board

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MICU Huddle Board

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MICU Huddle Board Location

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Example Videos: Structured Huddles

(all videos are also located on the password-protected web page for this project)

Download Viewing Option

(the download/buffering time is lengthy – approx 5-7 minutes)

Video Example of Structured Huddles

– Non ICU: http://www.mocps.org/wp- content/uploads/2011/07/Huddle%2 0on%208.wmv

Video Example 1 of Structured

Huddles – ICU: http://www.mocps.org/wp- content/uploads/2011/07/Huddle%2 0on%20SICU.wmv

Video Example 2 of Structured

Huddles – ICU: http://www.mocps.org/wp- content/uploads/2011/07/Huddlevid eo.mp4

YouTube Viewing Option

Video Example of Structured Huddles

– Non ICU: http://www.youtube.com/watch?v=6 0Ru5eDWleo

Video Example 1 of Structured

Huddles – ICU: http://www.youtube.com/watch?v=3 lnS5QAAf6M

Video Example 2 of Structured

Huddles – ICU: http://www.youtube.com/watch?v=B ZE3HI7X_34

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Structured Huddles Action Plan

Task Responsibility Due Date

Obtain executive buy-in Order Huddle board Select Huddle metrics for first board:

perational, quality/safety and patient

satisfaction Define huddle process: Define time of day and frequency Who will lead huddle Expectations of staff—who will attend Create agenda (in first huddles include

verview of purpose of huddles and huddle

process) Hang huddle board and fill in metrics Identify when huddles will begin Define process for changing huddle metrics Create evaluation process: how will I know if huddles are successful?

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Identifying a Defect

AHRQ HSOPS results
Staff safety assessment—how will the next patient be

harmed?

Non-compliance with a core measure
Event/incident reports
Issues identified on Executive patient safety rounds

Have you identified a defect? If not, where are you stuck?

,, 33

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CUSP Communication & Teamwork Tools

Next Steps

Multidisciplinary Rounds
Ask CUSP team to view sample videos
Complete action plan (slide 16)
Learning from a Defect
Identify next defect to solve (if haven’t done it yet)
Begin/complete through LFD steps
Structured Huddles
Show sample videos to unit leadership and CUSP team, gather questions
Complete action plan (slide 27)
CUSP Team Agenda (see Document 3 of Coaching Call Materials)
Choose next defect to take through the Learning from a Defect Tool or begin LFD process
Show videos of MDR to CUSP team; Complete MDR with DG action plan
Show videos of structured huddles; Complete Structured Huddles action plan
Ensure that concepts of Multidisciplinary Rounds and Structured Huddles are vetted by

executive sponsor for unit and VPMA/CMO

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We Are On a Continuous Journey

We have toolkits, manuals, websites, and monthly calls to learn from and with each other. Your job is to join the calls, share with us your successes and more importantly the barriers you face. Commit to the premise that harm is untenable.

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Questions?

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