IHI Expedition Expedition: Engaging Patients and Families in Multi- - - PowerPoint PPT Presentation
November 20, 2014 These presenters have nothing to disclose IHI Expedition Expedition: Engaging Patients and Families in Multi- Disciplinary Rounds Session 5: Putting it All Together: How to Sustain the Momentum Tammy Alvarez, RN, MSN, CCRN
Expedition: Engaging Patients and Families in Multi- Disciplinary Rounds Session 5: Putting it All Together: How to Sustain the Momentum November 20, 2014
These presenters have nothing to disclose
Tammy Alvarez, RN, MSN, CCRN Kathy Duncan, RN
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Morgen Palfrey, Project Coordinator, Institute for Healthcare Improvement, is the current coordinator for web- based Expeditions. She also contributes to the IHI Leadership Alliance, conducts research scans to assist with content development, and works with Strategic Partners in Singapore. Morgen is a member of Work- Life Wellness Team and Diversity and Inclusion Council at IHI, where she and fellow staff members develop strategies for improving the mind and body. Morgen graduated from the University of Florida in Gainesville, FL where she received her Bachelor of Arts degree in Political Science with a concentration in Public Administration.
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Kathy D. Duncan, RN, Faculty, Institute for Healthcare Improvement (IHI), oversees multiple areas of content, directs multiple virtual multiple learning webinar series and is the clinical lead for IHI’s National Learning Network. Currently she also serves as Faculty for the AHA/HRET Hospital Engagement Network (HEN) Improvement Leadership Fellowship (ILF). The ILF provides multi-faceted resources to support the learning and dissemination of improvement methods and tools. Most recently, Ms. Duncan directed content development and spread expertise for IHI’s Project JOINTS, an initiative funded by the Federal Government to study adoption of evidenced-based
evidence-based pre-and perioperative practices to reduce the risk of surgical site infections in patients undergoing total hip or knee replacement.
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Welcome Action Period Assignment Debrief Guest speaker: Shirley Sherman, Virginia Mason Medical Center Putting it All Together: How to Sustain the Momentum Congratulations! Closing
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Session 1 – Making a Case for Patient and Family Inclusion in Rounds Date: Thursday, September 25, 12:00 - 1:30 PM Eastern Time Session 2 – Building a Foundation for Rounds: Both Structure and Culture Date: Thursday, October 9, 12:00 - 1:00 PM Eastern Time Session 3 – Taking the First Step: How to Start Engaging Patients in Rounds Date: Thursday, October 23, 12:00 - 1:00 PM Eastern Time Session 4 – Measuring Success: Strategies for Identifying Improvement Date: Thursday, November 6, 12:00 - 1:00 PM Eastern Time Session 5 – Putting it All Together: How to Sustain the Momentum Date: Thursday, November 20, 12:00 - 1:00 PM Eastern Time
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Next Test(s)
– Measure something –
– Could be: # of participants, start on time, how much time, # of
changes made, # of pharmacy changes, etc)
– How are you going to measure? – Do you know if your change made an improvement?
What did you learn? What test are you most proud of?
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Areas of focus should be introductions: what is your role, and communication between disciplines. The differences between the responses received by the nurse group and the PCA (registration) group were not large. May reflect the feeling that the nurse group can have more impact in changing that particular area. The nurse group was team leaders, not the nurse caring for the patient. We wanted the family consultants to do some of the check ins to see if they received different information but they were unable to participate at this time due to previous commitments.
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IMCU:
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What did you test?
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Measuring inclusion of patient identified goal in rounds, currently Monday - Friday.
– What did you learn?
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Over the two weeks, this was accomplished for 43% of the patients included, and staff are becoming more comfortable addressing with patients and sharing this information in rounds with others.
– What is your next test?
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Continue practice with goal of increasing to all patients’ goals being identified and share
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CVSU:
– What did you test?
– Moved to holding rounds are larger number of patients at the
bedside and including patient/family identified need or goal for the day in discussion (specific percentage not available at this time).
– What did you learn?
– Staff becoming more comfortable in supporting and discussing with
patients/families their identified needs/goals, and are sharing these further with others.
– What is your next test?
– Continue to support staff in skills and comfort with bedside rounding
and increase number of patients/families included.
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5 East:
– What did you test?
– Measuring the percentage of patients discharged as anticipated
(“predicted/pending”) with SLIDR rounds.
– What did you learn?
– During the trial days with selected patients, 100% of patients
completed or met their discharge day as recognized and addressed during rounds, therefore supporting and reinforcing the benefit and use of SLIDR rounds.
– What is your next test?
– Expand the application with more patients and monitor for changes
in overall patients’ length of stay on unit.
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Virginia Mason
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Shirley Sherman, RN, MN, CCRN has been at Virginia Mason since 1983 in Critical Care starting as a staff RN and advanced to Clinical Director of Critical
engaging staff to improve the patient family experience. She has been involved with IHI for the last ten years and looks to the organization for inspiration and vision.
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28 bed Adult Medical Surgical Hybrid “open” unit
Teaching Hospital-interns/residents
Two Intensivists on days/One Intensivists on nocs Surgical Providers Hospitalists
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Focused on:
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frightened leading to unnecessary increased anxiety
hospitals and increase the likelihood of malpractice suit
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Know local culture (barriers) Identify clinician champions (MD and RN) Test on a small scale:
Provide structure/scripts/ expectations for all Communicate, communicate, communicate Do not fear failure
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Prepare rounding team to have families listen to dialogue
Script for families to ascent to the process
Introduce the team and purpose of MDRS to patient and family (ask patient permission first)
I’ve not taken care of this patient before, I have no idea what’s going on.” This does NOT work well with families
Standardize process with explicit roles for each team member
Implement standard content and sequence
Ask patient/family if they have questions (1 or 2)
Summarize daily goals for patient/family
Schedule time to meet with family if more time is needed
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Define explicit roles and responsibilities for all participants
Physicians Nurse Pharmacist Respiratory Therapist Social Worker Family Clinical Nurse Leader
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We are happy you are here. For the next few minutes we will be discussing your husband’s care and develop a plan for the day using medical language, much of it you will understand, some you may not.
While we want to answer all your questions because that is very important to you and us, we are on a schedule to see all
questions at the end of our rounds. If we don’t answer all your concerns this morning we will schedule a time to come back and meet with you. Is that OK with you?”
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1.
Rounding Schedule
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Sequence of MDR presenters
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Daily Goals and Plan of Care
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Patient Communication Board
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Involve family members in Multidisciplinary Rounds daily in ICU Improved Family- Centered Care
A P S D A P S D
Cycle 1: Hold rounds on Tuesday morning for the patient and one family member in bed 1 with the charge nurse, attending MD and patient nurse at 9:30 AM Cycle 2: Repeat cycle 1 for same patient and family at 8:30 AM the next day and invite the social worker to attend Cycle 3: Extend the invitation to the family for the patient in bed 2 and the case managers to attend the following Monday Cycle 4: Invite family to rounds for ½ of the ICU beds that Wednesday Cycle 5: Use white boards as a reminder to families to increase their attendance in rounds Cycle 6: Expand family presence in rounds to all ICU beds
“We know the team and we know the plan. If I don’t understand everything I can ask the nurse. I know she understands because she was there. I didn’t know planning the care was so complicated and takes so many people. It’s great that the whole team knows the plan. The doctors spend lots of time with us answering our
Somebody has to teach these young doctors. I’m glad you’re watching over them.”
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Will Promote healing relationships Ideas “Open the gate. Teardown that wall.” Families should be present at MDR’s Execution Make it happen. Begin and learn from small tests Results You will delight patients and their families and staff will be amazed by how family presence will bring joy to their work.
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Dr. Michael Westley, CCU Medical Director
Dr. David Kregenow, CCU Medical Director alumus Dr. Ian Smith, CCU Medical Director alumnus Critical Care patients and families Critical CareTeam: RNs/RTs/PharmDs/CNLs/ Social Workers/Palliative Care it takes a village
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Tammy Alvarez, RN, MSN, CCRN, Faculty, IHI, is currently the Executive Director of Improving Performance for the Saint Joseph Health System in Orange, CA. She is also a patient and family advocate and started the patient family advisory program at Saint Joseph Hospital of
health care leadership experience, and has implemented and re-designed numerous processes to improve quality and clinical care. Ms. Alvarez was Chief Nursing Officer at Community Hospital of Long Beach from 2008-2010. She has been responsible for nursing services in critical care with a focus on the cardiovascular, neurosurgical, and renal transplant patient populations.
We tend to want to move quickly when we see a good pilot. Sometimes its good to pilot consistently for 90 days or more. The more we pilot the more we learn and can make adjustment.
Reliable systems continually Plan, Do, Study, Act. They create systems and processes to support the change. Education, regular maintenance, and constant vigilance are key.
Thanks Carol Haraden, IHI VP
When we make it people dependent and not process dependent we fail. Good leadership and spread of any change requires for you to build a nation of believers. Identify unit champions to help you spread your success of rounds.
Avoid the phenomenon that a new process requires hours and hours of work to implement. We must be doing something wrong if we are not working 10-12 hours a day to implement a new change. It is quite the opposite. If your process is not simple and process dependent, then we are doing something wrong. Example in MDR- make the form simple, but explicit to you process. What are you trying to accomplish in your rounds Don’t “boil the ocean”. Go back to your AIM statement.
Standardize the process. Do not standardize the
Make specific to areas within the hospital. Identify the improvement you want to see within the identified units. Reduce falls in the medical surgical units. Reduce LOS in the
Improve patient satisfaction in the area of nursing responsiveness to call lights. Reduce CLABSI/CAUTI
Identify your champions who are passionate about this work. Avoid the timid and unwilling initially. Get your “cheer leaders” to help you drive change.
Improve daily. Don’t wait until 90 days. Can you remember what you did 90 days ago? Feedback to everyone is important. Most people want to know if they do something wrong and or incorrect “real time.” Patient falls- find the issue right then, during rounds, huddles. CLABSI/CAUTI- what happened, real time. Make rounds the vessel to improve. Immediate concerns of patient and families- how can we mitigate there concerns before they are discharged?
Huge opportunity and gap many of us fall into. We want results when we need to focus on a process that is hardwired to improve the AIM. Revisit what are we trying to accomplish?- Ask this question often Examples of pitfalls- attempting to improve reduction in harm events when we do not round consistently on the patients that are high risk for these harm events. Not having the right people in rounds to solve the problem we are trying to fix. Rounds are not structured and there is not agreed upon time and or structure.
Continue to pilot. Focus on the study and act phase of improvement. Leadership buy in and executive walking rounds to SEE the process. Make changes when you see the need to improve. Failures and problems within your new process are “golden nuggets”. Failure is a sign of success. Lead with humility.
Celebrate success. Communicate the work that you are doing? Plan for spread using the model of improvement. Its ok to make small, incremental change to meet your target. Go slow to go fast.
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Listserv for session communications: PatientFamilyRounds@ls.ihi.org To add colleagues, email us at info@ihi.org Pose questions, share resources, discuss barriers or successes
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