Lets Get Real! Trends and Directives That Dont Really Work E-23 - - PowerPoint PPT Presentation

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Lets Get Real! Trends and Directives That Dont Really Work E-23 - - PowerPoint PPT Presentation

Nov 28, 2023 11 likes •825 views

Lets Get Real! Trends and Directives That Dont Really Work E-23 Barbara Dellinger, MA, Teri Lura Bennett , RN Helen Lanes, CHID, IIDA, Andrea V Hyde , MDCID, FIIDA, CHID, EDAC, MDCID, CHID IIDA EDAC NIHQ NCIDQ CHID, NCIDQ NCIDQ Lead

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Let’s Get Real!

Trends and Directives That Don’t Really Work

E-23

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Teri Lura Bennett, RN

CHID IIDA EDAC NIHQ

Lead Interior Designer Johns Hopkins Health System, Baltimore, MD

410-955-5411

tbennet2@jhmi.edu

Barbara Dellinger, MA,

FIIDA, CHID, EDAC, MDCID, NCIDQ

Director of Interior Design & Research Adventist Health System Rockville, MD

240-826-6066

BDelling@adventisthealthcare.com

Helen Lanes, CHID, IIDA,

NCIDQ

Interior Design Project Manager Lanes Consulting Arlington VA

202-345-1241 Helenlanes@yahoo.com

Andrea V Hyde, MDCID,

CHID, NCIDQ

Senior Project Manager - Interiors Stanford Health Care Palo Alto, CA

650-497-2400

ahyde@stanfordhealthcare.org

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Continuing Education Information

Nursing CEU - 1 Nursing Unit Credit EDAC - Self submit for 1 EDAC Credit AIA – Self submit for 1 hour credit IDCEC – Self submit for 1 hour credit

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Teri Lura Bennett RN CHI D CI D I I DA EDAC NI HD Lead I nterior Designer, Johns Hopkins Health System s

Exam ine directives from … The Joint Com m ission, Facility Guidelines I nstitute, as w ell as Current Trends.

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Make it easy for people to do the right thing…design for the Real W orld!

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Valuable Resources or Boogeymen?

FGI TJC LEED HHI HCAPHS HHI CDC EPA

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Trick question, its both …because, its com plicated They can be an alphabet soup of Acronyms, all with their own primary directives;

  • ften at cross purposes,

& confusing at the very least!

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TJC aka The Joint Commission;

Behavioral Health Units receiving citations for furniture that is not anti-ligature, i.e. has a ligature point with an 18 inch drop! Challenge? Furniture is purported to be “Behavioral Health” appropriate but may not actually be anti-ligature!

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W hich Furniture is Anti-ligature?

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W ho decides? Bottom Line is, You do! ..or rather the entire clinical team does… . The Healthcare Interior Designer in collaboration with Clinical staff, & entire Risk Assessment team need to evaluate actual samples and make your own assessment! Clinical team, Facilities, Safety, Hospital-JC team all need to assess items for our locations!

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Lesson: You can’t take anyone's w ord for it, you m ust evaluate the risk for yourself!

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The Challenge? There is no CDC - EPA approved cleaning regimen for removing blood-borne pathogens from carpet!

FGI - CDC – EPA – in conflict?

FGI recommends carpet in a NICU, for the acoustic benefits… .

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CDC recommends replacing it!! Really? Blood-borne pathogens in our NICU flooring? I don’t think so! The Challenge? There is no CDC - EPA approved cleaning regimen for removing blood-borne pathogens from carpet!

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FGI - CDC - EPA

Our solution in NICU? Acoustic backed rubber flooring, & resilient sheet goods with recycled rubber backing. Charting Station alcoves, with Wall, Ceiling & Lighting treatments designed to reduce noise transmission.

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Existing Rubber floor with acoustic background, had issues of adhesion loss, requiring patching & replacing, with persistent soiling. Mfr is an active partner to help solve problems. Our clinical partners are enthusiastic supporters of rubber flooring with acoustic backing. Currently exploring steam cleaning process.

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Wood finish worn off by healthcare cleaning paradigm, exposing open pore wood, … … … imagine the bacteria on this wood armrest!

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In November of 2016, the CDC ruled against using antimicrobials in patient rooms and patient care areas. … & yet… .. Manufacturers continue to invest time and resources into using antimicrobial finishes!

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LEED – EPA – HHI & HCAPHS

Durable Coated Fabrics – Use Non-PVC Polyurethane; & get rid of Vinyl. Resulting in…

  • upholstery failures from real world use,
  • expensive to replace
  • lower HCAPHS Scores
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Specified 2014 We were going for “sustainable”.

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& another non-PVC Polyurethane

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Major donor funding, with directive to use fabrics with special treatments to provide cleanable, durable, moisture-proof woven textile upholstery

  • selections. Original furniture budget of several million dollars.
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It looked great for the photos, & on Day 1…

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… but on Day 201…

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After herculean efforts by our environmental services team to stay ahead of this problem we still had furniture pulled from service for permanent soiling, staining, puddling, found abandoned in BOH elevator lobbies, and basement corridors. The decision was made to reupholster all waiting and patient room furniture...

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Durable Coated Fabric Task Force HCD 2018 Presentation available

  • n AAHID web site:

https://aahid.org/wp-content/uploads/2019/02/durable- coated-fabrics-ppt-2018-hcd.pdf

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Designers, Facilities, EVC, Contractor, & Manufacturer were all active partners to solve the problem!

No Finger pointing allowed!

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2/21/2019 29

What can we do?

Encourage all interior designers to discuss this with their peers, clients, consultants… We don’t have all the answers yet, but can all partner to help find the solutions!

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Do the best you can until you know better. Then w hen you know , do better. Maya Angelo

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Helen Lanes CHI D I I DA NCI DQ I nterior Design Project Manager Lanes Consulting Arlington VA

How to make yourself indispensable to a Healthcare System.

In-house or contracted Interior Designer & Clinical Providers… What is your differentiator?

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Outpatient Cancer Center – with Research

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Health System task groups

  • Administration (vision)
  • Clinicians (needs)
  • Infection Prevention
  • Environmental Services
  • Safety/ Security
  • Facilities (maintenance)

All with their own primary directives and often at cross purposes; confusing!

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  • Healthcare clinicians don’t know, what they don’t know
  • Clinicians are looking at you as the expert to present solutions to

their problems and not be the “order taker”

  • Research driven data
  • P

.O.E’s

  • Disrupt the status quo
  • Timing for solutions
  • Don’t loose track of the big picture. Every LI TTLE detail has a

BI G im pact on the task groups

Don’t under value your com petence

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  • Administration (vision)
  • Clinicians (needs)
  • Infection Prevention
  • Environmental Services,
  • Safety/ Security
  • Facilities (maintenance)

You are here to make “their job better”

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  • Administration (vision)
  • Clinicians (needs)
  • Infection Prevention
  • Environmental Services,
  • Safety/ Security
  • Facilities (maintenance)

You are here to make “their job better”

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  • Administration (vision)
  • Clinicians (needs)
  • Infection Prevention
  • Environmental Services,
  • Safety/ Security
  • Facilities (maintenance)

You are here to make “their job better”

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Interior Design Guidelines

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I nterior Design tim eline:

Schem atic Design to Design Developm ent

  • Interior Finishes and Furniture Standards
  • Issues that need solutions
  • Architectural Specification guideline supplements and details

3 0 % -6 0 % Progress Docum ents

  • System’s Lesson’s Learned
  • Interior Finishes, materials and furnishings discussion –

expertise on technologies and proven track records

  • Review recommended “new” technologies and solutions –

buy-in required

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I nterior Design tim eline:

9 0 % Progress Docum ents

  • Review interior finishes and new technologies integration
  • Integration of supplemental architectural specifications

Perm it set Docum ents

  • Details, details, details…

. Ensure they are thought through and integrated

Contract Adm inistration and Quality Assurance

  • Details, details, details…

. Follow them through to the end

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You are the expert and when you step up to the plate, the system learns that they can’t live without you…

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Andrea V Hyde, MDCID, CHID, NCIDQ Senior Project Manager - Interiors Stanford Health Care Palo Alto, CA

How to adapt system-wide design standards to regulatory standards, befitting the quality & life expectancy of the project

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What do you really-really want?

  • What does TJC, CMS, FGI &
  • ther regulators really want

from Healthcare operations and their facilities? –Always Best to Go Directly to the Most Current Source Info…

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What do you really-really want?

TJC – 2018 National Patient safety goals for Hospitals…

TJC Goals – Purpose to improve patient safety – help us focus on the current problems and how to solve them…

https://www.jointcommission.org/a ssets/1/6/2018_HAP_NPSG_goals_fi nal.pdf

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What do you really-really want?

TJC – 2018 National Patient safety goals for Hospitals…

– Goal 1 - Improve the accuracy of patient identification – Goal 2 - Improve the effectiveness of communication among caregivers – Goal 3 - Improve the safety of using medications

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What do you really-really want?

TJC – 2018 National Patient safety goals for Hospitals…

– Goal 4 - Use alarms safely – Goal 5 - Reduce the risk of health care–associated infections. – Goal 6 - Identify safety risks inherent in specific area of use patient populations – Goal 7 - Prevent mistakes in surgery

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What do you really-really want?

CMS – 2016 - CMS Quality Strategy - Hospitals

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/QualityInitiativesGenInfo/Legacy-Quality-Strategy.html

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What do you really-really want?

CMS – 2016 - CMS Quality Strategy - Hospitals

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What do you really-really want?

CMS – 2016 - CMS Quality Strategy - Hospitals

– Goal 1: Make care safer by reducing harm caused in the delivery of care – Goal 2: Strengthen persons and their families as partners in their care – Goal 3: Promote effective communication and coordination of care

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What do you really-really want?

CMS – 2016 - CMS Quality Strategy - Hospitals

– Goal 4: Promote effective prevention and treatment of chronic disease – Goal 5: Work with communities to promote best practices of healthy living – Goal 6: Make care affordable (Let’s Get Real!...)

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What do you really-really want?

FGI – 2012 – CHD Designing for Patient Safety:

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What do you really-really want?

FGI & CHD 2012 – Designing for Patient Safety: Designing a Healthcare Setting With Infection Prevention in Mind

Developing Methods to Integrate Patient Safety Concerns in the Design Process https://www.healthdesign.org/sites/default/files/chd4 16_ahrqreport_final.pdf Cited the goals for design improvements that would significantly impact the physical and operational patient safety environment:

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What do you really-really want?

FGI – 2012 – CHD Designing for Patient Safety:

  • Model of Physical Environment Elements as Latent Conditions in Patient Safety
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What do you really-really want?

FGI & CHD 2012 Designing for Patient Safety:

Developing Methods to Integrate Patient Safety Concerns in the Design Process – Goal 1 - design issues that relate to the inappropriate administration of medications – Goal 2 - acoustical issues that optimize communication and minimize staff distraction – Goal 3 - involvement of patient family members in the care of patients

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What do you really-really want?

FGI & CHD 2012 Designing for Patient Safety:

Developing Methods to Integrate Patient Safety Concerns in the Design Process – Goal 4 - designs that accommodate optimum infection control techniques – Goal 5 - minimization of patient falls and other never events in the care environment – Goal 6 - designs that consider staff safety

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What do you really-really want?

TJC, CMS & FGI – Common goals Black – Reduce and control cost – improve ease of

care & sustainability of environments over life cycle Environmental Factor Examples…

  • Set all S&F standards based on type & value of facility,

length of use & ease of ownership

  • Limit products used by type category - increases

quantity purchases and standardizes system brand & staff knowledge of use/care efficacy

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What do you really-really want?

JC, CMS & FGI – Common goals Purple – Improve Communications & Reduce noise

Environmental Factor Examples…

  • Private patient rooms (Patient control of noise)
  • Team/charting areas location & design (staff voices)
  • Medication safety zones (distractions @ Med prep)
  • Acoustical treatments (ceiling tile, soft surfaces,

sound-absorbing cleanable surfaces)

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What do you really-really want?

JC, CMS & FGI – Common goals Green – Improve safety thru Infection Control

Environmental Factor Examples…

  • Private patient rooms (transference of infection)
  • Hand hygiene options & access
  • Surface & Furnishing material selections – smooth,

sealed, cleanable with EPA approved Biocide cleaners

  • HVAC and water system safety considerations
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What do you really-really want?

JC, CMS & FGI – Common goals Orange – Risk assessment for patient type/area

Environmental Factor Examples…

  • Flooring material selections – slip resistance/glare
  • Lighting – function, control and glare
  • Bath-to-bed relationship – Mobility assessment, Lifts
  • Storage to reduce hallway clutter
  • ADA/Bariatric – functional and safety considerations
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What do you really-really want?

JC, CMS & FGI – Common goals Pink – Patient Family & Community Focused

Environmental Factor Examples…

  • Private rooms
  • Family space in rooms
  • Education centers
  • In-room Internet access for patients/families
  • Ease of accessibility & clear signage/communications
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What do you really-really want?

JC, CMS & FGI – Common goals Blue – Improve safety of Medications process

Environmental Factor Examples…

  • Medication safety zones – away from distractions
  • Acoustical treatments (ceiling tile, soft surfaces,

sound-absorbing cleanable panels)

  • Lighting
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Barbara Dellinger, MA, FIIDA, CHID, EDAC, MDCID, NCIDQ Director of Interior Design & Research Adventist Health System Rockville, MD

How design standards were successfully adapted on tight budget in preparation for a behavioral health facility Joint Commission visit…

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Adventist Healthcare - Shady Grove Medical Center Behavioral Health

  • Expanding in 2019 with closure of Washington Adventist

Hospital (WAH) Behavior Health

  • 2 floors = 7 units including :

– Acute Inpatient Services (8 units) – Partial Hospitalization Program (PHP) – Out Patient Wellness – Assisted Living – The Ridge School – Lourie Center – Head Start

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Adventist Healthcare - Shady Grove Medical Center Behavioral Health

  • Expanding in 2019 with closure of Washington Adventist

Hospital (WAH) Behavior Health

  • Overall Nature theme: Gardens
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It’s not a hotel, it’s not “just” a hospital, it’s a Behavioral Health hospital.”

  • Risk Vs. Cost – where we drew the line;

– JC visit was a few months out – Money was very tight – We knew that major renovations would have to

  • ccur in 2018 and 2019

– Time vs. Money – On the surface, some decisions seemed risky

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Issues that troubled us:

  • Paper Towel dispensers
  • Toilets

– https://www.capecodsystemscompany.com/userfi les/Ligature-Resistant-Bathroom-Checklist.pdf

  • Doors
  • Furniture with “feet”
  • Decals
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Toilets and paper towels dispensers

“The best value isn’t always the best price”

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Toilet Room - Innovative “Squishy” Door

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Controversy over furniture

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Decals…

“Be population appropriate”

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  • Std. Finishes carry over to BH
  • Wall protection

– Same in all facilities, add anti-ligature “rail” behind the handrail.

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  • Std. Finishes carry over to BH
  • Upholstery – same failures issues across the

system – use InkGuard – BH black uniform pants ruined light color chairs.

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  • Std. Finishes carry over to BH

Colors used in Med/Surg/ Rehab/BH/OP to BH

Outpatient:

burgundy, dark blues, beiges

Inpatient:

warm beige, 3 of each (teal, green, blue) 1 gold

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Palette from SGMC works for BH

No Test Necessary!!!

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Trending

  • Integration of BH into Med/Surg
  • ED upgrades
  • Emphasis on Forensics
  • EPTU evolving into new PEPTU
  • Emphasis on improved children’s

environments (Lourie Center)

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Let’s Get Really Real…

–We are immersed in the weeds and details (And are not just the icing on the cake).

Members of the Clinical Provider Team must feel empowered to engage and speak up!

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Let’s Get Really Real…

–We need to be a voice at the table Whether you are a clinical provider, consultant or in-house facility interior designer

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Continuing Education Information

Nursing CEU - 1 Nursing Unit Credit EDAC - Self submit for 1 EDAC Credit AIA – Self submit for 1 hour credit IDCEC – Self submit for 1 hour credit