Mult ltidisciplinary Tool C628 2017 ANCC National Magnet - - PowerPoint PPT Presentation

In Inte terprofessional Rounding using a Mult ltidisciplinary Tool C628

2017 ANCC National Magnet Conference Friday, October 13, 2017 9:30 AM Marlene Marks, BSN, RN, CCM Lillian Hershberger, BSN, RN, CCM Goshen Health Goshen, Indiana

The presenters for this presentation have disclosed no conflict of interest related to this topic.

Goshen Health

Goshen Health

Hospital demographics 125 beds; 3-time Magnet Designated

Goshen Health

• Indiana Lakes Accountable Care Organization

– Comprised of Goshen Health System and the Medical Staff(PHO) – 200 physicians in a Clinically Integrated network – Medicare SSP(10,000 lives) + Medicaid(5000 lives)+Commercial ACO (20,000 lives)

Accountable Care Organization

Goshen Health

Goshen Health Payer Mix

Medicare Blue Cross Blue Shield Contracted Payers Indiana Medicaid Self Pay Medicare HMO Commercial

Workman’s Comp

AMISH

The Uncommon Leader (TUL) culture at Goshen Health is the foundation through which every Colleague has a voice. Colleagues are empowered to make a difference in the lives of

• ur patients, our communities and each other. In turn, every

Colleague has a responsibility to raise their voice for positive change throughout the organization.

The Uncommon Leader (TUL) Culture

Acute Care Coordination

• Nurse driven model with collaboration with social work
• 9 Registered Nurses
• 4 Social Workers
• 2 Support Colleagues
• Roles
• Transitional care planning
• Utilization Review
• Connecting patients to community resources
• Denials Management
• Identify opportunities to improve quality of care
• Goals
• Reducing readmission rates by identifying gaps in care
• Collaborate with hospital and community partners
• Maximizing revenue through appropriate statusing
• Unit based

Acute Care Coordination

Improvement Opportunities

• High readmission rate
• Patients not involved in developing the plan of care
• Fragmented communication
• Non-interprofessional approach
• Delayed discharges

Something had to give

TUL Culture: Rapid Improvement Event

A3 Thinking

• 1. Reasons for

Action

• 2. Initial state
• 3. Target state
• 6. Rapid

experiments

• 5. Solution

approach

• 9. Insights
• 8. Confirmed

state

• 7. Completion

plan

• 4. Gap analysis

Reasons for action

In today's acute care environment treatment plans are complex and require interdisciplinary coordination and care. Many elements of our current process are fragmented, which results in misinformed patients families and staff, redundancies and

• missions in the plan of care and increased length of stay. In
• rder to optimize outcomes and efficiency, we need to involve

the patient and develop a standard process for a core group of disciplines to address patient-driven healthcare goals.

Initial state

• Utilized interprofessional team

–Pharmacy –Dieticians –Therapy –Respiratory therapy –Bedside RN

• Hospitalist participation

Current State Target 30 Day 60 Day “Core” group of professionals present for daily rounding No Process Patient driven healthcare goal documented No Process

Target state

• Coordinated communication among professionals
• Patient-driven healthcare goals discussed and

documented

• Core team of professionals rounding at patient’s

bedside

Current State Target 30 Day 60 Day “Core” group of professionals present for daily rounding No Process 80% Patient driven healthcare goal documented No Process 80%

Gap analysis

Gap Suspected Root Cause Communication among professionals is fragmented, impacting the ability of caregivers to develop a comprehensive plan

• f care

Participation in rounding is inconsistent Documentation of disciplines in silos Bedside nurses feel unavailable or unequipped for rounds with the hospitalist Bedside nurses have approximately 26 minutes more work to do between the hours of 8-11 a.m. than they have time available Proposed CMS regulation requiring documentation of patient driven goal Did not have a patient centered approach

Solution approach

• Bring the “Core Team,” including the Nurse Care Coordinator,

into the bedside rounds with each hospitalist and nurse

• Leverage resources by utilizing our EMR; Combine pertinent

caregiver assessments into a single-page interprofessional rounding intervention in Meditech easily accessible by all

• Clearly define expectations for what a nurse needs to contribute

during rounding

• Identify ways to make rounds value add for everyone present
• Identify a process for discussing and documenting patient-

driven goals

Documentation Tool

Presenting this change in process at Magnet Conference 2017

Rapid experiments

• All disciplines were not available to round and would be intimidating to patient
• Developed “core” group for daily rounds
• Reviewing documentation of all disciplines during rounds was cumbersome and

time-consuming

• Single-page interprofessional rounding document
• Identified unit based model would not allow for Nurse Care Coordinator to

round with all patients, Hospitalist, and bedside RN

• Hospitalist based model
• Attempted to use paper Cardex
• Nurses did not feel more informed at rounds
• Dual documentation
• Asked providers to discuss patient driven healthcare goal
• Identified additional education needed

Overcoming Implementation Barriers

Patient Hospitalist provider Input from

• ther

professionals Bedside nurse NCC

Insights

• Open computer at the bedside
• Enter orders
• Gather information
• Document in real-time
• “Core” teams participation engaged the entire team
• Reduced phone calls to provider and nurse care coordinator
• Decreased re-work of having to communicate plan multiple times
• Decreased delayed discharges
• Patient’s engaged in developing plan of care
• Identified collaboration between care team
• Streamlined process for patients to identify needs or questions
• Provided opportunity for families to attend rounds
• Diversity and representation of all professions on team
• Quick implementation lead to continued momentum

Confirmed state

# Pillar Metric Initial State Target State % RIE Week 3/14 3/21 3/28 4/4 4/11 30 day 4/18 4/25 5/2 5/9 60 Day 5/16 1 Service

Core group of professionals present for daily rounding

No process 80% 100.0 % 92% COMMUNICATION WEEK 77% 92 82 91 86.0 94.0 94.0 91.0 89.0 92.0 93.0 3 Quality & Safety

Patient-driven healthcare goals documented

No process 80% 100.0 % 53% 93% 95 95 94 95.0 96.0 97.0 94.0 91.0 96.0 98.0

Case Study

Case Study

Presenter Contact Information

Marlene Marks, BSN, RN, CCM mmarks@goshenhealth.com 574-364-2918 Lillian Hershberger, BSN, RN, CCM lhershberg@goshenhealth.com 574-364-1377