Unit July # Days since Last Fall 3B 4 6 4AM 0 39 4AR 1 11 4B 0 24 5A - - PowerPoint PPT Presentation

Unit July # Days since Last Fall 3B 4 6 4AM 39 4AR 1 11 4B 24 5A 2 1 5B 2 2 6A 4 2 6B 7 3 ICU 316 IMC 64 ED 2 5 Total IP Units 20 1 Total Hospital 22 1 Other visitor 5 as of 7/22/2012 SF

ALARMS

 Alarms are an important means for notifying me when a

patient is attempting to get OOB without calling for assistance

 If the patient is identified as needing a bed alarm then I

will also need a chair alarm. Chair alarm pads are located in the central supply carts on each unit. The alarm unit will need to be obtained from SPD.

 I will engage bed alarms at night on all patients to

ensure they are safe and I know I can’t be every where.

THINKING ON MY FEET

 I will never leave a patient alone in the

bathroom if they are at risk for falling.(54%)

 I will never leave a patient to dangle on the side

• f the bed.( 6 falls in Dec) They will sit in a chair
• r lay in bed.

 I will answer call lights in a timely fashion even

when they are not mine to ensure patients are toileted safely.

MY ROOMS WILL BE SAFE AND FREE FROM CLUTTER

I WILL EDUCATE MY PATIENTS

 To never get up without help  To always call me its never a bother “I want to

help you”

 Why they are at risk for falling  What can happen if they fall:

Injuries that will extend their stay, lacerations(5)surgery(6), fractures(6), Deaths(1) etc.

NO SUCH THING AS A LITTLE CONFUSED

 If a patient has intermittent confusion

”They were fine for me "I will engage all fall prevention measures.

 Patients that are intermittently confused have a

higher risk for falls and injury.

I AGREE :

 To follow all fall prevention measures.  To educate my patients about fall prevention  To inform my coworkers when I have a patient

at risk for falling

 To support St Margaret's in all fall risk

initiatives in the future.

INPATIENT SUMMARY CAN BE FOUND ON THE LEFT SIDE OF THE PATIENT CHART UNDER MENU. LOOK FOR “INPATIENT SUMMARY” FOR A QUICK REFERENCE TO THE PATIENT’S VISIT

As of 6/27, the Weight Bearing Status order will have a required field. The required field is for the actual Weight Bearing Status and is a multi-select field. Figure 1: Weight Bearing Status Required Field Figure 1: Weight Bearing Status Required Field

Communication Type The new communication type, PowerPlan Initiate, is live as of 6/27, Figure

• 2. This new communication type will prevent orders from going to a

provider’s inbox for co-signature and will also give nursing an option that is more appropriate to use when PowerPlans are initiated.

Figure 2: PowerPlan Initiate Communication Type

HCAHPS Inpatient

UPMC St. Margaret

Displayed by Received Date CAHPS Apr '12 May '12 Jun '12 Jul '12 Top Box Top Box Top Box Top Box Rate hospital 0-10 61.4 ▼ 65.8 ▲ 66.3 ▲ 61.9 ▼ Recommend the hospital 69.9 ▼ 72.4 ▲ 68.1 ▼ 69.1 ▲ Cleanliness of hospital environment 55.5 ▼ 53.9 ▼ 60.3 ▲ 59.4 ▼ Quietness of hospital environment 36.0 ▼ 45.9 ▲ 36.5 ▼ 45.8 ▲ Comm w/ Nurses 72.9 ▼ 74.1 ▲ 75.4 ▲ 74.4 ▼ Response of Hosp Staff 52.9 ▼ 54.0 ▲ 52.1 ▼ 60.1 ▲ Comm w/ Doctors 75.8 ▼ 80.6 ▲ 79.8 ▼ 78.7 ▼ Hospital Environment 45.8 ▼ 49.9 ▲ 48.4 ▼ 52.6 ▲ Pain Management 69.6 ▲ 70.6 ▲ 69.9 ▼ 69.3 ▼ Comm About Medicines 58.8 ▼ 61.6 ▲ 58.6 ▼ 54.8 ▼ Discharge Information 89.9 ▲ 88.1 ▼ 86.5 ▼ 87.9 ▲

5% 40% 55%

Converti ting ng to a No Pull Un Unit

Not satisfied Satisfied Very Satisfied

Not satisfied 5 Satisfied 39 Very Satisfied 56

19% 40% 41%

Not

• t Having

g to Worry y Abo About Staffing ng Issue ues

Not satisfied

• t satisfied

Satis Satisfied fied Very ery Sat Satis isfied fied

Not satisfied 19 Satisfied 40 Very Satisfied 41

4% 21% 75%

Not

• t Having

g to Worry y Abo About Being Pulled d to an Area I am am Not Not Familiar ar With th

Not satisfied

• t satisfied

Sat Satisfie isfied Very ery Sat Satis isfied fied

Not satisfied 4 Satisfied 21 Very Satisfied 75

3% 34% 63%

Having ng Our Own Staff f Care for Pat Patients nts

Not satisfied

• t satisfied

Sat Satisfie isfied Very ery Sat Satis isfied fied

Not satisfied 3 Satisfied 34 Very Satisfied 63

 Nurse Talk  RIC Expanded Duties  Readmissions  UPMC East  Zuma Lifts

NURSETALK

RIC Duties

• 1. Code Relief

A. ICU nurse will remain the primary code responder. RIC nurse will relieve the ICU nurse or maintain the ICU nurse’s patient assignment during the code. B. Monitor patient and transfer to designated unit or remain with the patient until a bed becomes available.

• 2. Open and staff 1A Nursing Unit
• 3. Respond to Condition L and Condition M
• 4. Transport/monitor critically ill patients/maintain pt while off unit

A. CT Scan, MRI, Radiology, ect. 1. RIC may relief RN to go with patient who is unstable, RIC nurse will stay on unit and perform patient care to nurse’s second patient.

• 5. Floor Rounds

A. Assist with patient care Post-ops, unstable patients, new admissions, transfers

RIC Duties Continued:

2. Assist admission team with admissions during periods of down time. 3. Monitor patient that require transfer to higher level of care until a bed is available. 4. Hourly rounding on units to assist with care—answering lights, starting IV’s, taking vital signs, etc. when not busy. 5. Other activities as coordinated through the Clinical Coordinator/ICU Unit Director 6. Assist with transfers from PACU/ED 7. Review all Flex Monitor patients for appropriateness every morning and evening and report to resource nurse/clinical coordinator.

• 8. Attend monthly House Staff Coverage Meetings
• 9. Attend Daily Throughput meeting.
• 10. Administration of Lopressor
• 11. Involvement in QA activities (handwashing audits, bed alarm audits,

purposeful rounding, safety rounding, etc). Low Census guidelines: In the event low census would occur, the RIC nurse will be utilized in the IMCU, ICU, 3B. The RIC nurse may also provide support to the ED without a patient assignment or may act as an Admission Team nurse.

WHY READMISSIONS?

 17.6% of Medicare admissions resulted in readmissions

within 30 days

 $15B in spending  $12B for potentially preventable readmissions  1 in 5 Medicare patients readmitted within 30 days  50.2% of patients readmitted had no physician visit

between discharge and readmission

 1 in 10 non-obstetric Medicaid patients (age 21-64)

hospitalized in 2007 for medical condition had at least

• ne readmission within 30 days

2007 MedPac Report to Congress NEJM Jenacks 2009 Article (Jencks, Williams, & Coleman,

2009)

AHRQ 2010 Report

(Jang & Wier, 2010)

FAILING TO PROVIDE COMPLETE DISCHARGE INSTRUCTIONS

Percent Heart Failure Patients Discharged With Incomplete or Missing Discharge Instructions

Joint Commission and Heart Failure Registry Databases 70-80%

FAILING TO CLOSE THE KNOWLEDGE GAP

Percent of Medical Information Forgotten Immediately by Adult Learners

40-80%

Percent of Medical Information Incorrectly Understood by Adult Learners

Ambulatory Clinic

51%

ACKNOWLEDGING OUR PROGRESS IN PATIENT EDUCATION

Model Description Sample Questions Teach-Back Nurse educates patient, asks patient to restate in their own words what they have learned

• Which foods should you avoid?
• What signs and symptoms should you

report to your doctor? Demonstrate Back Nurse educates patient, asks patient to demonstrate practical application of lesson

• How do you take your water pill?
• How do you weigh yourself?

Ask me Three Patients encouraged to ask three basic questions to better understand their disease

• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?

Motivational Interviewing Nurse asks open-ended questions, provides affirmation, and listens; goal to incrementally address patient’s motivation for self-care behaviors

• What do you think about your smoking

habit?

• Has eating salty foods every caused you

problems before?

• What might work for you if you decided

to change?

IDENTIFYING THE PRIMARY CAREGIVER AT HOME

Three Questions for Assessing the Key Learner

Questions gather information about patient’s home behaviors Key learner prominently identified on patient’s white board for full care team visibility Education materials customized to match key learner’s learning style Case in Brief: Lehigh Valley Health Network

• Three-hospital, 951-bed health system headquartered in Allentown, Pennsylvania
• Hospital assesses patients’ home habits to identify who, besides the patient, should be taught

disease management skills

• Key learner engaged by full inpatient care team during discharge planning and patient education

1. Who assists you with your medication at home? 2. Who accompanies you to doctor appointments? 3. Who should be present to listen to your discharge instructions?

FY13 HOSPITAL READMISSIONS REDUCTION PROGRAM:

7/1/08 08-6/30/ 6/30/11 1 AMI HF HF PN PN Bedford 0.9707 0.9842 0.9146 Hamot 0.8781 0.8846 0.9303 Horizon 1.0072 0.9174 0.8798 Magee 1.087 0.9829 1.0370 McKeesport 0.9291 1.1011 1.0249 Mercy 1.1161 0.9419 1.0113 Northwest 1.1022 1.0234 1.0244 Passavant 0.9514 1.0286 1.0246 PUH/SHY 0.9973 1.0095 0.9423

• St. Mgt

1.1208 0.9950 0.9546

• Better than an average hospital that admitted similar (risk factors) patients will be <1.0; will not be penalized
• Worse than an average hospital that admitted similar (risk factors) patients will be >1.0; the closer to 1.0 the

lesser the penalty; the higher the ratio above 1.0, the closer to the cap of 1% penalty for FY13

• Publically reported on Hospital Compare in October 2012 (not part of the consumer “compare” feature)

Excess Readmission Rates (30-day, all cause, risk standardized, Medicare FFS)

VEHICLE TRANSFER

The Zuma™ Mobility Trainer has all the functions of the Zuma™ Mobility Assist, plus additional transfer and rehabilitation capabilities. This All-in-one device is one of the most versatile patient mobility devices available, combining multiple functions into one compact device: Sit-to-Stand Transfer Lifting Fallen Patient Sit-to-Stand Training Ambulation Training Patient Lift/Transfer Changing Sheets on Occupied Bed Bathing Limb Lifting