Communicating Using a Single Plan of Care

Transcription

1 Communicating Using a Single Plan of Care 1

2 A 233 bed community Hospital 700 Medical Staff & 1000 Employees Emergency Department (31,000 visits) Acute Care Nursing (Medical, Oncology and Surgical Care, Intensive Care, Pediatrics, Obstetrics/Gynecology) Level III NICU and Inpatient Psychiatry; A Surgery Program including Bariatric, Neurosurgery, and Robotic surgery; A comprehensive Cancer Treatment and Wellness Center; Sleep Medicine Center Family Caregiver Center Integrative Medicine Program Clinical Nutrition and Rehabilitation Services Transitional Care Unit 2

3 Agenda: Patient Communication around the Single POC: Care Delivery System (Dyad) - Standardized Shift Report - Walking Rounds - Communication Board Staff Communication: Nurse/M.D. &Team Huddles (Ask-Tell-Ask) Technology Enablers: Bedside Tablet and Vocera Transitions of Care: Teach-Back, Discharge Checklist, PCP appointments, Follow-Up Phone calls, Patient Warm Line Implement & Sustain the Gain: Education, Coaching, Debriefing Outcome Measures You ve heard all the ideas before. It s not the ideas, it s the EXECUTION of the ideas. Joel Seligman President and CEO, NWH 3

4 Background It s been a Journey The Inpatient Process Redesign (IPR) initiative began in 2009: Goal: To consistently provide a truly patient and family-centered experience on the medical and surgical units at NWH Objectives: Improve the: 1. "Patient Centeredness" of our processes 2. Effectiveness and efficiency of the support services and infrastructure which support clinical staff 3. Efficiency of the Patient Care Delivery System on the units 4. Effectiveness and communication of the interdisciplinary care team and the plan of care 4

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6 Intense Focus on Communication Tactics R.N.-R.N. Shift Report R.N.-P.C.A. Shift Report Walking Rounds Hourly Rounding Bedside Rounds Communication Boards M.D.-R.N. Huddles Ask-Tell-Ask M.D. Problem List Results: Improved Communication & Teamwork Better Organization of Dyad At change of shift Across R.N./P.C.A. Dyad With Physician With Patient/Carepartner 6

7 NWH Patient Care Delivery System & Theoretical Framework Dr. Jean Watson s Theory of Human Caring (Developed between cience.org) Relationship Based Care: A Model for Transforming Practice (Creative Health Care Management 2004) Planetree Philosophy 7

8 NWH Patient Care Delivery System Team Registered Professional Nurse (R.N.)/Patient Care Associate (P.C.A.) work in a team R.N./P.C.A. start and end shift together Days: Dyad for every 5 patients Nights: Triad for every 10 patients 8

9 I PASS THE BATON I Introduction P Patient A Assessment S Situation S SAFETY the B Background A Actions T Timing O Ownership N Next CHECKBACK - Question, Clarify and Confirm USMC, 2005, Strategies and Tool to Improve Handoffs and Transitions. 9

10 NWH s I Pass the Baton Standardized Tools Standardized Processes Patient-Centered Intra-Unit: R.N.-R.N. R.N.-P.C.A. Replicate Across Units ED- Medical Floor 10

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13 The Single Plan of Care at NWH. Begins with the Physician s Plan of Care 13

14 Process Maps Hardwire the Process and Roles 14

15 The Daily Huddle 15

16 C O M U N I C A T I O N

17 Ask-Tell-Ask Patient Centered Communication ASK the patient to describe understanding of issue (Start where they are!) TELL the patient in straightforward language what you need to communicate (Sit down!) ASK the patient to restate the information in their own words (Clarify and address gaps and concerns) Education program for Physician/R.N./Case Managers with Physician Consultant: Professional actors for simulations Pilot / Coaching / Rounding Feedback from Patient Family Advisory Council Not Tell-Tell-Tell

18 TEACH-BACK: This is important, I want to make sure I have explained it correctly. Please tell me what you understand. Staff Challenges: I am not used to imparting information this way. It s really hard to not ask Yes-No questions Train/Practice/Evaluate TEACH BACK Teach (BE PRESENT) Restate/Demonstrate - LISTEN Clarify misunderstandings Reinforce new skills (ENGAGE FAMILY/CARE PARTNER) Over 300 Staff trained to learn this new skill!

19 Taking Patient Engagement to Next Level Patient-Centered Care Innovation! 19

20 Vocera Patient to Nurse Call Process Goals: Patient has direct access to R.N. Removal of non-value added steps Technology enables process Elimination of handoffs Desired Outcome: Enhanced responsiveness for patients and staff Improved H-CAHPS Score for Nurse Responsiveness Process: Patient presses the pillow speaker Patient s nurse is contacted Nurse prioritizes care, gives instant verbal response. Built in escalation path Accountability: Nursing supervisor alerted if any calls are not answered

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22 My Care Team

23 My Labs My Total HDL

24 Entire Care Team Incorporates Access My Chart Into Daily Education

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26 Leaving R U Ready? Patient & Family Warm Line My Discharge Checklist Designed by PFAC! Follow-up Phone Calls PCP Appointments 3 5 days Bedside Medication Delivery Transition Coach- High Risk MU Patient Portal Sign Up Bye-Bye Banana Bread 26

27 The NWH Approach to Success and Sustainability Coaching & Debriefing Moving from I did it approach to Hardwiring new skills and behaviors Debrief Daily during launch As needed Identify & Address Themes/Issues Boosters Focus of the Week Leadership Rounding Readiness Rounds 27

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