To improve the quality of patient care.

Transcription

1 The Goal of the Nurse Directed Care Model To improve the quality of patient care. In the Nurse Directed Care Model the quality of patient care is improved by: The promotion of an atmosphere where staff and patients work together. An improved treatment milieu. Quality Nursing Programs.

2 Goals continued Knowledge of each patient as an individual. Knowledge of the nursing component of the plan of care. Promotion of continuous and consistent care within and across all shifts. Assurance of effective communication and accountability among staff.

3 What the Model Provides Timely feed back to the Treatment Team. Quality of care through clinical supervision of the Direct Care Providers. Enhanced patient-centered communication. Direct Care Provider accountability. A method to plan, implement, and evaluate professional nursing interventions.

4 NDCM Structure APN Role Medication NDC Team Patient PCM Role Staff Documentation

5 NDCM Master List TEAM A (RNs & LPNs) TEAM B (RNs & LPNs) DAY: EVENING: NIGHT: DAY: EVENING: NIGHT: Group A Group E PATIENT STAFF PATIENT STAFF 1. DAY: EVE: 1. DAY: EVE: NIGHT: 4. NIGHT:

6 LINEN / LAUNDRY RM. FRESH AIR NDCM STAFF ASSIGNMENT EMERG. MED. RECORDER DINING RM. MED LINE - 7AM SHOWERS VITAL SIGNS WEIGHTS T E AM A RN: Break: Lunch: Rounds: LPN/RN: Break: Lunch: Rounds: T E AM B RN: Break: Lunch: Rounds: LPN/RN: Break: Lunch: Rounds: Staff: Break: 1 2 Lunch: 2 2:30 3 3:30 4 4:30 Staff: Break: 1 2 Lunch: 2 2:30 3 3:30 4 4:30 GROUP A Hallway: PATIENTS GROUP E PATIENTS Hallway: High risk: Face ck./interm: High risk: Face ck./interm:

7 Methodology A staff/patient survey was developed and administered prior to the implementation of the NDCM in Abell. Staff education all levels all shifts. Developed a NDCM Manual. Developed shift specific patient/staff assignment sheet. Nine (9) months after implementation of the Model the staff and patients were resurveyed.

8 NDCM Clinical Awareness Abell NDCM Clinical AOutcomes 100 % Positive Name Patients DC Barriers Deescalation DC Goals Lvl Supervision Tx Team Attend... Staff Ratings

9 Patient Environment Observation Abell NDCM Patient-Environment Outcomes % Positive Showers Clothing Storage Clothing Appropriate Clothing Adequate Neatness Staff Ratings Odor Free Personal Items

10 Seclusion Restraint Seclusion Restraint Episodes Seclusion or Restraint Bldg A Bldg C Hospital Total 9/1/05-12/31/05 1/1/06-6/30/06 Location (raw data & corrected for census + time)

11 Patient Reports Abell NDCM Patient Report Outcomes % Positive Name Staff DC Goals DC Barriers Self Control Tx Plan Attendance Know Progrm Sched Patient Ratings

12 Staff Interviews Continued Section Chief: What is your opinion of the NDCM and does it impact the patients? The "NDCM" has impacted the provision of care dramatically and that is shown through statistical tracking and surveys as well as to the naked eye. Just walking on the units you could see the difference since the implementation of the program. Pts that were having trouble getting their voices heard now had an avenue to go through. They would speak to their DCP to ask the team something or make a suggestion for improvements on the units. It empowers the patients and fits in perfectly with the Wellness and Recovery Model.

13 Complex Administrator Interview Continued Also it provides more specific care to individuals. Staff are directly assigned to care for specific patients. This way they pay more attention to the details of everyday care of a patient...such as clothing, locker keys, developing rapport with them. This way they attend more treatment team meetings voicing the everyday struggles of that particular patient, etc. This is a model that works, but more than that it is a model that thrives.

14 Staff Interview Nurses: Does this model promote quality patient care? I am more able to focus on the patients I am more familiar with their diagnosis and treatment more able to track them. I am more familiar with their medications and their behaviors more able to prevent escalation.

15 Staff Interview Direct Care Provider: What do you like about the model? I know my patients needs. When I come in I know what kind of help each of my patients needs if they need assistance with their laundry.what groups they are assigned.do they need to be encouraged to attend group. I know my patients.

16 Patient s Interview Patient: Do you know who your Direct Care Provider is? Yes, I know who it is in the day time and evening. The day time lady helps me with my laundry, my bedroom and the evening one helps me with my shower and makes sure I have some dinner. I don t like to eat here

17 Patient s Interview Patient: How does the Direct Care Provider help you? She helped me with the move..i didn t want to go. She helped me pack my things and got clothes for me. He listens to me when I am upset and opens the shower for me during the day.i don t like taking a shower when other people are there.

18 Patient s Interview Continued She helps me deal with some of the people in this place.. the ones who make me angry. She takes me to Park Place. Sometimes I have to get off this floor and she takes me. MJG 08/12/08

19 The Goal of the Nurse Directed Care Model To improve the quality of patient care. In the Nurse Directed Care Model the quality of patient care is improved by: The promotion of an atmosphere where staff and patients work together. An improved treatment milieu. Quality Nursing Programs. 1

20 Goals continued Knowledge of each patient as an individual. Knowledge of the nursing component of the plan of care. Promotion of continuous and consistent care within and across all shifts. Assurance of effective communication and accountability among staff. 2

21 What the Model Provides Timely feed back to the Treatment Team. Quality of care through clinical supervision of the Direct Care Providers. Enhanced patient-centered communication. Direct Care Provider accountability. A method to plan, implement, and evaluate professional nursing interventions. 3

22 NDCM Structure APN Role Medication NDC Team Patient PCM Role Staff Documentation 4

23 NDCM Master List TEAM A (RNs & LPNs) TEAM B (RNs & LPNs) DAY: EVENING: NIGHT: DAY: EVENING: NIGHT: Group A Group E PATIENT STAFF PATIENT STAFF 1. DAY: EVE: 1. DAY: EVE: NIGHT: 4. NIGHT: 5

24 LINEN / LAUNDRY RM. FRESH AIR NDCM STAFF ASSIGNMENT EMERG. MED. RECORDER DINING RM. MED LINE - 7AM SHOWERS VITAL SIGNS WEIGHTS T E AM A RN: Break: Lunch: Rounds: LPN/RN: Break: Lunch: Rounds: T E AM B RN: Break: Lunch: Rounds: LPN/RN: Break: Lunch: Rounds: Staff: Break: 1 2 Lunch: 2 2:30 3 3:30 4 4:30 Staff: Break: 1 2 Lunch: 2 2:30 3 3:30 4 4:30 GROUP A Hallway: PATIENTS GROUP E PATIENTS Hallway: High risk: Face ck./interm: High risk: Face ck./interm: 6

25 Methodology A staff/patient survey was developed and administered prior to the implementation of the NDCM in Abell. Staff education all levels all shifts. Developed a NDCM Manual. Developed shift specific patient/staff assignment sheet. Nine (9) months after implementation of the Model the staff and patients were resurveyed. 7

26 NDCM Clinical Awareness Abell NDCM Clinical AOutcomes 100 % Positive Name Patients DC Barriers Deescalation DC Goals Lvl Supervision Tx Team Attend... Staff Ratings 8

27 Patient Environment Observation Abell NDCM Patient-Environment Outcomes % Positive Showers Clothing Storage Clothing Appropriate Clothing Adequate Neatness Staff Ratings Odor Free Personal Items 9

28 Seclusion Restraint Seclusion Restraint Episodes Seclusion or Restraint Bldg A Bldg C Hospital Total 9/1/05-12/31/05 1/1/06-6/30/06 Location (raw data & corrected for census + time) 10

29 Patient Reports Abell NDCM Patient Report Outcomes % Positive Name Staff DC Goals DC Barriers Self Control Tx Plan Attendance Know Progrm Sched Patient Ratings 11

30 Staff Interviews Continued Section Chief: What is your opinion of the NDCM and does it impact the patients? The "NDCM" has impacted the provision of care dramatically and that is shown through statistical tracking and surveys as well as to the naked eye. Just walking on the units you could see the difference since the implementation of the program. Pts that were having trouble getting their voices heard now had an avenue to go through. They would speak to their DCP to ask the team something or make a suggestion for improvements on the units. It empowers the patients and fits in perfectly with the Wellness and Recovery Model. 12

31 Complex Administrator Interview Continued Also it provides more specific care to individuals. Staff are directly assigned to care for specific patients. This way they pay more attention to the details of everyday care of a patient...such as clothing, locker keys, developing rapport with them. This way they attend more treatment team meetings voicing the everyday struggles of that particular patient, etc. This is a model that works, but more than that it is a model that thrives. 13

32 Staff Interview Nurses: Does this model promote quality patient care? I am more able to focus on the patients I am more familiar with their diagnosis and treatment more able to track them. I am more familiar with their medications and their behaviors more able to prevent escalation. 14

33 Staff Interview Direct Care Provider: What do you like about the model? I know my patients needs. When I come in I know what kind of help each of my patients needs if they need assistance with their laundry.what groups they are assigned.do they need to be encouraged to attend group. I know my patients. 15

34 Patient s Interview Patient: Do you know who your Direct Care Provider is? Yes, I know who it is in the day time and evening. The day time lady helps me with my laundry, my bedroom and the evening one helps me with my shower and makes sure I have some dinner. I don t like to eat here 16

35 Patient s Interview Patient: How does the Direct Care Provider help you? She helped me with the move..i didn t want to go. She helped me pack my things and got clothes for me. He listens to me when I am upset and opens the shower for me during the day.i don t like taking a shower when other people are there. 17

36 Patient s Interview Continued She helps me deal with some of the people in this place.. the ones who make me angry. She takes me to Park Place. Sometimes I have to get off this floor and she takes me. MJG 08/12/08 18