IHI Expedition. Today s Host 9/17/2014. Preventing Pressure Ulcers

Transcription

1 Tuesday, July 8, 2014 These presenters have nothing to disclose IHI Expedition Preventing Pressure Ulcers Kathy Duncan, RN Annette Bartley, RN Today s Host 2 Kayla DeVincentis, CHES, Project Manager, Institute for Healthcare Improvement, currently manages IHI s Passport program and the Joint Replacement Learning Community. She began her career at IHI in the event planning department and has since contributed to the State Action on Avoidable Rehospitalizations (STAAR) Initiative, the Summer Immersion Program, and IHI s efforts for Medicare-Medicaid enrollees. Kayla leads IHI s Wellness Initiative and has designed numerous activities, challenges, and educational opportunities to improve the health of her fellow staff members. In addition to implementing the organization s first employee health risk assessment, Kayla is certified in health education and program planning. Kayla is a graduate of Northeastern University in Boston, MA, where she obtained her Bachelors of Science in Health Science with a concentration in Business Administration. 1

2 Audio Broadcast 3 You will see a box in the top left hand corner labeled Audio broadcast. If you are able to listen to the program using the speakers on your computer, you have connected successfully. Phone Connection (Preferred) 4 To join by phone: 1) Click the button on the right hand side of the screen. 2) A pop-up box will appear with call in information. 3) Please dial the phone number, the event number and your attendee ID to connect correctly. 2

3 Audio Broadcast vs. Phone Connection If you are using the audio broadcast (through your computer) you will not be able to speak during the WebEx to ask question. All questions will need to come through the chat. 5 If you are using the phone connection (through your telephone) you will be able to raise your hand, be unmuted, and ask questions during the session. Phone connection is preferred if you have access to a phone. WebEx Quick Reference Welcome to today s session! Please use chat to All Participants for questions For technology issues only, please chat to Host WebEx Technical Support: Dial-in Info: Communicate / Join Teleconference (in menu) Raise your hand Select Chat recipient Enter Text 6 3

4 When Chatting 7 Please send your message to All Participants Expedition Director 8 Kathy D. Duncan, RN, Faculty, Institute for Healthcare Improvement (IHI), oversees multiple areas of content and is the clinical lead for IHI s National Learning Network. Ms. Duncan also directs content development and provides spread expertise for IHI s Project JOINTS as well as additional content direction for the Hospital Portfolio, directs a number of virtual learning webinar series, and manages IHI s work in rural settings. Previously, she co-led the 5 Million Lives Campaign National Field Team and was faculty for the Improving Outcomes for High Risk and Critically Ill Patients Innovation Community. In addition to her leadership on the field team during the Campaign, Ms. Duncan was the content lead for several interventions in IHI s 100,000 Lives and 5 Million Lives Campaigns. She also serves as a member of the Scientific Advisory Board for the American Heart Association s Get with the Guidelines Resuscitation, NQF s Coordination of Care Advisory Panel and NDNQI s Pressure Ulcer Advisory Committee. Prior to joining IHI, Ms. Duncan led initiatives to decrease ICU mortality and morbidity as the Director of Critical Care for a large community hospital. 4

5 Overall Program Aim 9 The aim of the Expedition is to provide participants with strategies for preventing pressure ulcers that have been tried and tested in a variety of different contexts with great success. Expedition Objectives 10 At the end of this Expedition, participants will be able to: Identify a range of simple tools and methods which will help you to prevent pressure ulcers Test strategies for identification of patients at risk for pressure ulcers Implement reliable processes for pressure ulcer risk assessment and pressure ulcer prevention Implement reliable processes for pressure ulcer prevention strategies s 5

6 Schedule of Calls 11 Session 1: Getting to Zero Strategies for Success Date: Tuesday, April 22, 12:00 1:30 pm ET Session 2: Identification and Assessment of Patients at Risk Date: Tuesday, May 6, 12:00 1:00 pm ET Session 3: Developing Reliable Care Processes Date: Tuesday, May 27, 12:00 1:00 pm ET Session 4: Measurement for Improvement Date: Tuesday, June 10, 12:00 1:00 pm ET Session 5: Engaging Patients, Families, and the Community in Pressure Ulcer Prevention Date: Tuesday, June 24, 12:00 1:00 pm ET Session 6: Generating Ideas from Frontline Staff Date: Tuesday, July 8, 12:00 1:00 pm ET Today s Agenda 12 Welcome and introduction Debrief from the action period Generating Ideas from Frontline Staff Guest presentation Summary of key learning points 6

7 Faculty 13 Annette Bartley is a registered nurse with over 30 years of experience in healthcare. She has held leadership roles in frontline clinical care, management and at director level. In 2006 she was awarded a Health Foundation Quality Improvement Fellowship spent at the US Institute for Healthcare Improvement (IHI), during which time she also completed a Masters in Public Health at Harvard University. Annette is now an Independent Quality Improvement Consultant responsible for developing, supporting and leading a number of highly successful quality improvement and patient safety initiatives across the UK at regional, and national level. Her work extends internationally and she is viewed as an authority on the prevention of avoidable pressure ulcers using quality improvement methodology. Annette s passion is inspiring and supporting frontline care teams to reliably deliver high quality, safe, person centered care. Action Period Assignment Debrief Undertake the wearing new glasses exercise. One member of the team to take an hour out to observe the way your unit and team provide patient and family centred care Undertake at least one PDSA test to engage patients and families in preventing pressure ulcers So how did it go- what did you learn? 7

8 Slide by: Bryan Sexton PhD The importance of happy staff Taking care of ourselves Taking care of each other Taking care of people/patients and families 8

9 How do we address burnout and stress in healthcare staff? Ideas generation 9

10 The Snorkel A process for generating ideas from frontline staff Harnesses the creativity Liberates thinking Generates energy and enthusiasm Engages staff Helps move individuals past learned helplessness Focuses minds on the positive Supports action To Innovate is to thrive The key to unlocking innovation is to apply both types of thinking with equal authority and in the right order. Strategy Ideas 10

11 IDEO The Deep Dive * TM IDEO is one of America s Leading Design Firms IDEO s special ingredients: Teams Culture Methodology Deloitte Consulting Limited * TM Outline of Snorkel Review of Project Vision and Charter What do we know about the current context? Propose a Design Challenge Storytelling How might we.? Brainstorming Select top ideas (multi-vote) Prioritize ideas for development Plan prototypes Enactments Design first series of tests 11

12 Understand the context What has worked well? What has been challenging? What needs to improve? Storytelling In lieu of doing actual observations, use storytelling to observe actual experiences Recall an actual story or experience which relates to the specific design challenge (personal, friend or family member or work-related experience) Who was involved? What happened? How did individuals feel and react? Give an example Tell stories in small groups (nor more than 2 minutes each) 12

13 Design Challenge How might we engage patients and families in preventing harm from pressure ulcers? How might we.? (used to create ideas for the brainstorming) Engage patients and families in preventing harm? Optimize nutrition? Engage others in preventing pressure ulcers Ideas should be actionable Write each idea on post-it notes or flip c 13

14 Rules for Brainstorming Chose one or two how might we scenarios. encourage wild ideas go for quantity want more than 500 ideas defer judgment be visual draw pictures one conversation at a time build on ideas of others stayed focused on topic ( how might we scenarios) Write each idea on post-it notes Multi-voting /Select Top Ideas Cluster together similar ideas from the brainstorming exercise brainstorming exercise Use dots to vote(everyone gets 7 dots): What are your personal favorites? What idea would you most like to try on your unit? What idea do you think will have the biggest impact toward achieving the how might we Participants can distribute their dots however they want - all on one idea, each dot on a separate idea, or anything in between Report out on favorite ideas (where there are most dots) 14

15 Matrix of Change Ideas Easy to Implement Place concepts in matrix. Strive for easy, low-cost solutions. Translate high-cost solutions into low-cost alternatives. Low Cost High Cost Difficult to Implement Matrix of Change Ideas High Impact Strive for high-impact, low-cost solutions. Translate high-cost solutions into low-cost alternatives. Low Cost High Cost Low Impact 15

16 Enactments Creating an enactment will help you illustrate an extreme future vision for your prototype Enables you to refine your thinking and build on ideas Helps to make your concept/abstract idea into something more concrete Action Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? A S P D Changes That Result in Improvement Implementation of Change Hunches Theories Ideas A S P D Very Small Scale Test Follow-up Tests Wide-Scale Tests of Change 16

17 Adaptations The Paddle The Moan Board Adapt Adopt Abandon Engaging Hearts & Minds If you want to build a ship do not gather men together and assign tasks. Instead teach them the longing for the wide endless sea (Saint Exupery, Little Prince) 17

18 Guest presentation 35 The Pressure Relievers Reducing Hospital Acquired Pressure Ulcers at Holy Spirit Hospital Camp Hill, PA Judith Himes, BSN, RN, CWON Leona Mlynek, MSN, RN, CWOCN 18

19 Holy Spirit Hospital - Camp Hill, PA Located in South Central Pennsylvania Community hospital with 311 patient beds Judith Himes, BSN, RN, CWON and Leona Mlynek, MSN, RN, CWOCN 19

20 Getting Started IHI 5 Million Lives Campaign Preventing Pressure Ulcers Began in 2007 with the goal of decreasing hospital acquired pressure ulcers by 50% The Beginning Holy Spirit goal- reduce the number of hospital-acquired pressure ulcers by 50 percent by April, 2008 A multidisciplinary team was formed and using IHI guidelines problems were identified Nursing unit selection for pilot program Data collection indicators selected 20

21 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 9/17/2014 What we learned Needs: Update moisture management Make supplies easy to obtain Pressure relief surfaces/turning Increase awareness among patient care staff Incorporated into pilot Successful pilot for 2 months on 1 unit Rollout to rest of patient care units HAPU Incidence per 100 Admissions Pressure Ulcer Incidence per 100 Admissions 7% 6% 5% National Average 4% 3% 2% 1% % Incidence Rate UCL +2 sigma +1 sigma Average -1 sigma -2 sigma LCL Goal Nat'l Avg. 21

22 Goal to Decrease HAPU by 50% Indicators Target 2012 PU incidence per 100 pts 0.6% 0.48% PU incidence per 1000 days 1.2% 1.05% Prevalence per month 6 6 % of at risk pt receiving full PU interventions 100% 100% % of pt receiving PU risk assessment 100% 99% Tools That Help Us HA Pressure ulcer investigation tool HAPU Monitor (monthly) HAPU Data Collection Tool (annual) Data grafts Online Wound Care Order Set (nursing reminders) 22

23 Ongoing efforts Orientation-review expectation of pressure ulcer prevention ICU skin rounds, involve clinical nurse specialists Case studies on individual units Lift team for mobility and positioning Magnet dashboards quarterly data (NDNQI) Monthly data to unit managers and directors Ongoing efforts. Revamping incontinence program Emergency care unit criteria ICU early mobility program Direct contact to Dr. Barbara Braden- pressure ulcer risk score best done day or evening shift Pressure reduction chair pads, heel boots 23

24 Questions? 47 Raise your hand Use the Chat Key Learning Points Everyone deserves care that is Safe (no needless deaths) Timely (no unwanted waiting) Efficient (no waste) Effective (No needless pain or suffering) Patient and family centred (no helplessness) Equitable (for all) Institute of Medicine Aims (IOM) Crossing the Quality chasm (2001) (Don Berwick-Institute for Healthcare Improvement) 24

25 Relational 9/17/2014 Its not just the older patients who get pressure ulcers Getting the balance right Warm but chaotic Everything works Unpleasant and inefficient Cold comfort farm Efficient but impersonal Coordinated, integrated Warm, fed, watered Battery chicks? Transactional Jocelyn Cornwell, Director of Point of Care, Kings Fund, London 25

26 Developing a system s based approach Risk Identification What will success look like? Partnership with patient Risk Assessment Communication of Risk status Appropriate preventative strategy implemented Support for staff Evaluation of outcome Simple but effective messaging If skin is pink think! If skin is red report! 26

27 New challenges beyond the hospital doors Who can help keep patients safe at home? 12months data showing 45% reduction in pressure ulcer incidence over time across Leicestershire Community Partnership Trust Friends Care agencies Family PERSON Doctor GP Neighbours District nurse In God we trust. All others bring data. W. E. Deming But not Data, data everywhere and not a drop to act? 27

28 Days Between 4/21/10 6/2/10 6/27/10 8/7/10 8/22/10 8/28/10 3/28/11 9/17/2014 Visual measurement Get to Zero Avoidable Pressure Ulcers! The Safety Cross (3) 7 8 (1) (1) (1) 25 (1) 26 Days since last (1) days New case identified Admitted /transferred with No avoidable harm Ward NHS Borders-Days Between Preventable Pressure Ulcers April, March Intended Direction Date 28

29 Process measure Data for Improvement Using Data to understand progress toward the team s aim Using Data to answer the questions posed on in the plan for each PDSA cycle The Improvement Guide, API 29

30 Repeated Use of the PDSA Cycle Sequential building of knowledge under a wide range of conditions A S P D Changes That Result in Improvement Spread Implementation of Change Hunches Theories Ideas A S P D Very Small Scale Test Follow-up Tests Wide-Scale Tests of Change 59 Questions? 60 Raise your hand Use the Chat 30

31 Expedition Communications Listserv for session communications: To add colleagues, us at Pose questions, share resources, discuss barriers or successes 61 To Conclude Our sincerest thanks to everyone for participating in this expedition and an extra special thanks to all our guest presenters. Remember that Getting to Zero avoidable pressure ulcers is our collective mission globally. So let s keep up the pressure to keep the pressure off!! 62 31