A11/B11: Partnering with Familiar Faces Embracing Diversity of Expectation. Tiffany Christensen Trevor Torres. Session Objectives

Transcription

1 A11/B11: Partnering with Familiar Faces Embracing Diversity of Expectation Tiffany Christensen Trevor Torres Session Objectives Examine the variety of expectations held by chronically ill patients and their families Explore and discuss a variety of tools for improving communication and engaging patients in safety efforts Write action plans for personal and organizational improvement based on the information shared The presenters in this session have nothing to disclose 1

2 Where we re going Today s demands for culture change takes your skill set to the next level. 2

3 Why the culture change? *Pts with more access to information * Competitive markets * Questions about boundaries And yet Providers asked to do more with less money So how do we keep up with shifting expectations? How do we improve the patient experience while attending to so many other demands? 3

4 The What: Person and Family Centered Care is putting the patient and the family at the heart of every decision and empowering them to be genuine partners in their care ~Institute for Healthcare Improvement Trevor Torres 4

5 You should get Diabetes! 5

6 My story, and things I ve noticed as a patient Just ask me! 6

7 Great teachers adapt Practicing PFCC THE PLATINUM RULE 7

8 Allow me to now narrate my care I like to know what s happening. My Upper Endoscopy 8

9 Patient and Family Centered Care Guiding Principle: Information Sharing The it s cold outside problem 9

10 Trying to get an A1C Chronic Inconvenience A.K.A. Red tape overdose 10

11 Patient and Family Centered Care Guiding Principle: Dignity and Respect I can haz video? 11

12 Patient and Family Centered Care Guiding Principle: Participation My style: The CEO metaphor 12

13 Patient and Family Centered Care Guiding Principle: Collaboration Here come the Millennials! 13

14 Thank you. It s your turn! 14

15 Group Exercise Betty s story Examine this story from the perspective of PFCC. Using the 4 Guiding Principles discuss: How safe is if for Betty to go home today? How might the conversation have gone differently? 4 PFCC Guiding Principles Respect and dignity. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care. Information Sharing. Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete, and accurate information in order to effectively participate in care and decisionmaking. Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose. Collaboration. Patients and families are also included on an institutionwide basis. Health care leaders collaborate with patients and families in policy and program development, implementation, and evaluation; in health care facility design; and in professional education, as well as in the delivery of care. 15

16 Another patient perspective Diagnosed at 6 months old with the gift of cystic fibrosis 16

17 I had a relatively normal childhood I had my first hospital stay at Age 12 I had three weeks of intravenous antibiotics and got my first taste for the need to be an advocate 17

18 This was just the beginning There would be countless more days spent in the hospital during my lifetime By age 21, I was sick almost all of the time. I was attending the North Carolina School of the Arts and I just couldn t keep up. I had to give up my Hollywood dreams and drop out. 18

19 I was on oxygen getting tube feedings. The doctors put me on the list for a bilateral lung transplant. I waited 4 years for my call I was 95 pounds and my lung function was 25% of capacity 19

20 Facing Medical Error Surgical Error: Wet Run and an apology Ripple Effect of Reactions: In the OR In the Transplant Protocols In Safety Procedures Hospital Wide Patient and Family Centered Care Guiding Principle: Information Sharing 20

21 I waited 1 more year for my first set of donor lungs Now, due largely to the surgical error, I was 87 pounds and my lung function was 18% of capacity April 4 th,

22 Patient and Family Centered Care Guiding Principle: Participation I was healthier and puffier than ever before! 22

23 In June of 2002, my lung function started to drop. I was diagnosed with my second terminal illness 6 months later. I had Chronic Rejection. Within two years, my lung function had dropped to 10% of capacity. I was 73 pounds. I was dying and the doctors gave me 6 more months to live. 23

24 Loss of Purpose and Worth I asked my doctors if I could have a second lung transplant. They said no. 24

25 After the stages of grief the soft arms of acceptance We got a new transplant coordinator. 25

26 Only 4 months after I was listed, I got the call My fear was overwhelming Going into the OR, I was looking for comfort Patient and Family Centered Care Guiding Principle: Dignity and Respect 26

27 On March 28, 2004 Despite my team s concern, the recovery was easier than the first time. 27

28 Unlike after the first time, I was not confused about what to do with my life. I felt a strong calling to reach out to others touched by illness. I wanted to share what I had learned Author Public Speaker Workshop Leader Hospice Volunteer TeamSTEPPS Master Trainer Respecting Choices Instructor/Facilitator Duke Patient Advocate 28

29 I fell in love love again 29

30 And again And again 30

31 Sister, Daughter, Friend And working on that other thing... 31

32 Collaboration: Duke PAC Established in 2005 by Dr. Victor Dzau, Chancellor of Health Affairs. Used to advise DUHS on patient centered care initiatives and culture at Duke University Health System Expansion/sustainability program: Local Councils providing feedback to specific clinical specialties Standardized Training for all staff and advisors Strategic structure and implementation Rigorous interview/approval process A different kind of feedback! 63 Patient and Family Centered Care Guiding Principle: Collaboration 32

33 Duke PAC Collaboration: Safety 2009 to date: 12+ Duke Health System PAC members trained as TeamSTEPPS Master Trainers The result: Partnership with Patients to reduce Medical Errors using TeamSTEPPS 33

34 TeamSTEPPS An evidence-based teamwork system to improve communication and teamwork skills among health care professionals. (Based on the aviation model of safety) Scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles. Developed by Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality. Increases team awareness and clarifies team roles and responsibilities. Resolves conflicts and improves information sharing. Eliminates barriers to quality and safety. Where is the patient? Yes and. 34

35 Sharing Tools SBAR (Partnering for time and clarity) CUS(S) (Partnering through frustration) Partnering through Preparation Symptoms Background (relevant) Assessment Request (immediate) 35

36 Partnering for Safety Concerned Uncomfortable Scared Safety Every interaction is an opportunity to build a partnership Expert Patient and Family: Trained in SBAR Eager Patient and Family: Track own data and medicines One Step at a Time Patient: One simple job at a time 36

37 And sometimes, no matter what, people will be dissatisfied Thank You! 37

38 It s your turn! Giving Your Patient a Job Remember our lack of purpose and worth? Help us by helping you! Give us a job to do to be proactive and safeguard our own health. Example: Next Slide 38

39 Ed Johnson from TeamSTEPPS Setting: Clinic Ed Johnson, a 41-year-old patient with a history of hypertension, is seen in the Cardiology Clinic for a follow-up after his recent admission to rule out a myocardial infarction. His vital signs are normal except for a BP of 170/110. An EKG shows NSR without evidence of ischemic changes. He states that he has been having episodic chest pain since his release, so the physician decides to repeat his cardiac enzymes. His CPK is 201, and a Troponin I level is pending. Mr. Johnson's pain resolves, and he insists on going home. The Troponin I level is still pending when Mr. Johnson is discharged with instructions to call the office the next day if he is still having problems. Shortly after Mr. Johnson is discharged, the Troponin I level of 0.22 (normal <0.03), indicating myocardial ischemia, is called in to the nurse in the clinic. The nurse notifies the physician of the result. No attempt is made to contact Mr. Johnson. Later, he is found unresponsive and having difficulty breathing. His friend calls 911, and when the ambulance crew arrives, they find him apneic and they cannot detect a pulse. Action Plan Using the 4 guiding principles, the TeamSTEPPS tools and other key messages you heard today: Write out 1 way in which you plan to improve the patient experience within your practice 39

40 Questions? Contact us! sickgirlspeaks.com diabetesevangelist.com 40