Passing the Baton: Best Practices in Handoff Communication October 9, :00 1:00 p.m.

Transcription

1 ACNL Webinar Passing the Baton: Best Practices in Handoff Communication October 9, :00 1:00 p.m. 1

2 Welcome and Introductions Brenda Brozek MAOL, RN ACNL Consultant Patricia McFarland MS, RN, FAAN ACNL CEO

3 Welcome and Introductions Tim Gilmore, MHA, RN Chair of ACNL Quality and Patient Safety Committee

4 Promoting Patient Safety & Interdepartmental Collaboration Through Unit-to-Unit Handoffs Ellen K. Fleischman, RD, RN, MBA, MSN, NE-BC Sharp Mary Birch Hospital for Women & Newborns San Diego, California 4

5 Our Presenter Ellen K. Fleischman RD, RN, MBA, MSN, NE-BC Manager, Maternal Infant Services Sharp Mary Birch Hospital for Women and Newborns

6 OBJECTIVES: 1. Describe outcomes achieved through implementing face-to-face handoffs. 2. Realize the impact of standardized approaches for handoffs to patient safety.

7 Background Sharp Mary Birch Hospital for Women & Newborns Free-standing 206 bed Women s hospital ~8,600 deliveries per year Located in San Diego, California Regional health system 7

8 Maternal Infant Services 72 bed postpartum unit on two hospital floors Multiple unit-to-unit handoffs due to admission volume Average daily admissions: 25 moms and 23 babies Peak census and throughput challenges midweek through weekend 8

9 Project Purpose Implement face-to-face handoffs for unit-to-unit transfers Optimize patient safety Improve teamwork and collaboration across units Increase patient satisfaction 9

10 Joint Commission Handoff communication must be accurate for patient safety Hospitals should have a standardized approach to handoff communications Communication is one of the top three causes of reported sentinel events 10

11 Method/Approach Lean Six Sigma Work-Out A process designed to bring the right stakeholders together to develop solutions and actions Review current practices and develop an improvement plan Participation from staff and leadership from all adult units San Diego State nursing leadership students assisted with the implementation phase

12 Implementation/Process Developed and implemented a standardized laminated report checklist with general and population-specific information 12

13 Implementation/Process Developed a WELCOME mnemonic for the bedside report process 13

14 Implementation/Process Online voice-over Power Point staff education module using Adobe Presenter Using cartoons drawn by a staff nurse, included staff role play of good and bad report and handoffs 14

15 Implementation/Process 2 phase implementation 1. Labor & Delivery to postpartum, LDR nurse accompanies the patient during transfer Included change of shift transfers 2. PACU to postpartum, postpartum nurse goes to PACU for face-to-face handoff prior to transfer Delayed implementation of shift change transfers due to safety concerns 15

16 Outcomes: Patient & Family 1 st handoff with Labor & Delivery Feedback 1 st handoff with PACU It was comforting to meet the next person taking care of me. Nurses really connected. They didn t do that the last time I was here. It made a difference. I liked that Dads were included in the handoff process.

17 Outcomes: Patient Satisfaction Report checklist trial April, 2012 Revised checklist September, 2012 LDR-MIS bedside handoff November, 2012 PACU-MIS bedside handoff December, 2012

18 Outcomes: Culture of Safety Survey

19 Outcomes: Culture of Safety Survey 70% 90% 60% 50% 40% 80% 70% 60% 50% 30% 40% 20% 10% 30% 20% 10% 0% Teamwork across units - score Teamwork across units - %ile 0%

20 Outcomes Staff Feedback Staff survey 64% positive in the first phase (Labor & Delivery) 82% positive in the second phase (PACU) Patients seem happy to meet the nurse before transfer. We resolved problems together! The PACU RN managed up well. The patient was settled and in good condition. The patient was happy to meet us. 20

21 Lessons Learned Involve staff in every step of the process Do a mini trial of handoffs before implementation Leadership available to accompany staff for first few handoffs Consider a warm welcome with treats the first couple of days/nights Don t combine two new processes at once handoffs and shift change transfers

22 Future Plans Continue to improve the shift change transfer process Expand face-to-face report in remaining hospital units Bedside report for shift-to-shift report (within the unit)

23 Questions?

24 A Performance Improvement Project: The Impact of the Registered Nurse to Unlicensed Assistive Personnel (UAP) Handoff on Patient Safety and Satisfaction Shannon Carevich, RN, BSN Clinical Nurse Educator Amanda Dye, RN, BSN, CBN Surgical Unit Clinical Nurse II Orange Coast Memorial Medical Center Fountain Valley California

25 Our Presenters Shannon Carevich BSN, RN Clinical Nurse Educator Orange Coast Memorial Medical Center Amanda Dye BSN, RN, CBN Surgical Unit, Clinical Nurse II Orange Coast Memorial Medical Center

26 OBJECTIVES: 1. Understand the value of using a standardized handoff process between the registered nurse and unlicensed assistive personnel. 2. Identify at least one positive outcome of implementing a standardized handoff process between registered nurses and unlicensed assistive personnel.

27 Background Orange Coast Memorial Medical Center 218 bed, not for profit community hospital Located in Fountain Valley, California Part of MemorialCare Health System Average daily census = 125 Total hospital admissions = 12,841 ER visits = 27,876 27

28 Medical & Surgical Units Medical unit - 35 beds Surgical unit - 30 beds Patient care team: RNs, LVNs, & Patient Care Assistants (PCAs) 79 licensed nurses 51 unlicensed assistive personnel (UAP)

29 Background Staff on the medical and surgical units were not satisfied with the current state of RN and UAP communication Current process was UAP to UAP handoff Handoff between RN and UAP was inconsistent and not formalized

30 Background 2006 National Patient Safety Goal Handoff Communication Delegation requires effective communication Communication used in delegation should honor the same communication process as during a handoff (NCSBN, 2005) Nursing assistants reported that communication with the nurse led to more successful delegation (Gravlin and Bittner, 2010) Potter and Colleagues (2010) discovered that RNs and UAPs value the sharing of relevant information in a timely manner and job satisfaction increases for nursing staff when proper delegation takes place promoted in their research a need to develop clear guidelines for RN to UAP handoff and create an environment on the unit that supports the delegation process

31 Aims of the Project Develop, implement, and evaluate a standardized handoff process between RN and UAP The primary aim was to improve patient satisfaction and increase patient safety The secondary aim was to increase staff satisfaction through better teamwork and communication

32 Methodology Development of a Standardized Handoff Staff participated in the development of the new handoff process The team interviewed the staff: Asked the RNs: What do you feel UAPs need to know about their patients? Asked the UAPs: What do you feel you need to know about your patients?

33 Implementation Methodology All staff were educated on the new process: UAP meetings Daily huddles Unit staff meetings Clinical supervisor meetings Department webpage

34 Instruments/Measures EVALUATION: Measurement & Outcomes Patient Satisfaction: Responsiveness Call Light Response Time Falls Hospital Acquired Pressure Ulcers (HAPUs) Secondary Outcomes: Staff satisfaction was assessed six months after implementation of the new process using the Modified Healthcare Team Vitality Instrument (HTVI)

35 Results- Patient Satisfaction

36 Results-Call light usage Ca ll Lig ht Usa g e Number of call lights pressed Me d ica l Surg ica l Me d ica l Surg ica l between Number of call lights pressed Pre -imp le me nta tio n Po st-imp le me nta tio n between Mean response time (mins.secs) between Mean response time (mins.secs) between

37 Falls per 1000 Pt Days Results - Falls Q4 (Pre-implementation) 2012 Q1 (Pre-implementation) 2012 Q2 (Implementation) 2012 Q3 (Post-implementation) 2012 Q4 (Post-implementation) Medical Surgical

38 % of Pt. with HAPUs Results - HAPUs Q4 (Preimplementation) 2012 Q1 (Preimplementation) 2012 Q2 (Implementation) 2012 Q3 (Postimplementation) 2012 Q4 (Postimplementation) Medical Surgical

39 Results - Staff Satisfaction HT VI Que stio n 6. Care team members on this unit feel free to question the decisions or actions with those with more authority. 7. Important care information is exchanged during shift changes. 8. Care professionals communicate complete patient information during hand offs. 9. I can discuss challenging issues with care team members on this unit. N Stro ng ly Disa g re e - Disa g re e Neutra l- Ag re e - Stro ng ly Ag re e N=67 15% 85% N=67 7% 93% N=67 15% 85% N=67 10% 90% 10. I speak up if I have a patient safety concerns. N=67 4% 96%

40 Lessons Learned Use a change theory framework Recruit more team members (handoff champions) Engage clinical supervisors and charge nurses before implementation Focus on one unit at a time Future Projects Standardize charge nurse handoff 40

41 Conclusions The medical surgical units. Demonstrated improvement in clinical patient outcomes Created a healthy work environment with better communication and teamwork among RNs and UAPs

42 Questions?? 42

43 Nurse Knowledge Exchange Plus: Partnering with Parents in Shift Change Design

44 Our Presenters Juli McGinnis, MSN, RN Education Consultant/ Improvement Advisor Kaiser Permanente Southern California Linda Fahey, MSN, RN, NP Regional Director, Quality and Patient Safety Kaiser Permanente Southern California

45 OBJECTIVES 1. Discuss strategies to promote staff and family collaboration in developing and enculturating safe, effective communication handoffs 2. Discuss the power of using video stories to capture and share patient and staff voices to promote cultural change

46 Kaiser Permanente Southern California Medical Centers 14 Medical Offices 202 Employees 61,379 Nurses 20,163 Physicians 5,897 Kaiser Permanente Members 3,642,825

47 What is Nurse Knowledge Exchange Plus?

48 Nurse Knowledge Exchange Plus: Evidenced-based Model Hour Prior to Shift Change Shift Change Last Hourly Round Careboard Update & Review Standardized Report (KP SMILE) Safety Check (HEAL) Pre-Shift Assignment Unit Support

49 Standardized Report & Safety Check 49 K P S M Know the Patient- Manage Up Employees Professional Exchange Report; Review outstanding orders and other important information Snapshot Report/ Systems Review Medication Administration Record (MAR) Review new and outstanding medicaitons I Input & Output L Labs: Critical Lab Results/ New orders E Education Safety Check High Alert Medications Equipment Alarms Lines S- Skin Assessment/ Sensitive Issues

50 One size does not fit all NKEplus within the NICU 50

51 Shared Best Practices Open NICU 24/7 Johns Hopkins Hospital, June 2012 Benefits of Bedside Reporting w/parents Parents will be our partners in their child s care. Displays active concern for the baby to the parents. Parent collaboration can help to prevent mistakes. Provides parents more autonomy and sense of control. Improves trust between parents and staff. Improves accountability between nurses. Decreases errors. Minimizes lost information and history throughout the stay by allowing the parents to comment.

52 KP Downey Medical Center NICU: How might we partner with parents in shift change (NKEplus) design? Lay the Foundation Spread & Enculturate Design/ Develop the Process 52 Implement Change Test the Process & Refine

53 Voice of the Family. Partnering in Designing Reliable, Safe Practices Downey NICU RN Prior NICU parents Downey Patient Advisory Council The real voyage of discovery consists not in seeking new landscapes but in having new eyes. -Marcel Proust

54 Standardized Report & Safety Check Standardize at the core; Customize at the margins Standardized Report K P Know the patient/intro/check Identification bands/ Manage Up Professional Exchange Report/Review pertinent systems S Snapshot/SYSTEMS M I L E Milk/Medication Administration Record/ Report/Overdue/ Intravenous Lines (IVs) In & Out/Vital Signs/Drains Lab/Critical Lab Value/Specimens Educate/Review of Education w/parents/poc Safety Check NKEplus High Alert Equipment Alarms Line Social Vasopressors, insulin drips, narcotic, TPN, paralytic agents, any drips (encompass High Alert list and add) Pumps, monitors, isolettes, body cooling devices, phototherapy, ventilator, O2, safety, ambu bag & mask, suction HUGS, monitor settings, signage, temperature alarm look, check, connect (IV, feeding tubes, chest tubes) Social/Sensitive Issues It Takes Two to Make a Thing Go Right!

55 NKEplus NICU Spread Jan 2011 One KP SCAL NICU open during shift change December out of 13 SCAL NICUs open during shift change 55

56 Results: What does success look like? The Care Board was always updated with the name of the nurse and my baby's plan rd Quarter rth Quarter st Quarter nd Quarter 2013 Top Box Score I was given good explanations of the daily care of my infant I knew the name of the nurse taking care of my baby rd Quarter rth Quarter st Quarter nd Quarter 2013 Top Box Score rd Quarter rth Quarter st Quarter nd Quarter 2013 Top Box Score

57 Questions

58 Wrap Up of Today s Webinar Evaluation Thank You for Participating!

59 Webinar Evaluation Goes Here 59