Nursing Advisory Council Meeting Date: February 19, 2013 Agenda Item Time Discussion Responsible Party Call to Order 1530 Katie Skelton called the meeting to order at 3:33 pm. Katie Skelton Welcome/ Introductions 1532 Katie Skelton welcomed everyone. Last month was the first meeting for many new members and a lot of input was given. Today, Katie and Carmen Ferrell, Executive Director of CIS, will focus on the work done over the past month. Katie Skelton / All March Madness meeting on March 27 th all Councils are invited. Please be sure your managers are aware. Julie Hernandez, Director of Risk Management and Patient Relations will be a part of the Nursing Advisory Council. Julie oversees Patient Experience and will give monthly updates. Reflection 1540 Katie Skelton shared a reflection from Kim Coker: Remember the Three R s by Mr. Richardson (Responsive, Receptive and Reasonable). Reasons for Action 1545 Problem: Our Patients Are Telling Us Their Experience Isn t What They Want It To Be Katie Skelton Katie Skelton Goal: Exceed Patient Expectations (Dignity, Service, Justice, Excellence) Review Minutes of 1/15/13 (Handout) Data Review Gap Analysis / Action Plan Document Scope: Patients Coming to St. Joseph Hospital For Care 1547 Minutes of 1/15/13 were reviewed and approved as submitted. Katie Skelton / All 1600 Carmen Ferrell, Executive Director of CIS, and Khanh Dao, PCS Analyst gave a high level overview via PowerPoint of the 72 items identified as barriers by Nursing Advisory Council members back in January. These items were broken down into 24 buckets because of similarity. Review of work that has taken place since January: DPC Challenges: Communication created e-mail (staff can e-mail a question, suggestion, etc and they will receive a response that someone will get back to them within 48-72 hours), Friday Flash (sent via e-mail every Friday to all RN s, CC s and Unit Secretaries), Notebooks (will be entered on DPC Website located on CareNet click Depts and Programs, click SJO DPC). Follow-ups: 48 hour response time, weekly education to managers and unit secretaries, daily rounding by team of DPC staff (working on how to address night shift, probably 2:00-4:30 am). Double Charting working on streamlining flow blood glucose (example Katie Skelton / Carmen Ferrell / Khanh Dao / All
shown of current bedside blood glucose documentation and diabetic data in the EMR and the new proposed / streamlined process). Khanh Dao gave a Meditech demonstration on blood glucose documentation. DPC needs one final approval before this new process will go-live. New Orders Alert this is currently being worked on. Change in RN/MD Workflow They aren t talking to me anymore! Check status board frequently. Currently experimenting with Med Tele to have new orders come up on the Unit Secretary screen so that US can notify the nurse. Hope to start by end of February. Chart at bedside. Brenda Acosta shared that most patients are receptive when a nurse says I m going to be here for a few minutes charting (communicate to the patient). Katie challenged everyone to see if there is a different way to handle your work flow (i.e. chart in room, not on paper only to have to enter later). Katie shared that Dr. Casciari may bring a team of doctors and nurses together to work on this communication flow, etc. Let Katie know if you would like to be a part of this team. Need Chartmax training. Will bring Chartmax training to nurses. Log-In / Log-out takes time. Easy Pass work happening. Citrix environment difficult IT is working on this. Password Expirations no changes as this is Health System Wide. o Meditech 90 days o Active Directory 120 days (PACS, Gen2, Outlook, Easy Pass) o Chartmax no expiration date o Pyxis fingerprint reader o Hugs no expiration date Medication Administration: Creating RN-Pharmacy Task Force to work on the following issues: o Student co-signatures working on 2 solutions (will have new process shortly) o Log-off emar to request missing med iatrics issue (handout distributed) o Tracking discontinued meds / new meds (handout distributed) o PCA & source document different Nursing Informatics SIG is working on this o Double RNs Dancing Around working on streamlining. Maybe if co-signed in Pyxis, it counts in Meditech. o Medication Reconciliation no access to MD office information. Action: Carmen Ferrell to work with Catherine Shinto for details (i.e. Heritage: MD s can access, but nurses cannot) o Pharmacy medication errors o Late medication flag issue normal part of Meditech don t take it personally (still being worked on exploring possibilities). o Morning medication pass is a busy time consider 10:00 am. Workload Barriers: Katie Skelton, Nursing Executive Directors, and Managers of Inpatient units will schedule themselves for one 12-hour, quarterly Walk In Your Shoes shift
to shadow a staff RN. This will be a full 12 hours, dressed in scrubs and will begin with the quarter April thru June. Patient Placement: Building hospitalist tracker Inpatient versus Observation (ED doctors and hospitalists are working on this). Ancillary Barriers: Move appropriate bed stripping tasks to EVS approved and already in place. Need Lift support a challenge to be looked at further o How do we do this using technology and not more people? o How do we work together at night to do this? Encourage NAs to tag team / buddy system for heavy care. Equipment: Call lights / TV system difficult for patients refer to Patient & Family Advisory for review Increase telemetry for Medical Pulmonary opportunity to review telemetry criteria (are we using as we should; will look at tele criteria). Admission / Discharge Challenges: Timing of admits / discharges (looking at flow and resources to units). New discharge process. Appropriate assignment to correct unit. Staffing: Using too much registry o Resource Pool being expanded (9 of 15 positions filled since last summer. Some of our Resource Pool take positions within that open up and then we continue to look for Resource Pool staff.) o Admit/Discharge Team being developed. Registry inconsistent. Not using PEP. Decrease registry. Level of Change: Too many things changing at once! This is recognized. What can we stop doing? The following handouts were distributed and reviewed by Carmen and Khanh. Agenda of Design for Perfect Care / Nursing Informatics Meeting (example of an agenda so all can see the kinds of things that occur at meeting). Nursing Requested Enhancements to Meditech (New Directions on the Intervention Work list) Think PINK. Situation: Orders being routinely missed or completed prematurely by Nursing. Recommended change: Nurse orderables on the Interventions work list will now create a reminder that will pink up in the Next Scheduled cell. This new process will be phased in as all order sets are addressed. Sample of an order entered shown. CPOE vs. Non-CPOE Physicians Finding the Orders for Both Instructions and samples shown. Clinical Informatics Services Education Updates (Friday Flash) Two
samples distributed on the Friday Flash education e-mailed to all RNs, CCs and Unit Secretaries: How do you find out which MD discontinued a medication? and Navigating EMT For Diabetic Data. Carmen explained that Meditech Standardization is scheduled to occur in June 2014 (the entire health system will match). Training will occur at least 3 months in advance. NAC member brought up a recent issue regarding thoracentesis and doctor not entering L or R. Carmen suggested bringing MD issues up to the DPC and DPC will then go to the MD Champion for investigation and decision. NAC member reported it is taking longer to log in these days. Action: Carmen to follow-up on computer launch time. Ongoing Business: Unit Council Updates Katie asked members for input on today s presentation as a follow-up to the January meeting. NAC felt as if the barriers they identified in January were heard and are pleased with the progress. 1635 Unit Based Council reports were deferred due to a lack of time. All New Business: Announce PEP Team Award (Handout) 1645 Julie Hernandez, Director of Risk Management and Patient Relations, announced that D Ann Gorman is the new Manager of Patient Relations. She is currently orienting herself to the nursing world by shadowing. E-mail Julie if you are interested in having D Ann shadow you or someone on your unit. Also, Julie, D Ann or John Senteno are available to come to your UBC meeting to answer questions and be an additional resource. Julie reviewed Team Awards (handout distributed). Highlights: With all inpatient units trained in the Patterned Behaviors, as we promised in the pep Talks, it s time for a season of play! Each Team (which includes, Case Managers, Therapists, EVS, and all those that serve patients on the unit) will have 3 chances to win!!! Opportunity #1 First Season: (January 2013 March 2013) Opportunity #2 Second Season (April 2013 June 2013) The top 2 teams that score the most points during each season will win a celebration with Steve Moreau, CEO, Jeremy Zoch, COO, Katie Skelton, CNO, and the entire Senior Leadership Team! Celebration will include presentation of an award with a team photo to be displayed on the unit and lots of yummy treats! (Not to mention bragging rights!) Points will be awarded as follows: 3 Points for Perfectly Executed Patterned Behaviors on 3 rd Party Random Audits 7 Points for Patient Compliments That Highlight Elements of Patterned Behaviors (Thanks for Caring, Letter, etc. sent to Julie for Peminic Julie Hernandez
entering) 7 Points for HCAHPS Responsiveness Scores above FY12 Baseline 7 Points for HCAHPS Nursing Communication Scores above FY12 Baseline 10 Points for HCAHPS Responsiveness Scores above the 50 th Percentile 10 Points for HCAHPS Communication with Nurses Scores above the 50 th Percentile Opportunity #3 (January 2013 June 2013) Each team that achieves HCAHPS Scores above the 50 th percentile for Nursing Communication and Hospital Staff Responsiveness will receive a celebration with Steve Moreau, CEO, Jeremy Zoch, COO, Katie Skelton, CNO and the entire Senior Leadership Team (can be multiple departments). Additionally, the team will receive a $1,000 Patient Experience budget for Fiscal Year 2014 (which begins July 1, 2013) for the unit to use as they choose to continue to improve the experience for their patients. (For this award we will use a roll-up of the unit s January-June scores not individual monthly scores.) Currently, working on a graph to track points for units. All employees in the hospital have responsibility. Pre-op type areas (PT/OT/EVS are included with discharged department, because they assisted). Discussion: 1 person or 1 shift can be the fallout for the difference in response by a patient answering usually or always. Other Double Floating Policy: Members shared examples of double floating that is occurring. Action: Float policy will be brought back to Nursing Advisory Council for review. Insights Recap Next Steps 1658 Assign reflection for next month Adjourned 1700 The meeting adjourned at 5:05 p.m. All Next meeting: March Magnet Madness Day Date: Wednesday, March 27 th Time: 8:00 am 3:00 pm Location: Mother Louis Room Future meeting: Double Floating (bring back policy and outline how we are managing Review Turnover Data Scrubs - Uniforms