STAR Safety Program and Importance of RT Education Rebecca Long, BA, RRT-NPS, LRT April 30, 2012 Pediatric Home Service (PHS) An independent pediatric home health care agency in MN with 22 years experience of taking care of medically-fragile children Provide patients and their families with a broad spectrum of services and support that includes: Respiratory/durable medical equipment (DME) IV nursing/infusion pharmacy Private duty nursing service (PDNS) In-home asthma management service Nutrition services Medical social work Education for health care professionals and families Who is this man? Captain Chesley Sully Sullenberger III Courtesy of www.huffingtonpost.com 1
Extraordinary Prepare One way of looking at this might be that for 42 years, I ve been making small, regular deposits in this bank of experience: education and training. And on January 15 the balance was sufficient so that I could make a very large withdrawal. -Chesley Sullenberger http://en.wikipedia.org/wiki/chesley_sullenberger Maximizing Teachable Moments Time constraints Patient education must be effective RT s must use every moment with patients as a teachable moment 2
Value and Mission of Education Project Employee-generated initiative to evaluate the overall safety of the Plan of Care for the technology-dependent child Understand caregivers preparedness and response in emergency situations Determine areas of improvement and raise emergency readiness of all in-home caregivers to reduce unnecessary health risks, trauma to families, and cost of emergency hospital services Estimate effectiveness of education and tools implemented Initial Survey December 2005-May 2006 Clinicians (RCP & RN) designed a questionnaire Selected Vent sort PHS clients of all vent clients, 86 agreed to participate in the survey 3 RCPs & 1 RN conducted and completed all in-home surveys In-home caregivers were advised of the nature of the survey before scheduling Survey was completed by the PHS clinician, based on the response of the inhome caregiver. RE-EDUCATION performed immediately if caregiver did not provide an appropriate response Communicated results with individual agencies (as applicable if respondent was an employee of an agency versus family caregiver) STAR Safety Program STAR acronym: Stop, Look and Listen perform an assessment of the patient. Take Inventory Check emergency bag and bedside supplies to make sure they are available. Assess Emergency Equipment make sure equipment function and settings are appropriate. Review Action Plan review the patients emergency action plan. 3
STAR Safety Program June 2006-May 2007 Collaborated Developed Trained STAR Safety Program June 2007-August 2007; 219 PHS patient caregivers initially trained on STAR materials (all Tracheostomy and Ventilator sort patients) STAR related concept knowledge taught upon initial setup and knowledge verified at each routine follow up visit Ventilator = monthly H&H to Tracheostomy = every 3 months STAR Safety Program September 2007-November 2007 Post STAR implementation survey; 65 of the initial surveys agreed to a follow-up survey (10 decannulated; 5 passed on; 5 refused; 1 transferred due to insurance) August 2009 August 2011 All existing patients who had not been previously surveyed were assessed (completed 152 assessments for this group of patients as of August 31, 2011) September 2011 - present All new patient in-home caregivers are assessed upon the 3 rd month of initial (completed 18 assessments) 4
Survey Says Survey results are in percentages based upon: Pre = before STAR safety campaign development/implementation Post = re-survey for all clients who had participated in initial survey 2011 = surveys completed from August 2009-August 2011 3 month = surveys completed after September 2011 (upon the 3 rd month post- from hospital to home) Green = Greater than 90% Red = 89% or less Equipment Assessment Is the equipment properly set up? 98.8% 98.5% 99.3% 100% Equipment Assessment Is the equipment properly maintained? 96.5% 89.2% 100% 88.9% 5
Equipment Assessment Are cables and cords properly connected and in good condition? 95.3% 100% 100% 100% Equipment Assessment Does the caregiver understand the purpose of each piece of equipment? 96.5% 100% 99.3% 100% Equipment Assessment Can the caregiver assemble a replacement circuit? 95.3% 98.5% 98% 88.2% 6
Equipment Assessment Is the caregiver able to locate orders for current equipment and supplies (trachs, G-tubes, formula) in the home? 68.6% 89.2% 98% 41.18 *16 of 18 respondents were family Equipment Assessment Are the equipment parameters set according to physician s orders? 87.2% 89.2% 98.7% 100% Equipment Assessment Are the alarms set properly and audible? 95.3% 95.4% 99.3% 100% 7
Equipment Assessment Do the caregiver s flow sheets reflect the current settings for the equipment? 90.6% 93.7% 96% 94.5% Equipment Assessment Can caregiver locate PHS literature and equipment manuals? 74.4% 81.5% 91.3% 100% Equipment Assessment Do the circuitry, tubing, or cords present a tripping or falling hazard? 17.4% 9.2% 4.7% 5.5% 8
Emergency Backup Equipment and Battery Can the caregiver locate backup supplies and equipment? 93% 96.9% 98% 94.1% Emergency Backup Equipment and Battery Is the backup equipment properly charged? 80% 93.8% 95.4% 94.4% Emergency Backup Equipment and Battery Can the caregiver demonstrate knowledge of how to hook up the battery to a charger and to the equipment? 81.4% 89.2% 98% 94.4% 9
Emergency Backup Equipment and Battery Does the caregiver know how to determine if the battery is charged? 75.6% 89.2% 96.7% 83.3% Emergency Backup Equipment and Battery Does the caregiver know the approximate battery life of each piece of equipment and where to find the information? 51.2% 78.1% 80.1% 83.3% Oxygen Safety Can the caregiver change an oxygen cylinder? 51.8% 63.1% 72% 66.7% 10
Oxygen Safety Can the caregiver tell you how long a tank will last at a given liter flow? 44.2% 63.1% 74.6% 94.4% Oxygen Safety Is there an oxygen sign posted on the door? 44.2% 67.7% 74.6% 94.4% ***Within the NO responses, we did not account for PHS documentation that a family refused to post a sign. Oxygen Safety Does the caregiver understand the safety issues related to oxygen? 76.7% 70.8% 98.7% 100% 11
Oxygen Safety Is there an adequate amount of back up oxygen in the home to meet the patient s current needs? 91.9% 98.5% 99.4% 94.4% Oxygen Safety Is the caregiver able to identify expiration dates of oxygen tanks? 55.8% 84.4% 62% 58.8% Emergency AMBU Bag Can the caregiver quickly locate AMBU bag? 97.6% 96.9% 98.7% 100% 12
Emergency AMBU Bag Can the caregiver demonstrate how to check the AMBU bag to make sure it is working properly? 36% 71.9% 89.3% 61.1% Emergency AMBU Bag Is the AMBU bag and mask the correct size for the patient? 76.7% 86.2% 98.7% 88.9% Emergency AMBU Bag Can the caregiver demonstrate knowledge that the emergency bag/bedside are fully stocked? 64.7% 83.1% 95.4% 94.5% 13
Emergency AMBU Bag Are the emergency back up and downsize trachs visible and easily accessible and within expiration date? 77.6% 89.1% 100% 100% Emergency Patient Response Can the caregiver locate a working flashlight in the patient s room? 87.1% 95.4% 97.3% 100% Emergency Patient Response Does the caregiver know where a list of emergency numbers are located? 98.8% 96.9% 100% 94.1% 14
Emergency Patient Response Can the caregiver tell you what they would do in the event of an obstructed trach? 74.4% 84.6% 96.7% 100% Emergency Patient Response Can the caregiver start the emergency oxygen and do they know the proper liter flow and use of the AMBU bag? 48.2% 53.8% 87.4% 77.7% Emergency Patient Response Can the caregiver tell you what they would do if s/he were unable to get the suction machine to work and the patient required immediate suctioning? 70.9% 81.2% 86.8% 100% 15
Emergency Patient Response Is the caregiver able to tell you what s/he would do in the event of a power outage? 94.2% 98.4% 98% 100% Emergency Patient Response Is the caregiver able to tell you what they would do in the event of severe weather? 88% 98.5% 99.3% 100% Emergency Patient Response Can the caregiver tell you what s/he would do in the event of a fire? 90.7% 97% 98% 94.4% 16
Emergency Patient Response Can the caregiver tell you what equipment s/he would take in an emergency? 96.5% 96.9% 98.7% 100% Emergency Patient Response Does the caregiver know whom to notify in the event of an emergency with the patient? 98.8% 100% 100% 100% What is your account balance? Individually Organizationally Patient-specific Courtesy of www.wrthd@blogspot.com 17