Value Collaborative: Final Report-out October 25, 2016
The Challenge (the problem you faced) 6SE nursing staff consistently report a lack of time to devote to patient engagement and education despite a clear desire to participate in such activities. Instead a great deal of time is spent on indirect patient care activities by nursing staff which is an inefficient use of nursing time and leads to an increase in OT, turnover and decrease nursing satisfaction.
The Goal (big picture of what you were aiming for with the innovation) Reduce the time required by nursing staff to locate medications in order to see an increase in the rate of nurses finding time to engage and educate their patients and family by 30% post implementation.
The Execution (what you did and how specific steps/tasks to achieve the action) 1. Solicited feedback from nursing staff on 6SE about indirect patient care activities that consistently take them away from the bedside and the acuity of each issue 2. Completed a 4 week study of events requiring a nurse to look for a medication and coded the cause of each event to assess for themes 3. Three multidisciplinary taskforces were created to make recommendations on possible solutions 1. Taskforce 1: Oncology Medication Flow 2. Taskforce 2: Medication Delivery Process in the Event of a Transfer 3. Taskforce 3: Pharmacy to Floor Communication and Floor Based Protocols 4. Leadership is assessing opportunity to implement a variety of interventions 1. Low tech: White board 2. High tech: Medication barcode tracking
The Metrics (quantify your results wherever possible) Improvement Category & Measurement Description Quality Nurse sensitive quality measures (NDNQI) Describe the quality of nursing care Administer medications on time (lower is better) Time to comfort/talk with patients (lower is better) Time to teach/counsel patients and family (lower is better) Asking a subset of the NDNQI questions seemed to skew the data Concerns of survey fatigue Service HCAHPS Responsiveness Annual measure Cost Nursing Turnover (lower is better) Cost associated with remaking a medication New finding data Process Observed events requiring a nurse to look for a medication Will repeat study
Team: The Summary (final 12-month Value Summary) Sue Theiler, Asst. Director, ED & 6SE (Role: Operational); Jessica Yanny-Moody, Manager QPS (Role: Quality Lead); Andrew White, MD, Assoc. Medical Dir. (Role: Clinical Champion); Grace Parker, Chief Nursing Officer (Role: Executive); Inpatient Pharmacy Leadership 1 DEFINE AND MONITOR Improvement Category & Measurement Description Baseline Goal Qtr 1 Qtr 2 Qtr 3 Qtr 4 Nurse sensitive quality measures (NDNQI) Describe the quality of nursing care Quality Administer medications on time (lower is better) Time to comfort/talk with patients (lower is better) Time to teach/counsel patients and family (lower is better) 3.54.62.77.77 3.99.41.51.51 Baseline 3.5.83.50.33 Service HCAHPS Responsiveness 55.56 73.89 Cost Nursing Turnover (lower is better) 9.2% 7% Scope: Title: University of Washington Value-Added Nursing Presenter: Grace Parker, Jessica Yanny-Moody, Sue Theiler, Dr. Andrew White 1. Improving nurse efficiency leading to improved nurse satisfaction and reduced nurse turnover. 2. Improving patient satisfaction and quality outcomes for 6SE patients. 2 PROBLEM AND GOAL STATEMENTS (SM-RT Problems/SMART Goals) 5 IMPACT Problem: Ideal state: Increase in nursing satisfaction and a reduction in reports of delayed medications, missed 6SE nursing staff consistently report a lack of time to devote to patient engagement and education despite educational opportunities, and missed therapeutic conversations. Patients will also experience greater a clear desire to participate in such activities. Instead a great deal of time is spent on indirect patient care activities by nursing staff which is an inefficient use of nursing time and leads to an increase in OT, turnover satisfaction with the nursing care they received and will have better outcomes post discharge. and decrease nursing satisfaction. Goal: Reduce the time required by nursing staff to locate medications in order to see an increase in the rate of nurses finding time to engage and educate their patients and family by 30% post implementation. Spread: Best practices developed through the taskforces will be spread to all floors to ensure all of the UWMCs patients experience the same high level of nursing care. 3 ANALYSIS AND INVESTIGATION 4 IMPROVEMENT DESIGN AND IMPLEMENTATION Quantitative review of existing NDNQI survey data and qualitative review of descriptive nursing feedback A baseline survey of 6 NDNQI questions was sent to nurses on 6SE aimed at tasks missed, satisfaction, and quality of care Two facilitated discussions with some of the nursing staff on 6SE about possible solutions to highlighted issues and the acuity of each issue 4 week study of medication issues on the floor reported to a light-duty RN and reviewed by pharmacy leadership Inpatient pharmacy and medication delivery shadowing Implementation Start Date:4/30/2016 Implementation Completion Date: Drop time for chemo hydration has been improved for patient receiving High Dose Methotrexate Identified need for better method to transfer patient specific medications when a patient is transferred Culture change: Pharmacy to floor communication Working on increasing visibility of pharmacy deliveries Education around pharmacy practice To include pharmacy practices in nursing orientation