Evercare Quality Improvement Awards

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Evercare Quality Improvement Awards

• Suzanne C. Cryst, RD, CSG, LD

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Faculty Disclosures

• Suzanne Cryst has disclosed that she has no
  relevant financial relationship(s).

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Learning Objectives

• By the end of the session, participants will be
  able to
• Understand steps to affect interdisciplinary
  change
• Identify 5 factors involved in this process
  improvement project
• Understand the positive impact of change

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Facility Demographics

• Maria Joseph Center
• Dayton, Ohio
• 351 beds during Improvement Process
• 331 Beds Currently
• Not for Profit Facility
• Independent Ownership

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Look Familiar ?
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Improving Outcomes

• Unplanned Significant Weight Loss
• Exceeding bench mark of less than 10 per month
• Based on monthly in-house data collected and
  Zimmerman Report
• Objectives
• To identify contributing issues
• To shift focus and process to implement change
• To improve overall outcomes

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Project Timeline

• The process began December 2002
• Data gathering began with issues affecting
  weights
• Assess Nutrition Services ( NS ) Department data
• Assess factors outside NS Department
• Conclusion - this was an interdisciplinary issue

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Project Timeline, continued

• Planning Implementation
• Assembled Data and discussed with Medical
  Director fourth quarter 2003
• 30 minute discussion with Quality Management
  Committee
• Outlined problem and concept
• Identified potential Stakeholders
• Planned team meeting time and duration
• Received consensus to start

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Project Timeline, continued

• Study ended March 2007
• BUT . . .
• Continue to monitor and evaluate
• Monthly weights
• Benchmarking reviews
• Scorecard reporting

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QI Planning Implementation

• Committee Design
• Chair- MDS 2.0 RN
• Facilitator Director Nutrition Services/RD,LD
• 1 RN/DON 1 RN Assessment Nurse
• 4 STNAs
• 2 DTRs
• Ad hoc Medical Director, 2 CDMs 1 NS
  Coordinator

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QI Planning Implementation, continued

• Team meetings
• Start with IDT issues
• Initial 3 45 minute sessions
• Subsequent team meetings 30 minutes planned
  for 4 months to implement this IDT segment
• Plan education sessions as issues arise
• Monitor and Evaluate throughout the process

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QI Planning Implementation, continued

• Communication of Plan and Results via
• Staff Development
• Nursing Leadership
• Staff Meetings
• Work Group Members to Peers
• Care Plan Meetings
• Facility Newsletter to Employees
• Resident Council Meetings
• Food Committee Meetings- new, increased frequency

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Issues Encountered

• December 2002 - 17 unplanned significant weight
  loss
• 38 supplementation usage
• Historical Food Satisfaction Scores- low 60s
• Accuracy of meal intakes being recorded
  inconsistent

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Issues Encountered, continued

• 2 different Weight Policies in writing
• No standard policy for process on the 7 units
• Nutrition not involved in process until after
  recorded in the Medical Record
• Interdisciplinary team not involved

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Issues Encountered, continued

• Lack of consistent vehicle to communication Acute
  Resident Issues to the IDT
• Lack of process for implementing
  interdisciplinary change
• Lack of framework to be Proactive vs Reactive

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Tools Used to Affect Change

• Education session for Work Group on Facilitating
  Change
• Charter Development
• Purpose
• Current issues measures
• Team members
• Timeline
• Focus
• Documentation reported to

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Tools Used to Affect Change, continued

• Development of ground rules
• Consensus building focus
• Reporting document format
• Subject
• Discussion
• Recommendations
• Responsible Party
• Time Frame

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Tools Used to Affect Change, continued

• Weight Tracking Tool
• Development of One Weight Policy
• Development of Weight Procedures
• Development of Weight Reporting Process

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Tools Used to Affect Change, continued

• Report and Celebrate the Victories
• Recognition of Staff that went Above and Beyond
• Staff teaching Staff

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Facility Expenses

• 942 Employee Hours over 39 months
• 300.00 Gift Cards to Thank the Work Group
  Members

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Outcomes

• A Great Work Group
• Improved working relationships/ communication
• Consensus for One Interdisciplinary Weight Policy
  
• Consensus for Facility Weight Procedure
• Less rework, Consistent MDS 2.0 reporting

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Outcomes, continued

• Unplanned Significant Weight Loss
• Dec.2002- 17
• May 2004 9.8
• Second Quarter Average 2005 8.3
• March 2007 4
• Supplementation usage reduced
• From 38 to average of 15 1600/month savings

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Outcomes, continued

• Customer Satisfaction Scores
• Steady improvement
• 2005- 76
• First Quarter 2007 81.18
• Accuracy of Meal Intakes Improved
• 32 improvement in recording after education
  session
• Nutrition Service Food First Focus

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Outcomes, continued

• Proactive vs Reactive - everyone has a voice in
  Morning Stand-up or Care Conferences or 11
  meetings
• Created a framework for future projects
• Templates and strategies used via the QMC and CQI
  Committee

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Closing Thoughts

• This project can be implemented in other
  facilities because it was based on a purpose,
  related to current issues that were not
  acceptable, related to benchmarking measures.
• The process to move forward is consistent with
  any other problem solving task.

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Closing Thoughts, continued

• Lessons Learned-
• Consensus is KEY
• Patience Flexibility Focus
• Revisit issues reinforce positive outcomes
• Monitor
• Re-educate as necessary

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Closing Thoughts, continued

• Helpful Tips/Insights-
• Seek out those in your organization who have the
  qualities of a change agent and get them
  involved. This person is not always in leadership
  position.
• Be open to change. A process may not appear to be
  broken, but it could be better.

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Closing Thoughts, continued

• Questions