Implementing Proactive Care Rounding in a Skilled Nursing Facility

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Implementing Proactive Care Rounding in a
Skilled Nursing Facility
Bryan K. Lindsay University of Kentucky Martin
School of Public Policy and Administration
Masters in Health Administration Capstone
Project Spring 2008
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Introduction

• Effects of Nursing Rounds on Patients Call Light
  Use, Satisfaction and Safety Dr. Christine
  Meade
• Desirable outcomes
• Call light use
• Falls and skin breakdown episodes
• Higher patient (and employee) satisfaction
• Proactively meeting routine needs at routine
  intervals

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Organizational Setting

• Pine Meadows Health Center
• 120-bed skilled nursing facility in Lexington,
  Kentucky
• A well-established environment for change

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Background Information
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Challenges for Change in a Skilled Nursing
Facility

• High turnover
• Quality improvement efforts disconnected
• Lack of education
• Lack of experience with best practices and the
  scientific method
• Lack of initiative to improve skills
• High regulatory environment
• Almost derailed our project after one week

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Plan of Attack

• Review other successful change attempts in long
  term care
• Reduce falls
• Skin breakdown
• Sun-downing behaviors
• Need to find a way to SUSTAIN proactive care
  rounding

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Plan of Attack

• Take it slow take time to develop necessary
  support
• Data Collection Tools
• Care Giver Interviews
• Call Light Tracking
• Quality Indicator Reports
• Care Giver Surveys

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Data Collection Tool
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Fishbone Diagram
Data Collection Tool
These are now their problems and not my
problems
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Data Collection Tool
Force Field Diagram
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Results
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Results
But only 25 of the day
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Results
50 of the day
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Implementation Methods
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Implementation Methods

• Development of a Steering Committee
• Nurse aides Licensed nurses
• Dietary aides Housekeeping aides
• Unit coordinator Activities director
• Admissions coordinator Director of nursing
• Facility administrator Nursing home residents
• This is my power group with the ability to make
  decisions and effectuate change

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Recommendation 1

• Implement a proactive care rounding team,
  incorporating principles associated with resident
  centered care
• Cross train every employees so that everyone
  helps

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Recommendation 2

• Adjust diuretic residents eating and toileting
  schedule to remove potential for care giver
  overload
• The current system perpetuates problems of
  increased demands at busy times of the day

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Recommendation 3

• Add a few questions to the already practiced
  turning schedule
• - Proactively address routine needs when the care
  giver is already in the room

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Recommendation 4

• Focus on individuals with increased demands
• Sundowner solution

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Recommendation 5

• Increase communication with residents regarding
  their care schedule
• Residents should know when to expect help

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Recommendation 6

• Hire an additional nurse aide for the busier
  hours of the day or allow shifts to overlap
• Give specific instructions to provide care
  rounding and additional help at strategic times
  and places

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Recipe for Success
Ability to Sustain the program over time
Steering Committee Decisions Individuals who
have the ability to make changes and see the
project through until completed
Care Giver Suggestions Discovery of the real
problems
My Ideas Collected and Communicated data
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Limitations

• Lack of time The actual Proactive Care Rounding
  was not actually implemented
• Accuracy of call light tracking cannot be
  guaranteed
• Results were presented as percentages rather than
  actual numbers
• Other category could be more specific in the
  future
• It will be difficult to prove that the number of
  call lights was actually reduced
• Hospitals had better success with this because of
  built in call light tracking systems

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Acknowledgements

• Dr. Sarah Wackerbarth Capstone Committee Chair
• Dr. Joseph Fink 2nd Committee member
• Dr. Martha Riddell Committee Member/Reader
• Joni Gosser Director of Operations of Louden
  Co, Inc
• Scott Stanton Manager of Service Excellence
  Kosair Children's Hospital
• Matt Sevier Paragon Healthcare Group

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Courses Used in Completing This Project

• HA 602 Managing Change and Strategic Planning
• HA 628 Human Resource Management
• HA 642 Organizational Leadership
• HA 601 Introduction to Health Care in the USA
• HA 623 Decision Analysis
• HA 604 Health Law
• HA 624 Health Information Systems

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Questions