Transforming Care at the Bedside across Wisconsin

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Transforming Care at the Bedsideacross Wisconsin

• Monthly Webinar for January

The 90 day Challenge!
Please mute or phone by using 6. Un-mute to
speak by using 7 Please mute your computer
speakers and call into the phone line
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Welcome to Todays Call
? Agnesian St. Agnes ? Aurora Burlington ? Aurora Lakeland ? Aurora Sinai ? Calumet Med Ctr ? Fort Health Care Froedtert Comm Mem ? Ortho ? Medical ? Froedtert Milwaukee ? Hayward Area Memorial ? Howard Young Med Ctr ? Mayo Eau Claire ? Mayo LaCrosse ? Mercy Janesville ? Wm S Middleton VA ? Midwest Ortho Spec H ? The Richland Hospital Spooner Health System St. Croix Regional Med Ctr ? St. Elizabeth Hospital ? Tomah Memorial H ? Westfields Hospital ? Wheaton Fran - Franklin ? Zablocki VA Hospital
Please confirm your hospital is in attendance (if
you miss roll call please e-mail Stephanie by 4
pm)
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Todays Agenda

• Announcements
• Site Visit Update from Judy
• CNO Reports and Innovation Logs
• 2. 90 Day Challenge Slides
• 3. Upcoming Webinars

4
TOPIC SICU Pain Improvement Score
DATE Jan. 3, 2014
HOSPITAL Froedtert Hospital Milwaukee
Lessons Learned
Measure
Aim Statement

• What will be done differently as a result of
  this improvement process
• 1) more attainable goal for the TCAB group for a
  90 day challenge
• 2) Difficult to do a quick fix on a long term
  problem in short time span
• 3) SICU will continue to strive for improved pain
  score (look at follow up)

2013 SICU Avatar Score

• What was your 90 day aim?
• Increase Avatar pain score by .2 from 85.85 to
  86.05 in 90 days. For ICUs, Avatar is similar to
  HCAPS score but consists of only four questions.
  The question related to pain is Given my medical
  condition, I was satisfied with how well my pain
  was controlled in SICU

Given my medical condition, I was satisfied with
how my pain was controlled in SiCU
Root Cause(s)?
Test Cycles Test Cycles
1 Briefly describe tests and trials poster developed on pain scales placed in staffroom for staff to read
2 e-mailed nurse reminders to reassess pain after medication admin
3 RAAPS (pain team) presented at staff meeting to discuss acute on chronic pain and management of both
4 pain reassessment audit from Joint Commission tool
5 TCAB members writing patient pain goals on white board in patient room when applicable
Follow Up

• What is the cause of the problem?
• There are only four questions related to a
  patients stay in the ICU. The N ( total number
  of returned survey )is low. One negative reply
  affects the total score.
• Difficult to totally relieve pain in certain
  populations (trauma, intubated waiting to be
  extubated, brain injury requiring neuro
  assessments)
• Pain reassessment not documented as indicated by
  audits

• What are the next steps?
• Posting trend of Avatar pain score
• Re-education at staff meetings, newsletter,
  posting in report room
• Utilization of pain info on white board in
  patient rooms laminated pain verbiage on white
  board along with pain score
• Developing a script to reflect the Avatar pain
  question on survey
• Updating patient education booklet to reflect
  Avatar statement

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BEDSIDE REPORT
JANUARY 2014
Fort Healthcare
Lessons Learned
Measure
Aim Statement

1. It does not take longer to do bedside report.
2. Patients and families like it and feel like they
   are participating in their plan of care.
3. Increase in near-misses caught in a timely
   manner (ex. Iv abx not infusing, bed alarm off,
   scds off, infiltrated IV sites, etc.)

• In 90 days increase patient safety and
  communication through consistently doing bedside
  reporting.

Place Run Chart or Graph here
Follow Up
Root Cause(s)?

1. Leadership to continue patient rounding for
   patients feedback on bedside report.
2. Implement Inpatient Services Folder containing
   information about bedside report to be given to
   patients on admission.
3. UBC to continue to encourage staff to participate
   in bedside report.
4. Monitor if decrease in patient falls
5. Monitor clarity events for near-misses.

Test Cycles Test Cycles
1 CNO memo sent to nursing staff
2 SWANK education for nursing staff
3 CPC developed Policy Procedure for performing bedside report
4 UBC designed template for nurses to utilize
5 Nursing leaders surveyed patients about if staff were performing bedside report

1. Lack of patient participation in plan of care.
2. Inefficiency of staff time during shift change.
3. Safety issues related to clarity events.

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TOPIC Nursing Vitality Scores
DATE01/07/2014
HOSPITAL Agnesian Healthcare (SAH)
Lessons Learned
Measure
Aim Statement

• What will be done differently as a result of
  this improvement process
• 1.What will be done differently as a result of
  this improvement process
• Work on projects that are quick wins if the end
  date is 3 month.
• Bring in the other disiplines early to get their
  feedback.
• Increase awareness for the associates working
  through the process. Often reminders of the
  change implimented.

• 1.Increase Vitality score by 1-2

Root Cause(s)?
Follow Up
Test Cycles Test Cycles
1 Trialed Break Buddies
2 Volunteers to sit with patients as a companion
3 Compliment Hot-Line
4 Medication Information Sheets
5

• 1.What is the cause of the problem?
• Associates not working as a team
• Staff turn-over
• Too many hoops to implement changes
• IT issues with Advanced Care Documentation

• What are the next steps?
• Implement Break Buddies on all the units.
• Work with volunteer Services to implement a
  partnership to help with patients that need to
  talk or want companionship.
• Encourage nurses to use the new medication
  sheets routinely.
• Continue to try to get a Compliment Hotline
  started

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TOPIC Pain Menu
DATE 1.7.2014
HOSPITAL Froedtert- Community Memorial Ortho
Lessons Learned
Measure
Aim Statement

• What will be done differently as a result of
  this improvement process
• More feedback from patients versus just asking
  yes/no questions.

• What was your 90 day aim?
• To increase patients awareness of ALL pain
  options, both pharmacological and non
  pharmacological.

During post discharge phone calls we have asked
patients if they felt they understood all pain
options provided to them.
Root Cause(s)?
Test Cycles Test Cycles
1 TCAB met in beginning of November to design the content for the pain menus
2 TCAB members took the mock pain menus back to staff to see if changes should be made
3 Phone calls made to discharged patients for two weeks in November. (11/6-11/22)
4 Pain menus used on the unit starting 11/20
5 Follow up phone calls made again December 4th-18th
Follow Up

• What is the cause of the problem?
• Being an orthopedic unit, pain management is
  always a concern. Pain control is also a
  strategic goal for our organization. Ortho TCAB
  wanted to do something that would focus on
  improving patients pain while they were
  inpatient and even when they go home.

• What are the next steps?
• Continue to use the pain menus and spread the
  word to the rest of the hospital

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TOPIC
Bedside Report
DATE
January 2014
HOSPITAL
Westfields Hopsital
Lessons Learned
Measure
Aim Statement

1. This is still a work in progress
2. Readdress the importance of this newly adapted
   bedside report and the impact it has on patient
   satisfaction

• What was your 90 day aim?

Our focus was to continue with bedside reporting
and each 30 days we would reevaluate, make
necessary adjustments and continue forward.
We wanted to include what our patient
satisfaction scores were
Root Cause(s)?
Test Cycles Test Cycles
1 Full bedside report with both RNs and patient/ family in patients room
2 RN shift summary introduction to nursing staff and removal of verbal report in patient room and replacing with computerized written handoff
3 Meet and greet in patients room with both RNs, introduction of nurse and update to care board, questions/ concerns
4 Implementation of RN shift summary meet and greet
5
Follow Up

1. Patient satisfaction is high, not enough nursing
   staff support
2. Old habits die hard continuing with more verbal
   report
3. Not enough understanding of importance to patient
   and family for bedside report

1. Encourage staff to continue with bedside report
2. Revisit new word/ phrases to use when taking care
   of same patient over time

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TOPIC
Hourly Rounding
DATE
12-19-13
HOSPITAL
St Croix Regional Medical
Lessons Learned
Measure
Aim Statement

• What will be done differently as a result of
  this improvement process
• Found through our call light study that the
  majority of the call lights were due to patients
  needing to use the bathroom, IV pump alarms and
  bed or tab alarms.
• It was difficult to match the RN and NA so that
  their schedules and job duties matched the
  rounding schedule.

• What was your 90 day aim?.
• To Develop a plan for Implementing Purposeful
  Hourly Rounding on the Med-Surg unit.

Root Cause(s)?
Test Cycles Test Cycles
1 Call light study
2 Trial of 1 RN and 1 aide team doing purposeful hourly rounding together.
3 Discussions at staff meetings to get input from staff on ways to successfully implement hourly rounding.
4 Discover what barriers exist and any solutions to those barriers.
5 Have all care boards hung in patient rooms to use
What is the cause of the
problem? Unsuccessful Implementation of Hourly
Rounding in the past. Was not a team approach,
but focused as a Nursing Assistant responsibility.
Follow Up
What are the next steps? 1- Develop 6 teams
of RN s and aides that work together on the
weekends to do another trial of rounding to find
more barriers or successes to our rounding. 2-
Develop a rounding schedule for the staff to be
able to visualize with times to keep on track.
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TOPIC Observation Patients and Problems
Associated with the Use of Home Meds
DATE January 3, 2014
HOSPITAL Aurora Lakeland Medical Center
Lessons Learned
Measure
Aim Statement

• What will be done differently as a result of
  this improvement process
• Formation of an interdisciplinary team to address
  designated storage area and process for ensuring
  that the patient is discharged with their home
  meds.

1. What was your 90 day aim? Implement a process for
   the identification and administration of home
   meds in the observation patient. This is to
   include the appropriate storage of the meds and
   subsequent return to the patient at discharge
   while the patient is hospitalized.

Root Cause(s)?
Follow Up
Test Cycles Test Cycles
1 Staff perceptions
2 Pharmacy interaction
3 Storage capabilities
4 Patient satisfaction with the current process
5

1. What is the cause of the problem?

1. What are the next steps? Creation of a
   formal process to address the issues/barriers of
   home meds in the observation patient

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TOPIC Medication Education
DATE 1/06/14
HOSPITAL Mayo Clinic Health System La Crosse
Lessons Learned
Measure
Aim Statement

1. On admission each patient will receive a
   medication information sheet with common
   medications listed, what they are used for and
   possible side effects in an easy to understand
   format in their admission folder.
2. It is the nurses responsibility each shift to
   look at the education sheet, highlight and
   educate about any medications the patient is
   taking.
3. The patient is able to take that education sheet
   home with them.
4. Data varies, depends on number of respondents,
   takes around 3 months to be accurate. Watch for
   consistency.

1. Increase HCAHPS scores for teaching patients what
   new medications they are taking are for from 75
   to 79 and teaching patients about side effects
   of medications they are on in a way they can
   understand from 48 to 50.

Root Cause(s)?
Test Cycles Test Cycles
1 One RN got list from pharmacy of common medications given on our unit. Created an education sheet with medication name, what it is used for, and side effects. Used this for one patient- got feedback if patient could take home with them.
2 One RN used to educate on 2 patients, received feedback about wording. Let oncoming staff know she was trialing this with the patients.
3 Made some changes to wording. One RN used on 3 of her patients, and had another RN try on her patients.
4 Two RNs continued to trial on their patients. All patients like format, thought information was good and easy to understand.
5

1. There was no standard way to educate patients
   about new medications they were taking and side
   effects of medications they were taking.
2. Completed HCAHPS education for staff at unit
   meeting and completed and A3 with RNs at each
   unit meeting.

Follow Up

1. Approval from hospital Education Council
2. Brand education sheets.
3. Educate all staff.
4. Add education sheets to admission folders.

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TOPIC Increase Time at the Bedside
DATE 12/28/2013
HOSPITAL Aurora Sinai
Lessons Learned
Measure
Aim Statement

• 1.) Focus again on supplies and equipment. Are
  they available, in working condition and readily
  accessible.
• 2.) Need to continue to enforce real time
  charting in rooms.
• 3.) Need to work on bedside reporting at shift
  change. Some staff are willing to try it and
  adopt it, while others still are reluctant.
• 4.) Hourly rounding has been adopted and is
  working.
• 5.) Implement rounding with MDs and nursing
  staff when rounding on patients.
• Will repeat time study in one month and see if
  the inventions we have placed above will increase
  our time at the bedside to 65.

• Aim was to increase time at bedside to 60.
• Goal was met, 61 of RNs time was spent at the
  bedside

Root Cause(s)?
1.) Supplies and equipment issues 2.) Time
management 3.) Poor shift to shift report/
transition 4.) Reluctance to change 5.) MDs
rounding on patients without nursing staff
Follow Up
Test Cycles
1.) Re-introduced Bedside reporting with RNs
and purposeful rounding -Staff willing
to adapt and adopt 2.) Hourly rounding
-Adopted and working 3.) Re-addressed supplies
and equipment issue
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TOPIC Medication Education Sheet
DATE 1/7/2014
HOSPITAL Tomah Memorial Hospital
Lessons Learned
Measure
Aim Statement
1. What will be done differently as a result of
this improvement process More medication
education will be given to patients which will
help increase our HCAHPS scores and help decrease
readmissions. When we predicted our goals for
improvement we did not take into consideration
the lag time for HCAHPS scores to be received.
We hope to see results with the incoming scores
in the next couple months.

• What was your 90 day aim?.
• By Dec. 31st we will improve patients
  understanding of new medication and increase at
  least 15 in HCAHPS Scores.

HCAHPS Question
Root Cause(s)?
Test Cycles Test Cycles
1 Get top 25 most used meds for hospital and make up sheets from that.( It takes 1 months to get info)
2 Get sheets from Fort Hospital and revise to make our own.
3 Have other departments help develop medication education sheets.
4 Pam RN trialed quiet time/teaching time for a few days. Come up with signs to inform staff and family (still in progress)
5 Roll out quiet time/teaching time to unit and possibly whole hospital.

• What is the cause of the problem?
• Our HCAHPS survey scores for questions 16, 17 and
  25 concerning patient medication education were
  unsatisfactory. Our unit feels as though we could
  always do more medication education with
  patients. Some reasons we havent been up to par
  is due to poor education material and not a lot
  of time to teach.

Follow Up

• What are the next steps?
• Finish respiratory education sheet.
• Develop more medication education sheets for
  other classes of drugs or diagnoses.
• Adopt, adapt, or abandon quiet time/teaching
  time.

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TOPIC Bedside Shift Reporting
DATE 1/2/2014
HOSPITAL Froedtert Health CMH - Med
Lessons Learned
Measure
Aim Statement

1. Increased patient involvement in plan of care
   enhances overall patient satisfaction with nurse
   communication.
2. Identify barriers to bedside report prior to
   implementation. Ours was time, once this was
   decreased it was an easier transition.
3. You need a few dedicated staff to keep the ball
   rolling and people motivated to continue bedside
   report.

• 1. By December 31, 2013, 75 of patients will
  answer yes to a question about participation in
  planning their care.
• According to collected data, 100 of patients
  called feel involved in their plan of care since
  implementation.

Root Cause(s)?
Pre TCAB Kardex Bedside
Test Cycles Test Cycles
1 Obtain baseline data including numbers of patients that answered yes to Did you participate in planning your care? during post discharge phone calls.
2 Implement bedside report. Begin with small test groups, increasing weekly to include all staff.
3 Hardwire process by prepping staff, patients and developing and defining criteria for bedside shift report.
4 Obtain data including number of patient that answered yes to did you participate in planning your care? during post discharge phone calls.
5
Follow Up

• Patients felt separate from the care they were
  receiving. Care was done to them not with
  them.
• Some important information was being missed on
  patients that were staying for long periods of
  time.

1. Auditing compliance and use of bedside shift
   report

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TOPIC Patient Partnership/ Activity Log
DATE Jan. 2014
HOSPITAL Midwest Orthopedic Specialty Hospital
Lessons Learned
Measure
Aim Statement

1. Not enough staff participation. Patients too
   sedated DOS to make use of the log.
2. Need more communication reminders to staff.
   Patients are better able to work on logs when m
   ore alert on POD 1.
3. Audit results more frequently so changes can be
   made to meet goals.

Improve partnership with patients by use of an
activity log to prevent post-op complications.
(IS, flex/ext. ankle exercises, CPM time, up in
chair,) In 90 days, 50 of patients will actively
be working on the log during audits.
Follow Up
Root Cause(s)?

1. Continue to audit more frequently and provide
   staff feedback.
2. Add to SCIP checklist
3. Monitor HCAHPS , Press Ganey, HAC reports.

• The activity log had been included in Welcome
  Folders several years ago to engage patients in
  tracking activity goals, but had not been
  utilized.

Test Cycles Test Cycles
1 1. Revised activity log. 2. laminate keep on communication board with clip. 3. Introduce to staff. 4. Explain log to patients keep at bedside. Initiate on DOS with first iS instruction. Audit patient rooms for use of tool.
2 1. Attach velcro with dry erase markers to log. 2. Initiate tool POD 1 when pt. more alert. 3. Audit patients POD 1 or gt for use of tool Q2 weeks.
3 1. Reinforce at staff meeting. 2. Reminders on white board in employee work room. 3. Audit patients POD 1 or gt for use of tool 2x/week.
Activity Log
16
TOPIC Break Buddies
DATE September 2013
HOSPITAL MCHS-Eau Claire
Lessons Learned
Measure
Aim Statement

• What will be done differently as a result of
  this improvement process
• Assure break buddies are assigned at every
  shift-Staff are not actively taking breaks unless
  held accountable by break buddy
• Show staff data at monthly staff meetings to
  support the use of break buddies

• What was your 90 day aim?
• In 90 days, increase the number of staff that
  take a lunch break with a goal of 99

Root Cause(s)?
Test Cycles Test Cycles
1 Break Buddies Assigned
2 Reminders posted around unit
3 LN rounding with each staff member
4
5
Follow Up

• What is the cause of the problem?
• Workload
• Turnovers of patients (d/c, admits, tx)
• Interruptions

• What are the next steps?
• Data collection

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Patient Education Discharge Teaching
01/08/2013
Milwaukee VA Medical Center
Lessons Learned
Measure
Aim Statement

• What will be done differently as a result of
  this improvement process
• Discharge teaching will begin upon admission
  instead of the day of discharge. Also, there will
  be specified teaching topics individualized to
  each veteran based on their medical conditions
  and teaching needs.

• What was your 90 day aim?.
• Our aim is to pilot a new process for
  implementing patient discharge teaching upon
  admission. It will be a detailed process followed
  by all staff on the unit.

Root Cause(s)?
Test Cycles Test Cycles
1 Pilot to begin 02/10/2014- We will conduct the pilot using four case studies, one per team on unit 9A.
2
3
4
5
Follow Up

• What is the cause of the problem?
• Currently, there is no standardized process for
  determining discharge teaching needs or
  timeframes for completing discharge teaching.

• What are the next steps?
• The next steps are to implement the pilot, obtain
  feedback from staff, and make adjustments based
  upon these recommendations prior to full
  implementation.

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TOPIC Team Vitality
DATE 1/1/14
HOSPITAL Spooner Health System
Lessons Learned
Measure
Aim Statement
a) Staff will stop chatting and wait until the
end of report for each patient to ask questions.
b) Staff will ask how well a patient is known
thereby preventing leaving out pertinent
information to new nurses c)Recommend to expand
use of whiteboards in patient room to communicate
further info ie fall risk, activity level, diet,
etc. d)Recommend use of white board for staff in
report room.
Percentage of 5/5 responses Shift Change
Patient Handoff mo/yr Info. Exchange
Info Exchange 10/12 32
24 03/13 25
5 10/13
25 15 (Will not have
results of test until next survey)

• What was your 90 day aim?.
• Increase of nurses who score 5/5 to the
  questions regarding communication between shifts
  and hand-off communication on the Team Vitality
  Survey.

Root Cause(s)?
Test Cycles Test Cycles
1 Each TCAB members queried 2-3 nurses what problems/barriers in nurse communication? and what ideas do you have for improvement?
2 Staff were interviewed regarding preference for taped vs face to face report.
3 RN queried staff regarding pros/cons of verbal vs. taped report.
4 Designated RN at report sessions coached staff over a 2 week period to not chat and to wait until the end of report to ask questions.

• What is the cause of the problem?
• a) Hand off from ED to floor feels rushed, not
  enough time to ask questions.
• b)Distraction is a large issue during report and
  at handoff., especially when sidebar
  conversations take place.
• c)unable to find reporting RN in a timely manner
  to ask questions after listening to taped report.
• d)Information is not always thorough during
  report.
• e) Some staff give oral report and others tape
  report.

Follow Up

• What are the next steps?
• a) Coach/teach staff to use SBAR during report.
• b) Nursing Management to be approached regarding
  option of assignments, role of charge nurse, use
  of staff white board.
• c) Continue to investigate pros/cons of taped
  vs. verbal report.

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TOPIC Bedside Report
DATE Jan 2014
HOSPITAL Mercy Hospital
Lessons Learned
Measure
Aim Statement

• Share testimonials from nurse to nurse about
  benefits of change process
• Temperature check of unit and team prior to
  implementing change process
• Encourage and praise
• Share progress with other departments

Place Run Chart or Graph here

1. Increase bedside report compliance by 50 on all
   shifts through standardizing bedside report
   process

Root Cause(s)?

• Miscommunication
• Lack of confidence
• Fear of change in process
• Misunderstanding of process

Follow Up
Test Cycles Test Cycles
1 Brief survey to RNs regarding barriers and bedside report satisfaction. Results shared with staff
2 Standardized time for bedside report to start 10 minutes after the start of each shift change
3 SBAR template to give report provided to all RNs
4 Revised and simplified SBAR template
5

1. Continue temperature check
2. Onboarding of new staff
3. Problem solving and intervention
4. Remain open to improvements

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TOPIC
Medication Education
DATE
1/2014
HOSPITAL Richland Hospital
Lessons Learned
Measure
Aim Statement

• Standard Teaching Documents being used for our
  most used medications.
• Nurses are now able to see medication education
  that is being done with patients.
• Better follow through on medication education
  based on the above.

To improve patient understanding of meds and to
increase HCAHPS scores by 10 in the category
Communication about Meds
Root Cause(s)?
Test Cycles
-Nurses doing routine med teaching and patients
not realizing med teaching being done. Need to
come up with a tool to use so patients realize
education is taking place and so nurses can still
complete teaching in a timely manner. -Hard to
find documentation on medication education
previous nurses have done with patient

1. Gathered Data TCAB developed a med question
   sheet to gauge how well patients know their meds.
2. Stole Shamelessly Obtained med teaching sheets
   from another TCAB team.
3. Applied to Our Patient Population Looked at our
   primary population and diagnoses and created med
   teaching sheets for our unit.
4. Colloborated with Pharmacy and EMR Worked with
   our pharmacy director to produce medication
   education sheets and EMR to build documentation
   screens into Meditech.

Follow Up

• Implementation of Medication Teaching Tool
• Continue EMR involvement as they work to build a
  more efficient way to document med teaching in
  Meditech
• Monitor HCAHPS for improvement

21
TOPIC Increase ambulation to decrease falls
DATE 1/7/2014
HOSPITAL William S. Middleton Memorial VA
Hospital
Lessons Learned
Measure
Aim Statement

• What will be done differently as a result of
  this improvement process
• Consistent documentation of ambulation in a
  specific section of the nurse shift summary note
  as identified by nursing and other disciplines
  caring for the patient.
• Increased awareness which will increase staff
  commitment to patient ambulation

• What was your 90 day aim?
• Increase purposeful patient ambulation and staff
  awareness of the need to ambulate through
  standardized documentation.

Root Cause(s)?
Test Cycles Test Cycles
1 Chart audit was completed to identify where the majority of staff documented ambulation
2 Ambulation was the focus of one staff meeting to identify where ambulation would be documented.
3 All staff were educated on the standardization of ambulation documentation
4 Markers were placed in the hallway to utilize as guides of documentation
5 White boards are used to communicate ambulation expectations and other disciplines involved in decision of where to document
Follow Up

• What is the cause of the problem?
• Nurses had different perceptions on where
  ambulation should be documented
• There was no guide of measurement in the hallway
  to assist staff with documentation of distance

• What are the next steps?
• Evaluate effectiveness in ambulation program for
  those patients that are high fall risk

22
DATE 1/9/13
TOPIC Break Buddies
Lessons Learned
HOSPITAL St. Elizabeth Hospital
Measure

• What will be done differently as a result of
  this improvement process?
• Continue to engage associates in a supportive
  manner and listen to their ideas
• Management coach associates who habitually miss
  their meal break
• Staff need to use scripting with patients to
  inform them of the staff break time and meet
  needs prior to taking their break
• Share the results with associates regularly to
  track progress

f
Aim Statement

• What was your 90 day aim?.
• 1. Decrease of No-Lunch punches by 50
• 2. Decrease dollars paid to employees for
  no-lunch punches by 50

Follow Up
Root Cause(s)?

• What are the next steps?
• Punching in and out during lunch break to ensure
  all employees have a 30 minute uninterrupted
  break
• Staff MUST hand-off phones for break so well
  purchase an extra phone to use on breaks for
  personal calls
• Spread our progress with other Ministry hospitals

Test Cycles Test Cycles
1
2
3
4
5

• What is the cause of the problem?
• Staff kept their phones with them on break and
  were constantly interrupted when trying to have a
  30 minute break
• Staff needed to hand their phones off to someone
  so they could actually take a break
• Staff required education on fatigue and the
  importance of taking a break

Cycle 1 2 RNS
Cycle 2 4 RNS paired
Cycle 3 6 RNS paired
Cycle 4 6 RNS 2 TCS paired
Cycle 5 6 RNS, 4 TCS, UC paired
23
TOPIC Nurse Server Stocking
DATE January 2013
HOSPITAL WFH-Franklin
Lessons Learned
Measure
Aim Statement

1. Important to make sure that locking mechanisms on
   nurse servers are easy to use.
2. Our keyholes were not easy to use so for new
   construction looking at a different options for
   locking mechanisms.

1. What was your 90 day aim?. To decrease amount
   of time that is spent between running and
   gathering supplies by stocking the nurse server.

Root Cause(s)?
Test Cycles Test Cycles
1 First came up with supplies most utilized at the patients bedside.
2 Ordered and stocked bins for one room to see if all the supplies were necessary .
3 Counted our steps prior to initiating for our baseline data.
4 Stocked all room nurse servers and implemented and planned a restocking process.
5 Handed out keys along with a process to pass to each shift.

• What is the cause of the problem?
• Nurse servers were not stocked with the most
  frequently used supplies so staff would spend a
  greater amount of time hunting and gathering
  instead of spending it with patients.

Follow Up

1. What are the next steps? Is to gather our post
   implementation step data week of January 13th.

24
TOPIC Fall Prevention
DATE Jan 8
HOSPITAL Aurora Memorial Hospital - Burlington
Lessons Learned
Measure
Aim Statement

• What will be done differently as a result of
  this improvement process
• There will be guidelines based on the Morse fall
  scale of 45 or greater that the beds will be set
  as follows.
• Brake on, Bed plugged into nurse call system,
  side rails up, bed in low position, bed alert on
  and programed to zone two, ibed on. All alarms
  are programed into every staffs phone and if the
  alarm goes off everyone goes.
• Fall tree on the unit with leaves placed with
  every day there is no falls, if a fall occurs all
  the leaves will come off.

1. We will have no falls for 100 days.

Place Run Chart or Graph here
Root Cause(s)?

• What is the cause of the problem?
• Increase in falls from July thru September that
  doubled our yearly fall total. Did not meet our
  goal of no falls with injury and to reduce falls
  my 50 from previous years total.

Test Cycles Test Cycles
1 Falls increasing tried using sitters but not good use of productivity. Not all staff cued in to answering others call lights.
2 Made it a challenge so staff would have some buy in to make the 100 day goal.
3 Made it to 34 days no falls when we had a fall that was due to defective equipment, and call light not ringing to staff, came up with process to check all supplies and equipment prior to placing patient into. Also developed a plan for a workgroup to routinely check all equipment and that it is in working order.
4 Continuing now into January day
Follow Up

• What are the next steps?
• Bed audits to ensure all the above criteria are
  met
• No further falls for the 100 days we set for out
  goal.

25
TOPIC Medication Education
DATE11/1/13
HOSPITAL Calumet Medical Center
Lessons Learned
Measure
Aim Statement

1. Time consuming- needs to be done prior to
   discharge
2. Provider compliance is a challenge
3. Written info appreciated by patients
4. Pt education is easier and consistent with
   medication cheat sheet.

To improve and be consistent with medication
education and documenting purpose of med in
patient copy of med list at least by 50 in 90
days.
Manual audit of patient copy of med list at
discharge to reflect purpose HCAHPS Understood
the purpose of medication
Test Cycles Test Cycles
1 Ask patient on admit if they know purpose of meds overwhelming majority doesnt know
2 RN to review medication purpose from medical record not always documented on record
3 Med purpose to be completed on discharge time consuming and delayed discharge
4 Started documenting purpose of meds on admit and during stay and working with providers as admission med-rec is being completed to include purpose of each med.
5
Root Cause(s)?
Follow Up

1. Patient dont always know their meds and its
   purpose potentially impacting compliance.
2. Pt education is inconsistent and lacking (
   purpose, side effects and when best to take)

1. Manual audit for med-purpose and reinforce
2. Work with providers to improve documentation
3. Encourage use of med-educ cheat sheet for
   consistency, validate on rounding with patient

26
TOPIC Discharge teaching
DATE 1/7/14
HOSPITAL Hayward Area Memorial Hospital
Lessons Learned
Measure
Aim Statement

• What will be done differently as a result of
  this improvement process?
• A randomized audit of charts was done for the
  month of November and December to audit for
  documentation of teach back on discharge. This
  audit found nursing used teach back in 38 of the
  randomized chart review in November and 39 in
  December.
• Nursing will be re-educated on the teach back
  method and the importance.

• What was your 90 day aim?
• Increase patient satisfaction with discharge
  education as evidenced by an increase in HCHAPS
  scores by 12/31/13.flkasjflkdjflkjsdfkljf

Test Cycles Test Cycles
1 Nursing was educated on teach back at a staff meeting with a power point presentation. This was also emailed to those that did not attend. Examples of teach back techniques were given.
2 Changes were made to the EMR, with the teach back method added for nursing to document against.
3 Evidenced by increase in HCAHPS scores related to the questions Staff talk about help when you left? and Information regarding symptoms/problems to look for? (See above graph) For the months of October, November, and December.
4 Plan to directly observe staff while discharging a patient and performing teaching using the teach back method.
5 Have staff role play teach back techniques.
Root Cause(s)?

• What is the cause of the problem?
• Nursing was instructing the patient on
  discharge, in regards to signs and symptoms and
  medications. However, the patient was not always
  understanding what was being taught. Therefore,
  when the patients returned home, the HCAHPS
  scores reflected that the patient did not feel
  that teaching was done to prepare them for self
  care at home.

Follow Up

• What are the next steps?
• To continue to audit the use of teach back and
  trend HCAHPS scores related to patient
  understanding of medications and discharge
  instructions.
• Re-educate Nursing on teach back method.

27
Summarizing Lessons Learned from
the 90 Day Challenge
28
Upcoming Topics
Patient Safety Reducing Hospital Acquired Conditions How to do good follow-up calls to prevent readmissions Feb
Leadership How staff can become leaders Leadership rounding Mar
Spreading TCAB A joint webinar with Cohort 3 Staff participation and feedback with TCAB Engagement of more staff in TCAB TCAB to other units April
29
Keep the data flowing.

• We will be wrapping up the data collection with
  the March 30th due date.
• We really want a complete data set so that we can
  accurately reflect the improvement you all have
  worked for.
• ? You can always check your current data on the
  Quality Center data portal