Relationship Based Care:

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• Relationship Based Care
• Family Centered Relationship Based
• Communication Guide
• Jeffrey A Beers RN BSN MA

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Communication Guide

• Evaluating
• Early intervention
• Planning
• Experts / consults
• Follow up
• To help us with
• Service recovery
• Family visitor needs
• Aggressive behavior
  
• No
  magic wand !

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Outline

• Violence nationally and at UH
• General communications concepts
• Review the communication guide
• Share video clip of a case
• How can we apply these concepts?
• Questions

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Workplace Violence Healthcare data

• Healthcare has higher rates of
• assaults than other professionals
• (Gates, Ross, and McQueen, 2006)

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Recent Reports

• patient dug fingernails into me
• patient bit left forearm
• patient striking out hit in chest
• patient swung cane at me, hit right hand
• patient punched me in the throat
• patient pushed a bed into my left thigh
• struck by patients grandmother in the face

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UH CMC data

• Patient advocate Complaints 2,200 this year
• Patient advocate Grievances 210 this year
• Code violet 143 in 2011
• PASS 5,251 in 2011

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Risk Management Cases

• Angry /violent patients and families
• Challenging cases
• protracted illness
• errors
• poor prognosis
• complications

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Personnel Affected

• Nursing staff coverage
• Attending physician coverage
• Physical distress

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Impact on Care

• Creates barriers to care
• Creates barriers to communication
• Longer patient hospitalization
• Extensive use of resources

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How do we address these challenges?

• Family Centered Relationship Based Communication
  Guide / algorithm.
• Evaluating
• Early intervention
• Planning
• Experts / consults
• Follow up
• To help us with
• Service recovery
• Family visitor needs
• Aggressive behavior

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High Reliable Organizations

• Expectations
• Explaining rules
• Clear Communication
• Respond to weak signals

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What is your plan here ?
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Algorithm Overview

• Recognize the patient as the center of care
• Recognize the family as a patient system
• Assessment and documentation of the family /
  visitor
• Implementing an interdisciplinary plan

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Algorithm Overview

• Recognizing when the plan is not effective
• Notifying management and administration
• Creating verbal and written contracts and
  agreements
• Empowering the bedside providers

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Color Coded Categories

• Receptive Green
• Requires attention - Yellow
• Concerning Orange
• Urgent Red

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Green Receptive

• The typical relationship enjoyed
• Involved in planning and sharing information
• The familys needs are being addressed
• The family is expressing satisfaction regarding
  the resolved needs

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Requires Attention Problem identified by
Clinical Team

• Family or visitors have verbalized some type of
  an issue
• Team communication
• Unanswered questions
• Address bad experience
• Home / work issues
• Anxiety / stress
• Personal needs meals / rest / hygiene
• Advanced directives

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ConcerningVisitor in formed of the issue

• Family or visitor is exhibiting conflict
• Concerns regarding issues previously addressed
• Behaviors that demonstrate excessive worry or
  anxiety
• Aggressively challenging physician and nursing
  care
• Threatening patient transfer
• Threatening legal action

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Urgent Action

• Exhibits physical or verbal aggression
• Interferes with patient care, does not follow
  staff directives of staff
• The family / visitor are not abiding by
  agreements or contracts.
• The clinical team is supported to implement
  necessary actions

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Who may become aggressive?
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Who may become aggressive?
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Only one more slide

• Expectations
• Explaining rules
• Clear Communication
• Creating a plan
• Early intervention
• Bringing experts to the help you
• Interdisciplinary Team coordination
• Reassess and revise plan
• Empower staff to act

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Questions
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References

• 2011 on track to be most violent year
  for U.S. hospitals. The Advisory Board Company
  On-line www.advisory.com, October 21, 2011.
• Janocha J, Smith R. Workplace Safety and
  Health in the Health Care and Social Assistance
  Industry, 2003-07. Bureau of Labor Statistics,
  August 30, 2010.
• Gates D, Gillespie G, Succop P, Violence
  Against Nurses and its Impact on Stress and
  Productivity.
• Nursing Economics, March-April
  2011/vol.29/no.2
• Nonviolent Crisis Intervention .
  Crisis Prevention Institute, Inc. Milwaukee, WI.
  
• The Joint Commission, Elements of
  Performance, July 2009.
• Griffien T. Applying Patient-and
  Family-Centered Concepts in Dealing with
  Challenging Situations with Patients and
  Families. Institute for Family Centered Care,
  March 25, 2010.
• Barthel V. We stop aggression as soon as
  it starts. RN Magazine, Oct. 1, 2004.
• Coehlo D, Gedaly-Duff V, Hanson S,
  Kaakinen J. Family Heath Care Nursing, Theory,
  Practice Research. Philadelphia F.A. Davis
  Company, 2010.
• Cardin S, Dambosie C. Family-Centered
  Critical Care. AJN, vol. 103, No. 6, pp.
  56AA-56EE., June 2003.