Falls and Patient Safety Facts. •Falls are a high risk, high volume, high cost
challenge. •Hospitals are at risk for losing Medicare reimbursement. •Studies ...
Reducing Patient Falls The St. John Medical Center TCAB Experience PeaceHealth Lower Columbia Region St. John Medical Center
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VISION 2012
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Keeping Patient’s Safe: Transforming the Work Environment for Nurses (Institute of Medicine, 2003)
Because nursing plays such a central role in patient safety, transforming the nurse’s work environment must be a critical part of every healthcare organizations patient safety efforts.
Institute of Medicine. (2004.) Keeping patients safe: Transforming the work environment of nurses.
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Transforming Care At The Bedside (TCAB) •Sponsored by the Robert Wood Johnson Foundation (RWJF) •Institute for Healthcare Improvement (IHI) •American Organization of Nurse Executives.
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TCAB Design Targets • Safe and Reliable Care • Vitality and Teamwork • Transformational Leadership • Patient-Centered Care • Value-Added Care Processes
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= Cohort One © 2008 PeaceHealth
= Cohort Two
Falls and Patient Safety Facts • Falls are a high risk, high volume, high cost challenge • Hospitals are at risk for losing Medicare reimbursement • Studies estimate that between 2% - 10% of hospitalized patients fall during their stay
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The cost of falls
• In 2000, the direct medical cost for fall related injuries was 19.2 billion • 63% of these falls with injuries occurred in hospitals © 2008 PeaceHealth
The over-looked cost to our patients •“Post-fall syndrome” •Hesitancy •Loss of self confidence •Loss of mobility •Loss of independence •Fear •Sense of shame •Decline in wellness •Depression •Feelings of helplessness •Social isolation
•Effects on Family •Concern for loved-one’s safety •Concern about dependency •Concern regarding need for long term care
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The “TCAB Unit” ~ Cardiology • 32 bed acute care medical telemetry unit • Average daily census 20 • Average length of stay 4.19 days • Average Admits a day 5.43 • 15% Observation Patients • Team nursing care model with RN/CNA “Care Pairs” on day shift and modified primary on nights • RNs work 12 hr shifts/CNAs work 8 hr shifts • Shared Leadership established 2002 © 2008 PeaceHealth
The TCAB Process • Quality Shared Leadership Team Introduced to TCAB • Baseline PDA time/motion data study conducted • Front-line team generates new ideas: Not Management – “Snorkel” sessions ~encourage wild ideas – “Steal shamelessly” – Adopting best practices – Conducting site visits • Testing Ideas and Measuring Outcomes : Small tests of change • Implementing and Spreading Successful Changes © 2008 PeaceHealth
TCAB “Snorkel” Session 220 Ideas!!!!!!
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Hourly Rounding Quality and Patient Safety Shared Leadership Team Cardiology Unit; St. John Medical Center
Goals
Process
The Quality and Patient Safety Shared Leadership team embarked on this project with three goals in mind
Seven Key Behaviors on initial rounds:
1. Increase patient safety by increasing staff presence at the bedside.
2. Perform scheduled care giving
1. Introduce yourself and your role on the healthcare team.
3. Address the three “P’s” – pain, positioning, potty.
2. Increase patient satisfaction by proactively addressing patient needs.
4. Assess additional comfort needs: fluff pillows, straighten linens, fill water pitcher, adjust light, etc.
3. Increase patient safety and staff satisfaction by reducing staff interruptions.
5. Conduct environmental assessment: • Call light is within reach • Telephone within reach
Results
Methods
• Light switch and TV control accessible • Bedside table positioned within reach
The Quality Team researched evidence based practice to discover what interventions would best
% of Calls per Patient Census by Shift
• Privacy provided as desired by patient 6. Closing key words and/or actions
6.0%
accomplish the goals. The team defined the
• “This is your call bell. It is for urgent needs that cannot wait until I return, such as chest pain, other pain, or shortness of breath.”
5.0%
practices and the method of measurement. Over the course of the pre-implementation period the practices were clearly defined and scripted. Call
4.0%
• “Is there anything else that I can do before I go. I have time.”
3.0%
bell frequency data was gathered for three months prior
to
implementation.
Staff
education
overlapped the pre-implementation data collection and continued through the months following implementation. Staff education included posters, progress reports at staff meetings, just in time training.
7. Explain when you or others will return. 2.0%
• “Either Sarah, our CNA, or I will be back every hour to check on you.”
1.0%
0.0% 1
2 Nights
3 Days
4
5
6
Evenings
Insert your references here
SBAR report
SBAR Report Tool S = Situation Why is B = Background the pt here?
pt label here
Diagnosis ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ __
Full Code DNR Comfort Care ____ Limited Code _____ Allergies:_________ _________________ _________________ _________________ NKA Significant hx/interventions _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ ________________
A = Assessment abnormal assessments, labs; imaging results
R=Recommendation
Daily Care/Delegation
ABN:_______________________ ___________________________ ___________________________ ___________________________ Skin/Wound Care _____________ ___________________________ Pain: _______________________ Last dose pain med____________ NSL Lines/Fluids/PCA ___________________________ ___________________________ ___________________________ O2 Therapy _________________ RT tx _____________ Sat _____ Tele________________________ Arrhythmias_________________ Tele DC date_________________ Last BM ____________________ Bowel Protocol Level__________ Other_______________________ ___________________________ ___________________________ ___________________________ _
What’s pending_____________ __________________________ Goal Progress ______________ __________________________ __________________________ Family issues/concerns_______ __________________________ __________________________ Anticipated DC date _________ DC concerns _______________ __________________________ __________________________
Vital Sign Freq _____________ POC Glucoses_______________ Daily Wt________Diet: General Heart Healthy ADA _________ NPO Other _______________ Fluid Restriction _____________ I&O foley drains/tubes_____ Activity: As tolerated Up in chair: for meals QS Turn Q2 hrs Ambulate: to bathroom; in hall ________ ft Use Lift Assist to ambulate:1 2 3 person walker cane crutches Fall Prevention Bed Alarm Chair Alarm Other Safety ___________________________ Isolation MRSA: wound urine sputum VRE C-Diff Shingles Bed Bath Shower Oral Care Peri-Care foley care HS care
Meds
08 09 10 11 12 13 14 15
Dry Erase Communication Boards
“Days Without a Fall” Poster
Poster adopted by Medical Unit
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Staff are Spending More Time in Direct Patient Care
© 2008 PeaceHealth
TCAB featured in “House Calls” community newsletter your care Melissa O’Neil, RN (left) & Darci Seay, RN know communication is an essential part of quality patient care
Working together
to transform care at the bedside
It's 1:30 in the afternoon in the Cardiology Unit at St. John Medical Center. The lights are dimmed, televisions are turned off, and soft music is playing overhead. Visitors are taking a break in the waiting room while their loved ones are getting some much needed rest.
St. John is promoting innovation to improve your care experience.
…and our journey continues
Questions?
• Contact Information: – –
© 2008 PeaceHealth
Jennifer Lefebvre, Clinical Manger-Cardiology
[email protected] Trece Gurrad, Director-Acute Care Services:
[email protected]
