November 20, 2014 These presenters have nothing to disclose IHI Expedition Expedition: Engaging Patients and Families in Multi- Disciplinary Rounds Session 5: Putting it All Together: How to Sustain the Momentum Tammy Alvarez, RN, MSN, CCRN Kathy Duncan, RN
Today’s Host 2 Morgen Palfrey, Project Coordinator, Institute for Healthcare Improvement, is the current coordinator for web- based Expeditions. She also contributes to the IHI Leadership Alliance, conducts research scans to assist with content development, and works with Strategic Partners in Singapore. Morgen is a member of Work- Life Wellness Team and Diversity and Inclusion Council at IHI, where she and fellow staff members develop strategies for improving the mind and body. Morgen graduated from the University of Florida in Gainesville, FL where she received her Bachelor of Arts degree in Political Science with a concentration in Public Administration.
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8 Expedition Director Kathy D. Duncan, RN, Faculty, Institute for Healthcare Improvement (IHI), oversees multiple areas of content, directs multiple virtual multiple learning webinar series and is the clinical lead for IHI’s National Learning Network. Currently she also serves as Faculty for the AHA/HRET Hospital Engagement Network (HEN) Improvement Leadership Fellowship (ILF). The ILF provides multi-faceted resources to support the learning and dissemination of improvement methods and tools. Most recently, Ms. Duncan directed content development and spread expertise for IHI’s Project JOINTS, an initiative funded by the Federal Government to study adoption of evidenced-based practices. In 10 US States, Project JOINTS spread three evidence-based pre-and perioperative practices to reduce the risk of surgical site infections in patients undergoing total hip or knee replacement.
Today’s Agenda 9 Welcome Action Period Assignment Debrief Guest speaker: Shirley Sherman, Virginia Mason Medical Center Putting it All Together: How to Sustain the Momentum Congratulations! Closing
10 Expedition Objectives At the conclusion of this Expedition, participants will be able to: Name the components of a high-functioning multidisciplinary rounding process. Identify opportunities and strategies to engage patients and families in multidisciplinary rounds. Test and implement a multidisciplinary rounding process that establishes daily goals with patients and families.
11 Schedule of Calls Session 1 – Making a Case for Patient and Family Inclusion in Rounds Date: Thursday, September 25, 12:00 - 1:30 PM Eastern Time Session 2 – Building a Foundation for Rounds: Both Structure and Culture Date: Thursday, October 9, 12:00 - 1:00 PM Eastern Time Session 3 – Taking the First Step: How to Start Engaging Patients in Rounds Date: Thursday, October 23, 12:00 - 1:00 PM Eastern Time S ession 4 – Measuring Success: Strategies for Identifying Improvement Date: Thursday, November 6, 12:00 - 1:00 PM Eastern Time Session 5 – Putting it All Together: How to Sustain the Momentum Date: Thursday, November 20, 12:00 - 1:00 PM Eastern Time
12 Action Period Assignment Debrief Next Test(s) – Measure something – – Could be: # of participants, start on time, how much time, # of changes made, # of pharmacy changes, etc) – How are you going to measure? – Do you know if your change made an improvement? What did you learn? What test are you most proud of?
13 Bonnie Rodio, ED Patient safety Coordinator, Children's hospital of Philadelphia
14 Bonnie Rodio - Children's hospital of Philadelphia Areas of focus should be introductions: what is your role, and communication between disciplines. The differences between the responses received by the nurse group and the PCA (registration) group were not large. May reflect the feeling that the nurse group can have more impact in changing that particular area. The nurse group was team leaders, not the nurse caring for the patient. We wanted the family consultants to do some of the check ins to see if they received different information but they were unable to participate at this time due to previous commitments.
15 Sam Kees, Bon Secours St Mary’s IMCU: – What did you test? – Measuring inclusion of patient identified goal in rounds, currently Monday - Friday. – What did you learn? – Over the two weeks, this was accomplished for 43% of the patients included, and staff are becoming more comfortable addressing with patients and sharing this information in rounds with others. – What is your next test? Continue practice with goal of increasing to all patients’ goals being – identified and share
16 Sam Kees, Bon Secours St Mary’s CVSU: – What did you test? – Moved to holding rounds are larger number of patients at the bedside and including patient/family identified need or goal for the day in discussion (specific percentage not available at this time). – What did you learn? – Staff becoming more comfortable in supporting and discussing with patients/families their identified needs/goals, and are sharing these further with others. – What is your next test? – Continue to support staff in skills and comfort with bedside rounding and increase number of patients/families included.
17 Sam Kees, Bon Secours St Mary’s 5 East: – What did you test? – Measuring the percentage of patients discharged as anticipated (“predicted/pending”) with SLIDR rounds. – What did you learn? – During the trial days with selected patients, 100% of patients completed or met their discharge day as recognized and addressed during rounds, therefore supporting and reinforcing the benefit and use of SLIDR rounds. – What is your next test? – Expand the application with more patients and monitor for changes in overall patients’ length of stay on unit.
18 Guest Speaker Virginia Mason
19 Shirley Sherman – Virginia Mason Shirley Sherman, RN, MN, CCRN has been at Virginia Mason since 1983 in Critical Care starting as a staff RN and advanced to Clinical Director of Critical Care. Her passion and focus is quality improvement engaging staff to improve the patient family experience. She has been involved with IHI for the last ten years and looks to the organization for inspiration and vision.
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Our unit 28 bed Adult Medical Surgical Hybrid “open” unit Teaching Hospital-interns/residents Two Intensivists on days/One Intensivists on nocs Surgical Providers Hospitalists
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From there to here…… Focused on: Complex patient and family Champion MD Engaged staff willing to participate 24
“Perceived Barriers” mostly from physicians Family will interrupt and lengthen the rounds Family will not understand medical terms, become frightened leading to unnecessary increased anxiety Family will be critical of team particularly in teaching hospitals and increase the likelihood of malpractice suit HIPAA violation 25
What have successful teams done to include families at MDRs? Know local culture (barriers) Identify clinician champions (MD and RN) Test on a small scale: Learn from tests Expand test if successful Redesign if not Provide structure/scripts/ expectations for all Communicate, communicate, communicate Do not fear failure 26
Prepare staff to be “on stage” standard work Prepare rounding team to have families listen to dialogue Script for families to ascent to the process Introduce the team and purpose of MDRS to patient and family (ask patient permission first) I’ve not taken care of this patient before, I have no idea what’s going on.” This does NOT work well with families Standardize process with explicit roles for each team member Implement standard content and sequence Ask patient/family if they have questions (1 or 2) Summarize daily goals for patient/family Schedule time to meet with family if more time is needed 27
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