Unit July # Days since Last Fall 3B 4 6 4AM 0 39 4AR 1 11 4B 0 24 5A 2 1 5B 2 2 6A 4 2 6B 7 3 ICU 0 316 IMC 0 64 ED 2 5 Total IP Units 20 1 Total Hospital 22 1 Other visitor 5 as of 7/22/2012 SF
ALARMS Alarms are an important means for notifying me when a patient is attempting to get OOB without calling for assistance If the patient is identified as needing a bed alarm then I will also need a chair alarm. Chair alarm pads are located in the central supply carts on each unit. The alarm unit will need to be obtained from SPD. I will engage bed alarms at night on all patients to ensure they are safe and I know I can’t be every where.
THINKING ON MY FEET I will never leave a patient alone in the bathroom if they are at risk for falling.(54%) I will never leave a patient to dangle on the side of the bed.( 6 falls in Dec) They will sit in a chair or lay in bed. I will answer call lights in a timely fashion even when they are not mine to ensure patients are toileted safely.
MY ROOMS WILL BE SAFE AND FREE FROM CLUTTER
I WILL EDUCATE MY PATIENTS To never get up without help To always call me its never a bother “I want to help you” Why they are at risk for falling What can happen if they fall: Injuries that will extend their stay, lacerations(5)surgery(6), fractures(6), Deaths(1) etc.
NO SUCH THING AS A LITTLE CONFUSED If a patient has intermittent confusion ”They were fine for me "I will engage all fall prevention measures. Patients that are intermittently confused have a higher risk for falls and injury.
I AGREE : To follow all fall prevention measures. To educate my patients about fall prevention To inform my coworkers when I have a patient at risk for falling To support St Margaret's in all fall risk initiatives in the future.
INPATIENT SUMMARY CAN BE FOUND ON THE LEFT SIDE OF THE PATIENT CHART UNDER MENU. LOOK FOR “INPATIENT SUMMARY” FOR A QUICK REFERENCE TO THE PATIENT’S VISIT
As of 6/27, the Weight Bearing Status order will have a required field . The required field is for the actual Weight Bearing Status and is a multi-select field. Figure 1: Weight Bearing Status Required Field Figure 1: Weight Bearing Status Required Field
Communication Type The new communication type, PowerPlan Initiate , is live as of 6/27, Figure 2. This new communication type will prevent orders from going to a provider’s inbox for co -signature and will also give nursing an option that is more appropriate to use when PowerPlans are initiated. Figure 2: PowerPlan Initiate Communication Type
HCAHPS Inpatient UPMC St. Margaret CAHPS Apr '12 May '12 Jun '12 Jul '12 Top Box Top Box Top Box Top Box Rate hospital 0-10 61.4 ▼ 65.8 ▲ 66.3 ▲ 61.9 ▼ Recommend the hospital 69.9 ▼ 72.4 ▲ 68.1 ▼ 69.1 ▲ Cleanliness of hospital environment 55.5 ▼ 53.9 ▼ 60.3 ▲ 59.4 ▼ Quietness of hospital environment 36.0 ▼ 45.9 ▲ 36.5 ▼ 45.8 ▲ Comm w/ Nurses 72.9 ▼ 74.1 ▲ 75.4 ▲ 74.4 ▼ Response of Hosp Staff 52.9 ▼ 54.0 ▲ 52.1 ▼ 60.1 ▲ Comm w/ Doctors 75.8 ▼ 80.6 ▲ 79.8 ▼ 78.7 ▼ Hospital Environment 45.8 ▼ 49.9 ▲ 48.4 ▼ 52.6 ▲ Pain Management 69.6 ▲ 70.6 ▲ 69.9 ▼ 69.3 ▼ Comm About Medicines 58.8 ▼ 61.6 ▲ 58.6 ▼ 54.8 ▼ Discharge Information 89.9 ▲ 88.1 ▼ 86.5 ▼ 87.9 ▲ Displayed by Received Date
Converti ting ng to a No Pull Un Unit 5% Not satisfied 40% Satisfied Very Satisfied 55% Not satisfied 5 Satisfied 39 Very Satisfied 56
Not ot Having g to Worry y Abo About Staffing ng Issue ues 19% 41% Not satisfied ot satisfied Satisfied Satis fied Very ery Sat Satis isfied fied 40% Not satisfied 19 Satisfied 40 Very Satisfied 41
Not ot Having g to Worry y Abo About Being Pulled d to an Area I am am Not Not Familiar ar With th 4% 21% Not satisfied ot satisfied Sat Satisfie isfied Very ery Sat Satis isfied fied 75% Not satisfied 4 Satisfied 21 Very Satisfied 75
Having ng Our Own Staff f Care for Pat Patients nts 3% 34% Not satisfied ot satisfied Satisfie Sat isfied Very ery Sat Satis isfied fied 63% Not satisfied 3 Satisfied 34 Very Satisfied 63
Nurse Talk RIC Expanded Duties Readmissions UPMC East Zuma Lifts
NURSETALK
RIC Duties 1. Code Relief A. ICU nurse will remain the primary code responder. RIC nurse will relieve the ICU nurse or maintain the ICU nurse’s patient assignment during the code. B. Monitor patient and transfer to designated unit or remain with the patient until a bed becomes available. 2. Open and staff 1A Nursing Unit 3. Respond to Condition L and Condition M 4. Transport/monitor critically ill patients/maintain pt while off unit A. CT Scan, MRI, Radiology, ect. 1. RIC may relief RN to go with patient who is unstable, RIC nurse will stay on unit and perform patient care to nurse’s second patient. 5. Floor Rounds A. Assist with patient care Post-ops, unstable patients, new admissions, transfers
RIC Duties Continued: 2. Assist admission team with admissions during periods of down time. 3. Monitor patient that require transfer to higher level of care until a bed is available. 4. Hourly rounding on units to assist with care — answering lights, starting IV’s, taking vital signs, etc. when not busy. 5. Other activities as coordinated through the Clinical Coordinator/ICU Unit Director 6. Assist with transfers from PACU/ED 7. Review all Flex Monitor patients for appropriateness every morning and evening and report to resource nurse/clinical coordinator. 8. Attend monthly House Staff Coverage Meetings 9. Attend Daily Throughput meeting. 10. Administration of Lopressor 11. Involvement in QA activities (handwashing audits, bed alarm audits, purposeful rounding, safety rounding, etc). Low Census guidelines: In the event low census would occur, the RIC nurse will be utilized in the IMCU, ICU, 3B. The RIC nurse may also provide support to the ED without a patient assignment or may act as an Admission Team nurse.
WHY READMISSIONS? 17.6% of Medicare admissions resulted in readmissions within 30 days 2007 MedPac Report to Congress $15B in spending $12B for potentially preventable readmissions 1 in 5 Medicare patients readmitted within 30 days NEJM Jenacks 2009 50.2% of patients readmitted had no physician visit Article between discharge and readmission (Jencks, Williams, & Coleman, 2009) 1 in 10 non-obstetric Medicaid patients (age 21-64) AHRQ 2010 Report hospitalized in 2007 for medical condition had at least (Jang & Wier, 2010) one readmission within 30 days
FAILING TO PROVIDE COMPLETE DISCHARGE INSTRUCTIONS Percent Heart Failure Patients Discharged With Incomplete or Missing Discharge Instructions Joint Commission and Heart Failure Registry Databases 70-80%
FAILING TO CLOSE THE KNOWLEDGE GAP Percent of Medical Information Percent of Medical Information Incorrectly Understood by Adult Learners Forgotten Immediately by Adult Learners Ambulatory Clinic 51% 40-80%
ACKNOWLEDGING OUR PROGRESS IN PATIENT EDUCATION Model Description Sample Questions • Which foods should you avoid? Teach-Back Nurse educates patient, asks • What signs and symptoms should you patient to restate in their own words what they have learned report to your doctor? • How do you take your water pill? Demonstrate Nurse educates patient, asks • How do you weigh yourself? Back patient to demonstrate practical application of lesson • What is my main problem? Ask me Patients encouraged to ask • What do I need to do? Three three basic questions to better • Why is it important for me to do this? understand their disease • What do you think about your smoking Motivational Nurse asks open-ended Interviewing questions, provides affirmation, habit? • Has eating salty foods every caused you and listens; goal to incrementally address patient’s problems before? • What might work for you if you decided motivation for self-care behaviors to change?
IDENTIFYING THE PRIMARY CAREGIVER AT HOME Three Questions for Assessing the Key Learner 1. Who assists you with Questions gather information about patient’s home behaviors your medication at home? Key learner prominently 2. Who accompanies identified on patient’s white you to doctor board for full care team visibility appointments? 3. Who should be present to listen to Education materials customized your discharge to match key learner’s learning instructions? style Case in Brief: Lehigh Valley Health Network • Three-hospital, 951-bed health system headquartered in Allentown, Pennsylvania • Hospital assesses patients’ home habits to identify who, besides the patient, should be taught disease management skills • Key learner engaged by full inpatient care team during discharge planning and patient education
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