Transcript Maximizing Positive Patient Outcomes through the Care

Maximizing Positive Patient
Outcomes through the Care
Improvement Team:
A Partnership with Patients and
Staff
Martie Carnie, AS, PFAC
Colleen Zidik, BSN, MBA, RN
Debra Moody, BSN, RN
Carolyn Hayes, PH.D, RN
In the Beginning:
Changing the Culture
1997: Joint Venture BWH & DFCI
Informational Town Meeting
 Active Work Group
Affiliation with IFCC
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Changing the Culture:
Evolution of Glitch Rounds
 DFCI Inpatient beds moved to BWH
– Each patient had a personal escort/advocate
– Informal rounding of Patients with Patients
 Issues uncovered with informal rounds:
Clinical
Environmental
Personnel
Communication
Educational
Glitch Rounds:
The Early Days
 Glitch Committee formalized by Inpatient
Leaders (MD, RN, QI) with Patient
Rounders
– Informal weekly meetings
– Members identified
– Active problem solving
Quick and easy fixes
Multidisciplinary solutions
Sticky situations
Glitch Rounds:
The Picker Effect
 QI reports influenced and prioritized the
focus of the work
– Clinical Issue of Emergent Admissions:
Need to bypass emergency room visits
Neutropenic Pathway
Algorithms trialed
– Educational Issues: Need to follow up
with patients at home
Day after Discharge Calls
Glitch Rounds: Initiation of
Day after Discharge Calls
 Brainstorm of Picker questions
– What do the poor scores mean?
– Need more information from the patient
perspective
– New Questionnaire developed using staff and
patient input (used in addition to the Picker
Survey)
Staff RN on “light duty” conducted calls
 Partners in Excellence Award in 2000
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Glitch Rounds:
The Accolades
 Partners in Excellence Award in 1998
 Patient Advocate participation in Joint
Commission Accreditation visit
 Patient Advocates as a resource
 Formalized into Care Improvement Team of
today, continuing the partnership with
patients and staff
Glitch Rounds: Transition to
the Care Improvement Team
 Membership has tripled since original
Glitch rounds
– Directors (MD, RN)
– Patients
– Staff at all levels & all disciplines
 Meetings are monthly
 Invited Guests to address current
concerns
Care Improvement Team:
Day after Discharge Calls
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Resource for calls was lost in 2002/2003
Gradual reduction in calls without resource
CIT Prioritized follow up calls in 2005
Staff RNs and Care Coordination RNs
conduct follow up phone calls
Staff concern the call is an “intrusion”
Issues Identified in Follow
up Phone Calls
Medication Questions
13.95%
2.33%
Prescription Question
18.60%
Activity
Physical Issues
11.63%
Services
Follow up
41.86%
11.63%
Press-Ganey Discharge Scores
100
90
80
70
60
Jul-Sep 05
50
Oct-Dec 05
40
30
Jan-Mar 06
20
10
0
Instructions care at home
Explain take medicine
Instructions re:resume
Inform danger signs watch
after discharge*
activities*
out for*
Formation of Discharge
Education Action Team
First meeting was April ’06
 Discussed previous initiatives trialed
 Quality data presented to the team
 Reinforced our focus on patient education and
improving patients’ transition from hospital to
home
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Discharge Education Action
Team
Team hypothesized Bone Marrow
Transplant scores would be better than
Oncology scores
 Follow up analysis of Press-Ganey Scores
confirm hypothesis
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Discharge Education Action
Team in Action
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Summer & Fall of 2006: Created “Going
Home: A Discharge Guide”
Expanded team to include MD, PA, PT, OT,
RD, SW, CC and Summer College Student
Ensured reading level at 8th grade
Debate about “Danger Signs”
Patient Education specialists worked on
patient friendly format and design
Created patient survey regarding education
needs
Discharge Teaching Pilot Plan
Survey patients 24-48 hours before DC
 Learning needs will be shared with RN
 Oncology Admissions on 5AB will receive a
copy of the “Going Home: A Discharge
Guide” and “A Handbook for patients,
families, and friends”
 Discharge checklist, supplemental patient
education “library”, and pre-printed plan of
care trialed
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Say Cheese!
Pre-Pilot Survey Results:
Educational Needs
54%
46%
46%
38%
23%
Sexual Activity
Activity and Exercise
Symptom Management
Medication
Danger Signs
Pilot Survey Results:
Educational Needs
25%
25%
25%
25%
Nutrition
Activity and Exercise
Symptom Management
What to Expect
Post-Discharge:
Patient Feedback
5 Post Discharge Surveys were conducted
 No Changes recommended to the booklet
 Impact on Patient’s Wife
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Evaluation of Pilot
Delay in starting the trial
JCAHO visit in mid-January
Began as a trial with a small supply of
“Going Home Guide”
Additional tools were not utilized in
pilot
Monthly Press-Ganey Results:
November through February
100
90
80
70
60
50
40
JJ
30
20
10
0
Instructions care at home
Instructions re:resume activities*
Inform danger signs watch out for*
Outcome:
What did the data tell us?
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Focus on Process! The “Going Home Guide”
alone did not impact survey results!
And next, what life was like before, during,
and after the pilot --- nurse and patient
perspective!
Pre-Pilot Environment
Two Pilot Units, Each have
– 12 Beds
– Primary Nursing Model
– Patient Population is Cancer Focused
Hematologic (i.e.: leukemia) and solid tumor
Intensive chemotherapy and research
protocols
Pre-Pilot Environment
Intense Teaching Needs
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Medication
Line care
Mouth care & personal hygiene
Safety needs/precautions
Activity
Diet/nutrition
Lab values
Pre-Pilot Environment
Varied sources of information
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Experience
Hospital guidelines
Other discipline expertise
Blum Resource Center
Pre-Pilot Environment
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Follow up phone call discoveries
– Reveal misinterpretation of information
– Find patients received conflicting information
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Began work on a discharge booklet
– Work put on hold in 2004
– Care Improvement Team prioritized this work
again in 2006 through Action Team work
Impact of the
“Going Home Guide”
No longer need to gather up varied
pamphlets to teach patients
 Guide has necessary information to be
taught in a logical sequence
 Every discipline can now teach from the
same “page”
 “Notes” section within the guide allow
“individualization” of the teaching tool
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Impact of the
“Going Home Guide”
Novice RNs and Float RNs benefit from
reading the guide
 Frustration when “Guide” is not available
 Positive responses from patients and
families
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Next Steps:
RNs will use the before discharge survey
for all patients & keep in bedside book.
 All disciplines can update “survey” to
document teaching & patient understanding
 All disciplines will use the “Going Home
Guide” to teach the patient
 Develop action plan for Patient Education
DVDs
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Success in My Eyes
-Martie Carnie
Thank you to:
Care Improvement Team:
Directors: Ted Alyea, MD; Carolyn Hayes, Ph.D RN
Members: Ann Hristov, PFAC; Martie Carnie, PFAC;
Judie Ham, PFAC; Joe Nies, PFAC; Cynthia Jodoin, RN;
Eileen Molina, RN; Ruth Muller, RN; Kerry Mahar, RN;
Escel Stanghellini, RN; Andres Sirulnik, MD; Kendra
Church, PA; Elizabeth Binari, RN; Ann Collins, RM; Deb
Duncombe, RM; Mrinalini Gadkari, QI; Mary Lou
Hacket, LISCW; Maggie Hewit, PFR; Meri Donlan, PT;
Deborah Hoffman, LICSW; Michael Hubner, LICSW;
Jennifer Kales, RN; Christine Sousou,PT; Lynne
Simonelli, RN; Colleen Zidik, RN
Thank you to:
Discharge Education Action Team:
Members: Ann Hristov, PFAC; Martie Carnie, PFAC; Patti
Smith-Allen, RN; Debra Moody, RN; Susan McDonald,
RN; Eileen Kelly, RN; Dianne Griffin, RN; Susan Bolton,
RN; Pamela Thomas, RN; Soheir Elebiary, RN; Joan
Deary, RN; Katie Filipon, RN; Ruth Muller, RN; Ann
LaCasce, MD; Andres Sirulnik, MD; Heather Hylton, PA;
Sara Dorfmier, PA: Mrinalini Gadkari, QI; Meghan
Cunningham, RD; Cara Dejong, RD; Nicole Varady, RD;
Bruce MacDonald, LICSW; Kim Peterson, LICSW;
Patricia Dwyer, LICSW; Mary Lou Hacket, LICSW; Meri
Donlan, PT; Christine Sousou,PT; Carol Ann Orrico, RN;
Ann Furey, RN; Danielle Sullivan, Program Assistant;
Susan Decristofaro, RN; Tamara Sobers, Student;
Colleen Zidik, RN
Thank you to:
Nursing Staff on 5AB: Lela Tatarouns, Christine
Leonard, Laura Allaire, Kathleen Slack, Debra Moody,
Patti Smith-Allen, Dianne Griffin, Eileen Kelly, Nancy
Murphy, Katie Fiel, Ana Velez, Suzanne Badavas, Mary
Chinian, Suzanne Corsetti, Paula Digiovine, Kerri Flynn,
Colm Gormley, Elizabeth Halloran, Yi Jin, Kristen Kane,
Susan Kenney, Allison Konefal, Karen Legere, Kathleen
McCarthy, Barbara Mullins, Lisa Olivo, Maria Raleigh,
Kay Sweeney, Jennifer Wright, Doreen Bannon, Gina
Coniglio, Maureen Conley-Rogazzo, Christine Cox, Sheryl
Fernandez, Nancy Green, Kim Irwin, Danielle Johnson,
Teresa Queally-Hanley, Jean Quinn, Marianne Saleda,
Tracey Slaven, Karen Valliere, Angela Whitter
Secretarial Support: Derlin Ryner, Maureen
Mohansingh, Leah Pearlman;