Transcript Patient & Family- Centered Care:

Patients, Parents and Providers :
Partnering to Provide
High Quality Care
Objectives
• Define patient and family engagement, and
• Discuss effective strategies to involve patients
and families in patient safety and quality
improvement efforts
Lev.
PFCC: A Definition.
Patient-and Family-centered care (PFCC) places
emphasis on mutually beneficial partnerships
between patients, families and healthcare
professionals. It acknowledges that families,
however they are defined, are essential to
patients’ health and well-being and are allies for
quality and safety within the health care system.
--Institute for Patient-and Family-Centered Care (2003)
Philosophy of Care:
• The family is the most important and constant
factor in the patient’s life.
• A collaborative relationship with patients &
family members fosters communication and
empowers active involvement in the care
team.
• Informed and engaged patients and family
members are allies in quality and safety.
A Closer Look:
Core Concepts of
PFCC
Core Concepts of
PFCC
• Respect and dignity
• Information sharing
• Participation
• Collaboration
Respect & Dignity
• We, as practitioners, listen to and honor
patient and family perspectives and
choices.
• Patient and family knowledge, values,
beliefs and cultural backgrounds are
incorporated into the planning and
delivery of care.
Respect & Dignity In Practice:
Interpreter Services
• PFCC includes meeting the communication needs of
our patients and families in their chosen language.
• Language Services provides several options for
interpretation and translation to Limited English
Proficient (LEP) patients and families; ensures that all
information given by the medical staff is conveyed in
a language the patient and family understand.
Information Sharing
• Practitioners communicate and share
complete and unbiased information with
patients and families in ways that are
affirming and useful.
• Patients and families receive timely,
complete, and accurate information in order
to effectively participate in care and decisionmaking.
Information Sharing:
Best practices at DCMC
Partnering with families in:
• Interdisciplinary Rounds at the bedside
• Bedside Nursing Report at change-of-shift
• Interdisciplinary Care Conferences
• Use of standardized “Care Boards” in
patient rooms
Project – Care Boards
• Surveys showed parents and
caregivers were confused by
names & roles of care team
members.
• Multidisciplinary team including
staff nurses, educators,
physicians, child life & a parent
created initial template for
standardized Care Board.
• Draft of board presented to
Family Advisory Council for
feedback and edits.
• Education created for staff with
family centered scripting with
each segment of the board
explained.
Care Boards - Outcomes
• After Care board implementation on 4 Central
and 3 Central, surveys showed steady, gradual
increase in score for low-scoring question
“Knew Who Was In Charge of Care”
• Based on NRC Picker survey results, the
percentage of families likely to recommend
Dell Children’s (Inpatient Net Promoter score)
increased from 77.29 to 82.32 in 13 months
NICUs: PFCC - The Journey
Families as Partners
Families as Visitors
Parents were considered
visitors & were required
to sign in to enter the
NICUs.
Only siblings over 3 years
of age were allowed in
the NICUs
Only 2 people were
allowed at each baby’s
bedside.
Parents were not allowed
to visit during physician
rounds, multi-disciplinary
rounds or shift changes.
NICUs were routinely
closed for admissions, all
types of procedures and
surgeries.
PFCC
Steps
NICU sent 2 Medical Directors, 4
Managers, 1 Vice President and 1
Nurse to the Institute for
Family Centered Care Seminar
Parent panels became a
routine part of staff education.
All NICU staff committed to
attend 2 Family Centered Care
offerings as part of their goals
during Performance Reviews.
Network Family Centered Care
Committee was formed —
including parents—for all 6
NICUs.
Parents are welcome 24 hours a day at
DCMC. At the other sites, parents may be
present at all times other than shift change.
Parents are part of the care team at all sites
& no longer sign in to spend time with baby.
The age limit was eliminated and other
restrictions on sibling visitation were relaxed.
The appropriate number of family & visitors
at each bedside may vary based on the
status of the infant (and other infants), and
the number of visitors in each bay.
Parents are welcomed and encouraged to
participate in physician rounds and
multidisciplinary rounds.
Parents may choose be present for routine
procedures (i.e., blood draws, IV insertion, etc.)
Parents may also choose to be present for
serious life-threatening events including
resuscitations.
The Family Care Conference:
A Critical
Communication Tool
Why Care Conferences?
Medical Team share
clinical information,
medical guidance
Family shares
perspective, values &
goals, observations,
questions with clinicians
and practitioners
Psychosocial practitioners
share information with and
provide support to
clinicians and family,
Common Triggers
for Family Care Conferences
• Change in status/goals of care
• Clarify/articulate goals
• Conflict
– Between team and family
– Among family
– Among team
• Multiple services/subspecialists
• Moral Distress in staff
• Prolonged hospital stay
• Complex chronic illness,
multiple admissions
Participation
• Patients and families are empowered and
supported to participate in care and decisionmaking at the level they choose.
• Patients and family members build on their
strengths by participating in experiences that
enhance confidence and independence.
FCC Case Study UMCB NICU ‘Tub Club’
•
The NICU at UCMB started the Tub Club to empower parents to participate
independently in the care of their infant. Parents learn how to bathe their baby and
where to get the supplies for baths. Babies have a yellow rubber duck placed at their
bedside when their parent has been educated on bathing and is ready to bathe their
baby independently.
•How?: The baby’s nurse (or a trained volunteer) teaches the parents how to give their
infant a bath, put monitors on standby, reattach pulse-ox. Tub Club supplies – including
bathtubs - are on shelves where parents can easily access them.
•Rubber Ducky!: Once the nurse assesses and documents that the parents can bathe
their infant without the nurse’s assistance, a rubber ducky is placed at the head of the
crib indicating that the parents have joined the Tub Club.
Culture Shift
System-Centered Care
 Families as visitors
 Paternalistic
 Focus on family
deficits
 Rigidity
 Rules
 Gate-keeping
PFCC
 Patients as partners
 Empowering
 Focus on family
strengths
 Flexibility
 Guidelines
 Transparency
PFCC:
Decision-making
System or
health care
provider
centered
e.g., decisions are
based primarily on
system or staff
priorities.
Patient or
family focused
e.g., decisions are
made by staff based
primarily on their
perceptions of family
needs or priorities.
Patient and
family
centered
e.g., decisions are
made collaboratively
by staff and patients/
families.
Words to Live By
 Visiting
 Welcoming or “family
 Rules
 Guidelines
 Allowed
 Welcomed or encouraged
 Inform
 Communicate
 Discharge
 Going Home
presence”
National Best Practices:
• Patients and families as advisors/faculty; Family
advisors on staff
• Active patient/family participation in decision
making (facility design, policies), etc.
• Practice standards (e.g., parental presence during
anesthesia induction, resuscitation)
• Family activated rapid-response teams
Staff who Practice
PFCC…
• Acknowledge that the word “family” can be defined in many
ways.
• Actively incorporate into their practice a respect for patients
and families as individuals with their own traditions, beliefs,
and value systems.
• Acknowledge the expertise of patients and families.
• Explicitly encourage patients’ and families’ participation in
health care decision-making.
• Encourage patients and families to share their observations,
ideas, and suggestions for the plan of care.
Staff who Practice
PFCC…
• Empower families to contribute their
expertise to the healthcare team
• Introduce themselves; knock before entering
patient rooms
• Call patients and family members by the name
they prefer.
Collaboration
Patients, families, practitioners, and health
care leaders collaborate in the ongoing
design, development & implementation of:
•
•
•
•
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Policies and Programs
Healing Environments
Process Improvement
Professional Education
Delivery of Care & Services
Food for Thought…
“Family-Centered
Care is a mind set,
not a skill set.”
-- Christine Low, LCSW
Patient & Family Centered Care Coordinator,
The Mount Sinai Kravis Children's Hospital