Transcript Management of Discharge Home Process of Preterm Infants

Management of Discharge Home
Process of Preterm Infants
Using the Gantt Chart
Department of Neonatology
Soroka Medical Center
Beer Sheva, Israel
In intensive care period
Parents in neonatal intensive care unit are in need of :
- Full and clear information on their baby’s condition.
- Support in coping with stress.
- Overcome uncertainty.
- Social support.
- Sense of involvement.
- Parent – child attachment
development.
Discharge home of a preterm infant
• The discharge home process is complex, involving
multidisciplinary team at different stages of the
process.
• Needs an organized, well implemented discharge
plan.
• Might be managed as a project, using project
management tools like the Gantt chart.
w rde in fast jeden Staat der USA
Israel
passen! Israel )mal in die USA (Alaska & Hawaii inklusive 768 Israel w rde passen! Das winzige
Die USA ist ein Land welches von friedlichen Nachbarn umgeben !w rde 7 mal in Florida passen
The Health Care System
of The State of Israel
• Population 7.000.000
– 5.300.000 of them are Jews.
• Health expenditure = 8.4% of GNP.
• National Health Insurance (since 1995).
• Free antenatal and postnatal care to
mothers and babies.
• A general hospital of 1000 beds.
• Serves the southern (desert) part of the country.
(60% of the country’s area).
• Provides services to a population of 500.000
(900.000 with referrals).
• The main teaching hospital of the Ben-Gurion
University Health Sciences Center.
• In the process of accreditation by the JCI.
Department of Neonatology
at the Soroka Medical Center
• A level III unit.
• 24 beds NICU
+34 beds SCU+Convalescence.
• 12.500 births per year.
– 55% of them are Bedouins.
– 150 VLBW babies (under 1500 gm BW).
• 2.000 admissions per year:
– 500 to NICU + 1500 to SCU.
Department of Neonatology
and the Family Centered Care ideas
• Associated in the WHO “Baby Friendly
Hospital” initiative.
• Parents are present in rounds.
• Medical records are accessible to
parents at bedside.
Accredited by ISO9001.
The Bedouin population
• A community in transition from
nomadic to urban life style.
• 27% of the population in the Negev
area but 55% of newborn infants.
• High fertility rate (average no. of
children per mother=7)
• High incidence of consanguinity.
• High incidence of congenital anomalies.
• High incidence of polygamy.
The Gantt Chart
A Gantt chart is a popular type of bar chart
that illustrates a project schedule. Gantt
charts illustrate the start and finish dates of
the terminal elements and summary elements
of a project. Terminal elements and summary
elements comprise the work breakdown
structure of the project.
Wikipedia
Create a Gantt chart by Microsoft Excel:
http://office.microsoft.com/en-us/excel/HA010346051033.aspx
Soroka Medical Center
‫מ‬
Department of Neonatology
ID Label
Discharge Home Plan
Beginning Date
15/08/2006
DATE 15/8 16/8 17/8 18/8 19/8 20/8
TASK LIST
WEEKDAY
1 Body weight >1500 gms: the baby is discharged from ICU
Tue Wed Thur
2 Parents informed on baby’s transfer to SCN
1
2
3 Parents get discharge plan and a tour to SCN
1
2
4 Writing discharge summary from ICU
1
2
5 Complete physical exam and meeting with the Neonatologist
1
2
6 Written summary by the social worker
1
2
Fri
Sat
3
7 Transfer from the incubator to a warming crib
21/8
Sun Mon
22/8
Tue
23/8
24/8
Wed Thur
25/8
26/8
27/8
28/8
29/8
Fri
Sat
Sun
Mon
Tue
30/8
31/8
Wed Thur
1/9
Fri
2/9
Sat
3/9
Sun
4/9
Mon
5/9
Tue
6/9
Wed
4
1
2
8 Completion of laboratory tests
1
2
3
4
5
6
7
9 Parents instructed in bathing, feeding and wearing the baby
1
2
3
4
5
6
7
1
2
3
4
2
3
4
5
10 Design a personal breast-feeding program
11 Preparing home: buying clothing, baby’s crib etc
1
12 Transfer to regular baby’s crib
6
7
8
9
1
13 Instruct parents on safety measures at home
1
2
14 CPR instruction
1
2
3
15 Prescriptions for vitamins, food additives and drugs
1
2
3
16 Telling parents the expected date of discharge home
1
17 Inform the community health services on coming discharge./home visit
1
2
3
18 Purchasing medical equipments (if needed) for home use
1
2
3
19 Completing information in discharge summary
1
2
20 Completing immunizations according to MOH regulations
1
2
4
21 Completing and signing discharge summary
22 Day of discharge home
Estimated Weight
Estimated date of Discharge
1
6/9
1500
1600
6 September 2006
1700
1800
1900
2000
Soroka Medical Center
‫מ‬
Department of Neonatology
ID Label
Discharge Home Plan
Beginning Date
15/08/2006
DATE 15/8 16/8 17/8 18/8 19/8 20/8
TASK LIST
WEEKDAY
1 Body weight >1500 gms: the baby is discharged from ICU
Tue Wed Thur
2 Parents informed on baby’s transfer to SCN
1
2
3 Parents get discharge plan and a tour to SCN
1
2
4 Writing discharge summary from ICU
1
2
5 Complete physical exam and meeting with the Neonatologist
1
2
6 Written summary by the social worker
1
2
Fri
Sat
3
7 Transfer from the incubator to a warming crib
21/8
Sun Mon
22/8
Tue
23/8
24/8
Wed Thur
25/8
26/8
27/8
28/8
29/8
Fri
Sat
Sun
Mon
Tue
30/8
31/8
Wed Thur
1/9
Fri
2/9
Sat
3/9
Sun
4/9
Mon
5/9
Tue
6/9
Wed
4
1
2
8 Completion of laboratory tests
1
2
3
4
5
6
7
9 Parents instructed in bathing, feeding and wearing the baby
1
2
3
4
5
6
7
1
2
3
4
2
3
4
5
10 Design a personal breast-feeding program
11 Preparing home: buying clothing, baby’s crib etc
1
12 Transfer to regular baby’s crib
6
7
8
9
1
13 Instruct parents on safety measures at home
1
2
14 CPR instruction
1
2
3
15 Prescriptions for vitamins, food additives and drugs
1
2
3
16 Telling parents the expected date of discharge home
1
17 Inform the community health services on coming discharge./home visit
1
2
3
18 Purchasing medical equipments (if needed) for home use
1
2
3
19 Completing information in discharge summary
1
2
20 Completing immunizations according to MOH regulations
1
2
4
21 Completing and signing discharge summary
22 Day of discharge home
Estimated Weight
Estimated date of Discharge
1
6/9
1500
1600
6 September 2006
1700
1800
1900
2000
Rate of weight gain (by BW groups)
during preparations for discharge home
5.0
< 1,000g
>1,000g
4.5
4.0
3.5
Days
3.0
2.5
2.0
1.5
1.0
0.5
0.0
1500-1600
1600-1700
1700-1800
Weight Gain (gms)
1800-1900
Soroka Medical Center
‫מ‬
Department of Neonatology
ID Label
Discharge Home Plan
Beginning Date
16/08/2006
DATE
TASK LIST
WEEKDAY
1 Body weight >1500 gms: the baby is discharged from ICU
2 Parents informed on baby’s transfer to SCN
3 Parents get discharge plan and a tour to SCN
4 Writing discharge summary from ICU
5 Complete physical exam and meeting with the Neonatologist
6 Written summary by the social worker
7 Transfer from the incubator to a warming crib
8 Completion of laboratory tests
9 Parents instructed in bathing, feeding and wearing the baby
10 Design a personal breast-feeding program
11 Preparing home: buying clothing, baby’s crib etc
12 Transfer to regular baby’s crib
13 Instruct parents on safety measures at home
14 CPR instruction
15 Prescriptions for vitamins, food additives and drugs
16 Telling parents the expected date of discharge home
17 Inform the community health services on coming discharge./home visit
18 Purchasing medical equipments (if needed) for home use
19 Completing information in discharge summary
20 Completing immunizations according to MOH regulations
21 Completing and signing discharge summary
22 Day of discharge home
Estimated Weight
Estimated date of Discharge
16/8 17/8 18/8 19/8 20/8 21/8
Wed Thur
1
2
1
1
1
2
2
2
1
Fri
Sat
2
Sun Mon
3
4
1
22/8
Tue
2
1
1
23/8
24/8
Wed Thur
2
2
3
3
25/8
26/8
27/8
Fri
Sat
Sun
4
4
5
5
1
1500
1600
7 September 2006
1700
Soroka Medical Center
‫מ‬
Department of Neonatology
ID Label
Discharge Home Plan
Beginning Date
16/08/2006
DATE
TASK LIST
WEEKDAY
1 Body weight >1500 gms: the baby is discharged from ICU
16/8 17/8 18/8 19/8 20/8 21/8
Wed Thur
2 Parents informed on baby’s transfer to SCN
1
2
3 Parents get discharge plan and a tour to SCN
1
1
1
2
2
2
1
4 Writing discharge summary from ICU
5 Complete physical exam and meeting with the Neonatologist
6 Written summary by the social worker
7 Transfer from the incubator to a warming crib
8 Completion of laboratory tests
9 Parents instructed in bathing, feeding and wearing the baby
10 Design a personal breast-feeding program
11 Preparing home: buying clothing, baby’s crib etc
12 Transfer to regular baby’s crib
13 Instruct parents on safety measures at home
14 CPR instruction
15 Prescriptions for vitamins, food additives and drugs
16 Telling parents the expected date of discharge home
17 Inform the community health services on coming discharge./home visit
18 Purchasing medical equipments (if needed) for home use
19 Completing information in discharge summary
20 Completing immunizations according to MOH regulations
21 Completing and signing discharge summary
22 Day of discharge home
Estimated Weight
Estimated date of Discharge
Fri
Sat
2
Sun Mon
3
4
1
22/8
Tue
2
1
1
23/8
24/8
Wed Thur
2
2
3
3
25/8
26/8
27/8
Fri
Sat
Sun
4
4
5
5
1
1500
1600
7 September 2006
1700
Soroka Medical Center
‫מ‬
Department of Neonatology
ID Label
Discharge Home Plan
Beginning Date
16/08/2006
DATE
TASK LIST
WEEKDAY
1 Body weight >1500 gms: the baby is discharged from ICU
2 Parents informed on baby’s transfer to SCN
3 Parents get discharge plan and a tour to SCN
4 Writing discharge summary from ICU
5 Complete physical exam and meeting with the Neonatologist
6 Written summary by the social worker
7 Transfer from the incubator to a warming crib
16/8 17/8 18/8 19/8 20/8 21/8
Wed Thur
1
1
1
1
2
2
2
2
1
Fri
Sat
2
8 Completion of laboratory tests
9 Parents instructed in bathing, feeding and clothing the baby
10 Design a personal breast-feeding program
11 Preparing home: buying clothing, baby’s crib etc
12 Transfer to regular baby’s crib
13 Instruct parents on safety measures at home
14 CPR instruction
15 Prescriptions for vitamins, food additives and drugs
16 Telling parents the expected date of discharge home
17 Inform the community health services on coming discharge./home visit
18 Purchasing medical equipments (if needed) for home use
19 Completing information in discharge summary
20 Completing immunizations according to MOH regulations
21 Completing and signing discharge summary
22 Day of discharge home
Estimated Weight
Estimated date of Discharge
Sun Mon
3
4
1
22/8
Tue
23/8
24/8
Wed Thur
25/8
26/8
27/8
28/8
29/8
30/8
Fri
Sat
Sun
Mon
Tue
Wed
2
1
2
3
4
5
6
7
1
2
3
4
5
6
1
2
7
2
3
1
1500
1600
7 September 2006
1700
3
4
Soroka Medical Center
‫מ‬
Department of Neonatology
ID Label
Discharge Home Plan
16/08/2006
Beginning Date
DATE
1
2
3
4
5
6
7
8
WEEKDAY
TASK LIST
Body weight >1500 gms: the baby is discharged from ICU
Parents informed on baby’s transfer to SCN
Parents get discharge plan and a tour to SCN
Writing discharge summary from ICU
Complete physical exam and meeting with the Neonatologist
Written summary by the social worker
Transfer from the incubator to a warming crib
Completion of laboratory tests
9
10
11
12
13
14
15
Parents instructed in bathing, feeding and wearing the baby
Design a personal breast-feeding program
Preparing home: buying clothing, baby’s crib etc
Transfer to regular baby’s crib
Instruct parents on safety measures at home
CPR instruction
Prescriptions for vitamins, food additives and drugs
16/8 17/8 18/8 19/8 20/8 21/8
Wed Thur
1
1
1
1
2
2
2
2
1
Sat
Fri
2
Sun Mon
3
4
1
22/8
Tue
23/8
24/8
Wed Thur
25/8
26/8
27/8
28/8
29/8
Fri
Sat
Sun
Mon
Tue
2
1
2
3
4
5
6
7
1
2
3
4
5
6
1
2
7
2
3
1
30/8
31/8
Wed Thur
3
4
4
5
1
1
1/9
6
1
1
2
2
16 Telling parents the expected date of discharge home
17
18
19
20
21
22
Inform the community health services on coming discharge./home visit
Purchasing medical equipments (if needed) for home use
Completing information in discharge summary
Completing immunizations according to MOH regulations
Completing and signing discharge summary
Day of discharge home
Estimated Weight
Estimated date of Discharge
1600
1500
7 September 2006
1700
2/9
Sat
Fri
1800
3/9
Sun
7
2
3
3
1
1
1
Gantt Chart for Discharge Plan
• Presented to the family at discharge from ICN.
• Presents stages of discharge plan along a time axis and
related to GA and body weight.
• Allows parents – staff
cooperation.
• Allows parents involvement
which is vital for a
successful discharge process.
Using Gantt Chart allows for:
 Clearly defined discharge criteria.
 Parents control on the process.
 Completion of goals
predetermined to
discharge date.
How much did we succeed
in following the Gantt chart
on time?
Data collection
 Between December 2006- June 2007
 Gantt charts of preterm infants 34 weeks
GA and 1500 gm. birth weight.
 Hospitalization for at least 3 weeks after
intensive care.
 Total number of 39 preterm infants.
Preterm Population
20
15
10
5
0
24W26W
26.1W28W
28.130W
30.1W- 32.1W32W
34W
Gestational Age
Distribution by Birth Weight and GA
gram
1600
1400
1200
1000
800
600
400
200
0
1144
1386
1420
30.132W
32.134W
1017
660
24-26W 26.128W
28.130W
Gestional Age
1800
BW and weight when discharge plan started
1600
1400
1200
1000
gram
800
600
400
200
0
24-26w
26.1-28W
birth weight
28.1-30W
30.1-32W
Gantt chart starting weight
32.1-34W
Goals completed on time
100
90
80
70
60
%
50
40
30
20
10
0
Parents informed on Discharge summary
discharge from ICN
Physical exams
% Goals completed on time
100
%
80
60
40
20
0
24-26w 26.1-28W 28.1-30W 30.1-32W 32.1-34W
GESTATIONAL AGE
CPR
PARENTS' TEACHING
CONNECTION WITH COMMUNITY
Difference (in days) between
Actual vs Planned Discharge Dates
(min/max and average)
30
DAYS
20
10
0
1
2
24-26
26.1-28
3
4
5
-10
-20
28.1-30
G A (WKS)
30.1-32
32-34
Summary
•
Parents involvement is vital for a successful discharge
home process of preterm infants.
•
The Gantt chart helps inform parents of stages of
discharge plan.
•
The Gantt charge allows:
- Parents and staff monitoring of stages of the discharge
process.
- Parent empowerment in active care.
- Parents partnership in the process.
- Parents control on discharge activities
Summary
• Many other treatment processes in the
medical establishment which are well
defined in their sequence of time and
events can be looked upon as “Projects”
and use a Gantt chart in their
management.
Discharge home team
Rina Marcu RN, MPH.
Hagit Raz RN, MN.
Shoshana Zilber RN, BN.
Osnat Goshen RN, BN.
Ehud Zmora MD, MHA