Transcript An Ongoing Discovery - Institute for Patient

Includes
Pitt County Memorial Hospital
Greenville NC
Brody School of Medicine
East Carolina University
Six community
hospitals in eastern NC
Pitt County Memorial Hospital
Total beds - 761 with CON approval to add 116 more beds
(includes adult floors)
Women’s – 38 beds for postpartum
8 beds for antepartum
Labor & Delivery – 23 beds
New Born Nursery – 42 beds
Convalescent newborn unit – 16 beds
Pediatrics – 32 beds
PICU – 12 beds
NICU – 50 beds
Pitt County Memorial Hospital, is a not-for-profit, tertiary care center
covering the 29 counties of eastern North Carolina and is one of five
academic medical centers in North Carolina. PCMH is the teaching
hospital for Brody School of Medicine at East Carolina University.
Many of our counties are living at or below the poverty level.
The state poverty rate is 12.3 while most of eastern NC is at
15 to 24%.
NC prosperity is threatened by having a region (eastern NC)
that has 10 of the poorest counties of the nation’s
top 20 poorest counties.
NC – 1 in 4 have a college degree
Eastern NC – 1 in 6 has a college degree
Eastern counties are dependent on agriculture and there
are fewer high paying manufacturing job opportunities in
the east.
Common barriers to health care
in eastern NC
Economically underserved
• Medically underserved
• High health care cost
• No insurance or under-insured
• Literacy rate
• Transportation
Measuring the region by years of life lost before
age 75, if eastern North Carolina were a state,
it would rank 49th.
Infant Mortality Rate
NC rate – 8.8 per 1,000 live births
Minority infant mortality rate dropped by 4.5%, from a rate
of 15.6 deaths per 1,000 births in 2004 to 14.9 in 2005.
The minority rate is still more than double the Caucasian rate.
Caucasian mortality rate increased from 6.2 in 2004 to 6.4
Pitt County – 9.4 per 1,000 live births
Bertie County – 17.4 per 1,000 live births
Edgecombe County – 15.3 per 1,000 births
Greene County – 14.9 per 1,000 births
Halifax County – 13.0 per 1,000 births
Lenoir County – 15.5 per 1,000 births
Martin County – 24.6 per 1,000 births
Washington County – 17.5 per 1,000 births
Prematurity and low birth weight accounted for 20% of deaths of
infants under 1 year old.
28% of the deaths of babies were under 28 days old.
17% of infant deaths were due to birth defects.
Sudden Infant Death Syndrome (SIDS) accounted for nearly 10% of
the deaths.
High quality prenatal care cannot compensate for a lifetime of poor
health, for unhealthy behaviors such as smoking, poor nutrition or
poor physical fitness and limited access to ongoing high
quality health care.
NC has a high rate of:
Heart disease
Stroke
Diabetes
Obesity
Other chronic health problems
NC per capita spending for public health is among
the lowest in the nation.
Ways we have implemented
PFCC
Child Life Mission
To provide developmental and emotional
support to children and families facing a
healthcare experience.
Child Life
Areas Serviced
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Pediatric Unit
Pediatric Intensive Care Unit
Neonatal Intensive Care Unit
Sedation Services
Emergency Department
C5 Clinic
Radiology
Convalescent Newborn Nursery
Women’s Services
Consults to adult areas
Child Life
Staffing
• 11 FTE Certified Child Life Specialists
• 1 PT CCLS
• 3 PT Child Life Assistants
• 1 FTE Supervisor
• Volunteers, students
Child Life
Implementing PFCC into Practice
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Family presence during procedures
Positioning for Comfort
Sibling involvement in hospital experience
Patient/Family participation (daily schedules,
interventions, pain, etc.)
• Liaison with communication
• Child advocate in adult areas
Family Support Network Eastern NC, Inc.
Providing emotional support and resource
information for families who have a child with a
disability, chronic illness, premature birth and for
families who have experienced the
death of a child.
Family Support Network Eastern North Carolina
* 1987 – Parent support began in local community 20 hours a week
* 1990 – Parent hired to provide support to other families in
Neo-natal Intensive Care Unit (15 hours a week)
* 1991 – Expanded services to include all of Children’s Hospital
(25 hours a week)
* 1992 – Expanded services to include mom’s on bedrest at risk
for premature delivery (Hired 2nd hospital employee)
* 1994 – Bereavement Support
Family Support Network Eastern North Carolina
* 2007 coverage includes
Children’s (NICU, Peds, PICU, NBN)
Women’s
Trauma (referrals)
Emergency Department (referrals)
Adult floors (consults cardiac, cancer, trauma)
Continuum of Care from Hospital to Home
* 11 employees (parents)
5 - full time
4 - thirty (30) hours a week
2 – less than 20 hours a week
Volunteers and Student Interns
* National Pierson Award Recipient for exemplary
services for children with disabilities.
Pediatric Asthma Program
* 1994 High School senior with a 12 year history of asthma
collapsed after band performance during football
game. Inadequate access to rescue inhaler.
* Pediatric Nurses and parent of student took the message to
officials at the Administrative Office
* Asthma Education and access to medications
mandatory in all Pitt County Schools
* 2006 Recipient of “Emerging Champion of Change in
North Carolina Medicine”
Bereavement Support
* 1994 – Families shared their stories
* 1995 – Our Children’s Garden
Cherished Lives Memorial Service
* 1996 – Quilt of Memories
* 1997 – Memory boxes
* 2007 – Palliative Care Room
C5--The Center for Children with
Complex and Chronic Conditions
The mission of C5 is to promote optimal health,
growth, development, safety, comfort and overall
well-being for children with special health care
needs. Respecting the central role of the family in
a child’s life, C5 provides resources and supports
systems of care that link the child, family, primary
care medical home, appropriate medical
specialists and the community in which
the family lives.
C5--The Center for Children with
Complex and Chronic Conditions
• Started with input from families.
• Involved in development of pre-visit
contact, care plans and satisfaction
survey.
• Patients and families participate in
quality improvement.
C5--The Center for Children with
Complex and Chronic Conditions
• Pre-visit contact---frames visit to address
patient/family concerns, goals (home, school,
transition, activities, etc.)
• Care plan—developed collaboratively
• Satisfaction survey—open, clear communication,
adequate time to discuss concerns and
questions, equal partner, etc.
What kind of directions are given?
We need to hear from our families
to make sure we are going in the
right direction.
Family Involvement
* Family Resource Room (co-chair)
* Cherished Lives Service
* Palliative Care Room
* Visitation - 24/7 open unit to parents in NICU, Peds,
PICU, Newborn nursery
* Hospital PFCC Steering Committee
* Infection Control
* Rehab committees
* Children’s hospital design and remodeling
* Presence during resuscitation (Children’s)
Adult ICU sporadic
* Free parking for bereaved families
* Cardiac Intensive Care
Developing Family Advisory Council
* Hematology/Oncology beginning to incorporate
family input into their practice.
Due to having such a large geographical area and the many variables
to participation we have families serving in the following ways:
• Attending meetings
• Email participation
• Phone calls
• Surveys
• Reading over materials and submitting their comments
Pediatric Intensive Care Unit Sentinel Event
Mom – hospital employee
Dad – police officer
Child – under 1, history of developmental delays muscle
weakness
Admitted to hospital unknown diagnosis
- didn’t want to mask symptoms
- involuntary movements causing loss of lines
- steroids and pain medicines over 2 months
* Infant restraints – new bed and restraints were too
short to tie under mattress, so tied to side rails
* Injury
- wrist broken and not noted until weeks later
* Transparency
- family involved in determining when and
how the wrist was broken
- child had been transferred to another
hospital in another state and back to PCMH
during the two months of being hospitalized
- Dad remembered the restraints
Restraint Company called – no one made infant
restraints long enough for the new type bed.
* Results - changes in infant restraints nationally
- infant restraints are being made 6
inches longer
How do we know if we are making a difference
with staff and families?
How can we measure the results?
Many hours of research and documentation.
Staff Survey: Patient- and Family-Centered Care Index
Overall Summary Results from Fall 2005 and Fall 2006
2005(n)=268 / 2006(n)=257
Theme
Current Practice
2005
Current Practice
2006
Desired Practice
2005
Desired Practice
2006
Mission
4.93
5.22
7.02
7.12
Collaboration
4.72
4.96
7.13
7.23
Plan of Care
Patient/Family
Strengths
4.80
5.08
7.04
7.18
4.69
4.89
7.06
7.16
3.63
4.06
6.35
6.76
3.94
4.48
6.75
7.06
Meetings/
rounds
Staff
Education
Theme
Current Practice
2005
Current Practice
2006
Desired Practice
2005
Desired Practice
2006
Visitation
5.22
5.72
6.78
7.08
QI
3.56
4.09
6.59
6.76
Medical
Record
Access
3.78
4.22
5.85
6.24
Cultural
Competence
4.48
5.01
6.99
7.27
Environmental
Design
3.55
3.86
6.87
7.06
• Current and desired practice levels increased from 2005 to 2006 in all
themes.
• Visitation and mission identified as our strongest current practices.
• The highest “desire to change practice” themes for 2006 are pt/family
involvement in environmental design and rounds/discharge planning.
The table below represents responses to the following question:
How familiar are you with the elements of patient and family-centered care as
defined by the Institute of Family-Centered Care?
Response
2005
2006
No answer
2.24%
3%
No knowledge
13.06%
7%
Some knowledge / not
applied to practice
.37%
.5%
Knowledgeable / concepts
sometimes applied
55.23%
45%
Knowledgeable / concepts
regularly applied
29.10%
44.5%
• Decrease in “no knowledge.”
• Significant increase in “concepts regularly applied.”
Patient/Family Survey: Children’s and Women’s Patient Satisfaction Results
April 18, 2006 thru September 26, 2006 (N=227)
3.00-3.99=Satisfied Most of the time / 4.00 = Satisfied Completely
Patient/Family member
perception
Overall
average
Patient/Family member
perception
Overall
average
Kept Informed about
condition/status
3.86
Talked about goals with
providers
3.82
Felt Welcomed
3.90
Staff professional and
prepared
3.84
Treated with courtesy and
respect
3.89
Staff cared about patient
3.88
Assured Privacy
3.89
Patient needs were met
3.81
Doctor was available
3.84
Treated or had pain relief
3.83
Patient was a partner in
his/her care
3.85
Provided education and
support for discharge
3.91
This survey tool has been shared with the
Perinatal Quality Collaborative of North Carolina
(PQCNC) and is being considered as a tool
for NICU’s across the state that are involved
in PQCNC.
PQCNC is looking at PFCC for all hospitals in NC
* Discussions are taking place around the following areas:
- Families on rounds
- NICU Advisory Councils
- Visiting hours
- Sibling access to visit
- Kangaroo Care, etc.
We are still on the journey.
We learn daily from patients and families.
Hospital administration - making changes to ensure
families, patients and visitors leave our hospital satisfied.
PCMH Admission book now titled “Information for
Patients, Families and Visitors”
Opening of PCMH Admission book reads:
“At PCMH, we believe that caring for you means
involving your family. Therefore, we encourage family
members to take an active role in the care of their loved
ones whenever possible.”
Regional Rehabilitation Center at PCMH
“The process of rehabilitation requires the best efforts of an
experienced, integrated patient care team. Patients and their
families form the core of our teams.”
PCMH Rapid Response Team—Team H
“Team H is a program that includes family members as part of the
care team….. When a nurse or family member is concerned about a
serious medical change in the patient such as bleeding, difficulty
breathing or when something doesn’t seem right, they can call
Team H….We appreciate family participation as we strive to
care for your loved ones.”
The Ride Home
“As a tertiary care hospital in rural eastern North Carolina, many of
our patients and their families have a long ride home at the end of
each stay. Imagine what that ride must be like and what the patient
and their family are talking about. They are talking about their
experience at our hospital. On that ride home, they are talking about
you and me. Are we doing everything possible to make sure that as
our patients and their families remember their experience at PCMH
that their story is positive? We have a great hospital and an
opportunity to create a wonderful story of caring, healing, compassion
and service for our patients and families.”
Stephen Lawler
President, PCMH
Contact information:
Brenda Boberg
252-847-5120
[email protected]
Amy Jones
252-847-6836
[email protected]