Transcript Document

Thought Leader Learning Series
It’s Critical – What YOU Should Be Doing
in Your ICUs
Cheryl Ruble MS, RN, CNS, Improvement Advisor
Maryanne Whitney MSN, RN, CNS, Improvement Advisor
Welcome
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Agenda
• Setting the Stage for Safety
• Hospital Journeys
• Wrap up
• CE’s - Provider approved by the California
Board of Registered Nursing, Provider Number
15958, for 1.0 contact hour
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Objectives
1. Develop an understanding of the synergy
between patient and staff safety.
2. Establish a strategy to engage bedside care
providers in a commitment for safety.
3. Identify the critical value of patient and family
engagement in overall departmental safety.
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Critical Elements for Excellence
• Establish a vision making safety a CORE
departmental value
• “Safety Huddles”
• Integrate efforts of patient safety and
employee safety
• Timely debriefings of
adverse patient and worker
Events-intent for learning
• Encourage the voice of
patients & families
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Creating an Umbrella of Safety
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Make it stick when YOU commit!
Enhance Reliability Efficiency & Outcomes
• Create a vision
• Leaders are highly
visible & “Walk the
walk”
• Physician champions &
nursing champions
modeling teamwork
• Learn, motivate,
educate & celebrate
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Untapped resources within your ICU,
where are they?
• Patients
• Family
• How do we invite their voice?
– Open visitation
– Multidisciplinary Rounds
– Presence during resuscitation
– Family meetings
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Making Safety Stick
Angie Sokal RN BSN
Critical Care Manager
Kaiser Permanente
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About Us
Serving California’s Silicon Valley
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Santa Clara Facility
• Features a medical office
building, opened in 2005,
and a 327-bed acute care
hospital, which opened in
August 2007
• 20-bed MICU, 10-bed CVICU
• More than 700 physicians
and 4300 staff care for
members in the service area
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Creating a
Vision for Safety
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Proclamation
Leadership
Huddles
Debriefing
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Leadership
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Set the department goals
Highly visible
Ensures employee involvement
Ensures accountability on all levels
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Huddles for Safety
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Patient concerns
Environmental concerns
Stretch and train
Transparency about
risks
• Review adverse events
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Debriefing/ Mini RCA’s
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Med error
Employee injury
Accidental extubation
CLABSI
VAP
C-Diff discovery
HAPU
• Events will happen
• Approach with curiosity
• Life long learners
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Work in progress
• Multidisciplinary Rounds- family involvement
• Open visiting hours
• White board PI work- in the department-(realtime planning with staff)
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Daily Hospital Safety Huddle
October 21, 2014
Karra Heggen, MSN RN, Vice President of Nursing
Leigh Poeppelman, MSN RN CCRN, Director of Critical Care Center and IV Team
Beacon Mission & Vision
• Opened in 1909
• 257 licensed beds
• Located on the St. Joseph
River in Elkhart, Indiana
• Strong Heart and Vascular
Service Line:
• Only hospital in
Northern Indiana to
provide Trans Aortic
Valve Replacement
(TAVR) procedures
• Heart Failure
Certification by Health
Care Colloquium
• Recognized by Health
Grades for Excellent
Cardiac Surgery
outcomes
• 23 Critical Care Beds
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Quality
Nursing Purpose:
• Ensure safe, compassionate, innovative patient
centered care
• Promote and engage in the advancement of
evidenced-based nursing practice
• Create a culture of collaboration,
professionalism and a healthy work
environment
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Leadership Safety Huddle
• Safety Huddle initiated October 15 2012
• Purpose:
– To communicate patient safety issues identified in past 24 hours
hospital wide, look forward next 24 hours, to promptly resolve
safety issues, and to have continuous follow up until resolved.
– Builds teamwork throughout the hospital
– Time of networking
– Mon-Friday 0900: Standing Room only
– Every department is encouraged to send leadership
representative.
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Original Safety Huddle Form
Daily Stats
10/2012
Daily Safety Huddle
Elkhart General Hospital
Date:
Follow up from previous:
Lost time: ___
Huddle Leader:
Sick Calls:
House Count:
10/2014
Days since last Employee
ER Visits prev day:
Daily Safety Huddle
Elkhart General Hospital
Date:
Sick Calls/Call offs:
House Count:
Days since last Employee
Lost time: ___
Huddle Leader:
ER Visits prev day:
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Huddle
Highlight
to be sent
Date____
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Past 24 hours
Any Safety Issues or
Challenges in the last 24
Follow-up
Issue/Challenge Required?
Responsible
Person
-High risk patients or procedures?
-Deaths? - Restraints?
- Falls?
-Sitters?
Added
Any Safety Issues or
Challenges in the last 24
hours?
Issue/Challenge
Follow-up Required?
Responsible Person
-High risk patients or procedures?
-Deaths
- Restraints
- Falls
-Sitters
- Codes
- ACT
-Code EMS - Armstrong
- Tele Boxes Available
- HITS/Occurrences?
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Anticipated next 24 hours
-Deficiencies in information,
equipment, supplies, or staff that
will make it hard to deliver safe,
high-quality care?
-What conditions outside our unit
could impact our ability to deliver
safe, quality care today?
New Medication Shortages?
Surgery volume?
Inpatient Surgeries?
Anticipated issues or
challenges for the next 24
hours?
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Added information in 2013 & 2014
Added after 2012
Blood Product Shortage?
Surgery volume ?
Inpatient
Surgeries
Anticipated
issues ?or challenges
for the next 24 hours?
Any critical safety issues to
address immediately?
Any potential reportable
Follow up from previous:
Other:
HITS
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Huddle Highlight
• Standardized succinct safety information will
be sent out to all management including
charge nurses to review at shift huddles.
• Start and stop date; requires associate to sign
form and unit keeps in binder.
• Developing criteria for use of Huddle Highlights
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Huddle Highlight
HUDDLE HIGHLIGHT
Please review at each huddle (a.m. and p.m.) until stop date. Each staff member is responsible to initial
information presented.
Start Date: ______9/16/14
Initiated by:
Stop Date: _______9/26/14
 EGH Safety Huddle
 Nursing Leadership
Details: Calling an Emergency Incident Code
Initials:
 You MUST dial 77 to call the switchboard
for an internal incident (ACT call, fire,
Code EMS, Code Blue, water leak, etc.)
 DO NOT dial the operator number to
call the switchboard.
 Then notify direct Supervisor (charge
nurse, team lead, shift coordinator, unit
director) immediately.
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Appreciative Inquiry & Inspiration
• To close the huddle, stories are requested that
related to teamwork or patient experience that
resulted in positive outcomes
• Inspirational readings from “Healing with
Heart” Martin Helldorfer & Terri Moss
• Huddle can last 5-15 minutes
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Critical Care “Huddles”
• Critical Care does a “short” report at 0700 and 1900 each day – the
charge nurse gives the whole team an overall picture of the patients
and the plan for the shift.
• During this time there is also discussion and sharing of any safety
concerns – issues that have arisen from housewide safety huddles,
Huddle Highlights, issues from the previous shift, etc.
• This all occurs in 5-7 minutes.
• Staff then get bedside report from the off-going RN.
• Safety concerns are also posted in bathrooms or communicated 1:1.
• Director or designee communicates safety concerns at Leadership
Huddle
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EGH Safety Net
• Frontline safety concerns are escalated to unit
leadership to share at Leadership Safety Huddle.
– Knowledge Transfer
• Culture of Safety encourages associates to speak
up related to potential or actual safety concerns
• Shift huddles and Leadership Safety Huddle
improves communication and teamwork for
improved outcomes.
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Questions
Karra Heggen VPN –
[email protected]
Leigh Poeppelman Director of Critical Care/IV
Team
[email protected]
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Contra Costa Regional Medical Center
Martinez, CA
Stuart Forman, MD
Director of Critical Care Services
Contra Costa Regional Medical Center
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Safety Initiative /ABCDE Bundle
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Departmental goals
Identify champions
Use all types of reminders
Post progress
Recognize & Reward
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Giving a Voice to the Family
• Stay Connected protocol
• 24 hours a day visitation- if they want to stay
they will be able to accommodate
• Family meeting 48-72 hours post admission/
social workers
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Creating an Umbrella of Safety
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Objectives
1. Develop an understanding of the synergy
between patient and staff safety.
2. Establish a strategy to engage bedside care
providers in a commitment for safety.
3. Identify the critical value of patient and family
engagement in overall departmental safety.
www.cynosurehealth.org
Creating an Umbrella of Safety:
Kaiser
• Safety proclamation
• Synergy between work place safety and patient
safety
• Real time debriefings for adverse events- HAPUCLABSI-C-Diff- Workplace injuries
• Safety Huddles- sharing risks identified in ICU &
with individual patients
• Multidisciplinary Rounds – adding value from
family involvement
• Open visiting
• White board PI work​
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Creating an Umbrella of Safety:
Elkhart
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Leadership role modeling
Leadership safety huddles
Critical Care huddles
Closing the loop – communication back to
staff
• Synergy of communication supporting a safety
net for staff, patients, and families
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Creating an Umbrella of Safety:
Contra Costa
• Clear departmental goals
• Identification of champions
• Giving voice to the family
– Stay Connected
– Family meeting within 48-72 hours post-admission
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Resources
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“Implementing the ABCDE Bundle: ABCDE Bundle at the Bedside” from AACN at
http://www.aacn.org/dm/practice/actionpakdetail.aspx?itemid=28328
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Debriefings: Great resource from AHRQ on the usefulness and how to conduct a debrief:
http://www.ahrq.gov/professionals/education/curriculumtools/teamstepps/instructor/essentials/pocketguide.pdf
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Open Visiting Hours: AACN Practice Alert on Family Presence: Visitation in the Adult ICU” from AACN
at: http://www.aacn.org/WD/practice/docs/practicealerts/family-visitation-adult-icu-practicealert.pdf
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Safety Huddles: Great resource from AHRQ on the usefulness and how to conduct a safety huddle:
http://www.ahrq.gov/professionals/education/curriculumtools/teamstepps/instructor/essentials/pocketguide.pdf
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Family included in MDRs: A great resource from Institute for Patient- and Family-Centered Care:
http://www.ipfcc.org/advance/topics/PH_RD_Applying_PFCC_Rounds_Pediatric.pdf
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Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation from TJC
at:
http://www.jointcommission.org/assets/1/18/TJC-ImprovingPatientAndWorkerSafety- Monograph.pdf
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Yassi, Annalee, and Tina Hancock. "Patient Safety - Worker Safety: Building a Culture of Safety to
Improve Healthcare Worker and Patient Well-Being." Healthcare Quarterly 8.Sp (2005): 32-38. Web
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Continuing Education Credit!
• Evaluation window will open as
soon as we close the meeting
• Provider approved by the
California Board of Registered
Nursing, Provider Number 15958,
for 1.0 contact hour.
• All RNs requesting CEUs must be
registered, provide their RN
license #, sign-in to the webinar
under their full name, and attend
at least 50 minutes.
• CE Certificates will be emailed to
you, directly
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Upcoming Offerings
Join us!
Are you in need of a Physician Champion for your Improvement Initiatives?
Tune in for our free webinar on
November 13th, 12-1pm PST
“Accelerate Change with Physician Champions: Tried and True Ways to Find
and Engage Effective MD Leaders”
AND
December 18th, 12-1pm PST
“Infection Prevention: Is It a Show?”
We will explore a provocative report about human behavior
and infection prevention.
Don’t miss either opportunity register now! www.cynosurehealth.org
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Cheryl Ruble MS, RN, CNS, Improvement Advisor
[email protected]
Maryanne Whitney MSN, RN, CNS, Improvement Advisor
[email protected]