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 www.cynosurehealth.org 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 www.cynosurehealth.org 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 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 www.cynosurehealth.org Creating an Umbrella of Safety www.cynosurehealth.org 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 www.cynosurehealth.org 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 www.cynosurehealth.org Making Safety Stick Angie Sokal RN BSN Critical Care Manager Kaiser Permanente www.cynosurehealth.org About Us Serving California’s Silicon Valley 9 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 www.cynosurehealth.org Creating a Vision for Safety • • • • Proclamation Leadership Huddles Debriefing www.cynosurehealth.org www.cynosurehealth.org Leadership • • • • Set the department goals Highly visible Ensures employee involvement Ensures accountability on all levels www.cynosurehealth.org Huddles for Safety • • • • Patient concerns Environmental concerns Stretch and train Transparency about risks • Review adverse events www.cynosurehealth.org Debriefing/ Mini RCA’s • • • • • • • Med error Employee injury Accidental extubation CLABSI VAP C-Diff discovery HAPU • Events will happen • Approach with curiosity • Life long learners www.cynosurehealth.org Work in progress • Multidisciplinary Rounds- family involvement • Open visiting hours • White board PI work- in the department-(realtime planning with staff) www.cynosurehealth.org www.cynosurehealth.org 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 18 www.cynosurehealth.org 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 19 www.cynosurehealth.org 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. 20 www.cynosurehealth.org 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: 21 Huddle Highlight to be sent Date____ www.cynosurehealth.org 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? 22 www.cynosurehealth.org 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? 23 www.cynosurehealth.org 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 24 www.cynosurehealth.org 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 25 www.cynosurehealth.org 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. 26 www.cynosurehealth.org 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 27 www.cynosurehealth.org 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 28 www.cynosurehealth.org 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. 29 www.cynosurehealth.org Questions Karra Heggen VPN – [email protected] Leigh Poeppelman Director of Critical Care/IV Team [email protected] 30 www.cynosurehealth.org Contra Costa Regional Medical Center Martinez, CA Stuart Forman, MD Director of Critical Care Services Contra Costa Regional Medical Center www.cynosurehealth.org Safety Initiative /ABCDE Bundle • • • • • Departmental goals Identify champions Use all types of reminders Post progress Recognize & Reward www.cynosurehealth.org 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 www.cynosurehealth.org Creating an Umbrella of Safety www.cynosurehealth.org 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 www.cynosurehealth.org Creating an Umbrella of Safety: Elkhart • • • • 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 www.cynosurehealth.org 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 www.cynosurehealth.org Resources • “Implementing the ABCDE Bundle: ABCDE Bundle at the Bedside” from AACN at http://www.aacn.org/dm/practice/actionpakdetail.aspx?itemid=28328 • 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 • 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 • 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 • 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 • 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 • 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 www.cynosurehealth.org 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 www.cynosurehealth.org 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 www.cynosurehealth.org Cheryl Ruble MS, RN, CNS, Improvement Advisor [email protected] Maryanne Whitney MSN, RN, CNS, Improvement Advisor [email protected]