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Improvement of Family Centered Care During Rapid Response Events

Improvement of Family Centered Care During Rapid Response Events. Mark Riccioni, DNP, APRN, CPNP-AC/PC Aarti Bavare, MD Baylor College of Medicine Texas Children’s Hospital Pediatric Critical Care. A REAL LIFE STORY NARRATED BY A FATHER.

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Improvement of Family Centered Care During Rapid Response Events

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  1. Improvement ofFamily Centered CareDuring Rapid Response Events Mark Riccioni, DNP, APRN, CPNP-AC/PC Aarti Bavare, MD Baylor College of Medicine Texas Children’s Hospital Pediatric Critical Care

  2. A REAL LIFE STORY NARRATED BY A FATHER.. “My 9-year-old son has had seizures all his life.  He was admitted for fever.  We have been in TCH before First night all went well. Next morning I thought something was not right, I called the nurse who I had not met before Nurse looked at my son and reassured me Soon my son seized Nurse rushed in and said she will make a phone call to get help Some people came into the room  later more crowd gathered some one tried placing an IV. It is hard to find his veins…. I was scared and felt helpless Later someone came and spoke to me and we were moved to ICU I was not informed that I could call this team “RRT” myself if I had concerns, I did not know what it was, who they were and what they were doing”.

  3. BACKGROUND: Rapid Response (RR) Systems • RRs are widely established across most hospitals1 • Goal: rapid assessment & triage  prevent cardiac arrest • RRs are proven to decrease cardiac arrest and mortality2 • Texas Children’s has a busy RRs (~ 1,000 events per year) 65% are transferred to ICU 5% die before discharge • RR events are often stressful Patient: Clinical Worsening Family: Stressed and anxious Care Team: Busy in clinical care RRT 1 2 Maharaj et al. Critical Care (2015) 19:254

  4. BACKGROUND: Family Centered Care IHI Quadruple AIM Family Centered Care

  5. BASELINE DATA

  6. BASELINE DATA: Confirmed Need For Improvement Family Interviews “I was not sure what to expect” “There were a lot of people, but I didn’t know who was doing what” “I wasn’t sure what was going on” “I felt scared”

  7. BASELINE DATA: Staff Survey • 25% reported language barrier is addressed • 1/3rd reported families get updated on plan of care • 18% reported there are clear team roles

  8. AIM STATEMENT OUR PROJECT By March 2019 we aim to improve provider/family communication and family engagement during a rapid response (RR) event by a mean FCC score of 10% as measured through direct observation by the House Supervisors. GOAL: Improve Family Centered Care during RRT

  9. Process Map • Complicated process • Multiple tasks • Multiple teams • Transfer of care Prone to lapses in communication

  10. Family Policy/Procedure People Fishbone Diagram Lack of family presence at bedside No expectations from team members to engage families Multiple AC units /teams Family expectation of RRs vary Nodefined process to inform families Disagreement between family and medical team when to call RRT Lack of understanding roles and responsibilities of staff Lack of family centered care during rapid response events Lack of defined roles for providers Census pressure Varying levels of staff knowledge of RRT process Lack of staff dedicated to family during RRT Staff belief that families should not be involved Critical clinicalcondition Lack of interpreter Dynamic clinical condition Lack of training on FCC components Time constraints Situation/Environment Training/Education Resources

  11. Key Driver Diagram Outcomes Primary Drivers Secondary Drivers Changes/Initiatives

  12. PDSA cycles Improve Family Centered Care @RR Introduction of team members for Role clarity 4 Identify a family liaison Address Language Barrier 3 Tool to measure FCC score 2 Gather baseline data 1

  13. METRICS

  14. DATA: Process Metric

  15. DATA: FCC Score For Information Sharing

  16. DATA: FCC Score For Collaboration PDSA: Nov 14 - Jan 20 PDSA: Jan 21- Feb 20 PDSA: Feb 21 - Mar 3 November December January February March RRT Events & Timeline

  17. DATA: FCC Score For Participation PDSA: Nov 14 - Jan 20 PDSA: Jan 21- Feb 20 PDSA: Feb 21 - Mar 3 November December January February March RRT Events & Timeline

  18. DATA: Balancing Measures • Median duration of RRT events remains unchanged (~20 minutes) • House Supervisors Feedback: - Need QR code to allow for completion of checklists on their phones - Need comments box • Fellows Feedback: - Easy to identify a family liaison - Just need to remember to do it

  19. LESSONS LEARNED Setting up meetings and communication among team members Sustainability Start from baseline data • Pre-identified roles within project team members helpful • Complimentary skill sets

  20. FUTURE DIRECTIONS

  21. QUESTIONS?

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