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The Power of Patient & Family Engagement: Falls University

The Power of Patient & Family Engagement: Falls University. Joanie Ching, RN, MN, CPHQ Administrative Director Hospital Quality & Safety. Objectives. Review our structured learning approach to patient falls Share our progress from measuring outcomes  reliability of processes

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The Power of Patient & Family Engagement: Falls University

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  1. The Power of Patient & Family Engagement: Falls University Joanie Ching, RN, MN, CPHQ Administrative Director Hospital Quality & Safety

  2. Objectives • Review our structured learning approach to patient falls • Share our progress from measuring outcomes  reliability of processes • Highlight patient and family engagement through delirium work Presented at Washington State Hospital Association Safe Table, 2/20/2013

  3. 2013 Organizational Goals Patient Quality and Safety: Care Delivery Innovations • •Delivering Patient-Centered Coordinated Primary Care • • Optimizing Care Transitions • • Smoothing Patient Flow • • Eliminate Healthcare Associated Infections • • Glycemic Control • • Prevention of Hospital Associated Delirium Vision To be the Quality Leader and transform health care Mission To improve the health and well-being of the patients we serve Quality, Safety, Service, People, Innovation •Respect for People Values Teamwork | Integrity | Excellence |Service • Service: Patient Experience • •Integration of the Patient Experience Strategies • People: Team Engagement • • Transformational Leadership • • Organizational Training & Education Innovation People Service Quality • Strong Economics • •Growth We relentlessly pursue the highest quality outcomes of care We attract and develop the best team We foster a culture of learningand innovation We create anextraordinarypatient experience • Integrated I.S.: Technology and Care • Delivery Partnerships • •Realizing the Potential of Our Electronic Health Record • • Update the Enterprise Orders & Documentation • Framework • • Ambulatory CPOE • • Measuring and Improving our Results Virginia Mason Team MedicineSMFoundational Elements IntegratedInformation Systems Strong Economics ResponsibleGovernance Education Research Virginia MasonFoundation Virginia Mason Production System Presented at Washington State Hospital Association Safe Table, 2/20/2013

  4. Every fall stops the line Stopping the Line: “Falling Star” What happened? • Leadership commits to “drop & run” • After Action Review • Staff involved, Patient, Family members • Every fall → Falls University (founded 3/09) Presented at Washington State Hospital Association Safe Table, 2/20/2013

  5. Stopping the Line “… when production stops everyone is forced to solve the problem immediately. So team members have to think, and through thinking team members grow and become better team members and people.” -- Teruyuki Minoura Toyota Motors, NA

  6. Prior to Falls University Presented at Washington State Hospital Association Safe Table, 2/20/2013

  7. At Falls University Presented at Washington State Hospital Association Safe Table, 2/20/2013

  8. PLAN PLAN Observation & Develop a New Vision Observe and develop a new vision ACT ACT DO DO Awareness- A Change In Thinking Rapid Implementation – Give it a try CHECK STUDY Study the results Falls University: Results-Oriented Study Planning Implementing Monitoring Presented at Washington State Hospital Association Safe Table, 2/20/2013

  9. Lack of Evidence-Base “ …in acute hospitals, no single interventions are fully supported by current evidence, and that multifactorial interventions may reduce falls by 18-31%.” Oliver, et al, 2010 Presented at Washington State Hospital Association Safe Table, 2/20/2013

  10. Increasing Patient Surveillance through Foundational Elements Geographic assignments Huddles every shift In room handoffs RN:PCT integration Hourly rounds by caregivers Documentation near the patient Daily Leader rounds People Link Boards updated & staff huddles monthly Presented at Washington State Hospital Association Safe Table, 2/20/2013

  11. Unattended Falls: Psycho-social Root Causes r/t Toileting 1/3: Left alone on toilet/commode 1/3: Don’t use call light 1/5: slip on way to BR Remainder: trip over clothing, SCDs or fumble/lose balance Presented at Washington State Hospital Association Safe Table, 2/20/2013

  12. Values Conflict • Patient autonomy • Privacy with toileting • Duty of care to all –v- high-risk Presented at Washington State Hospital Association Safe Table, 2/20/2013

  13. Variation STANDARDIZATION Improvement Without standards, there can be no improvement. Presented at Washington State Hospital Association Safe Table, 2/20/2013

  14. T Presented at Washington State Hospital Association Safe Table, 2/20/2013

  15. 13 of 35 points Presented at Washington State Hospital Association Safe Table, 2/20/2013

  16. Bundle for Highest Risk Group JH >13 and/or risk of injury (e.g. fracture risk or bleeding risk) • Mandatory gait belt • Mandatory bed and chair alarms** • Consider low bed and floor mats • Remain within arms-length of toileting patient • Level of Assist: • PARTIAL ASSIST- Keep hands on patient OR • MAX ASSIST- 2 People + Lift • Evaluate need for Constant Care Companion **unless pt has met criteria for alarm discontinuance Presented at Washington State Hospital Association Safe Table, 2/20/2013

  17. How would we know? We told everyone. We assumed they were all doing the bundle. Presented at Washington State Hospital Association Safe Table, 2/20/2013

  18. GenchiGenbutsu • “It’s all lies” unless you see it • Go to where the action is • Look at the process • Know your people and let them know you • Vulnerability is OK Presented at Washington State Hospital Association Safe Table, 2/20/2013

  19. Fall Prevention Audit Tool B C T I A 1 2 3 Presented at Washington State Hospital Association Safe Table, 2/20/2013

  20. But We Told Them to … Presented at Washington State Hospital Association Safe Table, 2/20/2013

  21. Falls University 201: Delirium • 10-31% of hospitalized patients, more likely to occur in the elderly population • Falls, functional decline, extended LOS, nursing home placement, cognitive deficits &  mortality • Constant Care Companions (CCCs) can provide supervision Presented at Washington State Hospital Association Safe Table, 2/20/2013

  22. “This is not the same person I’ve known.” -- A Family Member Presented at Washington State Hospital Association Safe Table, 2/20/2013

  23. Engaging Family Members Presented at Washington State Hospital Association Safe Table, 2/20/2013

  24. Ideas from Family Members Presented at Washington State Hospital Association Safe Table, 2/20/2013

  25. Acute Care of the Elderly PDSA • A quality improvement efforts to decrease constant care companion use on two inpatient units • Focus: Prevention and treatment of delirium • Education was provided to staff • Family members invited to participate in care • Patient rounds with multidisciplinary plan of care review • Fall rates, CCC use in hrs, and CCC costs were measured before and after the intervention Presented at Washington State Hospital Association Safe Table, 2/20/2013

  26. Results • Education was provided to 100% of staff • CCC use decreased by 4,048 hrs in one year • Cost savings over $73,000 • Fall rates and falls with injury ↓ Presented at Washington State Hospital Association Safe Table, 2/20/2013

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