1 / 25

On Boarding Call Schedule – Tuesdays 8/21–9/25 @ 2:00

On Boarding Call Schedule – Tuesdays 8/21–9/25 @ 2:00. Learning Objectives. To understand the basics of communication To understand the importance of having daily goals To learn how to implement daily goals in your ICU

baba
Download Presentation

On Boarding Call Schedule – Tuesdays 8/21–9/25 @ 2:00

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. On Boarding Call Schedule –Tuesdays 8/21–9/25 @ 2:00 Armstrong Institute for Patient Safety and Quality

  2. Learning Objectives • To understandthe basics of communication • To understand the importance of having daily goals • To learn how to implement daily goals in your ICU • To understand that daily goals is a tool to improve teamwork and communication AND supports interventions to reduce VAP Armstrong Institute for Patient Safety and Quality

  3. Implementing Daily Goals Nishi Rawat , M.D. Johns Hopkins Community Physicians Armstrong Institute for Patient Safety and Quality

  4. CUSP & VAP Interventions Armstrong Institute for Patient Safety and Quality

  5. Basic Components and Process of Communication Elizabeth Dayton, Joint Commission Journal, Jan. 2007 Armstrong Institute for Patient Safety and Quality

  6. Six Factors of Communication Risk Woods. Pt SafQual Healthcare May/June 2006 Armstrong Institute for Patient Safety and Quality

  7. Communication and Health Care Lawton et al. BMJ QualSaf2012;21:369-80

  8. Communication and Health Care • 65% of all sentinel events occur due to breakdowns in communication (JCAHO 2005) • Nurses: communication with physicians is a leading contributing factor for medical errors (NCSBN) • 7% of respondents involved in medication error in past year in which intimidation played a role (ISMP 2003) • High performing ICUs: team-oriented, shared beliefs, education, collegiality, informal but direct communication, collaborative problem-solving (Zimmerman et al. 2003) Armstrong Institute for Patient Safety and Quality

  9. ICU Physicians and ICU RN Collaboration Armstrong Institute for Patient Safety and Quality Huang, DT et al. Crit Care Med 2007 jan 35(1): 165-76 S Data

  10. ICU Physician Rounds • Should include a multidisciplinary group of professionals as applicable: • Physicians, nurses, pharmacists, respiratory therapists • Should be conducted at bedside if at all possible • Allows patient and/or family involvement Armstrong Institute for Patient Safety and Quality

  11. Crew Resource Management (CRM) • Safety training program focused on effective team management to improve performance • Targets cognitive and interpersonal skills • Goal: improve situational and self-awareness, communication, flexibility, assertiveness, adaptability • Create a culture where there is freedom to question authority Armstrong Institute for Patient Safety and Quality

  12. Communication and Aviation Accidents Aviation Safety Network Armstrong Institute for Patient Safety and Quality

  13. Conventional rounds • Communication defects are common • Rounds are generally provider rather than patient centered • Discussion on rounds is more divergent (brainstorming) rather than convergent (explicit plan) • Prevents effective real-time or future feedback regarding plan of care Armstrong Institute for Patient Safety and Quality

  14. Rounds with Daily Goals • Creates explicit goals and enables feedback toward goals to achieve more for the patient • Standardizes communication to reduce encoding and decoding errors, and creates independent checks • Adds convergent thinking to often divergent rounds • Helps ensure diverse input Armstrong Institute for Patient Safety and Quality

  15. Structure of Daily Goals Tool • Items organized by organ system • Medication review section • To Do, Disposition, Family meeting and Code status sections • What can we eliminate? Lines, labs, abx… • Safety item • Include VAP process measures • Check boxes vs open-ended vs combination • One column vs second column for night goals Armstrong Institute for Patient Safety and Quality

  16. How to Use Goals? • Be explicit • Important questions • What needs to be done for discharge? • What will we do today? • What is the patient’s greatest safety risk? • Completed on rounds and nurse reads back • Stays with bedside nurse • Modify to fit your hospital Armstrong Institute for Patient Safety and Quality

  17. Percent UnderstandingPatient Care Goals Implemented patient goals sheet Pronovost J Crit Care 2003;18(2):71-5. Armstrong Institute for Patient Safety and Quality

  18. Impact on ICU Length of Stay Armstrong Institute for Patient Safety and Quality

  19. Recent Data in Support of Daily Goals • Narasimhan et al. 2006: MICU • Provider understanding of goals improved • Improvement in communication scores • LOS decreased from 6.4 to 4.3 days • Agarwal et al. 2008: PICU • Provider understanding of goals improved • Trend toward decrease in LOS, not significant Armstrong Institute for Patient Safety and Quality

  20. Comprehensive Unit-based Safety Program (CUSP) Armstrong Institute for Patient Safety and Quality

  21. Action Plan • Present the idea to your ICU team • Draft a daily goals form • Obtain support from one or more ICU physicians • Pilot test on a couple of patients on rounds • Get feedback from nurses and physicians • Revise and expand • Monitor physician paging, track LOS…. • Share your tool with the other teams Armstrong Institute for Patient Safety and Quality

  22. Questions • Karol G. Wicker, MHS Senior Director, Quality Policy & Advocacy Maryland Hospital Association kwicker@mhaonline.org • Mary Catanzaro RN BSMT CIC Project Manager HAIs Hospital and Healthsystem Association of Pennsylvania mcatanzaro@haponline.org Armstrong Institute for Patient Safety and Quality

  23. What Should you do NOW? CUSP Preparation: 1) Assemble team 2) Schedule meetings CUSP Implementation: • Science of Safety Training for all staff • Identify Defects: How will the next patient be harmed? • Use elements of Toolkit, including Daily Goals Armstrong Institute for Patient Safety and Quality

  24. References - 1 Slide 5 Dayton E, Henriksen K. JtComm J QualSaf. 2007 Jan;33(1);34-47. Slide 6 Woods MS. How Communication Complicates the Patient Safety Movement. 2006 May/June. http://www.psqh.com/mayjun06/dun.html. Slide 7 Lawton R, McEachan RR, Giles SJ, Sirriyeh R, Watt IS, Wright J. Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review. BMJ QualSaf. 2012 May;21(5):369-80. Epub 2012 Mar 15. Slide 9 Huang DT, Clermont G, Sexton JB, Karlo CA, Miller RG, Weissfeld LA, Rowan KM, Angus DC. Perceptions of safety culture vary across the intensive care units of a single institution. Crit Care Med. 2007 Jan;35(1):165-76. Armstrong Institute for Patient Safety and Quality

  25. References - 2 Slide 12 Aviation Safety Network Slide 17 and 18 Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communications in the ICU using daily goals. J Crit Care. 2003 Jun;18(2):71-5. Slide 19 Narasimhan M, Eisen LA, Mahoney CD, Acerra FL, Rosen MJ. Improving nurse-physician communication and satisfaction in the intensive care unit with a daily goals worksheet. Am J Crit Care. 2006 Mar;15(2):217-22. Agarwal S, Frankel L, Tourner S, McMillan A, Sharek PJ. Improving communication in a pediatric intensive care unit using daily patient goal sheets. J Crit Care. 2008 Jun;23(2):227-35. Armstrong Institute for Patient Safety and Quality

More Related