Reflection

1. Releasing Time to Care (RT2C)Opening CeremoniesTuesday, August 7, 2012 1200-1500PPMC Cancer Center Amphitheater

2. Reflection

3. AGENDA • Welcome (5 min) • Key Note: Mary McFadden and Judy Tatman (5min) • RT2C Video (12 min) • Team Presentations (75 min) • Closing Remarks (5 min) • Unit Tours (40 min) • Questions and Discussion (30 min) • Passing the Torch (application process (10 min) • Closing Ceremonies

4. Session Objectives At the conclusion of this program the learner will be able to: • Describe Releasing Time to Care as a methodology for unit-based improvement. • Understand the value of RT2C in improving efficiency and effectiveness. • Understand the clinical and satisfaction outcomes associated with RT2C. • Understand the application process and plan for roll-out of RT2C at PPMC. • Apply information to own practice, unit or department to strengthen participation in RT2C or move toward applying for RT2C.

5. Mary McFadden, MSN RN, CNE Robert Wood Johnson Executive Nurse Fellow

6. Judy Tatman, RN, BSN, MS Regional Chief Nursing Officer – Oregon Region

7. RT2C House of Modules

8. Change Implementation Cycle

9. RT2C Video

10. 7S: Surgical Oncology Unit Knowing How We’re Doing Module Lisa McKerlick, RN BSN-BC &Michelle McSherry RN BSN-BC

11. What is Knowing How We’re Doing (KHWD)?

12. KHWD on 7S

13. KHWD on 7S • KHWD is an approach to measure, track and help improve the objectives chosen by the unit. • It will help you and your team see that the changes made are helping the team achieve your vision for your unit, and how the care you and your team give contributes to your organizations strategic goals. • Our key components include: • Display of safety crosses on a board which is visible to all. • Twice-daily huddles discussing safety crosses, action plans, • and updates by staff.

14. KHWD on 7S

15. KHWD on 7S 7 South Foley catheter data, to decrease CAUTI’s

16. 5R: Internal Medicine Unit Well Organized Ward Module Amy Bruninga, RN BSN

17. What is the Well Organized Ward (WOW) module? • Well Organized Ward is an approach to simplify the workplace and reduce waste by having everything in the right place, at the right time and ready to go. • WOW uses a set process, called the 5S process, to help us find where changes need to be made on the unit. • This is not just about organizing and cleaning! • It is about setting up a process that makes everything ready to go for the next person. A set process agreed upon by everyone on how to keep an area that way. • Monitoring and maintaining the area. • Ability to change things that aren’t working. 5S Sort Set Shine Standardize Sustain

18. WOW on 5R • Why should we use WOW on our unit? • Increase the proportion of direct care time. • It will make the unit look and feel better. • Increase staff satisfaction by making things easier and giving them the voice to participate in the changes in the unit. • Decrease error

19. WOW on 5R

20. WOW on 5R • Data Collection • Who use’s the area and what for? • Interview the stakeholders. • Time a process

21. WOW on 5R • Assess • What are we supposed to be using the drawer for? • Are things easy to find? • Do staff struggle in the area when attempting to accomplish a task? • What would a patient or visitor think? • What does this area say about our unit?

22. WOW on 5R Diagnose the area and the 5S Process Set and Shine Sort

23. WOW on 5R Standardize Sustain

24. WOW on 5R Keep your unit informed!

25. 7N: Medical Oncology Unit Well Organized Ward module Tina Magsarili, RN

26. WOW on 7N

27. WOW on 7N • Voting commenced over where the new cabinet would be located • Up to this point the cabinet was in a supply room and the telemetry boxes and leads were found there • The batteries were in another supply closet with electrodes and BP cuffs • The fax machine was in a totally different location • The Winner is? • The Zoo: a substation on our unit that contains a fax machine

28. WOW on 7N

29. WOW on 7N

30. WOW on 7N

31. WOW on 7N • New process = 232 feet travelled to put one patient on telemetry • KEY: 232 feet = 0.88 minutes (52.8 seconds) • What does this mean? • Before it took 559 feet, Now it takes 232 feet! • Every time you need to set a patient up on telemetry you save 1 minute 18 seconds of time that you can use directly caring for your patient rather than chasing down equipment!

32. 4R: Urology Gynecology Unit Patient Status at a Glance Module Nicole Bailey, RN CMSRN

33. What is Patient Status at a Glance (PSAG)? • The use of visual management to show important patient information so that it can be updated regularly, seen at a ‘glance’ and used effectively. • Why do it? • To ensure safe, reliable and efficient care by: • Making shift handovers quicker and safer for the patient • Making sure the patient journey from admission to discharge runs smoothly without delays • Saving time looking for patient information

34. PSAG on 4R • Team members decided on the goals of the board for our unit • Goals: reducing interruptions, decreasing redundancy of information, eliminating duplicate information • What information do we need to have “at a glance” and what is the most common information that nurses were interrupted for? • This list was long!! From there, suggestions were narrowed down to about ten items for staff voting

35. PSAG on 4R

36. PSAG on 4R

37. 5G: Diabetic Renal Unit RT2C Showcase unit Admissions/Discharges Process Module Cindy Christenson, RN

38. What are the process modules? • Process modules allow staff to identify key processes to improve overall work flow • Key component - use the same change implementation cycle as the other modules, but are less prescriptive

39. Process module on 5G: Admissions and Discharges • We’ve made many changes on 5G in relation to the Admissions and Discharges • How did we decide where to start this process?

40. Our biggest accomplishment to date… • The change in gowns saves: • $3,500 in annual laundry costs • additional savings of $3,100 • 21 hours annually on 5G • 197 hours annually house-wide

41. Our biggest struggle to date…

42. Lessons learned • Continue to follow up on implemented changes!

43. Acknowledgements • Mary McFadden, CNE

44. Unit Tour Instructions • Each unit will guide a unit tour to bring to life the concepts presented • Pick one unit to visit (7S, 5R, 7N, 4R, 5G) • Each presenting RN has a sign for their • No more than 20 people/unit please 

45. Questions:Post Unit Tours If you have further questions, please feel free to contact the following staff nurses on each unit: 7S - Lisa McKerlick, Michelle McSherry 7N - Tim Czuk, Jenn Moore 4R - Nicole Bailey, Susan Conley 5R - Amy Bruninga, Stephanie Shadduck 5G - Cindy Christenson, Candice Hoag, Grace Kelly

46. Application Information • Due date - August 20 • Return to Nursing Administration • Next cohort announced August 31 • Contact Kristin Haydon with questions • x56336

47. Thank You!!! • Don’t forget to sign in AND complete the evaluation to receive your CE credits. • For those who have been participating in RT2C, please stay for a debrief and dialog session.

48. Debrief • How do we get to a place where we’re using the RT2C tools and methods as how we do our work while maintaining the staff driven aspect? • What are our major successes to date? What should we continue doing? • What challenges have we had? What are your suggestions for improvement?