Falls/Safety Documentation Changes: Implementation Planning

1. Falls/Safety Documentation Changes: Implementation Planning Goals for the session: • Have beginning understanding of next level of the Documentation Framework • Support introduction of Safety & Education documentation changes as next building block of Documentation Framework • Have begun a unit-specific implementation plan • Know proposed rollout schedule, especially go live date for your unit. • Knowledge of resources available to support this work

2. Intro • We began to implement changes to our Nursing Documentation Framework in October, 2010 with the rollout of Priority Problems. • Based on feedback from nurses and from recent Magnet and JCAHO Surveys, this change has been the catalyst for dramatic improvements in documentation. • “My documentation reflects how I impact patient outcomes” (typical Staff Nurse comment when speaking about Priority Problems).

3. Intro. (cont.) • We are now ready to begin the next phase of the Nursing Documentation Framework change with implementation of the Falls/Safety Section and changes to Education Tab. • As with Priority Problems, this is less of a technical change, more of a practice change. • This is a huge ongoing culture change

4. Logistics • CAPS will sit with participant(s) from their unit(s) the extent possible but we want to work in teams, even if it’s not your unit team. • We will begin to craft a unit-specific Implementation Plans • We ask that you honor timeframes • Jot down questions and “ah-ha’s” as you go so you don’t lose them. If there are any issues we are not able to address today, we will put on Parking Lot for follow up after the session.

6. Kotter’s 1st Step:Increasing the Sense of Urgency • Falls expert brought in to address high Falls rate said our emphasis was on screening for rather than preventing falls. Our old screen had been modified to the point that it was NOT evidence-based. • Historical approach to a new regulation or problem – ADD a NEW Documentation section • Increases documentation burden on nurses • Nurses spend time documenting about instead of preventing problems • Our goal to help with increasing staff satisfaction – standardize and simplify documentation. • The hospital is a dangerous place for patients. • “First do no harm” (Hippocrates). Organizational Goal -- Culture of Safety

7. Kotter’s 1st Step:Increasing the Sense of Urgency At your table, identify 3-5 common safety risks for patients on your unit. • _____ • _____ • _____ • _____ • _____

8. Finding our way together…. Kotter’s Step Two: Form a Powerful Coalition

9. “Managing change isn’t enough – you have to lead it.” (Kotter, 1996) • As the Nursing Leaders of VUMC, we must actively LEAD this transformation of practice & documentation • Requires strong leadership & visible support • We cannot “manage” change from the sidelines

10. Managers create order & predictability, while leaders establish direction, vision, motivate & inspire people. (Weber & Joshi, 2000)

11. Building a Change Coalition • Nursing Leaders & Nursing Educators • Staff Nurses (novice to expert) • SuperUser Champions • SSS CAPS • HED Builders • Key Stakeholders: Medical Director, Physicians, Nurse practitioners • Engage Opinion Leaders early & engage as Champions

12. Change Coalition will… • Work as a TEAM • Build ongoing urgency & momentum for the need for change

13. Kotter’s Step 3: Create a Vision Vision Statement • Safety Documentation, including assessment, interventions, teaching, and notification, will result in a safer environment for our patients and will prevent or minimize injury. This will improve patient care and clearly define nursing’s contributions to patient care and the team.

14. If documentation is a reflection of our care – does it show that nurses make a difference?

15. 21 CCC Categories • Psych/Behavioral • Cognitive/Neuro • Coping • Health Behavior • Role Relationship • Self Care • Self Concept • Functional • Activity • Fluid Volume • Nutrition • Safety • Sensory/Pain • Physiological • Cardiac • Bowel/Gastric • Life cycle (pregnancy) • Metabolic (glucose) • Physical Regulation (infection) • Respiratory • Skin Integrity • Tissue Perfusion • Urinary • Medication

16. Assess * Care * Teach * Manage Priority Problems Building an Outcomes Oriented Documentation Framework A Home for Evidence Based Nursing Care

17. Kotter’s Step 4:Communicating the message • According to Albert Mehrabian’s research study in 1968 how much of the message is the actual words used? • 38% • 7% • 55%

19. Which of the following delivery methods is the most effective? • Email • Group meetings • One-on-one communication • Company publications • High level and executive storytelling delivered company-wide

20. According to the 2005 Change Management Best Practice Report…. • One-on-one face to face discussions that are honest and straight forward and that offer details of the change on a personal level • Cascading small group meetings to share information, brainstorm solutions and implement new processes

21. Communicating to Different Generations Traditionalists born before 1945 Baby Boomers born 1945 – 60 Millenials – grandchildren of boomers Generation X – children of boomers

22. Show Me generation--Body language is very important Favor top-down decisions Value respect Will fight for a cause Make decisions based on what has worked in the past Consistency is important Traditionalists Baby Boomers Generation X Millenials Value work and life balance Shaped by a culture of instant results Multi-taskers Avoid unnecessary meetings Highly Collaborative Optimistic Prefer messages presented from positive standpoint

23. Styles of CommunicationMatch the Generation to a Style Preferred by that Generation Baby Boomers • Blog • Face to Face communication • Email • PowerPoint Presentation Traditionalists Generation X Millenials

24. You can expect to see some/all of the following strategies used to communicate additional Documentation Framework Changes: • Web Site • E-mail updates • Monthly updates for leadership to communicate to staff • Newsletters

25. Area Specific Coalition and Communication Plan For the next 5 minutes discuss: • Who should be included in your unit’s coalition for change? List names and/or titles • Begin to identify your unit-specific communication plan – be specific and include timeframes

26. Kotter’s Step 5:Removing Obstacles & Empowering Action Obstacles are generally in 3 categories People Processes Structure

27. People • Leadership: Commit to change & voice consistent message • Educators & Super Users: Communicate advantages of new process • Curmudgeons: Listen to their feedback but don’t leave true resisters in leadership positions • 5 positive encounters to overcome 1 negative • All Leaders demonstrate their belief that the change will improve patient care & continuity of care

28. Process • Can’t be too complicated • Must be fairly easy to learn • Must fit into workflow • CQI: Looping process…education, implementation, evaluation, reeducate or change, reevaluate, reeducate/change

29. Structure • Commit to overtime pay: for SuperUsers to be available during implementation • Change takes time: hard-wiring to new processes can take up to 4 weeks • Adequate Education: Educators, Superusers, Staff • Identify competing projects: other quality/safety initiatives; policy/product changes… Anything that will require extra time • Watch out for staff and Manager overload!

30. Removing Obstacles & Empowering Action Take 5minutes to: • Identify obstacles to success & develop action plans to address • Include prior commitments that might influence timelines for Priority Problem rollout on your unit

31. Kotter’s Step 6: Create Short Term Wins • 9 North experience • What were improvements experienced with use of modified Falls/Safety documentation approach? • How did you hard wire the change? • What were the challenges to adoption?

32. Kotter’s Steps 7 & 8:Build on the Change & Anchor the Change in culture • Identify 2-3 successful changes they have experienced in VUH over the past 2-3 years • During any of these changes, did you identify short-term wins during the change process? • How did you celebrate these wins? • What techniques did you use to hardwire the change?

33. NEXT STEPS • Team completes Implementation Worksheet • Educator, Leadership Team member, CAPS partner to create unit-specific plan and begin training • Utilize your CAPS and watch for communication updates