National Forum Production Programmes May 2013

1. Accelerated Releasing Time to Care National Forum Production Programmes May 2013

2. Background • ADHB commenced Releasing Time to Care is 2009 with 33 Wards now underway • ADHB investigated alternative delivery options for RTC • An accelerated approach was chosen with a pilot ward commencing in July 2012 • Support resource was allocated to work with the team to deliver on a module a month until completion

3. Accelerated Programme Approach 7-9 Months Ongoing Shift Handover Meals Patient Observations Patient Hygiene Medicines Admissions and Planned D/C Ward Rounds Nursing Procedures Nursing Procedures Nursing Procedures Process Modules Foundation Modules Knowing How We are Doing Well Organised Ward Patient Status at a Glance

4. Module Implementation – Monthly timeline Preparation Week 1 Launch Week 2 & 3 Develop Week 4 Implement Follow Up • Agree team and confirm roster • Collect Data • Learn from other Wards • Generate excitement • Patient Interviews • Staff Interviews • Process follows • Review data • Go-see • Identify opportunities • Define new process • Agree implementation timeframe and communications plan • Develop Process Flowchart • Develop SOPs • Develop Templates • Engage other stakeholders • Order new equipment • Plan facilities improvements • Staff Education • Go Live with process improvements • New equipment • Facilities improvements • Audits • Celebrate success

5. Key Principles • Steal with pride - capitalise on the work done and improvements made by other wards • Manage scope – focus on specific areas of improvement • Communication, Communication, Communication – use the Daily Ward Meetings as a key tool to ensure everyone knows what is happening, why and when • Quick fire – keep energy, focus and motivation high by maintaining momentum • Share the load – utilise as many of the ward team as possible to implement change • Build for the future – develop resources to be utilised by other wards

6. Results - Overall Reduction in Pressure Injuries = 0 in 6 months Direct Care Time = 54% (38% Improvement) 7 Process Modules delivered Reduction in Length of Stay >0.8 days Patient Satisfaction = 91 % 3 Foundation Modules extended Sustained Smoking Cessation >95% Staff Satisfaction = 84 % Sustained Acute Patient Flow >95% “It really has increased the amount of time we can spend with the patients” – Staff Member

7. Knowing How We are Doing • Revisited the Ward Vision with input from the Multidisciplinary team • Implemented Daily Ward Meetings • Maintained communications boards and safety crosses “The atmosphere on the ward has changed.  You can feel it as you walk in, things are calm and organised.” - Staff Member

8. Well Organised Ward • 4 bedded Rooms • Equipment Room • Staff Base • Whanau Room • Education Hub • Ward Meeting Room • Sluice Room “I can find things! Everything has its place.” – Staff member

9. Patient Status at a Glance • Electronic Whiteboards updated with required flags • New wide screens to improve usability • Patient Bedcards implemented • Staff Status at a Glance Board • Rapid Rounds maintained

10. Shift Handover • ISOBAR Bedside Handover • Patient involvement • Improved information transfer • Safety checks • Significant impact on direct care time “When the nurses change shifts they introduce who they are and that they’re our nurse” - Patient

11. Meals • Improved focus on patient preparation • Implementation of a meal preparation bell • Nurses assisting patients to complete meal cards – ensuring sufficient food is ordered and less meal call backs are required • Improved use of assist flags for those patients needing any assistance at meal times • Improved timing of meal delivery

12. Patient Observations • Improved observation trolley set up to reduce waste looking for additional equipment • Relocation of observation equipment to point of use (i.e. within 4-bedded rooms and outside single bedded rooms) • Refreshed patient observation standards including education “The ward seems calm and everyone knows what they are doing.” - Patient

13. Patient Hygiene • Hygiene packs • Where am I posters for Commode and Wash Bowl Trolley • Agreed standards on patient hygiene requirements “The staff are fantastic! I would give them 100%. They work so hard and every single one of them took time for a chat and you were never rushed.” - Patient

14. Medicines • New layout and refurbishment of the medication room • Improved access to controlled drugs cabinet • Reduce stock levels • Improved education for patients

15. Admissions and Planned Discharges • New patient welcome pack including • Ward information Booklet • Ward and hospital maps • What to expect information • Transition lounge brochure • Hospital Resources • Staff Admission checklist • Agreement that discharge summaries are written 24 hours before discharge to allow for review by the consultant and better discussion with the patient

16. Ward Rounds • Agreed sequence and flow • Portable laptop to be used during Ward Rounds • Patient nurse to attend Ward Rounds • Ward Rounds information sheet for patients in the Welcome Pack including space to capture questions for the Medical Team • Improved signage and awareness around which teams are rounding and when • Consultant to sit down during Ward Rounds to enable better engagement with the patient and their support person(s) • Junior doctor to read back plan to ensure clarity and correctness

17. Conclusion • Ward 72 has benefited from the combined impact of the Accelerated Releasing Time to Care programme, Rapid Rounds and daily ward meetings • The ward is now better organised with clearly defined processes. • The improvements have resulted in a calmer work environment that provides a better patient experience • The fast pace of implementation along with the significant team involvement has resulted in a continuous stream of improvements on the ward keeping team motivation and engagement high “Getting better every day! Great place to work!” - Staff member

18. Questions Do you have any questions? For future questions please contact Abbi Harwood-Tobin (abbih@adhb.govt.nz or 021 584 021) Marie Mata (mmata@adhb.govt.nz or 021 0825 7224) Sarah Wilson (sarahwil@adhb.govt.nz 021 397 553) “It means nurses can identify REAL problems… and fix them!” - Staff Member