1 / 13

Patient Engagement through Patient Centered Goals

Patient Engagement through Patient Centered Goals. Chris Walker MSN, RN, MHA St. Cloud Hospital/CentraCare Health. Typical Transition Failures. Self-care Care Planning Health Literacy/Communication. Improvement Strategies. Self-care Care Planning

zenia-goodwin
Download Presentation

Patient Engagement through Patient Centered Goals

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. Patient Engagement through Patient Centered Goals Chris Walker MSN, RN, MHA St. Cloud Hospital/CentraCare Health

  2. Typical Transition Failures • Self-care • Care Planning • Health Literacy/Communication

  3. Improvement Strategies • Self-care • Care Planning • Health Literacy/Patient-Provider Communication

  4. Illness Management & Recovery(IM & R) • Psychoeducation • Behavioral tailoring for medication adherence • Relapse prevention training • Coping skills training • Social skills training

  5. Recovery Goals • Unique to each individual • Must be personally meaningful • Vary from modest to ambitious • Use of Motivational Interviewing (MI)

  6. Unique Treatment Plan (UTP) • Criteria and types • Plan development with patient and interdisciplinary team • Electronic health record access

  7. Interdisciplinary Staffing Note • RN/SW Communication • Plan of care Day of IP stay • Payor UTP (yes/no) • Suicide risk assessment Violence risk assessment • Event changes Family meeting • Illness, Management & Recovery (IM & R) • Recovery goal • Dialectical Behavior Therapy Protocol • Behavioral Chain Analysis • Diary card • Integrated Dual Disorder Treatment (IDDT) • Staged within 3 days of admission • Stages of mental health and/or substance use • Transition Plan • Disposition needs • Medical follow up

  8. Bedside Shift Report • Warm handoff • SBAR report • Focused pt and safety assessment • Review of tasks • Identify patient and family needs/concerns

  9. My Care Board

  10. Managing My Recovery • Relapse prevention plan • Reasons for living • Possible triggers • Early warning signs • Support people • Recovery goal • Strategies for success

  11. Discharge Checklist • Specific to disciplines • Improved consistency

  12. Transforming Care at the Bedside (TCAB) • Purpose • Rapid change cycle (PDSA) • Positive culture change

  13. References • www.rarereadmissions.org • Nurse Bedside Shift Report. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy3/index.html • Meyer, P. & Gingerich, S. (2009). Supporting Illness Management Recovery on Inpatient Units. • 2007: Robert Wood Johnson Foundation & Institute for Healthcare Improvement. TCAB Communications Guidelines

More Related