The Journey of One Thousand Miles Begins with One Step

Transcription

1 The Journey of One Thousand Miles Begins with One Step 1 A ROAD MAP TO PATIENT CENTERED CARE CULTURE CARMELA VA LENTINO, MPH CHES CPHQ BONNIE HAUPT, MSN CNL

2 About Us 2 VA Connecticut Healthcare System is a member of the VA New England Healthcare System Serve Veterans in Connecticut and southern New England. The West Haven campus is a 120 bed tertiary care facility classified as a Clinical Referral Level 1 Facility. The Newington campus is an ambulatory care center that provides primary and specialty care. 6 Community Based Outpatient Clinics. Over 40 University School Affiliations Medical, Nursing, Pharmacy, PT/OT, Dietary, PA Oct 2011 Thru Aug 2012 over 700,000 service encounters (All data provided by facility management and VA OIG)

3 Objectives Overview of quantitative and qualitative data use to engage staff in driving improvements in PCC. 3 Examine the benefits of partnering with a CNL on an acute unit as a pilot site for interventions aimed at improving the patient experience and organizational change. Identify interventions targeted at improving staff and patient experiences.

4 What Does PCC Mean to You? 4

5 PCC Definition Patient Centered Care as defined by the Office of Patient Centered Care: 5 An approach to health care that prioritizes the Veteran and their values and partners with them to create a personalized strategy to optimize their health, healing and well being. This definition highlights the importance of patients directing their health and wellbeing in collaboration with their caregivers.

6 The Patient Centered Care Experience 6 The goal is to see things from their perspective and through the Veterans eyes

7 PCC is a Team Effort 7 Leadership Staff Volunteers Veterans, Family and Friends

8 Planetree Components 8 Human Interactions Access to Information Family, Friends & Social Support Healing Environment Recreation & Creative Arts Spirituality Complementary Therapies Human Touch Food and Nutrition Healthy Communities Employee Engagement

9 Through The Veteran s Eyes 9 9

10 Employee Engagement 10 Employee of the month Shining Star Tokens of Kindness Staff Lounge Makeovers

11 Token of Kindness Spreading the Spirit of Kindness 11

12 CNL Partnership & Laying the Foundation SHEP/HCAHPS 12 PAT Complaint Rounding Data (PAT) MD Engagement (Inter-professional rounds) Focus Groups through Planetree and OPCCC

13 CNL Partnership 13 Selected an Innovative Unit 30 bed medical/surgical unit. 11 surgical specialties Assessed Veteran, family and unit needs PEO & CNL collaborated with key Inter-professional team members. Pre/post data collection with a focus on Veteran satisfaction with SHEP Dimensions.

14 Pre-Communication Boards 14

15 Plan Communication Boards Placed in 11 private rooms on the Innovations Unit. Categories on the boards. Every shift during handoff and hourly rounding information pertinent to the Veterans plan of care was updated on the boards. Veterans and members of the inter-professional healthcare team were encouraged to participate in the process. 15

16 Post-Communication Boards 16

17 Veteran Comments 17 The nurse was great we did it together. It lets me know what is going on. Did you see my message, I write one to the staff every day. My sister loves it, she leaves notes for the staff.

18 Summary Challenge Resources/Purchasing Changing culture and involving all inter-professional teams. Ensuring current and relevant information. Successes Increase in Veteran satisfaction Increased communication and dialogue among CNL, Veterans, families and other members of the interprofessional teams. VA Connecticut is in the process of ordering and installing communication boards in all private and semi-private inpatient rooms. Added pain. 18

19 Medication Cards 19

20 Percentage Medication Cards Initial Assessment of Veteran National Survey questions. SHEP (Survey of Healthcare Experiences of Patients) #16 and #17 regarding new medication education and medication education on side effects composite scores. VA National Benchmark 80% November of % % 80% November 2011 Scores Where we needed to go 60% 40% 20% 0% 1 2

21 What would you like to know about your medications or prescriptions? Veterans responded What is the medication, what is it all about and why am I taking it? Just tell me what my medications are for in simple terms How fast will the pills work and what should I look for if there are problems? I would like to know what the medication is for (if it is new).give me simple easy to read and understand paperwork. 21

22 Inter-professional Team Educate SHEP questions. Plan Collaborate in development of tool. Trial with TWO medication cards. Veterans receiving new medications would be given a medication card If Veterans had any questions or required additional printed information this would be addressed at point of contact. Focus on environmental resources, if Veterans had prior knowledge or minimal interest, staff would not be printing materials. 22 Script the staff Show me your card

23 Medication Cards 1. Why are you on this medication? This medication can be used to relieve mild to moderate pain or to reduce inflammation What are some common names of NSAIDS? Ibuprofen (Motrin),Toradol (ketorolac), Advil (Ibuprofen), Naproxen,Naprosyn (Aleve). 3. What are some possible side effects associated with this medication? You may experience constipation, diarrhea, dizziness, gas, heartburn, and/or upset stomach.

24 Medication Cards IMPORTANT THINGS YOU SHOULD KNOW ABOUT THIS MEDICATION: 1. Do not take if you are taking Aspirin for a heart condition. 2. Do not drink or smoke cigarettes while on this medication to reduce your risk of stomach ulcers. 3. Upset stomach may be reduced by taking with food or milk. 4. You should talk to a pharmacist before taking any over the counter medications or herbal/natural products. Where can you get more information? You can ask your nurse, doctor, or pharmacist. 24

25 Percentage Post Trial SHEP scores o SHEP scores in Quarter One of fiscal year 2012 (months of January, February and March) composite average increased to 82.2%. The pilot was successful allowing us to reach our benchmark. 25 Performance Measure Goal is 80% Percentage of Medication Outcomes

26 Challenges SUMMARY Resources, supplies printed medication cards in stock. Change of practice. Successes 26 Met our Benchmark for the year. Patient Satisfaction scores/comments. Simple, Easy to read and Right to the point. Staff are requesting making additional medication cards. Expanded to 15 medication cards. Medication education is crucial. Providing safe patient care and encouraging Veteran and family involvement improves human interactions with a focus patient centered care.

27 Benefits of CNL Collaboration Improved communication 27 Spread of improving PCC Adopting an intervention unit

28 Tips to Succeed 28 Buy in Leadership support Staff involvement & Inter-professional team member Family and caregiver involvement Don t start with 100% of patients (ramp up) Innovative Unit Focus on outcomes

29 Moving towards the Future 29 I am only one, but I am one. I cannot do everything, but I can do something. And I will not let what I cannot do interfere with what I can do. Edward Everett Hale

30 Questions??? Carmela C. Valentino, MPH CHES CPHQ Patient Experience Officer ext cell 30 Bonnie Haupt, MSN, CNL Acute Clinical Nurse Leader ext 7323

31 References Agency for Healthcare Research and Quality (AHRQ): 20 Tips to Prevent Medical Errors. Retrieved from Institute of Medicine. (2001). Shaping the future for health. Crossing the quality chasm: a new health system for the 21st century. Retrieved from Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf Hall, J., Peat, M., Birks, et al. Effectiveness of interventions designed to promote patient involvement to enhance patient safety: a systematic review. Quality & Safety in Healthcare, 19(5), 1-7, Spath P.,L. Partnering with Patients to Reduce Medical Errors. (2004). Chicago: Health Forum, Inc. The Joint Commission. (2012). Hospital 2012 National Patient Safety Goals. Retrieved from The Joint Commission Resources. (2008). Meeting the joint commissions national patient safety goals. Oakbrook Terrace, IL The Joint Commission: Speak Up. m 32