Patient Experience Value Based Purchasing HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Nursing

Transcription

1 Patient Experience Value Based Purchasing HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Nursing HCAHPS Domain Survey Questions Recommendation Communicate NEW MEDICATIONS Communicate SIDE EFFECTS Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand? Communicate NEW medications and why they were prescribed. Use the word SIDE EFFECT in your communication with patients Check for patient understanding at Discharge. I want to be sure that I explained your medication correctly. Can you tell me how you are going to take this medicine? PAIN Control often was your pain well controlled? often did the hospital staff do everything they could to help with your pain? Inform patient of the amount of pain to expect. Use Key Words: We are going to do all we can to manage your pain as safely as possible. Your safety is our number one priority. Due to your condition (or procedure), you will have some pain. We want to manage your pain as safely as possible and will make you as comfortable as we can. Care from NURSES often did nurses treat you with courtesy and respect? often did nurses listen carefully to you? often did nurses explain things in a way you could understand? Nurse Physician Rounding (preferably with family) to communicate the plans for treatment and testing. AIDET Acknowledge patient by name. Introduce yourself and each other, especially at shift change. Duration: Testing; Realistic Discharge Explain Pain medication and side effects Discharge Information During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital? During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital? Thank you for letting me take care for you. KEY WORDS: I want to keep you informed What questions do you have for me? PAUSE BODY LANGUAGE: SIT down rather than stand Call Dr. Alex Hover at if any questions. 3/28/2012 C:\Documents and Settings\cdw21360\Local Settings\Temporary Internet Files\Content.Outlook\R9P3O77A\FinalNurseHCAHPS3_28_2012.doc

2 HOSPITAL FLOORS Lower Level (LL) Human Resources, Tunnels, Co-worker Store, Nursing Administration Maintenance/Electronics 1 st Floor ETC (Emergency Trauma Center) (NORTH) Cafeteria Gift Shop, Pharmacy, Credit Union Morgue Mercy Mocha, Discharge Area (WEST), Admitting (FRONT/SOUTH), Children s Hospital Entrance (EAST) 2 nd Floor Laboratory (drop off specimens, pick up blood/blood products) Radiology, CT Scan, MRI Angiography, Medical Library, Medical Records (HMI), Infection Prevention, Administrative Offices 3 rd Floor 3A/3B Surgical patient rooms 3C Orthopedic patient rooms 3D Medical patient rooms 3E-ICU Surgical Intensive Care (SICU) 3F-ICU Dialysis 3J Pre-admit/AM admit OR - Operating Room 4 th Floor 4A/4B Cardiac monitored patient rooms 4C - Medical Surgical 4D Cardiac/Thoracic surgical patient rooms 4E-ICU Cardiac Medical Intensive Care (CMICU) 4F-ICU Pediatric Intensive Care (PICU) 4H - Cardiac Cath Lab (EAST) 4J - TDO (Talent Development & Optimization) 4K- Outpatient Nursing Services-PICC Team 5 th Floor 5A Mothers Unit (Post partum) 5B Gynecological Surgery patient rooms 5C/5D Newborn Intensive Care (NICU) Labor & Delivery 6 th Floor 6A-ICU Medical Intensive Care (MICU) 6B Medical & Cardiac monitored patient rooms 6C Neuro-Intermediate patient rooms 6D Neuro-trauma Progressive Care Unit (PCU) patient rooms 6F-ICU Neuro Trauma Intensive Care (NTICU) 6K Chapel 7 th Floor 7B Medical patient rooms 7C Pediatric patient rooms 7D Oncology patient rooms 7H Burn Unit/Out-patient Burn Unit (EAST PAVILLION) & Simulation Lab

3 2016 Hospital National Patient Safety Goals The purpose of the National Patient Safety Goals is to improve patient safety. The goals focus on problems in health care safety and how to solve them. This is an easy-to-read document. It has been created for the public. The exact language of the goals can be found at Identify patients correctly NPSG Use at least two ways to identify patients. For example, use the patient s name and date of birth. This is done to make sure that each patient gets the correct medicine and treatment. NPSG Make sure that the correct patient gets the correct blood when they get a blood transfusion. Prevent infection NPSG Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning. NPSG Use proven guidelines to prevent infections that are difficult to treat. NPSG Use proven guidelines to prevent infection of the blood from central lines. NPSG Use proven guidelines to prevent infection after surgery. NPSG Use proven guidelines to prevent infections of the urinary tract that are caused by catheters. Improve staff communication NPSG Get important test results to the right staff person on time. Identify patient safety risks NPSG Find out which patients are most likely to try to commit suicide. Prevent mistakes in surgery UP Make sure that the correct surgery is done on the correct patient and at the correct place on the patient s body. UP Mark the correct place on the patient s body where the surgery is to be done. UP Pause before the surgery to make sure that a mistake is not being made. Use medicines safely NPSG Before a procedure, label medicines that are not labeled. For example, medicines in syringes, cups and basins. Do this in the area where medicines and supplies are set up. NPSG Take extra care with patients who take medicines to thin their blood. NPSG Record and pass along correct information about a patient s medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Make sure the patient knows which medicines to take when they are at home. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor. Use alarms safely NPSG Make improvements to ensure that alarms on medical equipment are heard and responded to on time. This is an easy-to-read document. It has been created for the public. The exact language of the goals can be found at

4 Quick Reference Guide ACCESSING INTERPRETING SERVICES WHEN YOU NEED AN INTERPRETER 1. DIAL: MERCY4U ( ) 2. INDICATE: the language you need or press: 1 for Spanish 6 for all other languages 3. PROVIDE: additional information, if required Your Community Department Name Patient s E-Number 190+ Languages Anywhere Mercy Serves MERCY4U CONNECT: To an interpreter who will provide his/her name and ID number which you can document for reference. Summarize what you wish to accomplish and give any special instructions. If you have a dual handset phone: Lift handset and press the Red interpreter button, then follow the prompts. Once connected to an interpreter, give the second handset to the limited English proficient individual. When calling or receiving a call from a limit English proficient individual: Use the conference feature on your phone to make a 3-way call and follow the instructions above to connect to an interpreter. Important Information: INTERPRETER IDENTIFICATION Interpreters identify themselves by name and ID number. Feel free to note this information for future reference if your organization requires it for their records or to comply with regulatory requirements. WORKING WITH AN INTERPRETER At the beginning of the call, briefly tell the interpreter the nature of the call. Speak directly to the limited English speaking speaker, not to the interpreter, and pause at the end of a complete thought. Please note, to ensure accuracy, your interpreter may sometimes ask for clarification or repetition. CUSTOMER SERVICE To provide feedback, commend an interpreter, or report any service concerns, call or go to and click on the Customer Service tab to complete a Voice of the Customer form. 5/ LanguageLine Solutions Confidential Information V1

5 Video Remote Interpreter (VRI) equipment is now available: VRI connects caregivers and patients with live interpreters in 8 video languages including American Sign Language, Spanish, Vietnamese, Arabic, Russian, Cantonese and Mandarin Chinese and 180+ audio languages. If VRI is not available, please continue using telephone interpreting services by calling your hospital operator or dialing and asking for Language Line. It is never appropriate to use the following for medical interpretation: 1. Minor children 2. Unauthorized co-workers or physicians 3. Computer or smart phone applications Adult family members or friends may provide interpretation only after a Waiver of Interpreter Services (attached) has been signed by the patient. The waiver must be secured using an authorized interpreter (VRI, Language Line, or authorized co-worker interpreter). Reserve or check out VRI equipment at the following facilities by calling the provided contact below. Facility: Equipment Location: Contact: Springfield Hospital, Fremont Springfield Hospital SPD (4G) (417) Clinic, Marian Center Springfield Hospital Emergency Department Use Only Department Springfield Hospital PICU, NBN, PICU (417) Pediatrics, Mothers Unit & Women s Surgery only Springfield Cancer Center, Cancer Resource Center (417) Whiteside Clinic Springfield Surgery Center Surgery Registration (417) (includes Mercy Clinic suites) Aurora Hospital Emergency Room (417) Berryville Hospital Patient Access (870) Cassville Hospital/Clinic Emergency Room (417) Lebanon Hospital ICU (417) Smith Glynn Callaway Clinic Urgent Care (417) Mt. View Hospital Emergency Room (417) Rolla Clinic TBD Coming Soon Please direct any questions or feedback regarding VRI or Interpreter Services to Steve Fowler, Director of Mission Services at steven.fowler@mercy.net or

6 Mercy Hospital-Springfield Clinical Practice Bulletin Dr. Robert Cavagnol, Medical Director of Quality Resources and Patient Safety CUSS Words at Mercy Communication between providers and nurses plays a critical role in providing safe patient care. A lack of communication due to fear of repercussion should never occur. Mercy is participating in a national patient safety training program entitled TeamSTEPPS. Developed by the Department of Defense, the goal of the program is to optimize the use of information, people, and resources to achieve the best clinical outcomes for patients. One TeamSTEPPS tool modified for use at Mercy is CUSS Words. What are CUSS Words? They are key words and phrases co-workers will use to intervene anytime there is a question regarding the safety of the patient. Use of CUSS Words is a respectful approach to discussion and clarification of concerns. What does it sound like? Nurse pages provider regarding patient s status, stating the patient is anxious with respirations of 28 and oxygen saturation at 88% on 5 L. The physician orders Ativan for anxiety. Nurse states I m concerned about the patient s respiratory status because The provider is obligated to stop, reconsider and explain. If, following the explanation, the nurse is not convinced the concern should be escalated to: I am uncomfortable giving the Ativan, this is a safety issue. If the nurse is still uncomfortable following additional explanation, the next step is to follow the chain-of-command to their immediate supervisor. Refusing to carry out an ordered action is rare, but is appropriate if the provider is clearly impaired or the situation is so glaring that the nurse feels the patient is in immediate danger. CUSS is the acronym for a respectful but assertive approach to questioning a provider, using an escalating set of words. CUSS I am Concerned I am Uncomfortable Stop, this is a Safety issue OR if in presence of patient or family I need some Clarification on.? (this statement is a signal for the provider and nurse to step to a private care for conversation) Use of the CUSS Words is never meant to challenge authority of the healthcare provider. What if CUSS Words are used because of a concern and the concern is unfounded? No punitive action will occur for any question regarding the safety of a patient. This communication is one of mutual respect. It is a time to consider other options or additional information and is an excellent opportunity for learning. Resources: Department of Defense, Patient Safety Program Agency for Healthcare Research and Quality