F.A.S.T. Family Activated Safety Team A Rapid Response for Patient and Family Concerns Ellen Noel MN,RN-BC Clinical Nurse Specialist Ellen.Noel@vmmc.org
Overview What is F.A.S.T? Why do we need FAST? F.A.S.T. program development F.A.S.T. program implementation What we are learning from our FAST patients.
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I believe in looking reality right in the eye and denying it Garrison Keillor
Josie s Story www.josieking.org
Judy s Story
Health Care Process Reliabilities (Un)Reliability 10-1 Outcome/Process Beta blockers for MI; ASA in MI >3 Glycosylated hemoglobin tests/2 yrs Known preventive treatments 10-2 10-3 10-4 Adverse events in hospital Deaths in high risk surgery Neonatal mortality General surgery deaths Deaths in routine anesthesia 10-5? 10-6 For further reading, see: McGlynn EA, Asch SM, Adams J, et al.? The quality of health care delivered to adults in the United States. New England Journal of Medicine. 2003;348.
Communication Errors 65% http://www.jointcommissionreport.org/performanceresults/sentinel.aspx
Sentinel Events
Why F.A.S.T? Sorrel s story, Judy s story and those of many other families 98,000 hospitalized Americans die each year due to errors 1 53% MDs & 66% patients have experienced a healthcare error. 1 48% with serious health consequences F.A.S.T. is our next step toward providing each patient the safest possible hospital care 1 Keeping Patients Safe: Transforming the Work Environment for Nurses. (2004) Institute of Medicine
VMPS Methodology and F.A.S.T. Guiding Principles: Zero Defects Transparency Methods: Mistake Proofing: In-Process Inspection Stop the Line: Andon
The Customer With the Defective Product Is 100% Dissatisfied The Other 999 Customers Are Invisible
Mistakes are Fixed at the Source Within Just After Just Before Downstream A B C Pokayoke Self Check Successive Check Instant Fix Oops, I goofed! Hey, you goofed!
Andon: Stop the Line Patient Safety Alert System Medical Emergency Team Family Activated Safety Team
An Effective Andon MUST: Signal Action Success
Reasons for Activation Reason 2005 2005 Rate 2006 2006 Rate 2007 2007 Rate Totals Overall Rate Pain Management/ Medication Related Communication Breakdown 1 10% 15 42% 13 52% 29 40.85% 0 0% 3 8% 0 0% 3 4.23% Clarification of Orders 1 10% 1 3% 0 0% 2 2.82% Psychological Issues 3 30% 0 0% 0 0% 3 4.23% Discharge Planning 1 10% 4 11% 1 4% 6 8.45% Medical Management 2 20% 3 8% 5 20% 10 14.08% Diet Related 1 10% 0 0% 0 0% 1 1.41% Dissatisfaction w/ Staff 0 0% 3 8% 2 8% 5 7.04% No Data Reported 1 10% 7 19% 4 16% 12 16.90% Totals: 10 36 25 71 University of Pittsburg Medical Center at Shadyside
Structure for Success Stakeholders Clarify AIM Sponsors PLAN ACT Key Players DO STUDY
F.A.S.T. Program D evelopm ent Tim eline 1. Need Roles and Scripts 1. Lit Review (IH I, U PM C ) 2. Pilot Team Identified 3. P relim inary Planning Complete 1. Rapid Response Team Name Solicited F rom P ilot Unit Staff (FAST) 1. FAST Simulation #1. Test: a. Paging System b. Responders c. P atient R elations 2. Need Process Algorithm 3. Need Sequenced Ttriage @ Bedside FAST Simulation #3 GO LIVE CCU FAST Call # 3-6 Dec 07 Jan 08 Feb 08 March 08 April 08 May 08 June 08 July 08 Aug 08 Sept Oct 08 1. Response Model Identified 2. Perceived Fears Discussed 1. FAST Brochure Complete 2.Tested with Patient F am ily and Staff 1. Table Top Simulation #2 2. Algorithm, Script and Role Revision 1. Tool Kit Complete 2. P ilot Begins on Tele/IMC CCU FAST Call # 1 1. Organization Communication and Rollout Plan Begins CCU FAST C all # 2 1. Walking Rounds to Assess M essaging (Patient, Family and Staff) 2. Walking Round Feedback to Managers and Staff 3. Communication meeting #2
Patient / Family activate Family Activated Safety Team By calling 6-FAST from any hospital phone FAST Algorithm 05.08 PBX paging 5 minutes Responders DAYS 1. Unit ANM/Charge RN 2. Primary RN 3. CCU Charge RN. 4. Unit CNL/CNS Pulled by ANM 5.Unit Director 6. Service Rep. E- Handoff Responders NIGHTS 1. Unit ANM/Charge RN 3. CCU MET RN. 4. Rapid Response Flow RN 2. Primary RN Activate MET No Yes 1. CCU MET RN Screen Physiologically stable? Responder Huddle 1. Initial Action Plan 2. Person accountable for follow up. 3. If handoff anticipated with who and when? 4. Who will notify primary team of call? 5. Document above in progress note/care plan. Patient and Family Action Plan Update 24-48 HOUR PATIENT F/U Patient and Family Service F/U NOTE: For complex issues the Unit CNL(CNS) is responsible for care coordination until issue resolution. Virginia Mason Medical Center 2008
Results F.A.S.T Nature of Call N=20 pain control/ med related clarification of care plan 1 1 2 8 delay in care dissatisfaction with staff 6 communication related 3 psychosocial issues 6 10 environment issue diet related others
Results 7 FAST Action Taken N=20 15 managing MD notified required transfer to higher level of care MET activated Service recovery 0 8 6 1 0 Manager/ Director Contacted Follow up with Primary RN CNL notified Social Services Notified Patient Relations Team 9 Other 8 1
Results Patient Response to FAST. " Was there clear direction on how to activate FAST?" 9 8 7 6 5 4 3 2 1 0 Strongly agree Agreee Netural Disagree Strongly disagree
Results Patient Response to FAST " Did you feel comfortable calling FAST?" 12 10 8 6 4 2 0 Strongly agree Agreee Netural Disagree Strongly disagree
Results Patient Response to FAST "Were your concerns addressed?" 14 12 10 8 6 4 2 0 Strongly agree Agreee Netural Disagree Strongly disagree
Results Would You Call FAST Again? 18 16 14 12 10 8 6 4 2 0 YES NO
F.A.S.T. and the Virginia Mason Quality Equation Q = A (O + S) Q: Quality W A: Appropriateness O: Outcomes W: Waste S: Service
Did Your Paradigm Shift? Sometimes I've believed as many as six impossible things before breakfast. - Lewis Carroll
It s ALL about the PATIENT