PARKES 5 AGED CARE REHAB In Safe Hands Unit Structured Interdisciplinary Bedside Rounds (SIBR) Catherine McVeigh (Staff Specialist Aged Care) Julietta Cox (NUM Aged Care Rehab and AACE) March 2015
Outline of SIBR SIBR was developed by Jason Stein, MD SFHM, and team at the Emory University School of Medicine Improving Hospital Outcomes through teamwork in an accountable care unit Emory 6G Ward looked at clinical and qualitative outcomes over the 12 month period prior to and after implementing SIBR 53% reduction in mortality LOS Increased team work, staff satisfaction and staff turnover
Why does it work? Increased communication within the team and with patients / families- patient-centred Shared Goals of care and expectations Planned and co-ordinated delivery of care Shared mental model- everyone on the same page Collaborative cross checking Safety Checklist Scripted and timely
Designing SIBR for Parkes 5 A comprehensive education program developed including multidisciplinary training over 2 months to inform staff on processes, goals, handover techniques and practice sessions A collaborative approach around choosing rounding times and days Restructuring shift planning for nursing staff Re-organising mealtimes for therapy sessions Development of tools and forms for documentation
SIBR Ground Rules Parkes 5 Aged Care Rehabilitation All staff must come to SIBR prepared We SIBR on all patients Monday and Thursday and begin and finish on time All SIBR team members take positions at the patient s bedside Two exceptions: a) Patient is off the unit or otherwise indisposed b) Patient opts out or identified not suitable for participating in SIBR In which case, SIBR occurs outside the room in a manner that preserves confidentiality SIBR may start for each patient only when the doctor and bedside nurse are both present SIBR may end for each patient only after the plan-for-the-day has been verbalised All documentation and new (non-computerised) orders will be completed in real-time during SIBR
SIBR structure Introduction 15 seconds Update hospital course 45 seconds Update current status 45 seconds Review quality-safety checklist 45 seconds Multidisciplinary team input 90 seconds Synthesise plan 45 seconds Questions (patient and relatives) 30 seconds
Aged Care Rehabilitation Structured Interdisciplinary Bedside Rounds (SIBR) Affix identification label Date: Time: Team Members Present: Patient/Family NUM Consultant Registrar RMO Bedside Nurse PT OT Social Worker Dietician NPsych Pharmacist Summary of current issues: Diagnosis: Summary of nursing issues: Overnight events Specify: Functional Independence Score Score (FIM): Vital Signs PACE last 24 hrs: Yes No Last Obs Within Range: Yes No Pain Control Fluid & Food Urine & bowel Cognitive status + ADLs Goal for the day Falls Risk: Skin integrity/ wounds Specify: Specify: Urinary Continence Yes No LBO: / /20 Bowel Continence Yes No Specify: Specify: Score: Specify: Intervention: Cannula No Yes Date of Insertion: Site: Remove: Yes No Catheter No Yes Date of Insertion: Plan: Remove: Yes No VTE Prophylaxis Medication reconciliation Diabetes NFR (PACE) Allied Health Assessment sticker completed Yes No Specify: Specify: Specify: Specify: Mechanical: Yes No Chemical: Yes No EDD: Destination: Referrals: Patient and Family Concerns: Other Comments: Agreed Daily Plan: Print Full Name Signature d Print Full Name Signature Designation TRIAL FORM
Development of the Co-ordinator role: Pre-arranged rounding structure Support given to new staff members Invite / educate patients and family Ensure time management
Development of Whiteboards at bedsides: To update medical and bedside nurse's names State patients current mobility and functional ability State patient s goals Care plan Estimated Date of Discharge
What was our target? To improve efficiency and lessen risk Put patient at the centre of the care To lessen the amount of time spent discussing the patients progress amongst individual multidisciplinary teams- thereby allowing more time for actual therapy for the patient To come together for SIBR and promote a more open and combined conversation with the patient/ relatives- with everybody imparting the same information in real time
Length of stay Length of Stay data- before SIBR 21days, after SIBR 17days 10am discharges 36.4% (hospital average 15.4%)
Quality and safety improvements Appropriate VTE prophylaxis charted- continues to be 100% Pressure Injury Prevention- consistent monitoring and nil Pressure Injuries developed while patient on the ward FIMs- timely documentation of initial assessment- consistent compliance although can be improved (currently 87% the National standard goal is 96%)
Falls / 1000 OBDs PB5 Rate of falls; 2011-2014 Aged Care Rehab - Falls / 1000 OBDs 14 12 10 8 6 4 2 0 May Mar Jan-14 Nov Sep Jul May Mar Jan-13 Nov Sep Jul May Mar Jan-12 Nov Sep Jul May Mar Jan-11
Staff satisfaction Cohesive Teamwork- positive ward dynamics Nursing staff stepping up, having increased confidence in knowledge and skills- true advocacy for patients Reduction in patient-nurse calls Reduction in patient / family calls to medical team, family conferences Reduced Clinical review calls Reduction in after hours JMO workload?
Patient satisfaction- Standard 2 Staff knowledge Confidence in the healthcare team Involvement in care Feeling of teamwork Privacy Explanation of results Introduction by staff
Staff Knowledge
Involvement in Care
Challenges Consultation with staff for feedback and compromising on start times, shift planning and frequency of SIBR- to avoid clashes with therapy and maintain consistency and participation Ensuring that staff who can t be present handover to a colleague Ensuring timeframe for each patient is kept (5mins/patient) Ensuring accurate and honest information is provided to patients and families
Challenges cont. Re-designing and changing paperwork Making sure new staff are confident and perform well Making sure that issues/tasks or reviews are followed up and addressed Training a new SIBR co-ordinator for extra support Ongoing feedback to all staff about their SIBR performancesustainability
What will we do to improve? Maintain high standard of effective multidisciplinary communication- involving the patients and relatives. Endeavour to become more streamlined and efficient during SIBR- keep up the momentum Continue to re-analysing check lists, documentation, the timing of the ward round with a view to suiting the staff and patients. Continue to educate new staff to this new model of care and teamwork We have advocated for this In safe Hands program to be rolled out to other areas in Aged Care and beyond
Acknowledgements Morag Taylor (Senior physiotherapist) Melissa Gole (CNC Geriatric MAU) Jessica Van Schreven (Pharmacy department) Catherine McVeigh (Staff Specialist Aged Care) Julietta Cox (NUM Aged Care Rehab and AACE) Gemma Price (CNC Aged Care) Jan Woods (Manager Aged Care, Post Acute Care Services & Community Health)