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Maximizing Positive Maximizing Positive Patient Outcomes through Patient Outcomes through
the Care Improvement the Care Improvement Team:Team:
A Partnership with Patients and A Partnership with Patients and StaffStaff
Martie Carnie, AS, PFACColleen Zidik, BSN, MBA, RN
Debra Moody, BSN, RNCarolyn Hayes, PH.D, RN
In the Beginning: In the Beginning: Changing the CultureChanging the Culture
1997: Joint Venture BWH & DFCI
Informational Town Meeting Active Work GroupAffiliation with IFCC
Changing the Culture: Changing the Culture: Evolution of Glitch RoundsEvolution of Glitch Rounds DFCI Inpatient beds moved to BWH
– Each patient had a personal escort/advocate – Informal rounding of Patients with Patients
Issues uncovered with informal rounds: Clinical Environmental Personnel Communication Educational
Glitch Rounds: Glitch Rounds: The Early Days The Early Days
Glitch Committee formalized by Inpatient Leaders (MD, RN, QI) with Patient Rounders– Informal weekly meetings– Members identified– Active problem solving
Quick and easy fixes Multidisciplinary solutions Sticky situations
Glitch Rounds: Glitch Rounds: The Picker EffectThe Picker Effect
QI reports influenced and prioritized the focus of the work– Clinical Issue of Emergent
Admissions: Need to bypass emergency room visits
Neutropenic Pathway Algorithms trialed
– Educational Issues: Need to follow up with patients at home
Day after Discharge Calls
Glitch Rounds: Initiation of Glitch Rounds: Initiation of Day after Discharge Day after Discharge
CallsCalls Brainstorm of Picker questions
– What do the poor scores mean?– Need more information from the patient
perspective– New Questionnaire developed using staff
and patient input (used in addition to the Picker Survey)
Staff RN on “light duty” conducted calls Partners in Excellence Award in 2000
Glitch Rounds: Glitch Rounds: The Accolades The Accolades
Partners in Excellence Award in 1998 Patient Advocate participation in Joint
Commission Accreditation visit Patient Advocates as a resource Formalized into Care Improvement
Team of today, continuing the partnership with patients and staff
Glitch Rounds: Transition Glitch Rounds: Transition to the Care Improvement to the Care Improvement
TeamTeam Membership has tripled since original Glitch rounds– Directors (MD, RN)– Patients– Staff at all levels & all disciplines
Meetings are monthly Invited Guests to address current
concerns
Care Improvement Team: Care Improvement Team: Day after Discharge Day after Discharge
CallsCalls Resource for calls was lost in 2002/2003 Gradual reduction in calls without
resource CIT Prioritized follow up calls in 2005 Staff RNs and Care Coordination RNs
conduct follow up phone calls Staff concern the call is an “intrusion”
41.86%
13.95% 18.60%2.33%
11.63%
11.63%
Medication Questions
Prescription Question
Activity
Physical Issues
Services
Follow up
Issues Identified in Follow Issues Identified in Follow up Phone Callsup Phone Calls
Press-Ganey Discharge Press-Ganey Discharge ScoresScores
0
10
20
30
40
50
60
70
80
90
100
I nstructions care at home Explain take medicine
af ter discharge*
I nstructions re:resume
activit ies*
I nform danger signs watch
out for*
Jul-Sep 05
Oct-Dec 05
Jan-Mar 06
Formation of Discharge Formation of Discharge Education Action TeamEducation Action Team
First meeting was April ’06 Discussed previous initiatives trialed Quality data presented to the team Reinforced our focus on patient education
and improving patients’ transition from hospital to home
Discharge Education Discharge Education Action TeamAction Team
Team hypothesized Bone Marrow Transplant scores would be better than Oncology scores
Follow up analysis of Press-Ganey Scores confirm hypothesis
Discharge Education Discharge Education Action Team in ActionAction Team in Action
Summer & Fall of 2006: Created “Going Home: A Discharge Guide”
Expanded team to include MD, PA, PT, OT, RD, SW, CC and Summer College Student
Ensured reading level at 8th grade Debate about “Danger Signs” Patient Education specialists worked on
patient friendly format and design Created patient survey regarding
education needs
Discharge Teaching Pilot Discharge Teaching Pilot PlanPlan
Survey patients 24-48 hours before DC Learning needs will be shared with RN Oncology Admissions on 5AB will
receive a copy of the “Going Home: A Discharge Guide” and “A Handbook for patients, families, and friends”
Discharge checklist, supplemental patient education “library”, and pre-printed plan of care trialed
Say Cheese!Say Cheese!
Pre-Pilot Survey Results: Pre-Pilot Survey Results: Educational NeedsEducational Needs
54%
46% 46%
38%
23%
Sexual Activ ity Activ ity and Exercise Symptom Management Medication Danger Signs
Pilot Survey Results: Pilot Survey Results: Educational NeedsEducational Needs
25% 25% 25% 25%
Nutrition Activ ity and Exercise Symptom Management What to Expect
Post-Discharge:Post-Discharge: Patient Feedback Patient Feedback
5 Post Discharge Surveys were conducted
No Changes recommended to the booklet
Impact on Patient’s Wife
Evaluation of PilotEvaluation of PilotDelay in starting the trial JCAHO visit in mid-JanuaryBegan as a trial with a small
supply of “Going Home Guide” Additional tools were not utilized in
pilot
Monthly Press-Ganey Monthly Press-Ganey Results: Results:
November through FebruaryNovember through February
0
10
20
30
40
50
60
70
80
90
100
Instructions care at home Instructions re:resume activities* Inform danger signs watch out for*
JJ
Outcome: Outcome: What did the data tell us?What did the data tell us?
Focus on Process! The “Going Home Guide” alone did not impact survey results!
And next, what life was like before, during, and after the pilot --- nurse and patient perspective!
Pre-Pilot EnvironmentPre-Pilot Environment
Two Pilot Units, Each have– 12 Beds– Primary Nursing Model– Patient Population is Cancer Focused
Hematologic (i.e.: leukemia) and solid tumor
Intensive chemotherapy and research protocols
Pre-Pilot EnvironmentPre-Pilot Environment
Intense Teaching Needs– Medication– Line care– Mouth care & personal hygiene– Safety needs/precautions– Activity– Diet/nutrition– Lab values
Pre-Pilot EnvironmentPre-Pilot Environment
Varied sources of information– Experience– Hospital guidelines– Other discipline expertise– Blum Resource Center
Pre-Pilot EnvironmentPre-Pilot Environment
Follow up phone call discoveries– Reveal misinterpretation of information– Find patients received conflicting information
Began work on a discharge booklet– Work put on hold in 2004– Care Improvement Team prioritized this work
again in 2006 through Action Team work
Impact of the Impact of the “Going Home Guide”“Going Home Guide”
No longer need to gather up varied pamphlets to teach patients
Guide has necessary information to be taught in a logical sequence
Every discipline can now teach from the same “page”
“Notes” section within the guide allow “individualization” of the teaching tool
Impact of the Impact of the “Going Home Guide”“Going Home Guide”
Novice RNs and Float RNs benefit from reading the guide
Frustration when “Guide” is not available
Positive responses from patients and families
Next Steps:Next Steps:
RNs will use the before discharge survey for all patients & keep in bedside book.
All disciplines can update “survey” to document teaching & patient understanding
All disciplines will use the “Going Home Guide” to teach the patient
Develop action plan for Patient Education DVDs
Success in My EyesSuccess in My Eyes--Martie CarnieMartie Carnie
Thank you toThank you to::Care Improvement Team:
Directors: Ted Alyea, MD; Carolyn Hayes, Ph.D RN
Members: Ann Hristov, PFAC; Martie Carnie, PFAC; Judie Ham, PFAC; Joe Nies, PFAC; Cynthia Jodoin, RN; Eileen Molina, RN; Ruth Muller, RN; Kerry Mahar, RN; Escel Stanghellini, RN; Andres Sirulnik, MD; Kendra Church, PA; Elizabeth Binari, RN; Ann Collins, RM; Deb Duncombe, RM; Mrinalini Gadkari, QI; Mary Lou Hacket, LISCW; Maggie Hewit, PFR; Meri Donlan, PT; Deborah Hoffman, LICSW; Michael Hubner, LICSW; Jennifer Kales, RN; Christine Sousou,PT; Lynne Simonelli, RN; Colleen Zidik, RN
Thank you toThank you to::Discharge Education Action Team:
Members: Ann Hristov, PFAC; Martie Carnie, PFAC; Patti Smith-Allen, RN; Debra Moody, RN; Susan McDonald, RN; Eileen Kelly, RN; Dianne Griffin, RN; Susan Bolton, RN; Pamela Thomas, RN; Soheir Elebiary, RN; Joan Deary, RN; Katie Filipon, RN; Ruth Muller, RN; Ann LaCasce, MD; Andres Sirulnik, MD; Heather Hylton, PA; Sara Dorfmier, PA: Mrinalini Gadkari, QI; Meghan Cunningham, RD; Cara Dejong, RD; Nicole Varady, RD; Bruce MacDonald, LICSW; Kim Peterson, LICSW; Patricia Dwyer, LICSW; Mary Lou Hacket, LICSW; Meri Donlan, PT; Christine Sousou,PT; Carol Ann Orrico, RN; Ann Furey, RN; Danielle Sullivan, Program Assistant; Susan Decristofaro, RN; Tamara Sobers, Student; Colleen Zidik, RN
Thank you to:Thank you to:Nursing Staff on 5AB: Lela Tatarouns, Christine
Leonard, Laura Allaire, Kathleen Slack, Debra Moody, Patti Smith-Allen, Dianne Griffin, Eileen Kelly, Nancy Murphy, Katie Fiel, Ana Velez, Suzanne Badavas, Mary Chinian, Suzanne Corsetti, Paula Digiovine, Kerri Flynn, Colm Gormley, Elizabeth Halloran, Yi Jin, Kristen Kane, Susan Kenney, Allison Konefal, Karen Legere, Kathleen McCarthy, Barbara Mullins, Lisa Olivo, Maria Raleigh, Kay Sweeney, Jennifer Wright, Doreen Bannon, Gina Coniglio, Maureen Conley-Rogazzo, Christine Cox, Sheryl Fernandez, Nancy Green, Kim Irwin, Danielle Johnson, Teresa Queally-Hanley, Jean Quinn, Marianne Saleda, Tracey Slaven, Karen Valliere, Angela Whitter
Secretarial Support: Derlin Ryner, Maureen Mohansingh, Leah Pearlman;