Patient Advisor Rounding Vidant Medical Center

Kim BlantonPatient & Family Advisor

Melissa Thomason Patient & Family Advisor

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What you will learn today

What are Advisor Rounds? Why are they important? How do you do Advisor Rounds? Tools to support successful rounding Impact of Advisor Rounding Lessons learned

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System of Care

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A Day in the Life of Vidant Health

196 acute care admissions

136 surgeries 118 critical care

patient 822 ED visits 1,377 outpatient visits 2,000 VMG practice

visits

7 medical air transports

21 babies born 184 patients with

central lines 78 patients on

ventilators 144 patients with

urinary catheters

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Patients & Families as Team Members & Leaders

“Put Patients and Families on the Improvement Team” is noted as the leverage point

with the greatest potential to drive the long-term transformation of the entire system.”

IHI Seven Leadership Leverage Points to Drive Organizational Improvement

2008 IHI innovation series

System Wide Advisor Structure

Vidant BertieHospitalAdvisoryCouncil

Vidant ChowanHospitalAdvisoryCouncil

Vidant MedicalCenter

AdvisoryCouncil

Vidant DuplinHospitalAdvisory Council

VidantEdgecombe

HospitalAdvisory Council

Vidant Roanoke-Chowan HospitalAdvisory Council

AlbermarleHospital Advisory Council

The Outer Banks

HospitalAdvisory Council

Vidant BeaufortHospitalAdvisory Council(To be

Developed)

Vidant Pungo

HospitalAdvisory CouncilTo be

developed

VidantEmployee

HealthAdvisoryCouncil

VidantHome Health And Hospice

Advisory Council

Vidant MedicalGroup

AdvisoryCouncils

Vidant SurgiCenter

Advisory Council

Vidant MedicalCenter

Service Line AdvisoryCouncils

VIDANT HEALTHPATIENT-FAMILY EXPERIENCE TEAM

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Vidant Medical Center

Vidant Medical Center Advisor Structure

Vidant Health’s commitment is to have advisors at decision-making tables and to view care through the eyes of the patient.

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Patient and Family Advisors

Any role or activity that enables patients and families

to have direct input on policies, programs, and

practices affecting health care.

What do VMC Patient Advisors do?

Patient & Family

Advisors

Education

Literature Review

Safety

Rounding

Facility Design

Quality & Performance Improvement

Teams

System Input

Patient Communication &

Transparency

Storytelling

*Unit Rounds*Return to Care

Rounds*Safety Liaisons

Safety SummitSafety Boot

CampRCAs

FMEAs

FallsUTISkin

CLABSIVAP

MyChartCare Coordination

Board Presentations“Experiences in Care” Videos ConferencesNew Nurse Orientation

Provider Education

Patient EducationStaff Education

REAL DEAL training

Children’s EDCancer Center

Children’s HospitalHeart Institute

Hiring CommitteesStrategic PlanningVendor Selection

WHY Should Advisors do Rounds?

A real-time pulse check Strengthens partnerships Some patients are more comfortable

sharing concerns with a “former patient” Introduces a fresh perspective Front line workers see PFCC in ACTION Drives results. Yields better outcomes.

Vidant Medical Center Safety Liaisons

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Patient & Family Advisors who have completed risk assessments, HIPPA training and role orientation.

Patients give consent in advance.

Liaisons focus on safety and use a rounding tool.

Findings are documented and staff and advisors conduct debriefs with safety manager.

Pre – Safety Round Patient Consent Form

Safety Liaison Rounds:What we learned…

…. about Advisor Rounding Advisor Selection Important Builds Relationships Some patients more comfortable sharing with Patient

Advisors than with Staff

…. about our Care System Identified transition snags from acute to rehab Room nightlight preventive maintenance process

missing Discharge instructions in bright envelope; being used

throughout the system Patient-family engagement in bedside shift report, hourly

rounds and communication boards

Return to Care Rounds

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Advisors rounded with leaders from Office of

Patient & Family Experience

Used separate rounding tools and compared results

after each room

Hospital – wide results compiled by Office of

Patient & Family Experience

Service Line Rounds

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“ That’s what made a believer out of me….”

Diane HatfieldEast Carolina Heart Institute

Quality Chair

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Cardiac Intensive Care Unit

CICU

Cardiac Intermediate Unit

CIU

Cardiovascular Intermediate Unit

CVIU

Unit RoundsCVIU and CVICCVIU and CVIC

Cardiovascular Intensive Care Unit

CVIC

HOW do we do Unit Rounds?

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Meet with Unit Manager Review Unit Scores Identify Unit’s Needs (based on scores, manager’s needs & advisor’s input) Round with Managers Discuss Advisor Rounding Alone Report Findings to Unit Manager Act on Findings

A Success Story: CVICU

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From CVICU Rounds:

1. “Patient does not understand purpose behind the only new med she has received since admission”2. “No staff member has ever removed the “Commonly Used Meds” sheet from the boom for any reason.”

Unit Needs:Med CommunicationNurse Communication

Act on Findings

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1. TEAM strategy session

2. Small tests of change

3. Round to assess effectiveness

4. Make Improvements

5. Continue Rounding

One piece of the puzzle:

RESULTS:CVICU Med Communication

score rose from sub 10% to 98% within a year.

A Success Story: CIU

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“Wife stayed with husband for entire admission of 40+ days and was overwhelmed by the care she received as a family member. Nurses offered her extra meal plates at every meal time and checked on her regularly.”

Act on Findings

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1. Advisor and Wife immediately recognized nurse on duty

2. Advisor reported findings to Unit Manager at end of Rounds

3. Unit Manager and Advisor gave Wife Employee Recognition form

4. Form copies added to personnel files

5. Nurses received Staff Reward Points

1 West, Rounds - September 19, 2013, Patient Advisor Feedback

FOCUS: Pain Management and Quietness (Restfulness)

Patient 1:

Positive Feedback: Patient felt well-informed and well taken care of.

Needs Work: Patient’s largest complaint concerned restfulness. She felt as though staff members were in and out of her room all night long. Patient finally requested that staff please limit the times they come in during the night, and they made an effort to coordinate her care. She did add though that nurses/care partners are still coming in and making her get out of bed to weigh at 4am

Patient 2:

Positive Feedback: Pain is being managed well. Patient and husband both love that they always feel well prepared for what’s coming next. Staff makes it a point to tell them both what to expect ahead of time.

Needs Work: Communication Board not updated for current shift. (as of 4pm)

Patient 3:

Positive Feedback: Says that she’s had a perfect experience. Could not think of one thing that needed work.

Needs Work:

Patient 4:

Positive Feedback:

Needs Work: Patient was in horrible pain while in the ED the night before. She felt like no one was listening to her and ended up taking her own IV out. She offered no positive feedback. She did say that 1West staff is doing a better job of managing her pain but seemed completely unsettled by the ED experience.

Round, Round, Round …

VMC Outcomes 58% reduction in hospital acquired infections

(HAI) since 2008 95% optimal care on core measures (up 17

percentage points since 2007) 90th percentile inpatient experience Tripled number of patient-family advisors in

less than two years Hardwired hourly rounding, bedside shift

report and communication boards Nearly 90% of staff report organization

demonstrates commitment to patient-family centered care

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Advisor Rounding: Impact Strengthened Partnerships Advisor impact no longer dependent on

presence of Patient Experience Team leaders Boosted Patient Morale Boosted front-line staff support Made managers more open to Advisor input Increased Advisor satisfaction Improved scores & outcomes

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Lessons Learned

Not every manager is open to Advisor Rounding. Start small.

Not every Advisor will want to Round. Advisor selection matters.

Rounding requires mutual respect and open communication between Advisors and Managers.

Build on existing work. Don’t reinvent the wheel. Keep it simple!

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What can I do today?

Leader Rounds + Experienced Advisors

ADVISOR ROUNDING

“I love to round with advisors. It is the best thing a manager can do for her unit.”

Elaine ClarkManager, Women’s & Children’s

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Kim BlantonPatient-Family Advisor, Vidant Medical Center

blakimsab@embarqmail.com252.830.1794

Melissa ThomasonPatient-Family Advisor, Vidant Medical Center

mthomason@embarqmail.com252.886.2864

for more information contact