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2/12/2018
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TWI Job Instruction Validation
Habit #2: Begin with the End
in Mind*
*The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change,
by Stephen R. Covey
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FY15 FY16 FY17 FY18 YTD
32
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FALLS w/Harm
Fall Prevention MasterKata Storyboard –
Baptist Memphis
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“Being a 2nd coach on the Master Falls Board has been very eye opening. To see the work and accomplishments of the team as a whole is amazing. The learners are continuously growing their knowledge of the obstacles and using this information
daily to impact change. We have a 75% reduction in Falls w/Harm FY15-FY16 and a 63% reduction FY16-FY17. Total
reduction FY15 through Q1FY18 = 91% reduction = 29 fewer patients experienced a Fall with harm over FY 2015!”
- Jackie Barton, Director of Med/Surg Nursing
Started Kata on 1 unit FY 16
Expanded to a Master Kata Storyboard with 6 units and TWI - JI Shepherding Kata – FY 17
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Kata: Catheter-associated Urinary Tract Infections (CAUTI)
A single CAUTI can cost the organization $9,000 Kata has reduced CAUTIs from 29 – 22 = 7 fewer patients experienced a CAUTI FY15 over FY17 YTD
BAPTIST MEMPHIS DEPLOYMENT
Catheter-Associated Urinary Tract Infection
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Total
29
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TOTA
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AU
TIS
CAUTIs
Catheter-Associated Urinary Tract Infections (CAUTIs)
FY15 FY16 FY17 FY18 YTD
Started Kata May 2016
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60
80
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120
140
FY15FY16
FY17FY18 YTD
133
104
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CLABSI
BAPTIST MEMPHIS DEPLOYMENT
Central Line-Associated Bloodstream Infection
A single CLABSI can cost the organization $40,000 Kata has reduced CLABSIs from 104 – 16 = 88 fewer patients experienced a CLABSI FY16 over FY17 YTD
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Started Kata on 1 unit May FY 16
Started TWI - JI Shepherding Kata and Master Kata work on CLABSI - Oct FY 17
2/12/2018
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Results – Myelosuppression, Medical Oncology,
and Cardio-Pulmonary Transplant Unit
9 CLABSI’s for FY 17
Kata Started
Master KATA started
Days since our last CLABSI
on Myelosuppression:
Slide and data by Lindsey Brady, RN, Nurse Unit Mgr, Myelosuppression
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Job Instruction Breakdowns / TWI training
Variability among nurses
“Scrub the hub” JI Breakdown
“Dressing change” JI Breakdown
JOB INSTRUCTION BREAKDOWN SHEET –SCRUB THE HUB
Task: Scrub the Hub_________________________________________________
Supplies: ETOH prep pads (1 for each hub), clean gloves____________________
Equipment & Materials: ______________________________________________
0 steps: HH/AIDET
IMPORTANT STEPS KEY POINTS REASONS
A logical segment of the operation when something happens to advance the work.
Anything in a step that might - 1. Make or break the job 2. Injure the worker 3. Make the job easier to do, i.e. “knack”,
“trick”, special timing, bit of special information
Reasons for key points
1. Open alcohol pad
1. Thumb and index 2. Pinch and rip 3. 1 pad per hub
1. Minimal touching 2. Easy open 3. Avoid cross contamination
2. Scrub
1. Vigorous 2. Sides x5 3. Top x5
1. Friction & time to kill germs 2. Cover all hub surfaces 3. Cover all hub surfaces
3. Dry 1. Air dry 2. Keep clean
1. Kill time 2. Avoid recontamination/DO NOT lay hub down or let hub touch anything
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Slide and data by Lindsey Brady, RN, Nurse Unit Mgr, Myelosuppression
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Pulsatile Flushing
Different technique of flushing lines
– “Push / Pause”
– Prevents fibrin formation
– No Fibrin = No CLABSI
Pulsatile Flushing Job Instruction Breakdown
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Slide and data by Lindsey Brady, RN, Nurse Unit Mgr, Myelosuppression
The 10 Hour JI Trainer class is truly an introduction to the TWI teaching process!
Few leave performing at Proficient or Expert level
Many need “follow-up” to be effective
KATA your JIB deployments:
Yes, for Trainers
Validation
Class Complete √
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Inspect, Inspect, Inspect what your Trainers are doing
– Monitor “time to train” – provides great insight
Remember TWI Job Instruction Step 4 – Follow-Up
– Equates to Validation!!!!!
Look for Obstacles:
– What JIB(s) have you Rolled Out?
– How is training occurring?
Validation!
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Validation Examine Your Process and Overall Competence:
– Did a Change Occur?
– Did you hardwire the process?
– How effective are your Trainers? • How often are they training?
• Remaining steadfast in the TWI process?
How To Validate Staff and Trainers
Competence?
Now What? --What to Do with the “Novice and Advanced Beginners”
Trainer’s Trained, JIB’s Deployed, Now What?
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Validation? Where to Start?
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Manual Tracking is a Productivity Nightmare
Gift of a Macro (or Some Slightly Automated Method)
Tracking JIB Roll-Out Compliance
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Trainer Validation
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JIB Deployment – Validate staff for 6 months to hardwire the JIB
• Monitor & Tracking – find an easy method
Validation methods – Need a standardized methods – Monitor & Tracking
Trainers: Unit Champions? – Determine a process of efficiency support – Only as effective as your weakest Trainer
Remediation: Be prepared, Some Trainers will need it
Journey Overview
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Validation - TWI & KATA Together
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“The future is not a result of choices among alternative paths offered by the present, but a place that is created, first in mind, next in will, then
in activity.
The future is not some place we are going to, but a place we are creating. The paths are not to be discovered, but made, and the
activity of making the future changes both the maker and the destination.”
~~John Schaar
Conclusion
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