UF Health Jacksonville
Improving Responsiveness to Call Lights• UF Health Jacksonville is a private, not-for-profit academic
medical center affiliated with the University of Florida.
• This Lean Six Sigma project focused on inpatient units at both UF Health Jacksonville locations: a 600-bed hospital located in downtown Jacksonville and a 92-bed hospital in North Jacksonville.
• Melodie Logue, MA, CPHQ, CPXP, is a Performance Improvement Specialist in the Quality Management Department at UF Health Jacksonville. Melodie has 10 years of healthcare quality experience with over three years focused on patient experience.
• Angelique Brown, BSN, RN, CCRN, is the Nurse Manager of the Neurology unit at UF Health Jacksonville. She started working at UF Health 11 years ago as a bedside nurse, and has worked as a Nurse Manager for over four years.
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UF Health Jacksonville
Background
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• Hospital FY 2018 strategic goal to increase the average HCAHPS domain score to 70.2%.
• The FY 2017 HCAHPS Staff Responsiveness Domain score was 64.55%.
• Greatest opportunity for improvement within the domain was Call Button Responsiveness, with a FY 2017 score of 64.32%.
• After you pressed the call button, how often did you get help as soon as you wanted it?
• Problem Statement: Increase UF Health Jacksonville’s HCAHPS Call Button Responsiveness score from 64.32% to 70.2% or higher by June 30, 2018.
Staff Responsiveness Domain 64.55%
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The Five Why’s
• The team followed the DMAIC problem solving process.
• As part of the Analyze Phase, a Root Cause Analysis was performed by the team and a Cause and Effect (Fishbone) Diagram was created.
• Seven root causes were identified.
• Countermeasures were developed to address each root cause.
Pallet not selected correctly
Lack of probing for reason
Staff not trained on answering call lights
Lack of Teamwork
Poor communication
Inconsistent use of Buddy System
Inconsistent practice of No Pass Zone
No knowledge of the 5 minute standard
No standardized response time to call lightsLack of accountabil ity
Staff not held accountable
Leaders not aware staff are not responding in 5 min.
Inconsistent leadership rounding
People
Competing priorities
Equipment
Environment
In another room/procedure
Staff did not plan for another patient to call
Staff did not anticipate patient’s needs
Hourly rounding not purposeful
Method
Low HCAHPS Call Button
Responsiveness Scores
Did not receive page or beep
Not carrying pager
Forgot pager
Pager broken
Needs battery
No accountability to carry pager/locator
Pallet/Equipment
System down
Unable to speak to RN immediately and directly
Antiquated technology
Did not feel or hear beep
Teammates do not answer page
Lack of urgency
Proximity of assignments
Doesn’t pod assignments
Does not hear pager
Silent beepers = delay
Alarm fatigue
A
E
C
G
B
D
F
Culture/Lack of Teamwork
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ROOT CAUSE A - Staff not trained on answering call lights
Actions:
• Mandatory clerk training Phone etiquette on answering the call lights
How to probe for information from the patient
Clerk rounding on 4 patients per shift to introduce themselves and provide a face with a voice
• Secret shoppers to confirm interventions hardwired
Goal: To get the right reason for the call and the right staff member to the room as soon as possible.
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ROOT CAUSE B - No accountability to carry pager/locator
Actions:
• Revised Daily Pager/Locator Check Log form and process for accountability
Clerks responsible for ensuring all staff have their locators and pagers and that they are working properly
Charge nurses sign off
• Reviewed in mandatory clerk training and at Nursing Leadership Council
Goal: To enable quicker response to call lights by ensuring all staff on all units are carrying pagers and locators.
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ROOT CAUSE C - No standardized response time to call lights
Actions:
• Developed a standard response time of 5 minutes based on PRC recommendations and patient surveys
• Reviewed at Nursing Leadership Council, daily bed meetings, and staff huddles
• Secret shoppers to confirm interventions hardwired
Goal: To ensure meeting patient expectations of response time to answer call lights
UF Health Jacksonville
ROOT CAUSE D - Hourly rounding not purposeful
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Goal: To decrease call lights and anticipate patients’ needs by increasing the use of purposeful hourly rounding.
Actions:
• Patient Experience Simulation Training• Interactive experience
• Taught by unit leaders (manager, CQNL, educator, charge nurse)
• Scripting on the 6 P’s
• Every staff member had to demonstrate purposeful rounding
• Secret shoppers to confirm interventions hardwired
HOURLY ROUNDING 6 P’s
POTTY
PAIN
POSITION
POSSESSIONS
PREVENTION/SAFETY
PLAY/DIVERSION
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ROOT CAUSE E - Inconsistent use of the Buddy SystemGoal: To promote teamwork and share the patient care load by increasing the use of the buddy system
Actions:
• Developed flowchart to streamline process and increase consistency
• Reviewed at Nursing Leadership Council, daily bed meetings, and staff huddles
• Reinforced in the Patient Experience Simulation Training
Buddy System Process
Buddy is assigned on assignment board by Charge Nurse
Charge Nurse hands off buddy assignment to Clerical Associate
Staff goes on break/lunch
(“Buddy” takes care of patient needs)
Staff notifies Clerk, Charge, and “Buddy” of break/Lunch
Staff going on break hands off pager and gives report to “Buddy”
“Buddy” returns pager and updates on patient status
Process complete
Staff returns to the unit
How the Buddy System works
Buddy System Process
Process complete
“Buddy” returns pager and updates on patient status
Staff returns to the unit
Staff goes on break/lunch
(“Buddy” takes care of patient needs)
Staff notifies Clerk, Charge, and “Buddy” of break/Lunch
Staff going on break hands off pager and gives report to “Buddy”
Charge Nurse hands off buddy assignment to Clerical Associate
Buddy is assigned on assignment board by Charge Nurse
What is the Buddy System?
It is designed for your buddy to relieve you during your shift for breaks or if off floor assisting with patient care.
Why?
The purpose of the buddy system is for you to be able to take a break or be off the floor without the stress of having to worry about your patients’ care.
An important aspect of the buddy system is that there is always a staff member to share the patient care load.
Your buddy is assigned at the beginning of the shift and everybody knows who their buddy is. You do not have to try to find a buddy for the day—it is assigned.
This system also promotes teamwork and gives you a chance to work with many people.
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ROOT CAUSE F - Inconsistent practice of the No Pass ZoneGoal: To decrease patient wait time by hardwiring the use of the No Pass Zone
Actions:
• Developed a flowchart
• Reviewed at Nursing Leadership Council, daily bed meetings, and staff huddles
• Reinforced in the Patient Experience Simulation Training
• Secret shoppers to confirm interventions hardwired
Call light/ Alarm on
Passerby responds
Addresses Needs
Delegates to
appropriate staff
Need met
No
Yes
How the No Pass Zone works
What is the No Pass Zone?
Staff working on floor will respond to alarms and call lights immediately when activated. Responding staff will address the need or issue using AIDET. Responding staff will take care of the need or hand off to the appropriate staff.
The standard time established to respond to a call light with face to face contact is within 5 minutes. It should happen as soon as possible.
Why?
To decrease alarm fatigue.
To increase the safety of the patient because of faster response times.
It will decrease the number of times you are paged.
It will promote teamwork and cohesiveness on the unit because you can depend on your fellow co-workers.
Delegates to appropriate staff
Addresses Needs
Yes
Call light/ Alarm on
Passerby responds
Need met
No
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ROOT CAUSE G - Inconsistent leadership roundingGoal: To improve accountability on call light response time, No Pass Zone, Buddy System, and purposeful hourly rounding
Actions:
• Developed a flowchart
• Defined leaders and included charge nurses
• Provided evidence to validate intervention
• Reviewed at Nursing Leadership Council, daily bed meetings, and staff huddles
How Leader Rounding works
NO
No
YES
Leader Rounding
Pull Census
Use Leader Rounding Tool
Selects 4 patients
(Patient admitted for 24 hours or more )
Interview Patient
All needs met? Meet need
Rounding tool turned into Nurse Manager
Rounding completed
How Leader Rounding works
Meet need
No
YES
All needs met?
Leader Rounding Defined:
A leader is a Charge Nurse, Clinical Quality Nurse Leader, Nurse Manager or Director for the purpose of Leader Rounding.
Leaders will round on four patients every shift.
Why do leaders round?
To help patients feel safe and more confident in their care.
To obtain the patient’s perspective on care delivery.
As an opportunity to manage up and recognize staff as you round.
To be able to follow up quickly on identified problems.
It increases the consistency between caregivers.
Evidence:
A study reported that 72% of patients who experienced charge nurses making rounds were very certain that caregivers would attend to their immediate needs.
Leader Rounding
Use Leader Rounding Tool
Interview Patient
Rounding tool turned into Nurse Manager
Rounding completed
Selects 4 patients
(Patient admitted for 24 hours or more )
Pull Census
NO
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Results• HCAHPS Call Button
Responsiveness scores increased from 64% to 73% by June 2018.
• The increase in HCAHPS Call Button Responsiveness scores impacted the HCAHPS Staff Responsiveness Domain score, which increased from 65% in FY 2017 to 70% in FY 2018.
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Results• In addition to impacting HCAHPS scores,
the interventions had an impact on our hospital-wide call light response time.
• The average call light response time decreased from 5:42 to 4:09 minutes.
Lessons Learned:
• Refrain from conducting mandatory staff education during the holidays.
• Narrow the scope by focusing on pilot units before hospital-wide implementation.
• Focus on one intervention at a time to determine which has biggest impact on goal.
Improving Responsiveness to Call LightsBackgroundThe Five Why’sROOT CAUSE A - Staff not trained on answering call lightsROOT CAUSE B - No accountability to carry pager/locatorROOT CAUSE C - No standardized response time to call lightsROOT CAUSE D - Hourly rounding not purposefulROOT CAUSE E - Inconsistent use of the Buddy SystemROOT CAUSE F - Inconsistent practice of the No Pass ZoneROOT CAUSE G - Inconsistent leadership roundingResultsResults