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Mandy Sandford presented this at the 2014 Managing the Deteriorating Patient Conference. The conference discussed the latest strategies to recognise and respond to the acute patient in clinical deterioration. You can find out more about next year's conference at http://bit.ly/1sjQubi
Citation preview
Let Me Know
Planning and Implementing a patient
and family activated escalation
response
Mandy Sandford
Clinical Service Director
September 22nd 2014
AIM of PRESENTATION
• Describe the planning process for the service
• Engagement of consumers and staff
• Present the pilot model for Alfred Health
• Highlight communication strategies
• Discuss the results of three-month pilot
• Take home messages
No of Met calls per year
ACHSQC National Standard 9
•Communicating with patients and carers : Patients, families and carers are informed of recognition and
response systems and can contribute to the processes of escalating care.
•This criterion will be achieved by:
– 9.7 Ensuring patients, families and carers are informed
about, and are supported so that they can participate
in recognition and response systems and processes
– 9.9 Enabling patients, families and carers to initiate an
escalation of care response
Global initiatives
Many hospitals have now implemented a process to
enable patients and family activated escalation.
– Australia – REACH, PACE, CARE
– United States - Condition H, Partners in Care
– United Kingdom - Call 4 Concern
Overseas experience
This process is used sparingly. • Literature report 2-5 calls/month or less
• Others reports 5-6% of all Rapid Response calls
• No overload of false positives
• Calls have resulted in pain medication intervention
Other medications, IV fluids, diuretics
revision of discharge plan,
support to anxious pt/family,
some cases - returns to theatre or ICU
Planning
– Project Brief – 2 years ago
– Executive Support
– Reps from 3 sites (doctors & nurses)
– Interviewed & selected consumer reps
– Fortnightly meetings
– Briefings for consumer understanding
– Reviewed current models
– Scope of service – ED ICU M/health Opts
Brainstorming
– What would patients/families want to escalate?
– What calls should not come through this service?
– What characteristics of responders?
– Who could respond 24/7 and at three sites?
– Draft models to test with committees/sites
– Regular meetings with sites
Criteria for calls
– Change in behaviour/condition
– Patient not quite right and no-one listening
– Drowsy/confused – a new change, alarming
– Patient looks different, causing concern
– Patient in pain – unresolved
– Physical distress
– Concerns about treatment
– Anxiety (of patient/relative)
Patient / Family
concern
Nurse talks to patient/family
and assesses patient
Appropriate action/response taken and
inform NIC/HMO
Talk to Nurse looking
after patient
Ask to speak with
doctor/NIC Appropriate action/response
taken
Patient / Family call
Response team
1800 no
Patient/family still concerned
Patient/family still concerned
Draft Model
Press ‘1’ for Alfred Press ‘2’ for Caulfield Press ‘3’ for Sandringham
Responder Responder Responder
Project work
– Marketing: a big piece of work
• Engaged Public Affairs
• Name of program – aligned in-house programs
• Tested with consumers and patients
– Communication Strategy
• Who what when where and how
• What is the key message
– Education strategy
• For responders – skills and tools
Key Messages
• Most health care professionals listen and respond to patient and family
concerns when raised. This is about “casting the safety net” a
little further.
• Patients and families know their loved ones better than us.
• It is important that patients and families know we take their
concerns seriously. Some might fear a decline in the quality of
their subsequent care if they activate this process.
• Staff need to reassure patients and families that they are considered
valued members of the care team and activating this
process is not considered a criticism of staff.
Project timelines
– Sign-off: pick a date
– Information sessions
> Leadership committees to endorse
> Everyone – doctors, nurses, allied health, ward
clerks, cleaners (Switch)
> Nurses Forum
> FAQs
– Amazing response from staff and patients
Communication to the team
Let Me Know sticker in MR with call & actions
If serious, unit are involved
Exploring Riskman email
Evaluation audit of calls
Feedback
Implementation
– Launched July 1st
– CEO message to all staff
– Screen savers
– Patient TVs
– Brochures, posters, badges
– Intranet & Email address for feedback
– Consumers help
Pilot & Results
– 3 month pilot on The Alfred Site July-Sept
– Results so far: 10 calls in 8 weeks
– Types of calls
> Deterioration
> Care & Communication
> Complaint
> Other
0
1
2
3
4
5
July August Sept
Number of Calls / Month
0
1
2
3
4
Det/NQR Care issue Complaint Other
Reason for calls
Next Steps
– Review pilot results
– Refine model for Caulfield & Sandringham
– Pick a date
– Information sessions
– Message for staff
– Survey patients & families re awareness of service
Take home messages
– Executive support
– Engage consumers early
– Engage PR department early
– Pick a date and work towards it
– Message for all – communicate
– Follow-up call with patients & families
– Have fun and celebrate
Thank you