Patient

Transcription

Patient

Meaningful Metrics for
Nurse Call
© Sphere3, LLC 2011
Agenda
15
35
15
15
10
55
10
45
10
45
20
Introduction of Kourtney & Sphere3
US Toy Case
Break Out Session with Team
Group Discussion
Bio-Break
Nurse Call Value and Fundamentals
Questions / Bio-Break
Documentation Essentials
Questions
Metrics that Matter
Closing Comments
Kourtney Govro
 CEO Sphere3
 VP of ASDS
 Blogger
 Mother of 4 boys
 Soccer Fan
Company Overview
 Software Company with
Expertise in:
 We create Tools that enable
hospitals to better manage
the needs of the patient, the
capacity of the staff, and the
overall safety of the facility.
 Business Intelligence of
Medical Device Alarms and
Alerts
 Clinical Alarm and Alert
Workflow
 Nurse Call Systems and
Design
Accomplishments in 2 Years
 12 Hospitals in 5 states
 49 Units
 More than 75,000 Patient Days
 Key Victories




Fall Reduction: 8 Falls to 1.75
Increase Patient Sat: 79 – 89
Decreased Response Time 13 min to under 30 sec
“You make unusable Data Useable”
Solid Team:
Knowledge and Relationships
 100+ years of cumulative Healthcare Experience
 20+ years of Business Intelligence/ Data Mining
 Industry Specific Knowledge:
Dukane
Connexall
Amc
m
Our Story:
Unintended Secret Shopper
Noah Vomited
I pressed the Button
No One Came
30+ Minute Wait
This could be Better……
Research
Proclamation for Change
• RN’s walk 3.0 Miles
• Time Spent with patients 30% or
.76 hrs/patient
Effects of Rounding on
Nursing (AJN 2006)
• Over 50% of Calls No Require a
Nurse
• Rounding Reduces Call Volume
Personal Research
65,000 patient days +
•
•
•
•
Norm Calls/hr 6-12
Overtime Rate over 12%
Verbal Resp over 30 sec
Escalation Rate 8-12%
Permanente Journal
Cisco
Journal of Quality and
Patient Safety
NPSF
Core Values
 Patient is the PURPOSE for the hospital
 We must manage their Satisfaction
 Caregiver are CORE to Hospital Function
 We must manage their workload
 Safety issues are RESULTS of the first two
 Our ability to manage care impacts everything
Problem with Consulting….
Retrospective
When I was I the room with Noah….
It didn’t matter to me that a month later they would review
my data and say – woops we had a problem that day.
Artwork By Regina Holliday
Retrospective Reporting
 Looking Backwards
Dashboards
Rearview Mirror:
Retrospective
Interim Step:
More Readily Available
Consistent and Comparative
Completely Automated
Learn to trust Road Signs
Create Tools to Solve
 Meaningful Information that is Actionable
 Metrics NOT Transaction List
 Available On the Unit
Actionable
 Accessible on the Go
Available
Accessible
Sphere3 Aperum
In the Live screen the manager can select
the unit or click on the room and see a
specific room. The manager can pick the
timeframe to review. Clicking refresh will
allow them to see the activity that has
occurred.
All data is compiled in two ways. The “Raw”
quantity of calls is listed at the base of the graph.
The second way is by providing Indications of
Care “IndiCares” which analyze the patient
request rate, overall activity, activity that
exceeds the threshold, the amount of time the
patient waits to be spoken with, and the
probability that the patient will make another
request.
Sphere3 Aperum Trendit!
Trending information is done off of Indicares, not raw
data, this allows for the raw data to be compiled into
useable information.
Indicares can be trended by Clinical Unit, Patient
Room, or by Caregiver over a specified time frame.
Trending information is presented visually by
designated shifts and shift change, then compiled into
an overall average for the time period at the base of
the graph.
The Trend it page has the flexibility to show daily
averages as well by pressing the data expansion
button.
Aperum™ Command Ctr
Challenges
 Proprietary Systems with Hard to Reach Data
 Inconsistent Alarm Automation Design
 Data Records
 Creating an Understanding for the Data Value
 Current Metrics for Nurse Call Light Systems…
 Measurement and Comparison to other data sources
such as Patient Satisfaction
Case Studies & Research
Common Language For
Process
 Initiating Action
 Notification Action
 Acceptance Action
 Rejection Action
 Mandatory Action
Case Study:
US Toy company overview
 Started in 1953 by Frances
Klein
 6 Retail Locations & Massive
Catalog Biz
 Carnival/Party (aka
Chachkeys)




Season Décor
Novelty toys
Stuffed Animals
Toys
Distribution Center
 750,000 Sq Ft
 11,000 SKUs
 2,400 – 15,000 Boxes Shipped Per Day
 Reduced Spending by $500,000 per year for 5 years
through process improvement
 Recently installed a Warehouse Management System
(WMS)
Meaningful Change
 Powered Equipment
 Change from Manually
pushed Carts to various
locations
 Pallet Jacks
 Fork Lifts
 Order Pickers
 RECENT Safety Add “Cable”
in the floor to guide the fork
lift
Meaningful Changes
 Item Slotting:
 Identify highest volume SKUs
 Identify location associated with the “need” vs the restock
time
 Locate high volume SKUs in a particular pick zone
 REDUCTION: Stockers, Time, and Space Allocation
Meaningful Change
 Cartonization
 Original Process included
using plastic totes to be filled
with all items then boxing at
the end
 Added software that
analyzed the size and shape
to put cartonization at the
beginning
 REDUCTION: “Box” People,
better “box utilization” ,
Consistent Order processing
Pre-WMS Measurements
 Measurement was done with a manual count of items
in a specific location
 Information entered into a spreadsheet which sorted
the volume into “Good, Fair, Fail” for employee
evaluation
 Visual Evaluation
 Manual QC
 No way to identify who put what in a package if error
occured
Pre WMS Process
 Minimum of 13 people touched each order
 No ability to automate measurement
 Quality Control labor intensive
 Energy Waste by extra Conveyor Usage
Phase 1 Pre WMS Process
Order entered into
Order Entry
Software (validation
occurred)
Orders Print in
Warehouse
Printed and sorted
to “AREA” manually
Delivered to pick
zone
Order # written on
box & Paper Order
stuffed in 1st box of
order
Boxes placed on
conveyor
Boxes Travel to all 5
“Zones”
In each “Zone” the
order is removed &
the items are picked
If no Item then the
paper is put into the
box & box travels to
next zone
Box Travels to
Quality Control
for Review
Box is
Accepted
Box Travels to
“Dunage &
Tape”
Box Travels to
Manifestation
Box put on the
truck
Box is rejected
Pre WMS Notes
 Up to 13 People touched an order prior to it leaving on a
truck
Desires of NEW WMS
 Track all Box “Touches”
 Track the high volume “Areas” & “Zones”
 Track the efficiency of the individual “pickers”
 Track all items in each box for each order
 Reduction in Staff by better process
Post WMS Process
(IA) Order entered
into Order Entry
Software (validation
occurred)
(NA) Barcoded
Sticker prints &
AutoSorts for
“AREA”
(AA) Delivered to
pick zone
Time Savings 2 hours per
Day
Post WMS Process
Sticker Placed
on the box
Boxes placed
on conveyor
Box Travels to
ONLY the pick
zone where
there are picks
Post WMS Process
Barcode is
scanned in each
zone & it identifies
which items need
to be picked
Barcode scanned
when item is picked
Barcode is
scanned on box
when item is in the
box
Post WMS Process
Quality Control
Validation occurs
when the barcode is
scanned prior to
dunage
Box Travels to new
dunage & auto tape
Manifestation
Load on Truck
Post WMS Notes
 8 People touched an order prior to it leaving on a truck
 Error Rate Less than 1%
Measurements
 Weekly
 Lines Per Person compared
across Employees





Transaction Types
Error Rate
Material Movement
Volume Exits
Replenishments'
Measurements
 System provides a SQL database that allows for
development of automated report
 Historical Database available for transactional
documentation and review
 Order Entry System is too old to have API so interal
people wrote a custom code to integrate to WMS
Team Activity
 Look at the basic process presented
 Create a metric that could be used to assess
 Employee Productivity
 Quality
 Client Satisfaction
 Example:
 Time stamp is provided to identify when the order occurred
and Time Stamp when the order was shipped.
 Order Time to Ship Time – Speed of implementation
So What…..
 What is important to learn
from US Toy?
 Breaking process down to
the smallest step allow for
evaluation of efficiency
Break
Nurse Call Fundamentals
Agneda
Time
Topic
15
15
Who Cares about Nurse Call and Why?
25
Documentation and Plan towards better data
15
Bio Break
 Basic Goal: To provide notification/ Communication to Clinicians
from a Patient
 Trends:
 Added Capabilities to
automated different
processes and requests –
similar to the WMS software
it is an easy way to
document process (with or
w/o RTLS)
 Alarm Data that compliments
Patient Communications
Nurse Call Fundamentals: Players
Manufacture
Local/ Regional
Rauland
X
Hill-Rom
GE (Dukane)
Wescom (Intego)
National
X
X
X
X
Basic Design Principles
CENTRALIZED
DECENTRALIZED
HYBRID
Centralized Unit
Centralized : Old School with a NEW Twist
Places it Works Well: High Acuity Units
Challenge: This is generally NOT the best
way to reduce noise.
Decentralized
DeCentralized : Patient Calls go to Caregiver
Wireless Device
Places it Works Well: Moderate Acuity Units
Challenge: The Caregiver Ratios
Decentralized Example
Patient presses
a call Light
Call at the Main
Desk
Unit Secretary
Speaks to the
Patient
Documents
Request on a
Post-it
Watches for
Nurse to walk by
Distracted by
Doctor Request
Pages overhead
by Nurse
Nurse comes to
the desk
Identifies that
request can be
handled by PCT
Requests PCT
be paged
PCT paged
PCT comes to
the desk
Stops in Patient
Room to verify
the request
Retrieves patient
requested item
Takes it to the
patients room
Call Complete
Patient presses
a call Light
Call at the Main
Desk
Unit Secretary
Speaks to the
Patient
Documents
Request on a
Post-it
Watches for
Nurse to walk by
Distracted by
Doctor Request
Pages overhead
by Nurse
Nurse comes to
the desk
Identifies that
request can be
handled by PCT
Requests PCT
be paged
PCT paged
PCT comes to
the desk
Stops in Patient
Room to verify
the request
Retrieves patient
requested item
Takes it to the
patients room
Call Complete
Patient
Presses the
button
Calls PCT
wireless
phone
PCT Speaks
to patient
PCT retrieves
the needed
item
PCT takes it
to the Patients
Room
Call Complete
Patient
Presses the
button
Calls PCT
wireless
phone
PCT Speaks
to patient
PCT retrieves
the needed
item
PCT takes it
to the Patients
Room
Call Complete
Decentralized Tools
Water
Pain
Toilet
Customizable
Hybrid Example
Hybrid: Patient Calls go to Caregiver Wireless
Places it Works Well: High Caregiver Ratios
Challenge: The “Call Center”
Hybrid Example
WATER
Rm301
106: Meal
Delivery
 Centralization
 What are the limitations?
 What can you measure?
 Answer Time – to a central point
 Descriptive Request to In Room Response
 Decentralized
 What are the limitations
 Reduction of detail in type of request ?
 Even with new technology limited to 4 identifiers – is that
enough?
 What are the benefits?
 Hybrid
 What are the limitations?
 What can you measure?
 Answer Time – to a central point
 Descriptive Request to In Room Response
So What…..
 Nurse Call can be designed in a number of formats and
applications but the ability is varied based on the
available technology.
 Technology limitations may cause inability to automate
 Design to your workflow not to a technology limitation
Who Cares About Nurse Call?
 Patients
 Method of Communication for assistance
 Caregivers
 Method to know there is a need
 Safety
 Method to alert of impending critical event
Health 2.0: Patient Advocacy
Movement
Patients are
becoming
connected and
communicating via
social media and
advocacy groups.
They are demanding
informed care and
becoming more
educated.
Patient Story
 Have you been a Patient?
 http://reginaholliday.blogspot.com
 How did it feel when you pressed your button?
 A Thousand Years is a Day and a Day is a Thousand
Years
 Were you responded to quickly?
HCAHPS: Government Drives
Awareness
 Produce data about patients’ perspective of
care that allow objective and meaningful
comparisons of hospitals on topics that are
important to consumers.
 Results creates new incentives for hospitals to
improve quality
of care
 Serves to enhance
accountability by
increasing transparency of quality
http://cms.gov/hospitalqualityinits/30_hospitalhcahps.asp
HCAHPS
 27 Questions
 18 Core about critical aspects








Communication
Responsiveness
Cleanliness
Quietness
Pain Mgt
Meds Communication
Discharge
Recommendation
HCAHPS #4, #9, & #13
 During this hospital stay, after you pressed the call
button, how often did you get help as soon as you
wanted it?
 During this hospital stay, how often was the area
around your room quiet at night?
 During your hospital stay, how often was your pain
controlled well?
Caregiver
 Clinicians are 4-5 times less
satisfied with their jobs than the
Average American worker
 It costs the hospital 4 times the
salary of a Nurse to replace them
 Clinicians are the deciding factor
on a patients experience
 Think of them like the elbow
Measurement & Balance of
Clinicians
Satisfaction
 Miles Walked Per Day
 Time at the Bedside
 Bombarded with Information
Productivity
 Verbal Response
 In Room Response
 Clinical vs Concierge
Measuring Clinicians is different than measuring pickers – the education,
the pay, and most importantly the “product”.
Safety
 Alarm Fatigue
 Medication Errors
 Falls Falls Falls
Alarm Fatigue
 The point at which the noise,
vibration, or visual becomes
“ignored” by the caregiver
receiving it due to over
stimulation.
 Johns Hopkins (16 bed unit)*
 942 Alarms Per Day
 1 Critical Alarm every 90 sec
 Overstimulation
 Design
 Automation
 Data Management
* Boston Globe Feb, 2011
Errors
 Interruptions
 Procedural
 Clinical Errors
 Interruptions occurred in
more than 50% of meds
administration
*AMA 2010
12%
Falls….Falls….Falls…….
 Cost is $25,000 - $50,000 per incident
 Leading Cause of Death to persons over 65 in hospital
 30-48% of Falls result in serious injury
 Joint Commission
 CMS (Never Event)
So What…..
 All of the Data to measure those items is inside the
Nurse Call System
 It IS of Value
 It CAN BE Available
 It is CRITICAL to improving
 We must start with the Basics and Build to the meaning
 Consistent Current State Design Documentation
 Technology Knowledge
Nurse Call Fundamentals:
Documentation
 Understanding the Guts of
Nurse Call
 Call Types (Priorities, Call
Descriptions, etc)
 Escalation Paths (Call Stops)
 Output integration ability
McDonalds
 E-Myth Learning
 McDonalds in China vs
McDonalds in KC
Documentation
 Most Hospitals do not have their nurse call system
documented….
 Originally there were 5-10 “Call Types”
 3 of the 12 hospitals we have worked with have over 25
Call Types.
 Rush Hospital is going live with 96
Step One: Get Organized
 Create a Documentation Standard
 Technology Index
 Alert Description Index
 Escalation Design Index
Technology Index
 Documents Nurse Call
Systems in your hospital
 Many hospitals have multiple
Systems with different
capabilities
Executone LifeSaver
Rauland Responder 4
Dukane ProCare 6000
Step 1: Current Technology
Site Location
Floor
Floor/Unit
MFG
System
Devices
Quantity
ADI
EDI
Any Hospital East
1
ER
Rauland
Responder 5
Console
0
2
1
Any Hospital East
1
ER
Rauland
Responder 5
Patient Station
10
2
1
Any Hospital East
1
ER
Rauland
Responder 5
Staff Station
2
2
1
Any Hospital East
1
ER
Rauland
Responder 5
Duty Station
3
2
1
Any Hospital East
1
ER
Rauland
Responder 5
Bath/Shower/Toilet
7
2
1
Any Hospital East
1
ER
Rauland
Responder 5
Code Blue
12
2
1
Any Hospital East
1
ER
Rauland
Responder 5
Dome Lights
16
2
1
Any Hospital East
1
GI Lab
GE Dukane
Tellegence
Console
0
2
2
Any Hospital East
1
GI Lab
GE Dukane
Tellegence
Patient Station
9
2
2
Any Hospital East
1
GI Lab
GE Dukane
Tellegence
Staff Station
2
2
2
Any Hospital East
1
GI Lab
GE Dukane
Tellegence
Duty Station
3
2
2
Any Hospital East
1
GI Lab
GE Dukane
Tellegence
Bath/Shower/Toilet
2
2
2
Any Hospital East
1
GI Lab
GE Dukane
Tellegence
Dome Lights
15
2
2
Step 2: Alert Descriptions
 Consistent Descriptions are the only way to have
consistent measurement
Description Index
1,2,3
1
1
1
2,3
1
1
1,2,3
1
2
1
2
1
1
1
Name
"Normal"
"Pain"
"Normal Toilet"
"Water"
"Toilet"
"Toilet" (Audio)
"Toilet Normal"
"Shower"
"Code Blue"
"Code Blue"
"Staff Assist"
"Staff Assist"
"IV PUMP"
"Vent"
"Bed Exit"
Description
Red Call Button on the pillow speaker or bed rail
Pain button is located on the pillow speaker
Toilet Button on the Pillow Speaker
Water Button on the Pillow Speaker
Patient has pulled the Cord next to the Toilet
Patient has pulled a Toilet Pull Cord
Patient has pressed the Yellow button on the Audio Pull Cord Station
Patient has pulled the Cord in the Shower
Blue Button on the patient station
Stand Alone 2 buttons station blue button
Red Button on the patient Station
Stand Alone 2 buttons station red button
Auxilary Jack 1
Auxilary Jack 2
32 Pin Connector by the base of the bed
Category
U
U
U
R
E
E
R
E
E
E
E
E
U
U
E
Common Language
 Alert Description: the Nomenclature that is used to
describe the “alert” or “request” coming from a nurse
call system.
 Examples:
 Normal – Patient Request from Pillow Speaker or Bed
 Toilet – Patient Request from Toilet
 Things to think of when naming in your hospital
 Function and Location
 Alternate numbers and letters
Escalation Design:
Simple – Understandable – Common
 Common Language




Initiating Action
Notification Action
Acceptance Action
Rejection Action
 Always initiates another process
 Mandatory Action
So What…..
 Consistent Language and Documentation is critical
 Develop internal standards for communicating about
communication
 McDonalds
Measurement
Define a Starting Point – Your Baseline
Analyze Against Consistent Standards
Innovate Your new design
Determine the Measurements that are Meaningful to your hospital
Measure the Results
Listen
Analyze
Innovate
Weight Loss
 What are some things
“200ish” lbs
we do to lose weight?
 Initial Weigh-in
 Food Journal
 Track Exercise
 Determine the steps
to Improve
 Eat Less
 Exercise More
 Launch a Start Up….
“150ish” lbs.
Identify where you are
Monthly Comparison of Call Volume Vs.
Census Data
8000
723
Normal
6000
723
Census
713
5712
715
6900
710
2517
3083
3137
0
705
4 East January
Listen
725
720
6736
4000
2000
Over Time
4 East January
4 East February
Analyze
Innovate
Current State
 Other than process Things to
notice
 Shape of Unit
 Caregiver Ratios
 Staffing
Analyze
 Safety
 Accountability
 Redundancy
 Noise
 Technology
Analyze
 Basic Numbers at the Beginning Help Make Decisions on
Movement
Month
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
Unit
5 West
5 East
4 East
4 west
7E PEDS
6 WEST
7 West
CCICU (CCA)
SICU (CCA)
MNSICU (CCA)
6 EAST Adolescent
7-BICU (CCA)
MAIN ER
7E PEDS ICU
EXAM 18 A/B
Dialysis
6W CBCU (CCA)
training room
UNDEFINED
© Sphere3, LLC TOTAL/AVERAGES
2011
Avg Call Time (secs)
292
367
435
407
152
369
333
784
953
1133
448
239
37
11
25
7
12
4111
97
537
Avg Time to Answer (secs)
168
264
353
324
61
316
166
364
1075
2236
184
142
43
15
45
12
14
16672
214
1,193
Total Calls
12,069
11,724
10,101
9,895
8,469
7,324
3,529
3,529
2,010
1,843
1,267
1,252
1,076
410
85
15
6
4
3
74,611
Overtime Calls
3267
3639
2999
2809
1148
2235
773
1001
335
400
324
39
41
2
2
0
0
1
1
19,016
% Overtime
27.07%
31.04%
29.69%
28.39%
13.56%
30.52%
21.90%
28.36%
16.67%
21.70%
25.57%
3.12%
3.81%
0.49%
2.35%
0.00%
0.00%
25.00%
33.33%
25.49%
Escalation Design:
 Decide a Base of What Will
Work
 Test on 1 or 2 Units
 Measure the results
associated with the basics
 Document what works and
does not work
Escalation Design:
 From the base create
variation to meet specific
needs
So What…..
 We cannot measure what we don’t understand
 We cannot find meaning from “generalization”
 We cannot show movement until we know were we are
Patient is the Purpose.
We must manage their Satisfaction.
HCAHPS: Government Drives
Awareness
 Produce data about patients’ perspective of care
that allow objective and meaningful comparisons of
hospitals on topics that are important to consumers.
 Results creates new incentives for hospitals to
improve quality
of care
 Serves to enhance
accountability by increasing
transparency of quality
http://cms.gov/hospitalqualityinits/30_hospitalhcahps.asp
HCAHPS #4:
During this hospital stay, after you pressed the call
button, how often did you get help as soon as you wanted it?
“After you Pressed the Call Button”
“How often did you get Help”
“AS Soon AS You Wanted?”
“Pressed the Call Button”
 How often was the button pushed?
 “Button Push” is an Initiating Action which is described as
a “Normal” Call
 If Rounding is Occurring Per Patient there should be no
more than .5 calls per hour
 If higher then Director or Charge should engage the patient
to identify what is occurring
 Are they lonely?
 Are they recently out of surgery?
 Are they nearing discharge?
 Is Rounding Not Occurring?
 Is Rounding Not effective?
“HELP?”
 How often did you get “HELP”?
 Decentralization vs Centralized vs Hybrid
 Interruptions
 Minimum Data Recorded
 Help can be defined in two ways
 Clinical and Concierge
 Quickly identifying requests rates of certain types can allow
the director or charge to make adjustments
 Are there are a high quantity of pain calls? (Pt or Unit)
 Are there a high quantity of toilet requests?
“Soon?”
 “As soon as you wanted”
 Define verbal or in room response?
 “Soon”
 Style/ Design – Centralized vs Decentralized vs Hybrid
 Verbal Response DeCentralized should be 20-30 seconds
 Verbal Response for Centralized or Hybrid is <15 seconds
 Varies based on Style
 Varies based on layout of the unit
Measurement with Meaning
In Room Response Time
Patient Request
Total Concierge
Requests
188
Total Meds and
IV Requests
1413
1155
346
Total RN
Requests
5.48
5.75
Total Meds and IV
Requests: 1155
4.15
Total RN Requests: 81
9.13
5.60
Total Bathroom
Requests
81
Total Concierge
Requests: 188
Total CA
Requests
Concierge Requests = “Ice Chips” “Blanket” etc
Total Bathroom
Requests: 346
Total CA Requests:
1413
How?
 Centralized
 Define the standard requests
 Create “Canned” List with Associated auto assign
 DeCentralized
 Use the “Water, Pain, Toilet”
 What if I don’t have RTLS????
 Trick the Nurse Call System……
 Understand that variability
Hanson Rebecca (126)
4.62
Hanson Lindsey (53)
2.85
Hageman Grace (72)
4.35
Gregory Allison (11)
Average response time to room
3.92
Gomez Sabrina (192)
5.32
Garcia Kathy (72)
5.01
Fletcher Margaret (186)
11.48
Eeverson Kim (24)
11.66
Ellis Sarah (53)
Hidden
RNDow Kristi (74)
Divilbliss Cam (69)
Names
Day Jessi (145)
6.26
5.67
4.86
Avg Response time to room (minutes…
5.11
Clobes Julie (6)
4.98
Chavez Rayda (36)
4.13
Chauvin Debra
7.90
Chanyaem Anna (12)
13.44
Carpenter Janice (105)
3.97
Bunn Pam (8)
2.80
Bumatay Junie (108)
6.15
Barry Dawn (79)
8.24
0
5
10
15
HCAHPS #9: During this hospital stay, how often was the
area around your room quiet at night?
“How often?”
“Area AROUND your Room”
“Quiet at Night?”
How Often….
 When - @ what phase in the
process - does Noise Occur?
 DeCentralized
 Centralized
 Hybrid
Identify NOISE
Area AROUND your Room
 Where does noise come
from…..
 Any where the Caregivers
work?
 Potential for the Snow Ball
Effect….
Quiet @ Night
 Defining the time frame for
measurement
 Day – Night – SCA - SCP
 Patient Healing occurs all
day long – “Quiet” should be
measured at all times.
HCAHPS #13: During your hospital stay, how
often was your pain controlled well?
“How often?”
“Pain Controlled?”
“Well?”
Pain Controlled
 “Pain Request”
 Linked to
 Patient
 Caregiver
 Unit
 Link the pattern to the score……
Well
 Each patient is different
 Pain requests are minimized by Rounding
 Establish goals per caregiver on a qty of requests
acceptable per patient
 Watch out
 Some patients may figure out that “pain” is related to RN
Caregiver
 Clinicians are 4-5 times less
satisfied with their jobs than the
Average American worker
 It costs the hospital 4 times the
salary of a Nurse to replace them
 Clinicians are the deciding factor
on a patients experience
 Think of them like the elbow
Comparison
 Staff Productivity was
balanced with Quality
 “You can only speed a human
based process to a certain
point before you will create
more errors. We have found
that providing specific
expectations and measuring
them consistently with
individuals drives overall
productivity.”
 “Tracking errors and making it
a team goal to reduce them
promotes higher quality.”
 Vice President of
Distribution
Measurement & Balance of
Clinicians
Satisfaction
 Miles Walked Per Day
 Time at the Bedside
 Bombarded with Information
Productivity
 Verbal Response
 Clinical vs Concierge
Measuring Clinicians is different than measuring pickers – the education,
the pay, and most importantly the “product”.
Time at the Bedside
 36 Hospital Time Motion
Study*
 26% of the Nurses Time
Spent at the Bedside
 Nurses Walk 3.0 + Miles Per
Day
 Increasing Time at the
Bedside Decreases Nurse
Turnover**
 Nurses like people…..
*The Permanente Journal, Summer 2008
**Proclamation for Change JONA 2009
Balancing Act
Efficiency
Effectiveness
Time @ Bedside Centralized
Patient Request
188
1413
1155
346
81
Total Concierge
Requests
Total Meds and
IV Requests
Total RN
Requests
Total Bathroom
Requests
Total CA
Requests
In Room Response Time
Total Concierge
Requests: 188
5.48
Total Meds and IV
Requests: 1155
5.75
4.15
Concierge Requests = “Ice Chips” “Blanket” etc
Total RN Requests: 81
9.13
5.60
Total Bathroom
Requests: 346
Total CA Requests:
1413
Hanson Rebecca (126)
4.62
Hanson Lindsey (53)
2.85
Hageman Grace (72)
Average response time to room
4.35
Gregory Allison (11)
3.92
Gomez Sabrina (192)
5.32
Garcia Kathy (72)
5.01
Fletcher Margaret (186)
11.48
Eeverson Kim (24)
11.66
Ellis Sarah (53)
Hidden
Dow Kristi (74)
RN
Divilbliss Cam (69)
Names
Day Jessi (145)
6.26
5.67
4.86
Avg Response time to room…
5.11
Clobes Julie (6)
4.98
Chavez Rayda (36)
4.13
Chauvin Debra
7.90
Chanyaem Anna (12)
13.44
Carpenter Janice (105)
3.97
Bunn Pam (8)
2.80
Bumatay Junie (108)
6.15
Barry Dawn (79)
8.24
0
5
10
15
Can we REDUCE Miles?
Right
Information
Right
Time
Right
Person
Can We Measure
Safety
 Alarm Fatigue
 Medication Errors
 Falls Falls Falls
Alarm Fatigue
 The point at which the noise,
vibration, or visual becomes
“ignored” by the caregiver
receiving it due to over
stimulation.
 Johns Hopkins (16 bed unit)*
 942 Alarms Per Day
 1 Critical Alarm every 90 sec
 Overstimulation
 Design
 Automation
 Data Management
* Boston Globe Feb, 2011
Volume of Alarms @ Hip
Right Alarm
Right Person
Right Time
Right Alarm
Right Person
Right Time
Right Information
Right Person
Right Time
Errors
 Interruptions
 Procedural
 Clinical Errors
 Interruptions occurred in
more than 50% of meds
administration
*AMA 2010
12%
DND for Safety
 Remove the Interruptions
 Evaluate “interruption” for the
right and wrong reason
 Is it balanced?
 Is it working?
Falls….Falls….Falls…….
 Cost is $25,000 - $50,000 per incident
 Leading Cause of Death to persons over 65 in hospital
 30-48% of Falls result in serious injury
 Joint Commission
 CMS (Never Event)
Falls.
 Root Cause Analysis
 Do you use the data in your Nurse Call System (Or
Middleware) to assist in painting a picture of what was
occurring at the time of the fall?
August 12th
18
16
14
12
10
8
6
4
2
0
0
1
2
3
Normal
4
5
Normal OT
6
7
8
Toilet
9
10
Toilet OT
11
12
13
Shower
14
15
16
Shower OT
17
18
19
Staff Assist
20
21
22
Code Blue
23
24
Fall
25
So What
 Patients are the PURPOSE
 Caregivers are the CORE
 Safety is a RESULT
Conclusion
 Create a cross-functional team to determine what
needs to be measured
 Document all current alarm processes
 Determine what phase of the process you need to
measure to answer your questions
 Extract the data
 Analyze
 Engage the process for review and realignment
Sphere3
 Kourtney Govro, CEO
 913-433-3919
 @Sphere3CEO
 [email protected]
 Sphere3consulting.blogspot.com
 www.sphere3consulting.com

Patient

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