improving responsiveness to call lightsimproving responsiveness to call lights • uf health...

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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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%

UF Health Jacksonville3

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


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.


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.


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


Goal: To ensure meeting patient expectations of response time to answer call lights


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


HOURLY ROUNDING 6 P’s

POTTY

PAIN

POSITION

POSSESSIONS

PREVENTION/SAFETY

PLAY/DIVERSION


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


• 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.


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


• Reinforced in the Patient Experience Simulation Training


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


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


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


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.


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

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