thought leader learning series it’s critical – what you should be doing in your icus cheryl...
TRANSCRIPT
Thought Leader Learning Series
It’s Critical – What YOU Should Be Doing in Your ICUs
Cheryl Ruble MS, RN, CNS, Improvement AdvisorMaryanne Whitney MSN, RN, CNS, Improvement Advisor
Welcome
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Agenda
• Setting the Stage for Safety• Hospital Journeys• Wrap up
• CE’s - Provider approved by the California Board of Registered Nursing, Provider Number 15958, for 1.0 contact hour
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Objectives
1. Develop an understanding of the synergy between patient and staff safety.
2. Establish a strategy to engage bedside care providers in a commitment for safety.
3. Identify the critical value of patient and family engagement in overall departmental safety.
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Critical Elements for Excellence• Establish a vision making safety a CORE
departmental value• “Safety Huddles” • Integrate efforts of patient safety and
employee safety• Timely debriefings ofadverse patient and workerEvents-intent for learning• Encourage the voice of patients & families www.cynosurehealth.org
Creating an Umbrella of Safety
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Make it stick when YOU commit!
• Create a vision• Leaders are highly
visible & “Walk the walk”
• Physician champions & nursing champions modeling teamwork
• Learn, motivate, educate & celebrate
Enhance Reliability Efficiency & Outcomes
Untapped resources within your ICU, where are they?
• Patients• Family• How do we invite their voice?
– Open visitation– Multidisciplinary Rounds– Presence during resuscitation– Family meetings
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Making Safety Stick
Angie Sokal RN BSNCritical Care Manager
Kaiser Permanente
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About Us
Serving California’s Silicon Valley Santa Clara Facility• Features a medical office
building, opened in 2005, and a 327-bed acute care hospital, which opened in August 2007
• 20-bed MICU, 10-bed CVICU• More than 700 physicians
and 4300 staff care for members in the service area
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Creating a Vision for Safety
• Proclamation• Leadership• Huddles• Debriefing
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Safety
Proclamation
Leadership
• Set the department goals• Highly visible• Ensures employee involvement• Ensures accountability on all levels
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Huddles for Safety
• Patient concerns• Environmental concerns• Stretch and train • Transparency about
risks• Review adverse events
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Debriefing/ Mini RCA’s
• Med error• Employee injury • Accidental extubation• CLABSI• VAP• C-Diff discovery• HAPU
• Events will happen• Approach with curiosity• Life long learners
Work in progress
• Multidisciplinary Rounds- family involvement• Open visiting hours• White board PI work- in the department-(real-
time planning with staff)
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Daily Hospital Safety HuddleOctober 21, 2014
Karra Heggen, MSN RN, Vice President of NursingLeigh Poeppelman, MSN RN CCRN, Director of Critical Care Center and IV Team
Beacon Mission & Vision
• Opened in 1909• 257 licensed beds• Located on the St. Joseph
River in Elkhart, Indiana• Strong Heart and Vascular
Service Line: • Only hospital in Northern
Indiana to provide Trans Aortic Valve Replacement (TAVR) procedures
• Heart Failure Certification by Health Care Colloquium
• Recognized by Health Grades for Excellent Cardiac Surgery outcomes
• 23 Critical Care Beds19 www.cynosurehealth.org
Nursing Purpose:
Quality
• Ensure safe, compassionate, innovative patient centered care
• Promote and engage in the advancement of evidenced-based nursing practice
• Create a culture of collaboration, professionalism and a healthy work environment
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Leadership Safety Huddle • Safety Huddle initiated October 15 2012• Purpose:
– To communicate patient safety issues identified in past 24 hours hospital wide, look forward next 24 hours, to promptly resolve safety issues, and to have continuous follow up until resolved.
– Builds teamwork throughout the hospital– Time of networking – Mon-Friday 0900: Standing Room only– Every department is encouraged to send leadership
representative.
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Daily Stats
Original Safety Huddle Form
10/2012 Days since last Employee
Lost time: ___
Date: Huddle Leader:
House Count: ER Visits prev day:
10/2014 Days since last Employee
Lost time: ___
Date: Huddle Leader:
House Count: ER Visits prev day:
Huddle Highlight
to be sent Date____
Sick Calls/Call offs:
Daily Safety HuddleElkhart General Hospital
Follow up from previous:
Sick Calls:
Daily Safety HuddleElkhart General Hospital
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Past 24 hoursFollow-up Required?
Added
Follow-up Required?
Any Safety Issues or Challenges in the last 24 Issue/Challenge
Responsible Person
-High risk patients or procedures? -Deaths? - Restraints? - Falls? -Sitters?
Any Safety Issues or Challenges in the last 24 hours?
Issue/Challenge Responsible Person-High risk patients or procedures? -Deaths - Restraints - Falls -Sitters - Codes - ACT -Code EMS - Armstrong - Tele Boxes Available - HITS/Occurrences?
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Anticipated next 24 hours-Deficiencies in information, equipment, supplies, or staff that will make it hard to deliver safe, high-quality care?
-What conditions outside our unit could impact our ability to deliver safe, quality care today?
New Medication Shortages?
Surgery volume? Inpatient Surgeries?Anticipated issues or challenges for the next 24 hours?
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Added information in 2013 & 2014Added after 2012
Other:HITS
Blood Product Shortage?
Surgery volume ?Inpatient Surgeries ?
Follow up from previous:
Anticipated issues or challenges for the next 24 hours?
Any critical safety issues to address immediately?
Any potential reportable
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Huddle Highlight• Standardized succinct safety information will be
sent out to all management including charge nurses to review at shift huddles.
• Start and stop date; requires associate to sign form and unit keeps in binder.
• Developing criteria for use of Huddle Highlights
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Huddle Highlight
HUDDLE HIGHLIGHT
Please review at each huddle (a.m. and p.m.) until stop date. Each staff member is responsible to initial information presented.
Start Date: ______9/ 16/14 Stop Date: _______9/ 26/ 14
Initiated by: EGH Safety Huddle
Nursing Leadership
Details: Calling an Emergency Incident Code
You MUST dial 77 to call the switchboard for an internal incident (ACT call, fire, Code EMS, Code Blue, water leak, etc.)
DO NOT dial the operator number to call the switchboard.
Then notify direct Supervisor (charge nurse, team lead, shift coordinator, unit director) immediately.
Initials:
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Appreciative Inquiry & Inspiration• To close the huddle, stories are requested that
related to teamwork or patient experience that resulted in positive outcomes
• Inspirational readings from “Healing with Heart” Martin Helldorfer & Terri Moss
• Huddle can last 5-15 minutes
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Critical Care “Huddles”• Critical Care does a “short” report at 0700 and 1900 each day – the
charge nurse gives the whole team an overall picture of the patients and the plan for the shift.
• During this time there is also discussion and sharing of any safety concerns – issues that have arisen from housewide safety huddles, Huddle Highlights, issues from the previous shift, etc.
• This all occurs in 5-7 minutes.• Staff then get bedside report from the off-going RN.• Safety concerns are also posted in bathrooms or communicated 1:1.• Director or designee communicates safety concerns at Leadership
Huddle
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EGH Safety Net• Frontline safety concerns are escalated to unit
leadership to share at Leadership Safety Huddle.– Knowledge Transfer
• Culture of Safety encourages associates to speak up related to potential or actual safety concerns
• Shift huddles and Leadership Safety Huddle improves communication and teamwork for improved outcomes.
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QuestionsKarra Heggen VPN – [email protected]
Leigh Poeppelman Director of Critical Care/IV [email protected]
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Contra Costa Regional Medical CenterMartinez, CA
Stuart Forman, MDDirector of Critical Care Services
Contra Costa Regional Medical Centerwww.cynosurehealth.org
Safety Initiative /ABCDE Bundle
• Departmental goals• Identify champions• Use all types of reminders• Post progress• Recognize & Reward
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Giving a Voice to the Family
• Stay Connected protocol• 24 hours a day visitation- if they want to stay
they will be able to accommodate• Family meeting 48-72 hours post admission/
social workers
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Creating an Umbrella of Safety
www.cynosurehealth.org
Objectives
1. Develop an understanding of the synergy between patient and staff safety.
2. Establish a strategy to engage bedside care providers in a commitment for safety.
3. Identify the critical value of patient and family engagement in overall departmental safety.
www.cynosurehealth.org
Creating an Umbrella of Safety: Kaiser
• Safety proclamation• Synergy between work place safety and patient safety• Real time debriefings for adverse events- HAPU-
CLABSI-C-Diff- Workplace injuries• Safety Huddles- sharing risks identified in ICU & with
individual patients• Multidisciplinary Rounds – adding value from family
involvement• Open visiting• White board PI work
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Creating an Umbrella of Safety: Elkhart
• Leadership role modeling• Leadership safety huddles• Critical Care huddles• Closing the loop – communication back to
staff• Synergy of communication supporting a safety
net for staff, patients, and families
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Creating an Umbrella of Safety: Contra Costa
• Clear departmental goals• Identification of champions• Giving voice to the family
– Stay Connected– Family meeting within 48-72 hours post-admission
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Resources• “Implementing the ABCDE Bundle: ABCDE Bundle at the Bedside” from AACN at
http://www.aacn.org/dm/practice/actionpakdetail.aspx?itemid=28328
• Debriefings: Great resource from AHRQ on the usefulness and how to conduct a debrief: http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/essentials/pocketguide.pdf
• Open Visiting Hours: AACN Practice Alert on Family Presence: Visitation in the Adult ICU” from AACN at: http://www.aacn.org/WD/practice/docs/practicealerts/family-visitation-adult-icu-practicealert.pdf
• Safety Huddles: Great resource from AHRQ on the usefulness and how to conduct a safety huddle: http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/essentials/pocketguide.pdf
• Family included in MDRs: A great resource from Institute for Patient- and Family-Centered Care: http://www.ipfcc.org/advance/topics/PH_RD_Applying_PFCC_Rounds_Pediatric.pdf
• Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation from TJC at:
http://www.jointcommission.org/assets/1/18/TJC-ImprovingPatientAndWorkerSafety- Monograph.pdf
• Yassi, Annalee, and Tina Hancock. "Patient Safety - Worker Safety: Building a Culture of Safety to Improve Healthcare Worker and Patient Well-Being." Healthcare Quarterly 8.Sp (2005): 32-38. Web
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Continuing Education Credit!• Evaluation window will open as soon
as we close the meeting
• Provider approved by the California Board of Registered Nursing, Provider Number 15958, for 1.0 contact hour.
• All RNs requesting CEUs must be registered, provide their RN license #, sign-in to the webinar under their full name, and attend at least 50 minutes.
• CE Certificates will be emailed to you, directly
Upcoming OfferingsJoin us!
Are you in need of a Physician Champion for your Improvement Initiatives? Tune in for our free webinar on
November 13th, 12-1pm PST“Accelerate Change with Physician Champions: Tried and True Ways to Find and
Engage Effective MD Leaders”
AND
December 18th, 12-1pm PST “Infection Prevention: Is It a Show?”
We will explore a provocative report about human behavior and infection prevention.
Don’t miss either opportunity register now! www.cynosurehealth.org
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Cheryl Ruble MS, RN, CNS, Improvement [email protected]
Maryanne Whitney MSN, RN, CNS, Improvement [email protected]