Maximizing Positive Patient Outcomes through the Care Improvement Team: A Partnership with Patients and Staff

1. Maximizing Positive Patient Outcomes through the Care Improvement Team:A Partnership with Patients and Staff Martie Carnie, AS, PFAC Colleen Zidik, BSN, MBA, RN Debra Moody, BSN, RN Carolyn Hayes, PH.D, RN

2. In the Beginning: Changing the Culture 1997: Joint Venture BWH & DFCI Informational Town Meeting Active Work Group Affiliation with IFCC

3. Changing the Culture: Evolution of Glitch Rounds • DFCI Inpatient beds moved to BWH • Each patient had a personal escort/advocate • Informal rounding of Patients with Patients • Issues uncovered with informal rounds: • Clinical • Environmental • Personnel • Communication • Educational

4. Glitch Rounds: The Early Days • Glitch Committee formalized by Inpatient Leaders (MD, RN, QI) with Patient Rounders • Informal weekly meetings • Members identified • Active problem solving • Quick and easy fixes • Multidisciplinary solutions • Sticky situations

5. Glitch Rounds: The Picker Effect • QI reports influenced and prioritized the focus of the work • Clinical Issue of Emergent Admissions: Need to bypass emergency room visits • Neutropenic Pathway • Algorithms trialed • Educational Issues: Need to follow up with patients at home • Day after Discharge Calls

6. Glitch Rounds: Initiation of Day after Discharge Calls • Brainstorm of Picker questions • What do the poor scores mean? • Need more information from the patient perspective • New Questionnaire developed using staff and patient input (used in addition to the Picker Survey) • Staff RN on “light duty” conducted calls • Partners in Excellence Award in 2000

7. Glitch Rounds: The Accolades • Partners in Excellence Award in 1998 • Patient Advocate participation in Joint Commission Accreditation visit • Patient Advocates as a resource • Formalized into Care Improvement Team of today, continuing the partnership with patients and staff

8. Glitch Rounds: Transition to the Care Improvement Team • Membership has tripled since original Glitch rounds • Directors (MD, RN) • Patients • Staff at all levels & all disciplines • Meetings are monthly • Invited Guests to address current concerns

9. Care Improvement Team: Day after Discharge Calls • Resource for calls was lost in 2002/2003 • Gradual reduction in calls without resource • CIT Prioritized follow up calls in 2005 • Staff RNs and Care Coordination RNs conduct follow up phone calls • Staff concern the call is an “intrusion”

10. Issues Identified in Follow up Phone Calls

11. Press-Ganey Discharge Scores

12. Formation of Discharge Education Action Team • First meeting was April ’06 • Discussed previous initiatives trialed • Quality data presented to the team • Reinforced our focus on patient education and improving patients’ transition from hospital to home

13. Discharge Education Action Team • Team hypothesized Bone Marrow Transplant scores would be better than Oncology scores • Follow up analysis of Press-Ganey Scores confirm hypothesis

14. Discharge Education Action Team in Action • Summer & Fall of 2006: Created “Going Home: A Discharge Guide” • Expanded team to include MD, PA, PT, OT, RD, SW, CC and Summer College Student • Ensured reading level at 8th grade • Debate about “Danger Signs” • Patient Education specialists worked on patient friendly format and design • Created patient survey regarding education needs

15. Discharge Teaching Pilot Plan • Survey patients 24-48 hours before DC • Learning needs will be shared with RN • Oncology Admissions on 5AB will receive a copy of the “Going Home: A Discharge Guide” and “A Handbook for patients, families, and friends” • Discharge checklist, supplemental patient education “library”, and pre-printed plan of care trialed

16. Say Cheese!

17. Pre-Pilot Survey Results: Educational Needs

18. Pilot Survey Results: Educational Needs

19. Post-Discharge: Patient Feedback • 5 Post Discharge Surveys were conducted • No Changes recommended to the booklet • Impact on Patient’s Wife

20. Evaluation of Pilot • Delay in starting the trial • JCAHO visit in mid-January • Began as a trial with a small supply of “Going Home Guide” • Additional tools were not utilized in pilot

21. Monthly Press-Ganey Results: November through February J J

22. Outcome: What did the data tell us? • Focus on Process! The “Going Home Guide” alone did not impact survey results! And next, what life was like before, during, and after the pilot --- nurse and patient perspective!

23. Pre-Pilot Environment • Two Pilot Units, Each have • 12 Beds • Primary Nursing Model • Patient Population is Cancer Focused • Hematologic (i.e.: leukemia) and solid tumor • Intensive chemotherapy and research protocols

24. Pre-Pilot Environment • Intense Teaching Needs • Medication • Line care • Mouth care & personal hygiene • Safety needs/precautions • Activity • Diet/nutrition • Lab values

25. Pre-Pilot Environment • Varied sources of information • Experience • Hospital guidelines • Other discipline expertise • Blum Resource Center

26. Pre-Pilot Environment • Follow up phone call discoveries • Reveal misinterpretation of information • Find patients received conflicting information • Began work on a discharge booklet • Work put on hold in 2004 • Care Improvement Team prioritized this work again in 2006 through Action Team work

27. Impact of the “Going Home Guide” • No longer need to gather up varied pamphlets to teach patients • Guide has necessary information to be taught in a logical sequence • Every discipline can now teach from the same “page” • “Notes” section within the guide allow “individualization” of the teaching tool

28. Impact of the “Going Home Guide” • Novice RNs and Float RNs benefit from reading the guide • Frustration when “Guide” is not available • Positive responses from patients and families

29. Next Steps: • RNs will use the before discharge survey for all patients & keep in bedside book. • All disciplines can update “survey” to document teaching & patient understanding • All disciplines will use the “Going Home Guide” to teach the patient • Develop action plan for Patient Education DVDs

30. Success in My Eyes-Martie Carnie

31. Thank you to: Care Improvement Team: Directors: Ted Alyea, MD; Carolyn Hayes, Ph.D RN Members: Ann Hristov, PFAC; Martie Carnie, PFAC; Judie Ham, PFAC; Joe Nies, PFAC; Cynthia Jodoin, RN; Eileen Molina, RN; Ruth Muller, RN; Kerry Mahar, RN; Escel Stanghellini, RN; Andres Sirulnik, MD; Kendra Church, PA; Elizabeth Binari, RN; Ann Collins, RM; Deb Duncombe, RM; Mrinalini Gadkari, QI; Mary Lou Hacket, LISCW; Maggie Hewit, PFR; Meri Donlan, PT; Deborah Hoffman, LICSW; Michael Hubner, LICSW; Jennifer Kales, RN; Christine Sousou,PT; Lynne Simonelli, RN; Colleen Zidik, RN

32. Thank you to: Discharge Education Action Team: Members: Ann Hristov, PFAC; Martie Carnie, PFAC; Patti Smith-Allen, RN; Debra Moody, RN; Susan McDonald, RN; Eileen Kelly, RN; Dianne Griffin, RN; Susan Bolton, RN; Pamela Thomas, RN; Soheir Elebiary, RN; Joan Deary, RN; Katie Filipon, RN; Ruth Muller, RN; Ann LaCasce, MD; Andres Sirulnik, MD; Heather Hylton, PA; Sara Dorfmier, PA: Mrinalini Gadkari, QI; Meghan Cunningham, RD; Cara Dejong, RD; Nicole Varady, RD; Bruce MacDonald, LICSW; Kim Peterson, LICSW; Patricia Dwyer, LICSW; Mary Lou Hacket, LICSW; Meri Donlan, PT; Christine Sousou,PT; Carol Ann Orrico, RN; Ann Furey, RN; Danielle Sullivan, Program Assistant; Susan Decristofaro, RN; Tamara Sobers, Student; Colleen Zidik, RN

33. Thank you to: Nursing Staff on 5AB: Lela Tatarouns, Christine Leonard, Laura Allaire, Kathleen Slack, Debra Moody, Patti Smith-Allen, Dianne Griffin, Eileen Kelly, Nancy Murphy, Katie Fiel, Ana Velez, Suzanne Badavas, Mary Chinian, Suzanne Corsetti, Paula Digiovine, Kerri Flynn, Colm Gormley, Elizabeth Halloran, Yi Jin, Kristen Kane, Susan Kenney, Allison Konefal, Karen Legere, Kathleen McCarthy, Barbara Mullins, Lisa Olivo, Maria Raleigh, Kay Sweeney, Jennifer Wright, Doreen Bannon, Gina Coniglio, Maureen Conley-Rogazzo, Christine Cox, Sheryl Fernandez, Nancy Green, Kim Irwin, Danielle Johnson, Teresa Queally-Hanley, Jean Quinn, Marianne Saleda, Tracey Slaven, Karen Valliere, Angela Whitter Secretarial Support: Derlin Ryner, Maureen Mohansingh, Leah Pearlman;