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Overcoming Barriers of a Safe Patient Handling Implementation. Presented by: Lori Zinnecker Hoener, Karen Schumacher & Andrew Rich. Safe Patient Movement & Handling at NMH. Northwestern Memorial Healthcare Corporation NMH Chicago Campus: 8000+ Employees
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Overcoming Barriers of a Safe Patient Handling Implementation Presented by: Lori Zinnecker Hoener, Karen Schumacher & Andrew Rich
Safe Patient Movement & Handling at NMH • Northwestern Memorial Healthcare Corporation • NMH Chicago Campus: • 8000+ Employees • 894 Bed Acute Care, Academic Medical Center • Lake Forest Campus: • 1862 Employees • 215 Bed Community Hospital
Diligent Services • 30+ Clinicians (OT, PT & RN’s) • Partner to drive Safe Patient & Handling Program Success • We have collaborated in over 600+ facility success stories
Objectives This workshop is designed for anyone who is faced with the responsibility of implementing a SPH Program in their facility. The objectives are to: • Discuss factors that influence the success of safe patient handling programs • Define where you are in the continuum of implementing a program: Brainstorming to Sustaining • Look at common hurdles at each stage: • Technical (processes, policies, etc.) • Financial • Cultural • Reinforce Use of Tools & Techniques to apply to all levels in order to anticipate challenges/obstacles and change beliefs. • Begin/Create a strategy for your facility
Where You Are Now? Sustainability Plan
Anticipating Hurdles at Each Stage • Cultural Considerations • Communication to All Levels • Compliance, Expectation & Accountability • Buy In & Culture Change • Patient & Family • Employee s • Early Adopters • Late Adopters • Training • Marketing • Resources Technical Considerations Engineering • Equipment/Sling Solutions • Installation Considerations • Laundry • Storage Administrative • Define Problem • Create Processes • Develop Team • Problem Solve Obstacles • Training • Metrics Financial Considerations Budgeting: Initial, On-Going • Staff Time: Training Off Unit, etc. • Consultants • Support Service Costs
Anticipating Hurdles at Each Stage Beginning: Proposal Stage Implementation Stage • Spending more time on technical and financial aspects: • Defining the problem, • Getting support and funding, • Determining who you are communicating too • Exploring the options. • By this point, process is defined, now focus is on communication: • Training employees • Getting buy-in • Problem Solving Obstacles: • Financial – still need to replace / purchase/repair items. • Getting laundry done/turned around
STOP: Workshop 1 What stage are you in the process? What challenges are you facing in this stage? Technical: Financial: Cultural:
Tools & Techniques Have a Road Map • How did we tell our story? • What did we use? • Process Improvement Tool: DMAIC/Six Sigma • Project Management Tools: Timelines, Project Plan & Responsibilities • Internal and External Experts 6-Sigma DMAIC Lean Rapid Improvement Workshop Project Change Acceleration DMAIC = Interstate Highway 6-Sigma, Lean, and Rapid Improvement Workshops = Lanes Project Management and Change Acceleration = Support Structures Tools (Excel, toolkits, templates) = Side Rails and Lines Projects = Cars Project Management Project Goal
Overview Patient Movement & Handling • Linkage to Best Patient Experience/Best People and Exceptional Financial Performance • Best People: Assure a meaningful work experience for each employee. • Problem Statement:. • From FY00-FY04: • xxx NMH employees have been hurt moving/handling patients, resulting in: • xx lost & restricted days/employee incident, and • $ xx million cost to the organization • Caregivers lift/move/transfer 1500-3000# per shift • Bariatric Demographic • NMH admits xx patients/day that weigh > 500#, • NMH does not have equipment readily available for patients > 400-500# • There is no clear protocol for moving/handling dependent &/or bariatric patients. • Triggering Mechanism • There is no ‘trigger’ to cue staff to consider weight limits and patient dependency level to ensure patient and employee safety. • Staff Surveys: • xx% staff unsatisfied with their options to get physical or mechanical assist to move heavy, dependent patients. Defining your Problem Goal:By xx/xx/xx 1)Equipment to move patients that weight > 500# will be readily available (within 5-10 minutes) upon a “trigger” activating an equipment protocol. 2) Patient lift equipment will be compatible with NMH beds/carts. 3) Within 1 year of a hospital-wide implementation of a comprehensive patient ‘lift’ program, there will be a xx% reduction in both workers’ compensation costs and in lost & restricted work days that result from patient handling injuries (see projections on graph above). Scope: Initially implement a patient movement initiative on 4 Pilot Units , then if goals are achieved, plan to roll out facility-wide in FYxx. System Capabilities (see Key Metrics) Key Metric(s) Milestones: • Safety Loss Runs: Lost and Restricted Work Days, Workers’ Compensation Costs • Pt escort record time Escort gets request for patient to be transported and time patient is delivered to destination (includes delivery of equipment to transport) • Documentation: measure percent of time patient weight, height and BMI is recorded & when trigger for equipment is sent out. • Employee Satisfaction Surveys/Cornell Symptom Survey Date #1 Define Jan. #2 Measure Feb #3 Analyze March #4 Implement April, #5 Control Aug, #7 House-wide Proposal December Executive Sponsor: VP Sponsor: Nursing Director Project/Process Owner: Nurse Manager Improvement Leader: Safety Leader
STOP: Workshop 2 Who are your stakeholders? What roadmap will you use?
Measure: Key Metrics • Safety Loss Runs: • Lost and Restricted Work Days, Workers’ Compensation Costs • Patient Handling Financial Assessment Tool: • Calculates replacement costs. • Patient Escort Database: • record time Escort gets request for patient to be transported and time patient is delivered to destination (includes delivery of equipment to transport) • Documentation: • measure percent of time patient weight, height, BMI and patient handling equipment recommended is recorded in EMR. • Staff Surveys: • Measure pre- and post-implementation: staff satisfaction
Improve: Improvement Initiatives • 5 Pilot Unit Plan: • Capital Budget approved w/Consultant component • Identified Unit Needs, Purchased equipment • Installation • Equipment Delivery to Units • Pilot Protocol: Draft Written • Logistics • Laundry &Inventory Mgmt • Documentation & Metrics established • Training - Prevent provided training March to staff and super-users. • Marketing & Communication: • Communications on Intranet and in electronic documentation • Future: Nursing and Physician Newsletters • Metrics: • OSHA Logs and Loss Runs • Documentation – Documentation Query: BMI, Dependency Level & Width Triggers vs Actions Taken Strategy recommended and implemented by the team:
Improve:Loss Run Data Goal: 20% reduction in employee movement and handling incidents, lost and restricted days GOAL MET!!!
STOP: Workshop 3 How will you measure success? Who will monitor? What will be your control?
Program Sustainability • How will you know when there is a problem? • Who is responsible? • How will it get fixed?
Control: Based on Pilot Success - Go House Wide & Program Effectiveness To Date Policy Approved Pilot: 4 Units Note upward trend – Create Spc Teams Rollout Hospital Wide Gap Analysis & Recs
A Department Perspective We’ve discussed technical, financial and culture challenges that come along the way from a global perspective – let’s see how it impacted a Department …lessons learned… from overcoming obstacles to unexpected surprises
Department Application Benefits of Early Adoption • Free stuff! • Lots of one-on-one attention • Recognition • Opportunity to provide feedback • Meeting with manufacturer to discuss R&D • “Expert” status
Department Application Technical Barriers: • Ceiling lift installation • Sling storage locations • Securing laundered slings • Make friends with materials handling folks • Availability of floor based equipment • Troubleshooting broken or malfunctioning equipment
Department Application Financial Barriers: • No initial upfront cost for individual department • Early Adopter “Benevelance Stash” • Sling replacement cost • Repair costs • Residual workman’s comp costs
Department Application Cultural Barriers: Nursing Culture • Is the equipment most used by therapists conveniently located on the nursing units • Do nurses still “wait” for therapy to 1st mobilize pts? Physician Culture • Are the physicians willing to allow their patients (mostly post operatively ) use lift equipment? • Eg: ortho patients, gym patients Patient Culture • Are patients willing to use the lift equipment? • What happens when they refuse?
Marketing to patients, physicians and other HCPs • Decreased decubiti • Potential for decreased hospital acquired “super bugs” due to decreased length of stay from faster mobilization • Decreased falls, particularly with bedside transfers • Increased level of independence in all ADLs and mobility at time of D/C due to faster mobilization/decreased time spent in bed • Continuity with all health care workers involved in care of patient • Increased dignity for the patient with fewer caregivers required to assist, especially for personal hygiene.
Department Application Cultural Barriers for Rehab (con’t): • Therapist Culture • Overcoming therapists’ need to “assess” AND “treat” • Recognizing how nursing and therapists use lift equipment differently • Functional Mobility Assessment for Nursing vs Therapist’s Reference Guide for OT/PT
Department Application Cultural Barriers Changing the way we document • Documenting patient’s function (and progression)despite use of lift equipment • Providing documentation that patient is using a mechanical lift in addition to physical assistance for functional activities • Assuring documentation does not prohibit patient from going to next level of care Excerpt from Therapist Documentation Patient required minimal assistance to ambulate 30 feet with his rolling walker WBAT on the LLE . Lift equipment in place for safety, balance, and d/t history of knee buckling; however, patient was not dependent on lift equipment for ambulation.
Department ApplicationFinal thoughts on Culture… HR Opportunities • Preventing injuries in the tenured employees and the (yet uninjured) new hires • Using safe patient handling program as a recruitment opportunity Supporting the next generation of health care providers
Department Application “Staying the course” and keeping momentum… Ongoing annual competencies Training new staff and students after go-live Addressing department injuries • Post incident follow up • Having an action plan for change
If you know ahead of time where the obstacles will be… Why not- move them
We know… • Word of mouth is electric • You don’t get many chances to screw up • If you don’t risk screwing up – you will fail
That’s all great but BUT PLEASE
Story Time • Facts inform- stories resonate & make you feel • Stories inspire • Stories spread • Safe Patient Handling is an IDEA VIRUS
What is the story here http://www.youtube.com/watch?v=JXv262YKzc8
Mission Statement: Medical Center Hospital is a community-based teaching health system, providing high quality healthcare to all residents of the Permian Basin.
JoeS7264(8 months ago) I'm the one kneeling in gray scrubs. Hope you know how miraculous this video is. Only sat up for 10 seconds exactly 1-wk ago for first time in almost 3 months. From YouTube yesican32(8 months ago) Wonderful...but no matter your outstanding & unbelievable improvement, I'll still dance better than you. TxTechKami(8 months ago) OMG this is ABSOLUTELY AMAZING!!! Joe, you area true inspiration. Love you!
Training 91.83% 99.86%
“Taking the class as a refresher really helped. I feel I can use the equipment now in any situation” • “What an impact this have on my ability to care for my patients and myself”
