Room Service a What’s Next? Building Staff Accountability

1. Room ServiceaWhat’s Next?Building Staff Accountability Presented by: Lisa Marker, MS, RD, LDN, Duke Raleigh Hospital

2. 198 Beds Community HospitalOncology, Neuro, OrthoDuke University Health System

3. Room Service Operation • 7am to 7 pm • All-in-one Menu • Label CHO grams, Heart Healthy, High Sodium • Call Center • Bedside ordering – RS Assist • Tray Monitor • Added Interface Enhancements • Pt Needing Assistance, Disposable Service Ware • Overview of Program

4. Room Service Operation • Hospital Steering Committee • RN tip sheets, daily huddles • FS staffed trained 1 hr per day x3 mo • Support from DM&A • Launched July 2015 • Overview of Program

5. They don’t have our scripting Our ideas are implemented We get a response WE KNOW YOU ARE WATCHING

6. Foundations of Our Program Monthly Performance Improvement Data Auditing for Expected Job Results Annual Competency Investigative Uses • CBORD • Training Program • Competencies to Work Position • 30/60/90 Day Reviews • Weekly Brainstorming Sessions

7. CBORD The Backbone of our Program Hourly staff should not make nutrition decisions ITEMS: Nutrient Information, Ingredient Information, Allergen Information Compliance for diet orders andall allergens Diet Restriction Goals for all diets *Training When to Override

8. Training and Accountability • Audit for overrides on Dysphagia • When to Override

9. Training and Onboarding • Do not have supervisors available to train new employees. • Manual is used in conjunction with peer training. • Have two voluntary trainers. • Very successful hiring local nutrition students.

10. Room Service Screens

11. Room Service Screens

12. Scripting StandardsQuick Script provided to new employees

13. Tray Monitor TrainingAlso utilized by HUCs and Speech Therapy

14. Competency to WorkAmbassador

15. Competency to WorkAmbassador Continued….Grown out of incidents where I could not prove training. Layered approach where I can prove employee should be held accountable with various training tools.

16. Competency to WorkCall Center

17. Competency to WorkTray Line

18. Competency Disclaimers • Trainer lists specific areas for follow up when completing Competency for position. • These areas are the focus for the 30/60/90 day hospital required evaluations.

19. Weekly Brainstorming Session • Staff are given opportunity to bring topics • “How are things going?” “Is there a better way to do that?” • Reinforce training topics from manual – Scripting, Isolation Rooms • Review hospital Relate (dealing with complaints) – words that work • RS A Comfort Care • Restructure division of floors when working short (Tray Count Summary Report) • Sign off sheet with minutes – all staff are accountable for material • White Board near iPads to communicate immediate changes • Most Underestimated Tool

20. Words that Work Weekly Brainstorming Sessions

21. PI Data • Average Tray Delivery Time • Percentage of Trays Delivered on Time • Average Tray Pick Up Time • Percentage of Trays Picked Up on Time • Tray Pick up by Meal Time • Call Center: Average Speed to Answer, Max Wait Time, % Abonded Calls, RONAs, No Agent Logged In • Press Ganey Rank • Hand Hygiene • Posted Monthly on Bulletin Board • Discussed in Monthly meeting • Current month to date • All PG comments that mention an employee are read at Department Meetings

22. Hospital Evaluations: Expected Job Results • Reviewed with employees twice a year

23. Hospital Evaluations: Expected Job Results

24. Employee Rounding to Complete EJR Assessments

25. Annual Competency TJC HR.01.06.01 Staff are competent to perform their responsibilities. 60 Question, Multiple Choice Exam • What is the best way to chill thickened liquids: • Add ice • Put in refrigerator • Thick liquids should not be chilled • A patient has ordered honey thick orange juice. We are currently out of honey thick orange juice. What should you do? • Serve nectar thick orange juice • Get thin orange juice and thicken it to honey consistency • Tell the call center to tell the patient we are out • Substitute honey thick apple juice • You notice a patient has just been advance from NPO to an NDD2 diet. What should you be on alert for that the computer will not yet catch? • What liquid consistency the patient is allowed • If cookies should be on the tray • If there is a garnish (kale and tomato) on the tray • What illnesses do I have to report to my supervisor or manager? • Diarrhea • Vomiting • Jaundice • Sore throat with fever • Cuts or lesions • All of the above • When leaving the room, what is the best thing to should you say to the patient? • Enjoy your meal • Have a nice day • Is there anything else I can get for you? Can I close your door to reduce the noise? • Bye • You have prepared a tray for a patient and when you reach the floor. There is a sign outside of the door that the patient is NPO. What should you do? • Deliver the tray and notify the nurse • Leave the tray at the nurses station and tell the nurse that there is an NPO sign and that you cannot deliver the tray

26. ACCOUNTABLE EMPLOYEES

27. Investigation Tools Diet Order Not Followed Played call recording for employee. Employee did not state patients diet order per scripting. Employee did not stat patient was over their 60 gram carb limit and offer alternatives per scripting.

28. Investigation Tools • Ambassador shift 7 – 3:30 am. A patient ordered a tray at 2:46. Why was the tray not delivered to the patient? MIA scenario

29. Investigation Tools • A patient calls complaining that her tray was late. Asked Ambassador why a patients tray took 77 minutes to deliver. Ambassador stated, “We had slow production people on the line”. Showed that the tray was completed in 49 minutes and the ambassador took 28 minutes to deliver. Showed that this employee takes twice as long as any other ambassador to deliver tray. Tray Monitor Reports, Patient Tray Statistics Pivot Table

30. Investigation Tools • Speech Therapist tells you they were assessing a patient and found turkey sausage on a tray. They say, “I thought they could only have copped turkey sausage on the NDD3 tray”

31. Investigation Tools Which ambassadors are taking meal orders in their down time and which ambassadors are hanging out? Room Service Administrator Audit Reports Resident Audit by User Show All – Select all User IDs Enter Dates Export and Save Open in Excel Event ID – Select Print Ticket, Queue Ticket, Refuse Meal Simple way – highlight each user to see count

32. Investigative Tools: PG Comment Negative comment about server: “Only one server which was young African gentleman wasn’t nice and unhappy attitude.” “Male server did not have a personality at all. He needs to know how to greet people.” Can look up comment number to get MRN InfoTurn Barcode Enter ID number from complaint (BarCode ID) This gives you a Unique ID EPIC, Patient Station, HAR.#### (Unique ID) Log book of Ambassador’s floor

33. Investigative Tools Other scenarios to brainstorm? Questions?

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