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Time to Care: Common Ways Nurse Time Is Wasted

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How much time do nurses spend actually delivering bed-side care? The answer may surprise you - and frustrate them!

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Time to Care: Common Ways Nurse Time Is Wasted

  1. 1. Time to CareCommon Ways Nursing Time Is Wasted
  2. 2. Time to Care: Common Ways Nurse Time Is WastedIntroductionBrad White – Title: Operations Improvement Engineer – Description: Implements Lean Six Sigma at Baptist Health System
  3. 3. Time to Care: Common Ways Nurse Time Is WastedProject DefinitionDefect – High nurse turnover & low employee moraleBackground – The tele units at BMC were experiencing high turnover – Nurses said the floor was stressful – Nursing grid was changing from 1-5 to 1-6Goal – Retain tele nurses
  4. 4. Time to Care: Common Ways Nurse Time Is WastedObservation• First step in observation is learning what to observe• Be prepared for the first round of observations to yield little data• Find a structured yet flexible way to capture data
  5. 5. Time to Care: Common Ways Nurse Time Is WastedObservation Form
  6. 6. Time to Care: Common Ways Nurse Time Is WastedConvert to Data• Two basic forms of observation data: – Process – Work-Time Study• Convert observation notes into applicable data• Categories the times into various bins• Ask, is this of value?
  7. 7. Time to Care: Common Ways Nurse Time Is WastedCategorization
  8. 8. Time to Care: Common Ways Nurse Time Is WastedAnalysis Time Analysis Shift Day Night Day Night Average VA 13.5% 52.8% 7.9% 61.9% 34.0% Flex 14.0% 7.1% 31.4% 5.4% 14.5% NVA 72.5% 40.1% 60.7% 32.7% 51.5% Cost of the Waste $1,530,395/yr
  9. 9. Time to Care: Common Ways Nurse Time Is Wasted Spaghetti Diagram• Nurses were walking 750 mi. a year• That’s like walking from here to Memphis, TN!• Represents over $10,000 per nurse each year
  10. 10. Time to Care: Common Ways Nurse Time Is WastedOther Data• What else can be collected? – Staff opinion – Photos – Video – Audio – Anything that can put the environment into context for your audience
  11. 11. Time to Care: Common Ways Nurse Time Is WastedWaste Pareto• Detailed analysis will generate a “Waste Pareto”• This becomes the action items for improvement
  12. 12. Time to Care: Common Ways Nurse Time Is WastedData Analysis Wasted Time Analysis (In Hours, per nurse each year) 200 180 160 140 120 100 80 60 40 20 0
  13. 13. Time to Care: Common Ways Nurse Time Is WastedData Analysis Wasted Time Analysis (In Dollars, per nurse each year)$8,000$7,000$6,000$5,000$4,000$3,000$2,000$1,000 $-
  14. 14. Time to Care: Common Ways Nurse Time Is WastedMed Draw Analysis• Pulling medication was the #1 time waster (tied with discharging)• The observed reason for delays: – Multiple machines required multiple logins – Centralized location required travel and resulted in batching – Medication in bins required the nurse to fill the prescription
  15. 15. Time to Care: Common Ways Nurse Time Is WastedMed Draw Solutions• Re-balance machines to be patient-centric not drug-centric• Disperse machines throughout the floor instead of a central location• Have pharmacy fill each med pass by patient• Install med boxes outside each room
  16. 16. Time to Care: Common Ways Nurse Time Is WastedDischarge Analysis 30% 25% Admit Done 2 20% 1 Discharge Start 15% Expected Admission 10% 3 Done 5% Expected Discharge Start 0% Orders Start to End to Admit Time to Start End Leave Total Mean 77 Mean 125 59 36 220 Std. Dev 59 Std. Dev 146 42 63 251 Min 13 Min -155 -55 -10 Max 250 Max 665 205 250 N 22 N 58 80 24
  17. 17. Time to Care: Common Ways Nurse Time Is WastedDischarge Solutions• Collect proper information early in the process• Prepare for discharge by completing patient education prior to discharge orders• Eliminate unnecessary paperwork in the discharge process
  18. 18. Time to Care: Common Ways Nurse Time Is WastedKey Lessons• Nurse time not spent at the bed time is waste – Nurses aren’t happy – Patients aren’t happy – Management isn’t happy• Poor staffing is concealed with busy work so cost are hidden and a paper profit is shown• High turnover is expensive, drains morale, and decreases patient satisfaction and safety• The answer is rarely more staff or more equipment, but rather better layout and processes
  19. 19. Time to Care: Common Ways Nurse Time Is WastedIs This of Value?
  20. 20. • Questions?

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