Peace health Safe and Sound Leader workshop of May 16, 2014, Ketchikan

1
W E L C O M E !
K a r e n C u r t i s s
M a r c h 1 6 , 2 0 1 4
Engaging with Patients and Families
for Safe, Compassionate Care
Presented by: Karen Curtiss and Mary Foley RN PhD
Hosted by: PeaceHealth, Ketchikan, May 16, 2014

2
For You, Your Family, and Your Patients
Tragedy
Transformed
To Tools
Copyright@2014, PartnerHealthSafe & Sound Tools for Nurse Leaders

3
Today… We’re All About the Power of 3’s
Patient Safety Crew

4
My Story is Your Story Too
Patient Safety Crew

5
The Power of 3 in Head Heart Hands
For your family
For your patients
For your peace of mind

6
Leading with my heart..
I Was a Care Partner for My Dad
IPF:
Devastating Diagnosis
Bill
Aydt,
married
to
Margaret,
51
years

6
children,
9
grandchildren
(Lily,
age
3,
shown)


7
Successful lung
transplant at Super Star!
IPF cured!
Bill
Aydt,
married
to
Margaret,
51
years

6
children,
9
grandchildren
(Lily,
age
3,
shown)


8
Successful lung
IPF cured!
Fall
Bill
Aydt,
married
to
Margaret,
51
years

6
children,
9
grandchildren
(Lily,
age
3,
shown)


9
Successful lung
transplant at Super Star
IPF cured!
Fall
VAP
Bill
Aydt,
married
to
Margaret,
51
years

6
children,
9
grandchildren
(Lily,
age
3,
shown)


10
Successful lung
IPF cured!
Fall
VAP
MRSA
Bill
Aydt,
married
to
Margaret,
51
years

6
children,
9
grandchildren
(Lily,
age
3,
shown)


11
Successful lung
IPF cured!
Fall
VAP
MRSA
C diff
Bill
Aydt,
married
to
Margaret,
51
years

6
children,
9
grandchildren
(Lily,
age
3,
shown)


12
Successful lung
transplant
IPF cured!
Fall
VAP
MRSA
C diff
DVT
Bill
Aydt,
married
to
Margaret,
51
years

6
children,
9
grandchildren
(Lily,
age
3,
shown)


13
Successful lung
IPF cured!
Fall
VAP
MRSA
C diff
DVT
PE
Bill
Aydt,
married
to
Margaret,
51
years

6
children,
9
grandchildren
(Lily,
age
3,
shown)


14
Successful lung
IPF cured!
Fall
VAP
MRSA
C diff
DVT
PE
MRSA… again
Bill
Aydt,
married
to
Margaret,
51
years

6
children,
9
grandchildren
(Lily,
age
3,
shown)


15
Successful lung
transplant
IPF cured!
Fall
VAP
MRSA
C diff
DVT
PE
MRSA… again
C diff… againBill
Aydt,
married
to
Margaret,
51
years

6
children,
9
grandchildren
(Lily,
age
3,
shown)


16
Successful lung
IPF cured!
Fall
VAP
MRSA
C diff
DVT
PE
MRSA… again
C diff… again
Stage 4 Bed Sore all the while
Bill
Aydt,
married
to
Margaret,
51
years

6
children,
9
grandchildren
(Lily,
age
3,
shown)


17
And failed.

18
Next, I was a Care Partner for my husband, Sandy
“Routine” Bowel Resection
Sepsis
Emergency Surgery to remove dead tissue
VRE
Follow up surgery to repair bowel system
Then, for our
son, Alex
Misdiagnosis:
Appendicitis

19
Who are Your Nearest and Dearest?

20
Crying at Stoplights

21
Peeling Onions for Answers

22
1 in 3 Patients Needlessly
Suffer or Die from Preventable “Adverse Events”*
* ‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured, David Classen, et al, April 2011.

23
And the Death Toll?
400,000 lives every single year
  Equal to 3 Boeing 747’s
crashing every single day with
no survivors2
3rd Leading Cause of Death
Cost? $60 billion+
  Imagine the number of nurses
who could be recruited,
educated and paid
1. A New Evidence Based Estimate of Patient Harms
Associated with Hospital Care, John James, Journal of
Patient Safety, Septembeer 2013
2. Almost 1000 planes, about 400 passengers in each.

24
What’s More –
These Tolls are Likely Under-Reported

25
Air Travel is 3,000 Times Safer Than Hospital Care

26
“The house is on fire…
and no one smells the smoke.”
Of the 19 industrialized
countries, the U.S. has the
highest rate of preventable
death from medical errors.
(World Health Organization)

27
So… What’s the Harm in Hospital Care?
Around 2008, the term Never Events was coined to describe common
and preventable harm and death to patients, like….
*MDRO Infections *Falls Blood Clots
*Medication Mix-ups Bed Sores *CLABSI
*Sepsis UTI/CAUTI VAP
  *

28
What Does This Mean in Human Terms?

29
Pick 2

30
OR
Choose
ZERO

31 Copyright@2014, PartnerHealthSafe & Sound Tools for Nurse Leaders
Heroes Choose ZERO

33
Patients Need Informed & Engaged
Care Partners
Patients families are the Quarterbacks for care
  Keep a daily care journal (track medications, tests, results, questions, answers, goals,
trends in vitals)
  Coordinate with other family members and friends if necessary
  Trust your gut
  Speak up
- Politely, but firmly
- Repeat as necessary
  Accept personal discomfort
(Expect not to be popular)

3434
Families for
Patient Safety
CampaignZERO.org
  Checklists to
ZERO OUT HACS
  Safe & Sound
Community
Workshops

35
So I Wrote this Guide Book for
My Family & Yours
If we’d had Safe &
Sound in the
Hospital for my
father’s hospital stay,
he would be alive
today.

36
My Family & Yours
Checklists to Prevent…
  Falls
  Hospital Infections
  Blood Clots
  VAP
  Bed Sores
  Readmissions
  MORE

37
My Family & Yours
  What to Look For
  What to Say
  What to Do
  When to get a nurse!

38
Checklists Work!
P L E A S E
Wash Hands!
About
Bloodstream
Infections:
Germs can invade the
body through cuts or
breaks in the skin,
resulting in serious
infection that’s
carried through the
body in the
bloodstream.
Risk Factors:
Use of a tube and
bag system called
an “IV” or a “central
line” to deliver
fluids because the
skin has to be
broken for these
lines to be inserted.
24
Use this Checklist to
Help Prevent Bloodstream Infection
P When a central line is inserted, ask: “Are you using a
central line bundle?"
P Watch to make sure that nurses and doctors always:
I Wash their hands thoroughly before touching your
loved one
I Use sterile instruments and supplies
I Sterilize the skin
I Choose the safest spot
Ask, “Why?” if groin is chosen
I Use a clean sheet to drape your loved one's body
I Wear a mask
I Cover the area with a sterile pad
P Make sure any openings in the skin are kept covered at
all times.
xxx
xxx
x
x
x
Central line
IV lines often go here
(but not always)
Central line can go in
the groin, but it’s not
the safest place
xxx shows example surgery sites
Quick information
6th grade literacy level
Icons and pictures

Help Prevent a Urinary Tract Infection (UTI)*
P Every day, ask if the Foley catheter can be removed.
P When no longer needed, ask the doctor for a written
order to take it out.
I If not taken out as ordered, politely remind at every
shift change until the tube and bag are removed from
your loved one’s body.
P Ask about the cleaning plan (daily is ideal).
P To prevent urine from going back into your loved one’s
body, keep an eye on the tube for kinks and tangles, and
straighten them.
I Make sure the bag hangs below your loved one’s
stomach area so urine can’t back up the tube.
P Make sure the bag is replaced when full.
P L E A S E
Wash Hands!
About Urinary
Tract Infections
A urinary tract
infection (UTI) can
develop when germs
enter the body
through a plastic tube
used to drain urine.
The bladder, kidneys
and urethra can all be
infected. (*This
infection is also called
a CAUTI for Catheter
Associated Urinary
Tract Infection.)
Risk Factors::
Use of plastic tube
and bag system for
urine collection
(called a “Foley”
catheter)
GetaNurseif:
Youseesignsof(oryourlovedonetellsyouabout):
I Chills,shivering,bodyaches,headaches,confusion
I Painoraburningfeelinginthelowerstomacharea
I Lowerbackpain
I Bloodinurinebag(Youmayseeaslightlypinkcolor.)
Notes:
31
Remember,
It’s OK to
Speak Up

40
One Penny’s Worth of Cardboard Can Save a Life
30 Degree Angle Guide
This can help you check that your loved one’s
head and back are supported at an angle of 30 degrees or more.
© PartnerHealth www.partnerhealth.com

41
Follow Checklists, Take Notes, and Share
36 s
Daily Care Notes Day 1 Date:
Today’s Nurses:
Today’s Care Partners:
When doctors and nurses “hand off” their notes about your loved one to the next shift,
ask them to do so in front of both of you. Speak up about any incorrect or incomplete
information. Make sure corrections are made to your loved one’s chart.
Questions and Concerns to Share with the Medical Staff:
Their Answers, New Information:
Be Sure to Cover Goals for the Day:
What to Expect for the Day:
If you need more Daily Care Notes pages, just go to www.SafeAndSoundBooks.com to download and print.36 s
Care Partner To-Do List for the Day
Ask for a copy of your loved one’s medication chart every morning.
Note date and time of review on chart.
Ask attending doctor to review it.
Follow the checklists on pages 20 to 33 that apply to your loved one.
Keep germs away from your loved one! If needed, remind to wash hands
— even doctors and nurses!
Help double check every time your loved one gets a medicine.
Take good care of yourself too! See page 12 for some ideas.
Get a nurse for any alarms that ring in your loved one’s room.
Spend time planning for your loved one’s care at home (pages 47 – 52).
Vital Signs Ask nurses for this information when they check vital signs.
Ask for attending doctor if vital signs worsen
Time: (am/pm)
Temperature:
Pulse:
Blood Pressure:
Oxygen Saturation:
Trend is: II Better II Same II Worse
Time: (am/pm)
Temperature:
Pulse:
Blood Pressure:
Oxygen Saturation:
Time: (am/pm)
Temperature:
Pulse:
Blood Pressure:
Oxygen Saturation:
Time: (am/pm)
Temperature:
Pulse:
Blood Pressure:
Oxygen Saturation:
37

42
Connect the Mind-Body-Spirit – Healing for All
Howto
GetStarrted
— Hubert H. Humphrey
Howto
GetStarrted
The greatest healing therapy is friendship and love.
— Hubert H. Humphrey

43
Remember,
It’s OK to
Speak Up
Remember to
Wash Hands!

44
Reactions: “Peace of Mind” is Common
100% of users surveyed say they would recommend Safe & Sound checklists to friends and family.
“Since my husband and I are both in our
middle 80's, probably one of us will be in the
hospital sometime.
I carefully went through the checklists…
realizing that these records would be very
helpful!!
It will bring comfort and peace.”
– Joanne L. Cerling
Review posted on Amazon*
4
4
*See more at: http://www.amazon.com/Safe-Sound-Hospital-Must-Have-Checklists/

4545
Deity Docs Stressed Out Nurses
“
But… Will They Throw Them Under the Bus?

46
So We’re Partnering for Patients and Families
….for Safe & Sound Care
Copyright@2014, PartnerHealth
Karen Curtiss Ma Mary Foley RN PhD
Safe & Sound Tools for Nurse Leaders
Co-Authors
Safe & Sound
Nursing Tools for
Patient and
Family
Engagement

47
“It may seem a strange principle to enunciate as the very first
requirement in a hospital that it should do the sick no harm.”
Florence Nightingale
British Nurse and Humanitarian
1820-1910

48
Good News/Bad News:
Sometimes Hard to Tell Which is Which
Circa 2000
Circa 1900

49
Swiss Cheese Health Care

50
The U.S. Holds the Worst Record Among
Industrialized Nations for Medical Errors
Plus…
  Our rate of improvement is much slower than the other 18 industrialized
countries. (WHO)
And…
  We spend more on healthcare per capita
than any other industrialized nation. (Rand data)

51
Why?
What would we have if we built a car from the very best car parts:
Ferrari engine + Porsche brakes + BMW chassis -- wrapped in a Volvo body?

52
A Very Expensive Pile of Junk
that Doesn’t Go Anywhere!
Our Fractured, Expensive, Unsafe Health Care System

53
Why?
“We have trained, hired and rewarded
people to be cowboys, but it is pit crews
that we need – pit crews for patients.”

54
Nursing’s Glass Ceiling
(Voting Rights Act Needed!)
  CNOs are often part of the senior leadership team, but a 2011study of 8
hospitals by the National Center for Healthcare Leadership revealed they
were not voting members of any of the boards (although they had active
board agenda presence) and
  The CNO as a senior team member was apparent in driving clinical projects,
but leadership in setting quality and patient safety goals was not as clear

55
Another Kind of Glass Ceiling
Journal of Nursing Care Quality, Djukic and Kovner, RN Work Project report
Nurses licensed before
2007- 2008 are usually
not included in
performance
improvement efforts in
their hospitals.

56
“Naval Gazing” Impedes Innovation

58
“I am a patient and I need to be heard.”
Morgan Gleason
- Aged 15

59
Decrease HACs by 40% by 2014
Improve Care Transitions & Drive Down Readmissions
Engage Patients and Families in Patient-Centered Care

60
3-out-of-4 patients, age 64+, leave the hospital
with an incorrect prescription or no understanding
of at least one medication regimen. (Yale New Haven study,
December 2012)
Yale New Haven study by Dr. Leora Horwitz of patients aged 64+ with heart failure, acute
coronary syndrome or pneumonia, December 2012.

61
Patients Forget 80% of What You Tell Them*
Remembered
Forgotten
* Numerous studies in the U.S and U.K.

62
20% of Patients are Back Within 30 days
  Can’t get to follow-up doctor appointments
  Can’t get prescriptions filled
  Take medications incorrectly
  Leave the hospital with infection and don’t know signs, don’t get treatment
early
  Don’t know, or ignore/minimize, early warning signs of common post-stay
complications (i.e. blood clots)
  Don’t know, or ignore/minimize, early warning signs for complications related
to their condition, especially congestive heart failure

63
Checklists Activate Clinicians –
Why Not Patients & Families?
AHRQ Keystone ICU Checklist Project results:
  Virtually eliminated CLABSIs in ICU’s in U of Michigan Hospitals
  Reduced mortality rate overall by 10%
SAFETY CHECKLIST USE YIELDS 10 PERCENT DROP IN HOSPITAL DEATHS, John Hopkins, Release Date of
01/31/2011

64
Simple Solution to a Complex Problem
Don’t you just love this?
When patients receive recorded discharge
Instructions to take home, the results
are astounding…
  15% reduction in readmissions
  63% increase in HCAHPS scores
  100% of patients who used the recordings are “glad to have them”
  100% say they “improve my understanding” of discharge instructions
Study at Cullman Regional Medical Center, Cullman, Alabama, Good-to-Go Discharge Program,
http://www.crmchospital.com/for_patients_guests/good-to-go_discharge_instructions.aspx

65
Patient & Family Engagement:
Key to Meeting the Triple Aim of Health Care
Wherever engagement takes place, the emerging evidence is that patients who
are actively involved in their health and health care achieve better health
outcomes, and have lower health costs, than those who aren’t.”
Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’
‘Scores’ Judith H. Hibbard, Jessica Greene, and Valerie Overton, Health Affairs February 2013

66
What’s an Activated Patient?
  Less likely to choose surgical interventions
  More likely to have better functional status
  Reports higher satisfaction, and
  Has higher medication adherence rates
* Health Affairs study, Feb. 2013

67
An average of 17 years is required to
translate new research into practice.
IOM, Crossing the Quality Chasm, 2001

68
We Don’t Have 17 Years

6969
We cannot
solve our
problems with
the same
thinking we
used when we
created them.
- Albert Einstein

70
Informed & Engaged Families: Untapped Resource
to Support Safety AND Accelerate Change
No one is
more
patient-
centered.
No one knows
your patient
better.

71
Sarah’s Story

73
Good Starting Places!

74
Together, We Accelerate Quality
Improvements with New Thinking

75
First and foremost, evidence-based:
  Quality & Safety Education for Nurses
methodology as the main platform (see more at www.QSEN.org)
  Content and evidence from the
National Quality Foundation report (most recent edition)
  Incorporates additional content and evidence from the
Partnership for Patients, Joint Commission, CDC, AHRQ
and others
Aligned with goals of the goals of the Affordable Care Act
Endorsed by clinical leaders in patient safety
Aligned with the majority of HCAHPs metrics
Safe & Sound Nursing Tools for Patient & Family
Engagement – for Patient Safety

76
Patients’ Families:
Your Extra Pair of Eyes, Ears and Hands
  No one Is better able to interpret patients’ slightest gestures or words for signs of
recovery – or problems.
  Safe & Sound Checklists for Care Partners…
  Teach new information quickly
  Shift attitudes (anxiety to confidence)
  Change behaviors (helpless to helpful)

77
Your Good Communication is Critical
  It is well documented that communication between care givers, patients, and
family members can improve outcomes
  Patients and families learn
better, faster coming from
YOU!
  Teamwork requires
effective communication

78
Your Leadership and Coaching are Critical!
Every Patient Looks up to Nurses as Partners
No one spends
more time with
patients and their
families.
The best
communicators are
the best listeners.

79
The Power of Empathy

80
Safe & Sound Collaborations for Patients --
“QSEN Style”
Connect with the heart:
“We’re in this together”
Every patient could be me, or my loved one
Share Facts with Patients:
Simple checklists
Evidence based
Friendly, matter-of-fact delivery
Provide Tools:
Antibacterial wipes
30-degree angle tool
Hand washing reminder tent signs
Canes, non-skid socks... More

Help Prevent Your Loved One from Falling
P Tell nurses you are concerned about your loved one
taking a fall or falling out of bed.
I Ask about getting a cane or walker, and using bed rails.
I Ask about the hospital's fall protection equipment such
as low beds and floor padding.
P Look for things in your loved one’s room that might
cause a trip and fall.
I Point out all furniture and equipment on wheels.
I Discuss ways to move around the room without leaning
on wheeled items for support.
P Ask for a bed alarm and a room close to the nurses'
station.
P Make sure someone helps your loved one go back and
forth to the bathroom or commode, and that someone is
on standby in your loved one's room for every trip.
P Hang the “CAUTION!” signs (at right) in can’t-miss
spots in your loved one’s room, such as on doors or over
the head of the bed.
P Bring non-skid socks or slippers for your loved one to
wear when out of bed.
P If you are able, lend your arm for support when your
loved one walks.
I Please don’t take a risk you might injure yourself — it’s
OK to ask for help.
P Watch to make sure the hospital gown and any IV tubes
won’t trip your loved one.
P L E A S E
Wash Hands!
About Falling:
Falls can happen to
anyone in an
unfamiliar place.
Most patients are
tired, weak or sleepy
from medications, or
suffering from
conditions affecting
balance.
Who’s At Risk:
All patients are at
risk for Falling
30
P R I N T P
© Partne
FA
P R I N T P A T I E N T ’ S N A M E A B O V E
C A U T I O N !FALL RISK
P R I N T P A T I E N T ’ S N A M E
© PartnerHealth www.
C A U
FALL
P R I N T P A T I E N T ’ S N A M E A B O V E
C A U T I O N !FALL RISK
Your Toolkit!
Head Written 6th Grade
Literacy
Heart Aural Active
Voice
Hands Tactile Positive
“Can Do”
  Checklist
  Sample Script
  Practical Tools

82
Take the Hard Hat Challenge Today!
Copyright@2013, PartnerHealthwww.PartnerHealth.com
Who wants to prevent falls?
Who wants to prevent infections?
Right here, right now!

83
The Safe & Sound Rubric
for Creating Care Collaborations
Head Written 6th Grade Literacy
Heart Aural Active Voice
Hands Tactile Positive “Can Do”

84
Quick Tips!
  Use the active voice
  6th grade literacy level: 1 and 2-syllable words
  Simple declarative sentences: avoid compound sentences
  Use common terms
  “Bed sores”
  not “pressure ulcers” OR “debicutus”

86
Safe & Sound Collaborations for Patients --
“QSEN Style”
Connect with the heart:
“We’re in this together”
Every patient could be me, or my loved one
Share Facts with Patients:
Simple checklists
Evidence based
Friendly, matter-of-fact delivery
Provide Tools:
Antibacterial wipes
30-degree angle tool
Hand washing reminder tent signs
Canes, non-skid socks... More

87
It’s Your Turn! What’s Your Plan to…?

88
Be the Change You Want to See
For your family
For your patients
For your peace of mind

89
To all the world
you are just
one person
But to one person
you could mean
the world.

Thank you for the gift
of your time today.
It means the world
to us.

91
Ideas? Questions? Contact us at:
Karen@PartnerHealth.com
Telephone: 847.208.6074

Peace health Safe and Sound Leader workshop of May 16, 2014, Ketchikan

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Peace health Safe and Sound Leader workshop of May 16, 2014, Ketchikan