Picker poster proof ihi 10 11-12


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Picker poster proof ihi 10 11-12

  1. 1. ISHAPED: Developing a Patient-Centered Approach to Handoffs Mary Ann Friesen PhD, RN, CPHQ1, Anna Herbst MSN, RN1, Karen Gabel Speroni PhD, RN1, Jeanine W. Turner PhD2, James Robinson PhD3, & Joseph Snipp MA4 1 Inova Health System • 2 Georgetown University • 3 University of Dayton • 4 Professional Research Consultants Overview A hospital system used Lean strategies to develop a method to structure transmission of information and to support patient engagement, in the change of shift bedside handoff. To better understand patient perspectives of handoffs, the project team worked in collaboration with a Parent Advisory Council and Patient/Family Advisory Council to design and implement a patient-centered handoff process entitled ISHAPED I=Introduce, S=Story, H=History, A=Assessment, P=Plan, E=Error Prevention, and D=Dialogue), and education campaign. Aim Statement Context Develop and implement a patient-centered change of shift handoff Handoffs present among the most challenging communication process Always Event® and education program for nurses with input from in healthcare. Inova a multi hospital system identified opportunities patient and families. Patients will always be included in the ISHAPED to improve the change of shift handoff process. Analyses of a multi- change of shift bedside report (handoff) process. hospital system handoff procedure indicate variance in definitions • Assess perceptions regarding the ISHAPED bedside handoff and processes across the system. A telephone report away from the process patient bedside process was used on a number of nursing units. • Use the patient feedback to optimize patient-centered-bedside Inova Health System – AlexandriaHospitals Hospital Inova Our Hospital Inova Fairfax Inova Fairfax Hospital handoff process for Children • Develop education modules on how to conduct patient-centered bedside handoff Inova Fair Oaks Hospital Inova Loudoun Hospital Inova Mount Vernon Hospital Inova Alexandria Hospital Inova Fairfax Hospital Inova Fairfax Hospital for Children Project Design/Strategy Inova Fair Oaks Hospital Inova Loudoun Hospital Inova Mount Vernon Hospital A Kaizen (Handoff Performance Improvement Team) utilizing the Pugh matrix, the team assessed six types of I Introduce handoff methods and selected the highest scoring method. The team had developed an ISHAPED strategy to guide nursing communication during the change of shift handoff S Story that was based on best practices and evidence-based strategies. The ISHAPED model incorporates a standard H History template, customizable for different inpatient units. The use of the ISHAPED model and templates helps assure that important information A Assessment is conveyed and provides an Bedside RN Shift to Shift Handoff Process P Plan opportunity for patients to participate in the process, thereby E Error Prevention addressing the principles of Update Near the end of your shift, round on patients; ask Near end of shift, review, Meet with Share any confidential or Conduct bedside Conduct shift Introduce report using ISHAPED if there’s update, and on-coming RN sensitive D Dialogue handoff using patient-centered care. Change patient to ISHAPED tool, handoff tool anything you complete the outside patient’s information script on-coming give to throughout shift can do for them ISHAPED room outside patient’s before report RN on-coming RN handoff tool. room The Nursing report at the begins Walk in room together change of shift changed from a Update* Italicized type denotes information that can be telephone report (asynchronous White Board & include Pt in Handoff Ask questions, dalogue with off-going RN Move to next handoffcommunicated away from the bedside based on communication) to a face to face Diagloguepatient situation and professional discretion. bedside report (interactive with Figure 1 patients). Innovation ISHAPED was piloted on intervention units and compared with control units a quarter before and after the implementation. Of the eleven Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questions examined, six questions showed an increase in percentage of patients who said “Always” in the quarter following the intervention and seven showing an increase in mean scores. On the other side, the control units showed declines in nine of the eleven measures, both in percent of patients answering “always” to the question as well as in mean. None of the gains in the Target Units were statistically significant. The ISHAPED innovation needed to be more patient focused. The Inova Health System was awarded a Picker Institute Always Events® Challenge Grant for the developing a patient-centered handoff. In order to develop a patient-centered handoff, input from patients and families was sought. A patient survey and interview guide were developed in collaboration with the Parent Advisory Council and Patient/Family Advisory Council. Findings: Results obtained from 22 interviews provided insight into patient perceptions regarding change of shift The ISHAPED logo was bedside report. Five themes emerged from the qualitative analysis. designed based on recommendations • Introducing the new nurse- at the change of shift from the Councils • Knowing through collaboration and communication-assuring information is shared and communicated to signify a • Engaging the patient to participate and provide their perspective- include the patient in the conversation patient-centered approach to • Educating the health care providers-lessons from patients for nurses what to do in the bedside report. communication • Managing privacy - the need to know and respect privacy and transition of care. The findings were reviewed by the Parent Advisory Council and Patient/Family Advisory Council who provided guidance to the project team members for the development of nursing educational modules. Educational videos were developed to include lessons learned with emphasis on addressing issues of lower scores 1, 3, 6, & 8. The education videos developed from this project were viewed by 94% or 3,161 inpatient nurses. Conversion of ISHAPED to Electronic Record is underway. The new ISHAPED electronic template is scheduled to launch November 2012. Educational videos were developed to include lessons learned with emphasis on addressing issues of lower scores 1, 3, 6, & 8. The education videos developed from this project were viewed by 94% or Examples: 3,161 inpatient nurses at Inova. The videos are available at http://alwaysevents.pickerinstitute.org/?p=1251 Face to Face Interviews (16 patients, 6 parents) “Where as this is really nice because I can hear. I can correct them if I need Pilot Study Survey Results to.” Question   Number         Patient   Parent   n=93   n=14   Combined   n=107   “It’s good. It shows me that there is continuity, that they are explaining to the Survey Item next shift what is going on. So, it makes us feel comfortable           I have learned more about my condition and plan of 1   care during the bedside shift to shift report. that the next shift understands what is happening with our son.” 3.97   3.69   3.93   The nurses were knowledgeable about my care 2   during the bedside change of shift report. 4.44   4.63   4.47   The bedside shift to shift report process between It definitely makes me feel more comfortable knowing that I know what’s nurses made me think that the nurses were really 3   paying attention to me and my health needs. 4.31   4.25   4.3   being communicated to the next shift and can voice in if I agree or disagree I liked being introduced to my new nurse at the end 4   of the shift. I felt comfortable asking questions during the 4.6   4.81   4.64   or have something I want to add.” 5   bedside change of shift report. 4.28   4.75   4.36   I felt like the bedside shift to shift process allowed 6   me to contribute to my health care. The nurses exchanged information with me using 4.07   4.13   4.07   Surveys (93 patients, 14 parents) 7   words I could understand. The nurses reviewed today’s goals and wrote the 4.32   4.5   4.35   “I found the exchange of information to be very reassuring and helpful.” 8   plan of care on the white board I would rather the nurses NOT exchange 3.71   3.19   3.64   “One thing I do like is seeing the nurse right at the beginning of shift.” information at my bedside. (This item has reflected and can be interpreted by removing NOT from the 9   item) 4.36   4.81   4.43   The nursing bedside change of shift report gives me 10   confidence in the healthcare I received. 4.13   4.44   4.18   I like having the nurses provide a bedside change of 11   shift report. 4.43   4.75   4.48   Timeline of Events 2010 2011 2012 March April May June July Aug Sept Oct Nov Dec Jan Feb March April May June July Aug Sept Oct Nov Dec Jan Feb March April May June July Kaizen ISHAPED Pilot Analysis Modify Implement ISHAPED Need to enhance Grant Recruit Patient/Family members Patient Perception Pilot Study Development of Educational Modules; Educational Campaign Program patient centered awarded Parent Advisory Council and new Script writing; Production Development of New Outcome Indicators Evaluation aspect of new Patient Advisory Council handoff. Apply for Picker Grant Outcome Measures A step wise regression was conducted to identify contributors to the overall quality of care rating as measured by the HCAHPS -Overall Rating for Quality of Care as measured by question: Using any number from 0 to 10, “0” being the worst and n = 3659 “10” the best, what number would you rate this hospital? Coefficients Standardized P Adjusted R Square Beta The following variables collectively were statistically significant and indicated that 49% of the Overall teamwork Nurses’ promptness in responding to calls .293 .137 .000 .000 .396 .457 variance could be explained; overall teamwork, nurses promptness in responding to call, staff Staff keeping you informed on condition Pain management .134 .102 .000 .000 .475 .484 keeping you informed on condition, nurse introduction of new-shift nurse, nurses understanding and Nurse introduction of new-shift nurse Nurses’ understanding and caring .075 .078 .000 .000 .489 .493 Nurses’ instructions and explanations .063 .001 .494 caring, pain management. Lessons Learned Changing from a telephone report to a patient centered report requires a major culture change and ongoing efforts to sustain a change of this nature. • The evolution from a nurse focused communication handoff to a patient centered report requires caring, connection and communication. • Collaboration with Patient/Family and Parent Advisory Councils was catalytic in enhancing understanding of the patient/family perspective • ISHAPED is a model that can be utilized to support a patient centered communication process. But processes and system must be designed to support patient engagement in order to impact patient outcomes in a meaningful manner. • Collaboration with and engaging patients must be valued and supported in the in the healthcare environment. • There are a number of contributors to overall rating for the quality of care that were statistically significant including “nurse introduction of new- shift nurse” • If the patient experience or patient satisfactions perceptions are to be impacted positively there is not one intervention that will provide a solution, but rather set of behaviors focused on patient-centered care. Teams Research Team Jackie Wavelet Ann Crowder Kaizen Lean Teams Okey Hendrick Paula Blackwell Acknowledgments: Maureen Swick CNE/SVP, Mary Ann Friesen Asha Rodriguez Kymberly DeLoatche Ann Miner Rachel Lewis-Bayliss Mary Smeill Quality Leadership, Chief Nurses Executives, Karen Speroni Angela Servidio Jerry Johnson Darryl Hampton Season Majors Jamie Ulrich Patient Care Directors, Inova Nurses Anna Herbst David Andrews Sandy Johnson Alice Penn Ritter Susan Peldo-Metzler Ashley Renkes Jackie Wavelet Robin Jackson Angela Lozano Barbara Harrison, April Hardy Peterson Kim Golansky Cynthia Earley Anne Doyle Les Touart April Peterson Angela Servidio Jessy Cartledge Karen Hicks Cheryl Schmitz, Tammy Turner Elaine Alexander Sigrid Butler Patient/Family Advisory Council Performance Improvement Team Freddi Brubaker Robert Watson Marta Lamas Barbara Slivers George Lesmes Asha Rodriguez Kristy Weirsky Monica Work Kadi Jolloh Jeannine Turner John Morison Mary Ann Friesen Skip Reece Ashley Matthews Anne Hooper John Pfeiffer Stefanie Lescallett Angela Servidio Education Team Sonia Astle James Robinson Eleanor Lindeman Mary Dixon Joan Manning Mary Anne Leitch Cheryl Schmitz Joseph Snipp Elizabeth (Betsy) Galeota Ken Leeson Julie Pierce Robin Jackson Les Oakes Clinical Documentation Project Team Vickie Bamsey Joanna Anukam Christine Czajkowski Nigel Brown Gloria Boateng Education Team Parent Advisory Council Robin Jackson Khristina Cagayat Liz Sakallaris Anna Herbst ( Team Lead) Kristen Bendien Shirley Cahill Katie Kostka Mary Ann Friesen Tom Bendien Frances Collins Nina Mosquera