2. Nursing Unit Environment of Care (EOC) Optimization
What is EOC?
Opportunity Approach
> Make rapid, meaningful, grass roots-enabled improvements to our work > Core team leads the overall effort
environment
> Steering/ SWAT team helps us implement quickly
> Deepen relationships among nursing and support services to foster
collaborative problem solving > Nurse champions lead optimization in their units
Objective Scope
> Create an environment of care with shared ownership of patient needs > Highest and best use of space, sort and straighten
* Develop realistic, mutually agreed upon goals that are measurable > Enhancements to supply management
* Ensure that the patient experience is the focus of all services
* Help all staff, nursing and support services, find a sense of meaning and > Support Services processes & relationships
purpose in their work through patient-focused goals > Patient environment improvements
> Make changes sustainable
Guiding Principles Timeline
> Implement visible solutions quickly to generate excitement > Jun to Nov 2010: Adult acute—Parnassus, Mt. Zion
> Create grass-roots momentum for change > Nov to Dec 2010: Adult ICU—Parnassus, Mt. Zion
> Look for opportunities to reduce variation among units > Jan to Feb 2011: Children’s Hospital
> Break down barriers with dedicated leadership team
> Build long term relationships and a structure to sustain improvements
3. Our EOC Objectives
o Make rapid, meaningful, grass roots-enabled improvements
to our work environment
o Deepen relationships among nursing and support services
to foster collaborative problem solving
Optimize in Acute Care Units Develop RPI Capability
Assess Across Units Optimize in ICUs Optimize at Children’s Hospital
June 2010 July August September October November December
Kick Off 8S 12 L 9L 10 CVT 11 L 13 L 14 M 8/11 NICU 6L 7L 15 L 6 PICU
8L 12 GCRC 5 E/W 4E 4 ICU 14 L 9/13 ICU 6 PCRC 7N 7 PCICU
5N 11 M 10 ICC 15ICN
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4. Nursing Unit
Environment of Care (EOC) Optimization
List of Projects
Accomplished! In Progress Opportunities
* Unit by unit optimization: SWAT walk through, punch list, * Implement 3-day hospitality kits * Optimize environments in ED, OR, ACC
relationship building * Deploy two standardized clean supply locations on Long * BMS/ CPP—optimize its use
* 10 to 15 improvements each for: 8S, 8L, 9L, 10CVT, 11L, * Communication/escalation sheets for MS and Hospitality * Mission Bay operations optimization and planning
11AHU, 12L, 12M, 13L, 14L, 14M, 5E/W, 5N, 4E, 9/13 ICU, 8/11 * Continued Recycling & Med Share deployment * Challenges with communication
NICU, 10ICC, 4ICU, 6L, 7L, 15L/WB, 6PICU, 6PCRC, 7E, 7N, * Physician supplies ship to location on 14M * APEX adoption among nursing staff
15ICN * Hygia reprocessing * Implement high impact Bright Ideas
* Launched online tool to M/L, CH, and MZ * Respiratory precaution carts * Bin cheat sheet-who, what, schedule, contact
* 15+ supply cart reconfigurations and hot tickets * Oxygen set up kit * Chemo roll out
* Standardized RT cart configuration * Rapid response box * Standardize BP cuffs
* Supplies photographs * Trach caddy * SCD pumps in room
* Beds and equipment photographs * Remaining orders: e.g. blanket warmers * Other kits
* Return bin process * Rings guidelines * New Product introduction
* Hospitality bed turnover checklist * E shift PSA pilot in the ICUs * Recall communication
* PSA support in the ICUs * Preventative maintenance process in the ICUs * MREs
* L837, L1037, L1137 dirty to clean utility conversion * Specimen refrigerator * NPO and tube feeds process improvement
* Tub room shower removal and floor retiling * Patient room EOC upgrades * Pillows opportunities
* Mt Zion tub, hopper, and sink removal * Outside patient room precaution sign booklet * Gloves opportunities
* Erected temporary walls in L908, L1108 * Epic common area workstations recommendations * Forms
* 7L swap use and locations: med room and clean supply * Supply/computer cart selection * Remaining ring deployments
* Secured charting and family consultation rooms for 14M/14L * Dirty utility remodel to accommodate many bins * Expand 10CVT phlebotomy process improvement to
* Over door isolation caddies * 12L Pyxis reconfiguration to look like 10CVT house
* Emergency response/disaster kits deployment * 15ICN Remove large scrub sink * CE battery replacement process
* Risk Management--belongings case * 12 GCRC casework and remodel * COW, WOW sweep--removal and/or fix process
* Pharmacy rings deployment: M/L and MZ acute units * 13ICU Replace sinks with handles to get hot water * SLAs
* PYXIS reconfiguration on several units * 6E, 7E Remove brown intercom phone system in Peds ICU units * Sleep room strategy
* Designed “PFS late tray” pilot * 7E Remove toilets in the rooms
* Tray announcements * 9L, 11L Partitioned wall furniture--final
* Launched AONE survey for champions * 7L Regrout common area bathroom floors
* Put forth approach for determining # of common area APEX * 7L Move 2nd refrigerator from clean supply to pantry
workstations * Adult M/L: 2nd refrigerators and any med room casework
* Bar Coding--device trial and selection * 9L Nursing station--insert in the middle
* Link to APEX orders team: procedure supply order sets * 14L Remove wall in 14L med room
* EOC champions attended 11/2 APEX town hall * 15ICN Create ECMO room
* HUSC/AA champions identify Materiels, Hospitality and * 15ICN Redo of main desk--nurses are ripping their clothes on it
Phlebotomy * 15L Remove sink in instrument room to expand counter space
* CE ordering process education for AAs * 15M Remove hopper and sink to convert usage to lactation
* Toured Kaiser Innovation Center learn their strategies supply closet
* Toured MB mock ups to identify environmental improvements * 6E improvements to family kitchen area
* 7E Reconfigure desk so HUSC doesn't have back to entrance
* 7N Remove sink near front of unit to expand counter space
* 7N Remove large sink in the pantry
* CH: 2nd refrigerators and any med room casework
5. Collaboration from:
o Code Blue Committee o Providers
members
o Purchasing
o Adult and Children’s Hospital
o Pharmacy and Therapeutics
o Ambulatory Care Committee
o CNS’s o Policy Steering Committee
o RN’s o Medication Safety Committee
o ICC Charge RN’s o Children’s Hospital Medication
o Nursing Education Safety Committee
o Pharmacy
o Materiel Services
o Respiratory Therapy
o Rapid Response Team
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6. Supply Chain
Procurement Automation
Where did we begin?
o High Volume of Manual Orders
o High Freight Costs
o High Invoice Discrepancy Rate
o Poor Employee Productivity
o Poor Customer Service
8. FedEx Freight Program
FedEx Freight Charges
$22,000
$20,000 Achieved Savings of $55,000 while
adding 82 vendors to the program
$18,000
$16,000
Projected Savings of $75,000
$14,000 for FY12
$12,000
$10,000
$8,000
