Top of Form
Event ID: 2231106
Event Started: 9/24/2013 3:00:12 PM ET
[ Captioner is ready and standing by ]
I have Peter manner.
And also bridge view, lynette. Is anybody else on?
Green field.
Great.
Is that Amy?
Yes.
We're just a little -- little bit after three. I think we can get started. If you can mute your phones unless you want to ask a question.
How do we mute?
It would be star number six. Some phones do have a mute button. If you want to ask the question, you would do star number six to unmute.
Okay. I'm still hearing background noise. Well, this afternoon we will focus on measuring the tracking tool. One of the gurus Don per wick said not all improvement -- all improvement is change. Just to talk a little bit about data and quality improvement, the process. It's a way to know where you are and that is actually the baseline, is once you start measuring that first month, that will provide you with the baseline. If this will be the first time you're starting to use the hospitalization tracking tool, you can use this first month's worth of data as your baseline measurement. It targets where you want to be, kind of like a target goal. It will tell you if you are improving. It also, you want to look at what processes are associated with the outcome. Once you start an intervention, what are the incremental steps or processes that you're carrying out in order to implement that implementation because that will give you the process measures that you want to be able to track as you're going through and implementing your intervention. And that's how you know actually, once you're going through the plan, do, study, act or PDSA cycle that's how you know if you are seeing the change or have a change. So when you're implementing a new intervention, what are the processes that you need to measure. Otherwise, you have no idea and you don't know if people are implementing it or not. It also provides you an idea of when you have a -- when you change a process, how do you know you have the effect you wanted. That's what the outcome S for the hospitalization it will be reducing -- nursing homes, reduction in acute care transfers, but those are the -- that's how you kind of know you're getting to where you want to be. If you don't see any change in your -- if you're having changes and make change but you don't see any change in your outcome or any movement toward what your target goal is, then you know, actually, you know that you're not implementing the changes that are really affecting that process or that problem or issue within your acy. Then you have to go back and start looking at, digging a little deep are saying what is causing this to be done, to occur within your facility. When you're getting started, measurement is the way you can track, trend and benchmark your measures and benchmark between other facilities. Your baseline is your first month of tracking. Using the quality improvement tools within the interact collaborative or tool kit is a way to begin your root cause analysis. All of you are becoming familiar with the acute care transfer forms as well as the summary forms that aggregates that information into one. You're starting to learn what are causing your acute care transfers. I think I remember from the last phone call, there was a shoutout by one person that said they were finding that families were really asking or requesting that patients be sent to the hospital. What is it about that and why are they asking for their loved one to go to the hospital when in actual ti -- actuality you might be able to service them right in the facility and a transfer may not be necessary. When you look at your root cause analyses and some of the reviews, it's a better way to focus your interventions. That's how you can how the root cause analysis can be used as a guide and to fine tune your interventions. We chose at the very beginning to implement the stop and watch tool and S about tool. As well as getting you starting in reviewing your acute care transfers. Very often the transfer of patient information and communication between -- is a good place to start to begin the interventions there. Then you can start as well as start looking at the causes of your acute care transfers. So that's why we started with the stop and watch tool and S bar. We knew that some facilities had already implemented them. It was a way to get facilities involved quickly and probably next month we will focus a little bit more on your acute care transfer reviews and what's happening with that. That's why we started it. Very often communication is a good place to start within the process and it's usually one of the bigger issues when we start talking about acute care transfers and skilled nursing facility or nursing home arena. So as we don't with every call, we wanted to find out -- this is the time to share. How will you -- are you progressing with your SBAR implementation. A lot of you said you were starting it and starting to do youredcation and implementation in September. So I wanted to get an idea from you how are those things going. What have upfound that's worked well. What might not be working well. How did you implement it. Did you implement it by unit or the whole -- your whole facility and what was the response of your clinicians as well as the physician's response from that. Does anybody have stories? When I call facilities myself and just talk to them directly, very often they're telling me, oh, we were able to not send so and so to the hospital because we were able to manage this inhouse. So are you starting to gather those stories of acute care transfers that you may have, had that not occur and also, how are you measuring. So does anybody want to share what's happening within their facility or what's going on? You don't have to be shy.
This is ter resa. I think -- Teresa. I think we had spoken. We started with the 9th floor, with SBAR and we have a few people left to educate. Then we're going to start using the form on the 9th floor. We're almost there and in two or three weeks we'll be up and running completely with it. Claudia is using the SBAR form and the acute care transfer form so. That's where we're at.
Great.
Implemented the stop and watch, too?
We just have a few more CNA's. We're in the process of finishing a policy and that will be done the second week in October, we'll be up and running with the 9th floor.
Great, great. Anybody else would like to share what they've done with SBAR this past month?
This is Sharon.
We implemented a couple months ago. Really, we're looking for the people who went to the hospital. Do they have an SBAR done. We had one incidence where somebody pulled ut a peg -- out a peg tool. Compliance is good. I asked the Docs if they thought they were getting all the information they need right up front when the staff called for a transfer and the physicians were really happy. He related it more to the -- he's happy with the information he's getting. Our measurement we are seeing our hospital transfers go down because the staff knows it's an incentive not to send them as opposed to trying to send them.
Great. Do you have any stories that are coming out of that where you might have averted a transfer?
I don't really have any stories. Actually, one of the physician's comments was that sometimes nurses argue too strenuously not to send them. Apparently, I got my message across, so he has to evercompensate for that but I don't have any particular stories. We're the ones where we have families requesting. Some families are ready for that palliative care and others are ready to say oh, yeah, this is ridiculous.
A true culture change.
Yes.
It's interesting, you might look at the patients who are transferred that your nurses may have felt that they could be managed inus a and to see if -- inhouse and to see if they are being admitted to the hospital, having an ER vest only. I wonder if they're having an ER visit only, could this have been, whatever they did in the ER, could that have been managed inhouse and that resident would not have had that ER stay, which very often can be several hours. So you might consider looking at that.
Hello?
Hi.
This is Lynette from bridge view.
Hi, Lynette.
The last time I told you we had developed a policy for use of the SBAR and integrated the stop and watch as a part of it. We haven't serviced the staff and because the second floor was the floor that seemed to be using the stop and watch mode, we used the SBAR on a pilot. We are using it on a pilot basis there.
Great. What is the staff's response?
Very good, very good. They've been calling ahead to the hospital.
Okay.
We've had at least two cases in which the hospitalization was prevented because we used intravenous fluids. We used hydration and then there's the same variances at this time. We are going to meet with the hospital authorities in two woox, and after that -- weeks and after that we will be implementing it on the third floor and then the fourth floor until we complete the facility.
Great. Great.
So maybe those hospitalizations, you prevented -- those transfers you prevented, may be brought forward as stories.
They will be. As a matter of fact, we will use those at the monthly meeting of the doctors next week, so the vacancy, that we really are serious about what we're doing.
That's a great strategy.
Have you gotten any response from the physicians when they're receiving finance calls from the nurses?
No negative response.
Okay.
They have been very helpful. You see, it's see qnsed now. When they call the doctors, they have the information, so he can make a call at that time.
Great. Does anybody else have some strategies or something to share regarding the implementation of SBAR? I know not everybody likes to share, but for people who do, it's really nice to hear your strategies and how you're incrementally implementing the SBAR tool and using it successfully. That's great. And for Lynette, one of your measurements could be the averted acute care transfers, so you would have the two that you averted.
Yes.
That's great. Wonderful. How are you hearing about the transfers that you averted? How do you -- I mean, how do you know about them? How are people reporting those out?
Well, we haven't had to yet. It happened this month. So next book we have the doctor's meeting and the quality improvement meeting. We will discuss it because this has become part of our quality improvement reporting.
Great. Great. Anybody else have yig -- anything to share.
This is Teresa. I just want to let you know what we're doing just so we're looking at the practice. We have actually given scenarios where the nurses are becoming very, very proficient on the one unit to be able to use the SBAR form of communications and it was -- the response was wonderful. They really are happy about what we're doing and we introduced the use of the care pass, so I just wanted to share that.
Great. Great.
Hi. This is susquehanna.
Hi, Tammy.
The other Tammy. There are two. I'm the QWAPI Tammy. We integrated the SBAR into our system so the nurses could fill it out. We thought we would get more come loans that way. We had a meeting and they approved the forms, to improve exon cation between the nurses and the physician. Hopefully, we'll see this improvement and we plan on starting this stop and watch within the next month.
Great. That's wonderful. So the nurses are starting to use the SBAR or they haven't started yet?
We just started. We inserviced the nurse managers and supervisors last Friday. This Friday we're inservicing all the licensed staff.
Great. Wonderful. Good. So you've had a positive response so far.
Yeah, I think so. I think the Docs are looking for this to help us out a little bit. The other thing we are up to date on our interact tool.
Good.
From January, put into the system.
Oh great. Great.
Anybody else would like to share.
Christine, this is Peggy.
Hi, Peggy.
Over the weekend we utilized the SBAR tool with physicians by way of phone and were able to avert a hospitalization for a patient here. So we'll do some training of the staff of that tool. We were able to utilize that over the weekend and it worked really well because the resident ended up staying at the facility and she's improving.
Great. That's wonderful. Congratulations. That's a story to bring forward to maybe write up and share amongst the whole facility.
Yes. That would be something actually, we would be making -- the other departments and other staff that have come to the quality assurance meeting.
Yes.
That's something we would be bringing to them, actually tomorrow.
That's great. You think about when a resident is transferred to the hospital, there's always that chance that they will be admitted and come back sometime in a let worse state than they came. Certainly functionally although their illness or their condition would have been treated but very often they lose ground as far as functional status and sometimes there are other issues that are unrelated.
Yes.
So that's good, very good.
Thank you.
Anybody else that would like to share. That's a success story. That's a good thing, so your staff can feel good about that. Of course you don't want to avert transfers that Ned to be but people that stay are very -- that you're able to manage inhouse is really nice. Anybody else like to share? Sounds like?