Releasing Time to Care National Forum Production Programmes May 2013 Background ADHB commenced Releasing Time to Care is 2009 with 33 Wards now underway ADHB investigated alternative delivery options for RTC ID: 527788
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Slide1
AcceleratedReleasing Time to Care
National Forum
Production Programmes
May 2013Slide2
Background
ADHB commenced Releasing Time to Care is 2009 with 33 Wards now underway
ADHB investigated alternative delivery options for RTC
An accelerated approach was chosen with a pilot ward commencing in July 2012
Support resource was allocated to work with the team to deliver on a module a month until completionSlide3
Accelerated Programme Approach
Shift Handover
Patient Observations
Patient Hygiene
Medicines
Admissions and Planned D/C
Ward Rounds
7-9 Months
Ongoing
Nursing Procedures
Nursing Procedures
Nursing Procedures
Process Modules
Knowing How We are Doing
Well Organised Ward
Patient Status at a Glance
Foundation Modules
MealsSlide4
Module Implementation – Monthly timeline
Week 1
Launch
Preparation
Week 2 & 3
Develop
Week 4
Implement
Follow Up
Agree team and confirm roster
Collect Data
Learn from other Wards
Generate excitement
Patient Interviews
Staff Interviews
Process follows
Review data
Go-see
Identify opportunities
Define new process
Agree implementation timeframe and communications plan
Develop Process Flowchart
Develop SOPs
Develop TemplatesEngage other stakeholdersOrder new equipmentPlan facilities improvements
Staff EducationGo Live with process improvementsNew equipmentFacilities improvementsAuditsCelebrate successSlide5
Key PrinciplesSteal with pride - capitalise on the work done and improvements made by other wards Manage scope – focus on specific areas of improvementCommunication, Communication, Communication – use the Daily Ward Meetings as a key tool to ensure everyone knows what is happening, why and whenQuick fire
– keep energy, focus and motivation high by maintaining momentumShare the load – utilise as many of the ward team as possible to implement changeBuild for the future – develop resources to be utilised
by other wardsSlide6
Results - Overall
7 Process Modules delivered
Direct Care Time
=
54%
(38% Improvement
)
Patient Satisfaction
=
91 %
Staff Satisfaction
=
84 %
Reduction in
Length of Stay
>0.8 days
Reduction in
Pressure Injuries
= 0 in 6 months
Sustained
Acute Patient Flow >95%
Sustained
Smoking Cessation >95%
3 Foundation Modules extended
“It really has increased the amount of time we can spend with the patients” – Staff Member Slide7
Knowing How We are Doing
Revisited the Ward Vision with input from the Multidisciplinary team
Implemented Daily Ward Meetings
Maintained communications boards and safety crosses
“The atmosphere on the ward has changed. You can feel it as you walk in, things are calm and organised.”
- Staff MemberSlide8
Well Organised Ward
4 bedded Rooms
Equipment Room
Staff Base
Whanau
Room
Education Hub
Ward Meeting Room
Sluice Room
“I can find things! Everything has its place.”
– Staff memberSlide9
Patient Status at a Glance
Electronic Whiteboards updated with required flags
New wide screens to improve usability
Patient
Bedcards
implemented
Staff Status at a Glance Board
Rapid Rounds maintainedSlide10
Shift Handover
ISOBAR Bedside Handover
Patient involvement
Improved information transfer
Safety checks
Significant impact on direct care time
“When the nurses change shifts they introduce who they are and that they’re our nurse”
- PatientSlide11
Meals
Improved focus on patient preparation
Implementation of a meal preparation bell
Nurses assisting patients to complete meal cards – ensuring sufficient food is ordered and less meal call backs are required
Improved use of assist flags for those patients needing
any
assistance at meal times
Improved timing of meal deliverySlide12
Patient Observations
Improved observation trolley set up to reduce waste looking for additional equipment
Relocation of observation equipment to point of use (i.e. within 4-bedded rooms and outside single bedded rooms)
Refreshed patient observation standards including education
“The ward seems calm and everyone knows what they are doing.”
- PatientSlide13
Patient Hygiene
Hygiene packs
Where am I posters for Commode and Wash Bowl Trolley
Agreed standards on patient hygiene requirements
“The staff are fantastic! I would give them 100%. They work so hard and every single one of them took time for a chat and you were never rushed.”
- PatientSlide14
Medicines
New layout and refurbishment of the medication room
Improved access to controlled drugs cabinet
Reduce stock levels
Improved education for patientsSlide15
Admissions and Planned Discharges
New patient welcome pack including
Ward information Booklet
Ward and hospital maps
What to expect information
Transition lounge brochure
Hospital Resources
Staff Admission checklist
Agreement that discharge summaries are written 24 hours before discharge to allow for review by the consultant and better discussion with the patientSlide16
Ward Rounds
Agreed sequence and flow
Portable laptop to be used during Ward Rounds
Patient nurse to attend Ward Rounds
Ward Rounds information sheet for patients in the Welcome Pack including space to capture questions for the Medical Team
Improved signage and awareness around which teams are rounding and when
Consultant to sit down during Ward Rounds to enable better engagement with the patient and their support person(s)
Junior doctor to read back plan to ensure clarity and correctnessSlide17
Conclusion
Ward 72 has benefited from the combined impact of the Accelerated Releasing Time to Care programme, Rapid Rounds and daily ward meetings
The ward is now better organised with clearly defined processes.
The improvements have resulted in a calmer work environment that provides a better patient experience
The fast pace of implementation along with the significant team involvement has resulted in a continuous stream of improvements on the ward keeping team motivation and engagement high
“Getting better every day! Great place to work!”
- Staff memberSlide18
QuestionsDo you have any questions?For future questions please contact Abbi Harwood-Tobin (abbih@adhb.govt.nz or 021 584 021)Marie Mata (mmata@adhb.govt.nz or 021 0825 7224
)Sarah Wilson (sarahwil@adhb.govt.nz 021 397 553)
“It means nurses can identify REAL problems… and fix them!”
- Staff Member