Product Library- Video clips
- Audio clips
- See
inside our books
- Job Postings
- Reading Room
Additional
Resources
Long-Term Care
Strategies for Nurse Managers July 2010 |
|
|
|
Checklist tool helps staff evaluate the entire patient, identify readmissions After reading this article, you will be able to:
Healthcare professionals tend to focus on the reason patients present to the hospital and sometimes ignore other patient characteristics. For example, if a patient presents with pneumonia, the staff member might not consider other comorbidities (e.g., wounds or the patient’s living situation) that do not directly relate to the diagnosis. Failure to address these underlying issues can lead to unplanned, preventable readmissions. An examination of the patient’s entire medical condition helps improve patient care, thereby preventing readmissions. The case management department at Jennie Edmundson Hospital in Council Bluffs, IA, developed a tool that helps staff members do just that, says Loretta Olsen, MSN, RN, senior director of revenue cycle at the hospital. Readmission assessment tool Before implementing the Discharge Planning for Social Work Referral tool, Jennie Edmundson had a readmission rate of 8%. Despite its already low rate, increased regulatory focus on readmissions prompted Lorrie J. Reddish, RN, the hospital’s lead case manager, to reevaluate the case management department’s understanding of readmissions. “When I started talking to our staff, everybody had a different idea of what was important to refer a patient to home health or a lower level of care,” Reddish says. The differing opinions had a lot to do with which area of the hospital the staff member worked. New staff members also had different ideas of what factors could be a warning sign of a possible readmission. Reddish created the Discharge Planning for Social Work Referral tool using information from those conversations as well as information that was published in “Identifying Potentially Preventable Readmissions” in Health Care Financing Review, fall 2008. As the tool’s name suggests, patients identified as readmission risks are referred to a social worker, who in turn arranges for necessary postacute services (e.g., home health, skilled nursing, insurance applications). The result is a tool that helps staff members at Jennie Edmundson identify a patient’s readmission risk at the time the patient admits to the hospital and throughout his or her stay. The assessment tool in action The following is an example of how case managers at Jennie Edmundson use the tool: A patient receives news that she is diabetic. The case manager reviews the patient’s record and sees that the patient weighs more than 300 lbs. The physician has prescribed insulin. The case manager conducts a screening interview with the patient and discovers that she lives alone. Based on this information, this patient would receive four checks:
This patient is at moderate risk for readmission, according to the Discharge Planning for Social Work Referral tool. Staff do not refer patients to social workers based solely on the number of checks. The intention of the tool is to allow staff to focus their efforts on the patients who need more attention, says Reddish. Based on the research Reddish conducted, some characteristics that would trigger an automatic referral to social work include a patient who:
“Specific diseases are at higher risk for readmission, with the top ones being heart failure, [chronic obstructive pulmonary disease], and pneumonia,” says Olsen. For example, patients who are self-pay and/or have limited prescription coverage trigger an automatic referral so the social worker can attempt to find resources that will help them maintain their healthcare after discharge. Currently, staff members use the tool more as a guide and an educational tool than actual documentation, but Reddish hopes to improve the tool and possibly use it to document the need for a social work referral. Part of a bigger whole The Discharge Planning for Social Work Referral tool is just one part of the overall commitment to discharge planning at Jennie Edmundson. Discharge planning starts at admission and, in some cases, extends after the patient has gone home. Upon admission to the hospital, patients receive a discharge flyer that includes the patient’s estimated length of stay (LOS) and information about what they can expect during their stay. “[This flyer] ensures a patient feels confident about their healthcare at discharge,” says Olsen. Staff also discuss the LOS with other members of the healthcare team so they can initiate the appropriate discharge planning. Before patients leave the hospital, they must fill out a checklist that ensures patients know what to expect after their hospital stay and encourages them to ask any questions they may have. Source Adapted from Case Management Monthly, May 2010, HCPro, Inc.
Patient safety Quilt, staff brainstorm contest help promote patient safety After reading this article, you will be able to:
Next time you’re brainstorming a way to engage staff in a patient safety–related fair or observance, consider creating a quilt. That’s what staff at Boone (IA) County Hospital, a 25-bed critical access hospital, did to promote Patient Safety Awareness Week (PSAW), which took place March 7–14, and was a big hit for staff members and visitors to the hospital. “It’s nice because we have a pretty close-knit community, and they really like stuff like this,” says Anna Green, who works in quality management and patient satisfaction at the facility. Planning the event Green started planning for PSAW in the months leading up to the event. At the hospital’s monthly patient safety committee meeting, Green and her quality department staff asked for volunteers for a PSAW committee to brainstorm ideas that would engage staff, patients, and visitors to the facility. The hospital has participated in PSAW in prior years, as well as facility safety fairs, and wanted to replicate the effort, but with something new and creative, says Green. The idea for a quilt came from the director of clinical informatics, who was not directly involved with the PSAW committee. However, because she and Green are friends, Green says she persuaded her colleague to join the committee and share her creativity. Green says she tries to encourage many different staff members to be a part of patient safety efforts. “She’s creative, and I knew it, so I wanted her to be a part of the team, even though she doesn’t typically attend specific patient safety committees,” says Green. “I think it’s a good way to get everyone involved and sends the message to other staff that we want their participation as well.” Soliciting ideas Boone County Hospital decided to utilize the National Patient Safety Foundation’s Ask Me 3™ program in creating the quilt. Ask Me 3 is a campaign to promote patient education by arming patients with three questions they should ask their caregivers. The departments at the facility identified specific questions that they often receive and creatively displayed them on a quilt square. (See p. 5 for a picture of the quilt.) Involving numerous departments within the facility in this project helped spread the message of PSAW hospitalwide. Green sent out instructions to each department for how to determine the questions that would be displayed on its quilt square, as well as samples and suggestions for designing the square. Additionally, Green provided some of the materials necessary for creating the square, simplifying the involvement required at the department level. Those departments that participated in creating the quilt were also required to answer the questions they selected and use those answers to create a handout that would be made available to patients. (See an example of the ED’s handout on p. 6.) Green was amazed at the artistic and inspired quilt squares she received. Some participants sewed on 3-D attributes, whereas others imaginatively incorporated the department’s three questions into an overall theme. She displayed the quilt throughout PSAW and is keeping it for future patient safety fairs and events. (To get a better idea of each department’s three questions, see the sidebar on p. 5 for a sampling.) Other activities of the week In addition to creating a patient safety quilt, Green and her staff helped run a patient safety “idea challenge,” encouraging staff members to submit their thoughts for how to improve patient safety around the facility. Green offered multiple ways to enter—via phone, e-mail, or paper. The patient safety committee reviewed all entries and chose its top three for implementation. The winning staff members received a prize. “With this quilt, although some departments have done this quilt, once we hung it up, their part was done. We wanted to have another activity, so we decided to have this patient safety challenge,” Green says. Another fun activity run in conjunction with PSAW was a fall risk room. Run by the education department, the fall risk room was set up with multiple fall hazards, and staff were challenged to see whether they could identify these risks. Of those staff members who listed all the hazards, four won gift certificates via a random drawing. Ultimately, Green’s goal for the week, and in general at the facility, was to involve staff members in patient safety initiatives who might otherwise not be. Although it can be difficult to connect with and support various types of staff members, such as the night staff, it’s still something Green tries to accomplish. “We try and make it fun, but it surprised me—for the patient safety challenge, we’re getting some really cool stuff,” says Green. “I’m trying to do things to get people involved that we might not touch on a normal basis, like people who don’t come to committee meetings ... or aren’t on the front line. They have really good ideas too, so trying to get them involved is something we like to try and do.” Source Adapted from Briefings on Patient Safety, May 2010, HCPro, Inc.
Examples of questions on the quilt The following are some of the questions that appeared on Boone (IA) County Hospital’s quilt squares, based on the National Patient Safety Foundation’s Ask Me 3™ program:
- How can I be assured there won’t be a needle, sponge, or instrument left in my belly? - How can I be assured I won’t be given a medication that I’m allergic to? - How do I know the surgical staff is going to perform the correct procedure on me?
- What is congestive heart failure? - What are the signs and symptoms of congestive heart failure? - How do you treat congestive heart failure?
- Does my food meet the safety standards? - Does my food meet the allergy and diet restrictions? - Does my food meet my immunity system (protein) needs?
- What hours are you open? - Is it okay to eat or drink before my lab tests? - Can I get my lab results?
- How do I know I’m receiving the lowest dose possible? - What will this x-ray show? - Why can’t you tell me the results?
ED patient safety handout Visits to the ED can be very stressful times for patients and families. Often, people don’t know what to expect or how things will work in a typical emergency situation. The three questions below along with explanations should help clear up misunderstandings and frustrations. 1. How long is my ED visit going to take?
2. What are the criteria for a patient to be seen in the ED?
3. Why is the person who arrived after me going in before me?
Source: Boone (IA) County Hospital, reprinted with permission.
Nurse development Prepping presenters: Helping nurses develop poster presentations After reading this article, you will be able to:
When Cheryl Burnette, MEd, BS, RN, CPLP, nurse retention coordinator at Centra in Lynchburg, VA, began to develop her program for helping nurses with poster presentations, the spark came from one source: Nurses had plenty of impressive things to talk about. “As the nurse retention coordinator, it’s important for me to highlight staff at the bedside and their professional practice,” says Burnette. “They’re the ones who achieve those outcomes.” Burnette wanted to find a way to give Centra’s nurses an opportunity to present on those great outcomes. Finding the outcomes wasn’t the problem, as Burnette challenges the staff to take their outcomes to the next level and talk about them in a conference setting. However, Burnette wanted a way to enhance opportunities for nurses to present and to coach nurses at the bedside. “When I see a professional colleague presenting for the first time at a national conference and really having an ‘ah-ha’ moment, it’s very gratifying,” she says. As Burnette travels from unit to unit talking with staff nurses, meeting with staff in various forums (she is on the nursing leadership team as well), she will hear about an outcome that might make for a good presentation. “I’ll say to them, ‘What about writing this up? Presenting? Let’s find a conference. I’m searching for outcomes. We need to tell people about this,’ ” says Burnette. Code of ethics “Part of American Nurses Association Code of Ethics for Nurses states that we participate in promoting and advancing our professional practice,” says Burnette. “We need to communicate best practices not only to our professional colleagues, but also to the public.” When Burnette learns of a best practice, she works with leadership to determine who the point person was on a given project. Leadership puts them in contact with each other, and Burnette starts the process of finding a way to share the best practice outside the organization. “We find a conference that is appropriate,” Burnette says. Her goal is always to start with a national conference, which might sound intimidating, but there is logic behind this goal. “Often they may want to start off at the local or state level, but I want us to start with national. The worst that can happen is you don’t get accepted,” she says. If nurses have never prepared an abstract, Burnette will help them through the process to submit it to the conference. Once they’ve been accepted to present at a conference, Burnette works with nurses on the design and creation of the poster. Using available internal and external resources helps ensure that the posters are professional and visually appealing. Comfort level The next step is to work on the presentation. Burnette confers with soon-to-be presenters to assess their comfort level and then tailors her coaching to help them prepare for a live audience. It isn’t all about the presentation, though—this coaching extends to include talking with people one-on-one about the poster. When Burnette coaches presenters, it’s not a formal class. They may practice how they stand at the poster. For some, it’s a very natural process, but others require more help getting comfortable, be it role-play, discussing body language, tone of voice, sometimes even their handshake. They also look for ways to actively engage passersby. “I have noticed that if nurses are in fact present at the posters that they may not reach out to the participants,” says Burnette. “Actively reaching out is an opportunity to shine and to present your outcomes.” It’s often not about confidence, but more the facilitation of conversation. Most of the nurses representing these best practices are extremely willing and excited to talk about their projects when approached, but once they have some help from a facilitator, they’re on fire. Centra staff have presented at the Nurse Management Congress and the Institute for Healthcare Improvement, among others, and Burnette has noticed a change in nurses after their first presentation. “When they have presented, it is very gratifying,” she says. “It really hits home—we’re doing amazing things here. We’re proud of our organization and our nurses.” Highlights of recent presentations include:
It’s all about looking to get the most out of the conference, Burnette says. “When I go to a conference, at the very minimum, I’m going to apply to present,” she says. “That’s the mind-set I want staff to have.” This attitude has led to a very high success rate. When representatives from Centra attended the Nurse Management Congress in Chicago, they had four poster presentations out of the approximately 40 presentations made. “It is so gratifying to see colleagues present,” Burnette says. “They are rock stars when they do it. When you have a colleague who can articulate about their outcomes and answer questions in real time, it’s a real opportunity for growth in their professional practice.” Although the program isn’t limited to any one part of the nursing staff, the real focus has been on getting the bedside nurses more exposure, says Burnette. These are the professional nurses practicing and influencing quality patient care, and she wants to promote and support nurses in presenting these outcomes. Next step Attending conferences gives experienced nurses a good sense of what it’s like to be a new nurse in 2010. They can also be confidence boosters for newer nurses. “With pub and presenting, they think it’s something they think they can never do,” Burnette says. “If we start at the national level … they talk it up with their colleagues. Communicating our work is part of our professional practice.” Once staff nurses have presented, the next step is to become teachers themselves—Burnette calls it a “do one, teach one” process. “I want professional staff to also look at their outcomes and think, ‘How can we present this material either at poster, podium, or publication?’ ” she says. These staff members are acknowledged in front of their peers, from nurse retention to nursing leadership. “I’ve been a nurse for almost 30 years, and it’s so gratifying to see colleagues discuss their professional practice and outcomes in a national forum,” says Burnette. Centra’s success placing nurses in key positions has expanded beyond poster presentations. The Virginia Nurses Association has a director-at-large position intended for a nurse who has been in practice three years or less. The role was filled previously by a Centra nurse, and as her term neared completion, the organization wanted to make sure one of its nurses was again selected as a candidate for the role. Centra put forth a new graduate with a lot to offer, and she was voted in successfully for the latest term. “It doesn’t cost any money to identify the outcomes and to coach the staff,” Burnette says. Costs for poster materials are minimal—she considers them “marketing costs.” And the mileage the facility can get out of a successful poster (e.g., winning an award at a national conference) is immeasurable. In Burnette’s experience, a successful poster or podium presentation has led to publishing articles on the same topic, additional speaking engagements, and showing other nurses that they too can find success within their own programs. Source Adapted from HCPro’s Advisor to the ANCC Magnet Recognition Program®, May 2010, HCPro, Inc.
Leadership A culture of trust: Staff development’s role in enhancing organizational culture After reading this article, you will be able to:
by Jo-Ann C. Byrne, RN, BS, MHSA Author’s note: I have been involved in healthcare education since the late ’70s when I pirouetted from my nursing role in the ED and became a critical care educator. It was a journey full of challenges and excitement. I have worn, and continue to wear, many hats: educator, consultant, manager, and director. Currently, I’m the system director for education and organizational development at St. Vincent’s Healthcare in Jacksonville, FL. As an educator, how many times have you been asked to participate in changing a culture? The question is often asked as though it were something you could plan today and implement at change of shift tomorrow. Sound familiar? Organizational culture is basically the personality of an organization. Cultural change strategies are not to be taken lightly and should not be oversimplified. For the purpose of this article, I will talk about one facet of culture—the culture of trust—and the significant role we as staff development professionals play in the process of helping that culture thrive. How do you know whether trust is an issue at your organization? Non-trusting behavior exhibits itself in many ways. Pollyanna Pixton (2008), an international leadership expert, identified eight characteristics of a non-trusting team:
Trust is about confidence and belief. A positive culture must be demonstrated at the top levels of an organization, and it must be lived and encouraged for it to become pervasive across the entire system. We know it can erode quickly when aberrant behavior begins to take root and is ignored. The following red flags should alert you that your organization has some lapses in trust:
Lapses in trust must be addressed. We need to talk about trust, or the lack of it, and how to foster it. Recently, my organization pulled together a group of future leaders to talk about trust. Several of our more senior positions were held by interim employees, and our most recent staff engagement survey revealed that confidence in leadership was a concern. Our chief operating officer felt that the management team might benefit from a discussion of the importance of trust and the ways in which we could bolster it in the organization. Our session started with the “Leadership traits exercise” (see the tool on p. 11). Participants were asked to complete the exercise, noting which leadership skills they felt were more soft than hard and vice versa. They indicated in the last column whether they felt the trait could be measured. We defined “measured” as something we could quantify. Our real goal was to get leadership to realize that trust could be measured. In the discussion that followed, most agreed that compassion, empathy, and the ability to inspire, listen, and trust were soft skills. Surprisingly, as if hedging their bets, many suggested that almost all of the skills could be measured. But they were hard-pressed to provide quantifiable evidence of the softer skills, which was exactly our point. Although stories and anecdotal information are affirming, numbers are what help drive change. From there it was an easy transition to a roundtable discussion about how to instill and measure trust. As facilitators, we first introduced Covey’s (2006) formula: “Trust always affects two outcomes—speed and cost. When trust goes down, speed will go down and cost will go up. When trust goes up, speed will also go up and cost will go down.” Using that information, participants were able to identify examples of how to measure trust, such as:
Next, the group identified specific ways they might foster a trusting environment, such as: • Allowing failure (i.e., not always being successful), followed by an analysis of what went wrong and action plans to ensure that the same mistakes don’t happen again. Examples of acceptable failure include:
• Rewarding teams and measuring t |
||
E-mail
Print
PDF
Product Spotlight
|
