division of nursing - nyspfp · 2016-12-16 · division of nursing response to “access”: •...
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DIVISION OF NURSING
Wm. Dan Roberts, DNSc,
ACNP-BC Associate Director of Nursing Quality,
Research, and Nursing Support Services
Acknowledgements for this presentation:
A. Kabackinski, NM; E. Rubin, CNS; E. Valdez, Admin Asst
A REGIONAL RESOURCE
• 597 beds
• 34,000 discharges
• 88,000 emergency visits
• 345,000 hospital OP visits
• 4,000 births
• 5,600 employees
• 1,700 nurses
• 1,000 physicians
• 496 medical students and 481
resident physicians
• 634 research projects with
$113 million in funding
IHI Triple Aim: Value based with focus on
Access, Quality, Cost
– Access: Available bed for the optimal medical
service
– Quality: Clinical excellence reported as
outcomes but controlled by best practice
processes and measurement of these
processes [e.g., Central Line Bundle]
– Cost: An appropriate plan of care with an
expected length of stay
Framing Methodology
Division of Nursing response to “Access”: • The right patient [the patient is appropriately admitted for
necessary care needs]
• The right diagnosis [assigned primary working diagnosis]
• The right unit [appropriate level of care for the diagnosis
and acuity of the patient]
• The right plan of care [comprehensive plan of care that
addresses all immediate care needs]
• The right nurse [appropriate assignment with skill set to
meet the nursing needs of the patient]
IHI TRIPLE AIM: ACCESS
IHI TRIPLE AIM: QUALITY
IHI TRIPLE AIM: QUALITY
IHI TRIPLE AIM: QUALITY
IHI TRIPLE AIM: QUALITY
OPERATIONALIZING QUALITY
DATA: MED/SURG UNIT
FMR Daily
Operational Budget
Volume 26.6
Clairvia PCR
Budgeted
FTEs 59.45
Clairvia PCR
Filled FTEs 53.5
FMR
Budgeted
HPPD 10.4
%OT /Total
Hrs Wkd 10.92
% of
Unscheduled
Absence to
hours worked 4.05
Clairvia Avg.
Daily Census 26.6
Annual
Operational
Budget Total
paid FTE 60.82
Unschedul
ed
Absences
to OT hrs. 0.37Total OT
hours 1000.58*Sick/LOA/FMLA/
Fam Sick
Clairvia
Cumulative
Census 880.83
Productive
Hours Target Hours Variance T/P Ratio Float Out Float In
Productive
HPPD Target HPPD Extra Shift
Extra Shift
DRL
*Unscheduled
Absence
744.00 296.00 448.00 39.78% 0.84 0.34 54.75 20
4288.00 4771.25 -483.25 111.27% 120.00 20.00 4.87 5.42 138.5 16.5 144.67
3384.00 3395.78 -11.78 100.35% 56.00 779.33 3.84 3.86 603.58 124
744.00 537.75 206.25 72.28% 24.50 0.84 0.61 187.25 82.5
0.00 #DIV/0! 0.00 0.00
0.00 #DIV/0! 0.00 0.00
0.00 #DIV/0! 0.00 0.00
0.00 #DIV/0! 0.00 0.00
0.00 #DIV/0! 0.00 0.00
0.00 #DIV/0! 0.00 0.00
9160.00 9000.78 159.22 98.26% 176.00 823.83 10.40 10.22 984.08 16.5 371.17
Productivity
Report
Productivity
Report
Productivity
Report
Productivity
Report
Clairvia Staff
Manager
Clairvia
Staff
Manager
Productivity
Report
Productivity
Report
Clairvia
Staff
Manager
Clairvia
Staff
Manager
Clairvia Staff
Manager
RN(RN+DN+Admit RN
12S Clairvia Dashboard Report for March 2012 321343
Skill
T&R III
Total
Source
NA
NSC
Telemetry
UE
MARCH 2012
OPERATIONALIZING QUALITY
DATA
Workforce and Capacity Management Solutions
Demand Manager™
Patient Progress Manager™
Outcomes-Driven Acuity™
Care Cost Manager™
Resource Assignment Manager
CareAware Tracking™
Staff Manager™
Physician Scheduler®
ShiftAlert™
CareAware Patient Flow™
Staffing and Bed Management Managed Services
Care Value Analytics Services
* Featured Solutions
Cerner Clairvia at Stony Brook Medical Center
Target/Scheduled Staffing
Cerner Clairvia at Stony Brook Medical Center
Patient Pattern Manager:
Cerner Clairvia at Stony Brook Medical Center
Patient Acuity
Cerner Clairvia at Stony Brook Medical Center
OPERATIONALIZING QUALITY
DATA: MED/SURG UNIT
Two patient falls on
March 27, 2012:
• Harm score 3
• Post Falls Analysis:
mini-RCA within 1
hour of the event
• Assessment of
Operational Data
Target/Staffing
Assessment:
• Scheduled for one
less RN
• Scheduled for two
less NAs
Operational Data
Trend:
• Reduction in OT as
operational target
• Increased
Absences in RN
staff and NA staff
March 2012
Target/Scheduled Staffing
Cerner Clairvia at Stony Brook Medical Center
FALLS
OPERATIONALIZING QUALITY
DATA
Mar Apr May Jun Jul Aug Sept Oct Nov Dec
RN 111.27 91.35 96.23 96.23 96.05 92.76 91.24 91.64 87.98 88.32
NA 100.35 90.16 119.26 119.26 119.54 111.12 109.46 103.83 109.12 115.02
T/P > 105 = Not enough
staff
T/P < 95 = Too much staff
OPERATIONALIZING QUALITY
DATA
Mar Apr May Jun Jul Aug Sept Oct Nov Dec
RN 111.27 91.35 96.23 96.23 96.05 92.76 91.24 91.64 87.98 88.32
NA 100.35 90.16 119.26 119.26 119.54 111.12 109.46 103.83 109.12 115.02
T/P > 105 = Not enough
staff
T/P < 95 = Too much staff
Med Surg Unit Demographics:
• 60-75% of patient population have a
Psych/Behavioral Health co-diagnosis
• Large Orientation group annually: 4-6 RNs
are in orientation each quarter
• 28% RN Turnover rate; Training unit for Med
Surg experience in order to transfer to ICR or
ICU level care
• At least 7 FTEs are utilized each month in
SCA/1:1 sitters
OPERATIONALIZING QUALITY
DATA
OPERATIONALIZING QUALITY
DATA
Mar Apr May Jun Jul Aug Sept Oct Nov Dec
RN 111.27 91.35 96.23 96.23 96.05 92.76 91.24 91.64 87.98 88.32
NA 100.35 90.16 119.26 119.26 119.54 111.12 109.46 103.83 109.12 115.02
T/P > 105 = Not enough
staff
T/P < 95 = Too much staff
Solutions:
• Target staffing needs: “Nursing Matrix: how
many staff members of a certain skill are
needed for a given number of patients”
[Target]
• Per shift: How many staff members of a
certain skill mix are working [Productive]
• Watch for over and under staffing by skill mix
• For Stony Brook: Falls and Pressure Ulcers
are sensitive to NA HPPD
Operationalizing quality data OOPERATIONAL DATA:
SOLUTIONS
Operationalizing quality data OOPERATIONAL DATA:
SOLUTIONS
Solutions:
• Understand the unit demographics, in a
meaningful way, for each metric [e.g., post falls
assessment for Patient, Environmental,
Location, Patient Activity, Unit Acuity, Staffing
and Staffing Skill Mix
• Use Operational-Quality data to change
Staffing and Skill Mix
• Be compliant with the New York State Nursing
Care Quality Protection Act [e.g., data driven
Staffing Models
Operationalizing quality data OOPERATIONAL DATA:
SOLUTIONS
NDNQI: Medical-Adult 0 Direct +
Indirect
Care Nurse: Pt Ratio 1: 4 ADC 25.2 Occup 87% Nurse: Pt Ratio 1: 4 ADC 25.2 Occup 87%
Staffing Plan: RN, NA, NSC 7 days; NM 5 days Beds 29
Beds 29
RN1&2 NA LPN Total NM NSC HA Aides RN3 Total
Day 7.00 5.00 0.00 12.00 Day 0.40 1.00 0.00 0.00 1.00 2.40
Evening 0.00 5.00 0.00 5.00 Evening 0.00 1.00 0.00 0.00 1.00 2.00
Night 7.00 5.00 0.00 12.00 Night 0.00 1.00 0.00 0.00 2.00 3.00
Total 14 15 0 29 Total 0.40 3 0 0 4 7.4 36.40
FTE Calculation FTE Calculation
Hrs/Day 168.00 120.00 0.00 288.00 Hrs/Day 3.20 24.00 0.00 0.00 48.00 75.20
Hrs/Week 1,176.00 840.00 0.00 2,016.00 Hrs/Week 16.00 168.00 0.00 0.00 336.00 520.00
Hrs/Year 61,152 43,680 0 104,832.00 Hrs/Year 832 8,736 0 0 17,472 27,040
FTE 29.40 21.00 0.00 50.40 FTE 0.40 4.20 0.00 0.00 8.40 13.00
PTO 18% 5.29 3.78 0.00 9.07 PTO 18% 0.00 0.76 0.00 0.00 1.51 2.27
Overtime 0.00 Overtime 0.00
Subtotal FTE 24.78 0.00 59.47 Subtotal FTE 0.40 4.96 0.00 0.00 9.91 15.27 74.74 Use text box for
comments ---> Readjust NA's to 5due to increased sitters averaging 7 FTE's/month. Add Nurse Educator to night shift under indirect RN 3. Average of float in NA hrs.
=300. NA HPPD are under the NDNQI mean.