moore, sills 1 - american psychiatric nurses association · transforming nursing practice that...

APNA 27th Annual Conference Session 1022: October 9, 2013

Moore, Sills 1

Mixing Models: Creating Synergy in a Trans-Disciplinary Environment

Oct. 9, 201327th Annual American Psychiatric Nurses Association Conference

Tammy Moore, MS, RN, NEA-BCChief Nursing Officer, OSU Harding HospitalGrayce M. Sills, PhD, FAAN, Professor Emeritus OSU College of Nursing

Disclosure Statement

2

The presenters have no known conflict of interest to disclose.

Learning Objectives

3

1. Describe the key assumptions of the AACN Synergy Model and the various trans-disciplinary models of psychiatric nursing care.

2. Articulate the process for evaluating professional practice models of care and incorporating the “best of the best” to create a relevant psychiatric professional nursing model.

3. Incorporate the concepts and processes in transforming nursing practice that delivers excellent patient outcomes within the accountable care organization parameters.

Questions & Answers

Background

Implementation

Outcomes

Mixing Models:

Creating Synergy in a Trans-disciplinary

Environment

Overview

4

55

Overview: The Ohio State University Wexner Medical Center

6

MissionTo improve people’s lives through innovation in research, education and patient care

VisionWorking as a team, we will shape the future of medicine by creating, disseminating and applying new knowledge, and by personalizing health care to meet the needs of each individual


Moore, Sills 2

7

ValuesExcellenceCollaborating as ONE UniversityActing with Integrity and Personal AccountabilityOpenness and TrustDiversity in People and IdeasChange and InnovationSimplicity in our WorkLeadershipEmpathy and Compassion

PromiseImproving people’s lives… through personalized health care

Strategicgoals

8

Become a top-20 academic medical center and a top-10 NCI-funded cancer program through advancements in research, education and patient care

Become a high-performance organization & workplace of choice

Generate an investment fund for mission development

Note: Top 20 across research, education and patient care as measured by NIH, Best Medical Schools, Best Hospitals, number of publications/citations and endowment

8

9

As one of the most comprehensive health sciences campuses in the country, with nearly 7 million square feet of research, education and patient care facilities operated by more than 16,000 dedicated faculty, staff and students, The Ohio State University Wexner Medical Center plays a pivotal role in helping The Ohio State University achieve eminence.

Every Day is an Opportunity

10

3281 FY 12 Admissions- OSU Harding- 74.8 % from the Emergency Department

7 days- average inpatient Length of Stay

OSU Wexner Medical Center Expansion

11

Revitalization of the research, education and patient care spaces, utilities, infrastructure and green spaces across our Medical Center campus, which includes the construction of the new James Cancer Hospital and SoloveResearch Institute and Critical Care Center.

This is the largest expansion project in Ohio State’s history.

National Recognition

12


Moore, Sills 3

College of Nursing Partnerships

Joint Faculty Appointments

Clinical rotation for Undergrad, Graduate and Psych NP Students

Collaboration for Evidence Based Practice and Research initiatives

BSN, RN to BSN Programs, Graduate Entry Nurse Practitioner Programs, Traditional Masters, DNP, PhD

13

Questions & Answers

Background

Implementation

Outcomes

Mixing Models:

Creating Synergy in a Trans-Disciplinary

Environment

Overview

14

1515

Background: Why do we need a model for nursing?

Professional Practice Models

17

AACN Synergy Model

Trans-Disciplinary, Trauma Informed Care, Recovery Models

What other models are organizations using?

18


Moore, Sills 4

19

Mixed Model for Transdisciplinary Psychiatric Mental Health Nursing Practice

Foundational

Foundational• Nurse Practice Act• Scope and Standards of

Practice• Code of Ethics• Joint Commission • Social Policy Statement• Magnet


Practice• Code of Ethics• Joint Commission • Social Policy Statement• Magnet


Foundational

Nursing Discipline

Nursing Discipline• Collaborative Nurse-Patient-Family

Relationship• Nursing Assessment and Plan• Wholism (mind/body/spirit)• Documentation• Pharmacology




Psychiatric Mental Health Generalist

Nursing Discipline

Foundational

PMH Generalist• Strengths-based/Recovery • Trauma-Informed• Quality/Measurement• Team (discipline/inter)• Cultural Competence• Patient-Family Education• Milieu• Medical Co-Morbidities



Psychiatric Mental HealthTransdisciplinary


Nursing Discipline

Foundational

PMH Transdisciplinary• Individual and Group Psycho-

therapeautic Modalities• Transdisciplinary Trauma informed care• Trauma informed psycho-therapeautics

(TICPT, TICBT, TIDBT, MI, SF)• Psychopharmacology• Integrative Care• Positive Psychology/Post-Traumatic

Growth• Collaborative Team• Medical Co-Morbidities








Nursing Discipline

Foundational


Practice• Code of Ethics• Joint Commission • Social Policy Statement• Magnet Standards


Practice• Code of Ethics• Joint Commission • Social Policy Statement• Magnet Standards
















Moore, Sills 5




Nursing Discipline

Foundational

Synergy

Synergy

Synergy

Making the Model Real

26

Follow staff progression from “novice to expert”

Use by staff/supervisors/educators to set goals-incorporate into staff evaluations and goal setting.

Share training and educational opportunities

Measure quality and patient satisfaction Decrease restraint/seclusion Decrease falls Decrease contraband Decrease readmission rates Sleep? Ask the question!

Questions & Answers

Background

Implementation

Outcomes

Mixing Models:

Creating Synergy in a Trans-disciplinary

Environment

Overview

27

2828

Implementation: How are we doing this?

Team Interventions

Competency Assessment

Synergy Education

Skills Day

Multidisciplinary Patient Planning- Flolan case study

Trauma Informed Care Education

De-escalation education

Core Teams

Treatment Team Design

Unit Leadership Councils- Shared Governance


30

Based on Essential Psychiatric Mental Health Competencies, Archives of Psychiatric Nursing, Vol. 26, No. 2 (April), 2012: pp 80-110.

Utilized Survey Monkey- 50% return rate.

0

10

20

30

40

50

60

70

Safe management incrisis setting

Establish therapeuticrelationships

Develop ImplementSuicide Prevention

Strategies

Identify signs &symptoms of major

disorders

OSU HARDING ESSENTIAL PMH COMPETENCY SURVEY STRENGTHS

% of staff that rated highlycompetent/very competent


Moore, Sills 6


31

Opportunity Results

0

5

10

15

20

25

30

Critically analyzeresearch reports as a

consumer

Articulate knowledge ofneurobiological

mechanism of psychmeds

Evaluate the degree ofevidence-based

available to supportcommon psychiatric

nursing practice

OSU HARDING ESSENTIAL PMH COMPETENCY SURVEY OPPORTUNITIES

% of staff that rated not competent orsomewhat competent

Synergy Education

32

System wide Nursing education retreat

Unit education initiatives

Model review and evaluation with key staff committees

Skills Day

33

Recognized need to enhance nursing competencies with medically complex psychiatric patients- match the nurse competencies with the patient needs- Synergy Model.

Utilized the role of the Nurse Educator to develop a comprehensive skills day that evaluated psychiatric and medical-surgical skills.

Multidisciplinary Patient Planning- FlolanCase Study

34

Psychologist at Nationwide Children’s Hospital consulted the Medical Director of OSU Psychiatric Emergency Services regarding a young woman having worsening auditory hallucinations and aggressive behavior requiring psychiatric hospitalization.

The patient also had Pulmonary Hypertension from a young age and had been on IV Flolan, administered through a central line for 8 years.

Flolan Case Study

35

The referring psychologist also mentioned that other inpatient psychiatric hospitals had denied the admission because of the complexity of the medication.

With the help of a system wide multidisciplinary team, the decision was made to admit the patient and care for both her acute psychiatric needs and her ongoing medical needs.

Flolan Case Study

36

A multidisciplinary team of physicians, nurses, and pharmacists came together to plan for her admission.

The question became, should this patient be admitted to the psychiatric unit with cardiology following, or to the heart hospital with the psychiatry consult team managing her psychiatric illness?

Given that the primary reason for her hospitalization was psychiatric (hallucinations), the team was motivated to treat her at Harding Hospital if possible.


Moore, Sills 7

Flolan Case Study

37

The psychiatric nurse educator pulled together information on pulmonary hypertension and care of the central line for the nursing staff

The pharmacist educated on Flolan and arranged for the vendor of the infusion pump to in-service the staff

The CNS from the cardiac area agreed to assist the psychiatric nursing staff on a daily basis with changing out the medication cassette and caring for the central line

Flolan Case Study- Key “Takeaways”

38

Gather the team

Make the appropriate decision for the patient’s primary needs

Educate, Support and Educate!

Include the patient and family

39

Incorporating Trauma Informed Care

40

Provide some information on how it informs the trans-disciplinary model for psychiatric specific needs

Increase sensitivity to trauma history and its effects on present experience.

Provides a basis for multidisciplinary treatment planning

Provides a rationale for trauma informed specific treatment modalities.

41

De- Escalation Training

42

Provide stats on how violence has increased

System wide training on CPI

Educator is trainer for the program


Moore, Sills 8

Core Teams

43

Core Charge Nurse Team

Core Programming Team

Matching competencies with needs of the patients

Maximizing skills and areas of expertise/passion

Treatment Team Design

44

3 teams- MD, RN, Tech, SW

Collaborative example of Synergy and TIC

45

Unit Leadership Councils

46

Shared Governance- allow the staff to identify areas of focus based on patient and family needs and staff level of competency.

Questions & Answers

Background

Implementation

Outcomes

Mixing Models:

Creating Synergy in a Trans-Disciplinary

Environment

Overview

47

4848

Outcomes: What impact have we seen?


Moore, Sills 9

49

Quality Slides

80.0%

82.0%

84.0%

86.0%

88.0%

90.0%

HelpfulnessGroup Therapy

Helpfulness ofContact with Staff

HelpfulnessSocial/RecActivities

Overall ProgramActivities

Satisfaction

OSU HARDING PATIENT SATISFACTION WITH PROGRAM ACTIVITIES

FY 2012 FYTD 2013*

Pe

rcen

t S

atis

fact

ion

*June 2013 data not yet availableData Source: Press-Ganey

Quality Slides

*June 2013 data not yet availableData Source: Press-Ganey

85.4%86.0%

9.7

7.6

0

1

2

3

4

5

6

7

8

9

10

80.0%

81.0%

82.0%

83.0%

84.0%

85.0%

86.0%

87.0%

88.0%

89.0%

90.0%

FY 2012 FYTD 2013*

OSU HARDINGPATIENT SENSE OF SAFETY COMPARED TO RATE OF UNIT VIOLENCE

Felt Safe on the Unit Violent Incidents/1000 Patient Days

Per

cent

Who

Fel

t Saf

e o

n U

nit V

iolent In

ciden

ts/1000 Patien

t Days

Quality SlidesInstances of Contraband on the Units

29

14

0

5

10

15

20

25

30

35

FY 2012 FY 2013

Data Source: Unit-Based Data

Inst

ance

s of

Con

trab

and

53

Future Initiatives

54

CALM model- ED services

NP Bridge Programs

Neurodiagnostic growth

Psych Rapid Response

Unit and Individual goals reflecting the models

Multidisciplinary Core Teams


Moore, Sills 10

Questions & Answers

Background

Implementation

Outcomes

Mixing Models:

Creating Synergy in a Transdisciplinary

Environment

Overview

55

5656

What questions do you have?

moore, sills 1 - american psychiatric nurses association · transforming nursing practice that...

Documents