Welcome to CUSP Communication & Teamwork ToolsCoaching Call 3

The session will begin shortly. To access the audio for the session, Dial: 800-977-8002, Participant code 083842#.

The materials for this coaching call can be downloaded from the CUSP Communication & Teamwork Tools password-protected web page. Directions for how to access this web page can be found on each of the coaching call meeting notices (appointments) sent to you.

The phone lines will be open during the presentation. Please keep your phone on mute unless you are asking a question. If you do not have a mute function on your phone, you can press *6 to mute your phone (and *6 again to unmute if you want to ask a question). PLEASE DO NOT PUT YOUR PHONE ON HOLD!!!

If you experience any problems, please call Marilyn Nichols at the MOCPS office at 573-636-1014, ext 221 or mnichols@mocps.org.

CUSP Communication & Teamwork Tools

Pat Posa RN, BSN, MSA Kimberly O’Brien, MHASystem Performance Improvement Leader Project ManagerSt. Joseph Mercy Health System Missouri Center for Patient SafetyAnn Arbor, MI Jefferson City, MOpatposa@comcast.net kobrien@mocps.org

Coaching Call 3:Hardwiring Multidisciplinary Rounds with Daily Goals;

Sample HuddlesAugust 16, 2011

Document 1

Documents for this Session(All can downloaded from the CUSP Communication & Teamwork Tools password-protected

web site. Detailed instructions are located on each of the coaching call meeting notices/appointments emailed to you by Kimberly O’Brien)

1. This PowerPoint presentation2. Monthly Team Leader Checklist3. Sample Agenda for August CUSP Team Meeting4. Sample MDR and huddle5. An audio file recording of this session will be

emailed to you shortly after the call today

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Agenda• Multidisciplinary Rounds with Daily Goals

– Review action plan status– Creating rounding tool– Questions –struggles—strategies– Setting up a pilot/test of change

• Structured Huddles– Review action plan status– Questions--struggle—strategies– Defining metrics– Setting up pilot/test of change

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CUSP Communication & Teamwork Tools Interventions

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Multidisciplinary Rounds with Daily GoalsStructured Huddles

MDR with DG Action PlanTask Responsibility Due DateObtain executive buy-in

Define members of rounds and their roles

Define time of day and frequency

Structure of rounds:•Review of systems (or major issues)•Define components of checklist•Time for each patient

Documentation:•What is documented in medical record• daily goal—where is it documented?

Educating staff

Define metrics and evaluation process

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Who?• Physician

– Team leader: guide rounds, ensure follow defined process, elicit input from all members, summarizes define daily goal

• Resident:– Present patient in system format– Place orders in computer during rounds– Document note in chart

• Bedside nurse– Provide clinical information, current patient status, changes over previous

24hrs, patient or family concerns/issues (if not present on rounds)• Case manager/social work

– Could function as leader if physician not present– Oversee discussion of discharge planning– Define patient/family concerns/issues

• Charge nurse/CNS/CNL– Function in leader role if designated and physician not present

• Others– Pharmacist, respiratory therapy, PT/OT, pastoral care, palliative care

• Patient----how will the patient and family be included7

Structure of MDR

• Time of day• Frequency• Process for each patient

– Checklist

• Documenting– Which pieces of rounds?– Daily goal

• Define daily goal follow up process

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Multi-Disciplinary RoundsCommunication Tool

• Overall Plan of Care– Diagnosis?– Patient’s Chief Concern?– What does patient need to accomplish to be discharged?– Tests today?– Procedures today?– Medication changes today? – Medication issues?– Consulting services?– Expected discharge date?

• Discharge Plans– Placement?– Home health needs?– Transportation?– Equipment?

• Patient safety– On VTE prophylaxis?– Can any lines or tubes be removed?– Can we reduce fall risk?– Can we reduce skin injury risk?

• GOAL FOR THE DAY 99

Where are you struggling?

• Buy-in? Physician? Nurses?• Defining roles?• Creating structure/checklist?

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Test of Change

• One nurse, one physician, one day, one patient

• Test the roles and process(checklist)• Get feedback

– Observe rounds– Survey participants

• Make revisions

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EvaluateAttending: Resident:RN: Intern:Circle others in attendance: Pharmacy Nutrition Respiratory Therapy CNLRoom #: __________________Rounding outside patient room: yes no

Nursing notified: yes no n/a

Nursing present during rounds: yes noRT present during rounds: yes noChecklist followed as outlined: yes no(If no, what objectives were omitted) __________________________________________

Sepsis screen, sepsis bundles reviewed/signed by team: yes noDaily goals in room board updated by intern: yes noPlan of care/daily goals clarified with team: yes noNursing questions/concerns addressed: yes no n/aPhysician questions/concerns addressed: yes no n/aPatient/family questions/concerns addressed: yes no n/aWere team members listening to each other: yes noDid leaders ask others for input: yes noFeedback to team members (professionalism, team interaction, timeliness, efficiency, thoroughness, organization and clarity):_________________________________________________________________________________________________________

_________________________________________Was criticism positively presented: yes no

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Evaluate• Survey participants: (5 point scale)

– Was your voice/opinions heard and valued?– Did you have a understanding of what the goals

and plan for the patient was for the day?– Did the leader facilitate the rounds to ensure

efficiency and open communication?– Did MDR with DG improve how you cared for your

patient?– What worked?– What could be improved?

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• Enable teams to have frequent but short briefings so that they can stay informed, review work, make plans, and move ahead rapidly.

• Allow fuller participation of front-line staff and bedside caregivers, who often find it impossible to get away for the conventional hour-long improvement team meetings.

• They keep momentum going, as teams are able to meet more frequently.

Structured Huddles

Use this strategy to begin to recovery immediately from defects---IE: falls, sepsis and daily to focus on unit outcomes

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Structured HuddlesTask Responsibility Due DateObtain executive buy-in

Order Huddle board

Select Huddle metrics for first board: operational, quality/safety and patient satisfaction

Define huddle process:•Define time of day and frequency•Who will lead huddle•Expectations of staff—who will attend•Create agenda (in first huddles include overview of purpose of huddles and huddle process)

Hang huddle board and fill in metrics

Identify when huddles will begin

Define process for changing huddle metrics

Create evaluation process: how will I know if huddles are successful?

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Selecting Metrics Should reflect improvement opportunities that have been identified by unit,

aligned with unit and hospital goals and objectives Must be specific and measureable – and feasible to monitor frequently Identify who will be collecting data and updating board Define goal for metric---this will help you decide how long to keep metric going

Quality: IE: core measures, handwashing, falls, delirium, skin etcPatient Satisfaction: IE: use results from hospital’s patient satisfaction

survey----- pain is controlled, noise at night etc

Operations: IE: unit functioning, efficiencies---% of patients discharged by 11am, time from transfer or discharge order

till patient moved

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Selecting MetricsQuality: (IE: core measures, handwashing, falls ect)

Med-surg: pneumonia core measure—your unit is falling short in one area—vaccination.

Metric: # of patients who received the vaccine(PNE)# of patients who qualified for it

ICU: ventilator associated pneumonia prevention-your unit is not consistently performing the spontaneous awakening trial (SAT)

Metric: # of patient who received a SAT# of patients who qualified for SAT

LAB: turnaround time for stat lab—CBCMetric: # of CBC resulted within 30 minutes

# of CBC in previous 24 hrs

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Selecting MetricsPatient Satisfaction: IE: use results from hospital’s patient

satisfaction survey-Med-surg: call lights being answered within 5 minutes

Metric: # of call lights anwered withing 5 minutes# of call lights in 24 hrs

ICU: pain reassessment in 1 hourMetric: # of patient who’s pain was reassessed in 1 hour

# of patient episodes audited

Radiology: patient waitingMetric: # of in-patients that waiting in the hallway 5min

# of inpatients brought to department for testing in 24 hrs

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Selecting MetricsOperations: IE: unit functioning, efficiencies-

Med-surg: percent of patients discharged by 11amMetric: # patients discharged by 11am

# of patients with discharge orders in place before 11am

ICU: delirium assessmentMetric: # of patient with 2 documented CAM-ICU in last 24 hours

# of patient in ICU

Radiology: no show rateMetric: # of out patients that miss schedule appointment

# of outpatients scheduled for testing in 24 hrs

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Where are you struggling?

• Buy-in? Physician? Nurses?• Picking best time of day?• Creating metrics?

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CUSP Communication & Teamwork ToolsNext Steps

• Multidisciplinary Rounds– Complete action plan and a test of change

• Structured Huddles– Complete action plan– Define first metric and do a practice huddle on one shift, one day

• Learning from a Defect– Identify next defect to solve (if haven’t done it yet) – Begin/complete through LFD steps

• CUSP Team Agenda – Choose next defect to take through the Learning from a Defect Tool or begin LFD process– Complete MDR with DG action plan– Show video’s of structured huddle; get feedback/questions from CUSP team and unit

leadership for next Coaching Call– Ensure that concepts of Multidisciplinary Rounds and Structured Huddles are vetted by

executive sponsor for unit and VPMA/CMO

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We Are On a Continuous Journey

• We have toolkits, manuals, websites, and monthly calls to learn from and with each other.

• Your job is to join the calls, share with us your successes and more importantly the barriers you face.

• Commit to the premise that harm is untenable.

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Questions?

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