Confronting barriers and producing outcomes
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Confronting Barriers and Producing Outcomes. Don Packard, PT, MSPT University of Michigan Hospital. Objectives. Illustrate use of the EBP Process using Early Mobility in the ICU, sharing the benefits and barriers to working with the multidisciplinary team.

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Confronting barriers and producing outcomes

Confronting Barriers and Producing Outcomes

Don Packard, PT, MSPT

University of Michigan Hospital


Objectives

Objectives

  • Illustrate use of the EBP Process using Early Mobility in the ICU, sharing the benefits and barriers to working with the multidisciplinary team.

  • Compare and contrast patient outcome data from pre-intervention to intervention

  • Understand process change for global culture change and implementation.


Confronting barriers and producing outcomes

Culture of Immobility

  • Management of the patient – MD and RN

  • Changes in medications and technology

  • Apathy and training level of therapy staff

    (Multifactoral)

“BUT THAT’S THE WAY WE’VE ALWAYS DONE IT”


Confronting barriers and producing outcomes

Needham, D.; Perme, C. “Early Mobility in the Critically Ill: Getting Started in Your ICU.” Webinar 10/13/11 SCCM


Confronting barriers and producing outcomes

The actual therapy in the ICU is not different, but the process by which we deliver it needs to evolve.


Confronting barriers and producing outcomes

PROCESS of Evidenced Based Practice

  • Literature

  • Identify need

    • Recognized Literature

    • Unit Data

  • Gather Team Members

  • Literature Synthesis

  • Identify Outcomes

  • Site Visit

  • Choose Intervention

    • Specify Intervention

    • Criteria for Inclusion

  • Core Group

  • Change Champions

  • Survey: Mobility Routine

  • Education: Facts

  • Language

  • Immersion

  • Observable Outcomes

  • Time

  • Iowa Model: EBP Change

  • Implementation Model


Confronting barriers and producing outcomes

LEAN Process - Therapy

  • Current State

  • Future State

  • Therapy would wait for physician decision for consult.

  • Need to have stable staffing.

  • Low volume

  • Need to be involved more quickly.

  • Need to shift our staffing coverage.

  • Potential for increased volume.


Change champions

Change Champions

  • Identify Benefits

  • Promote the Cause

  • Identify Barriers

  • Participation

    • Unit Survey

    • Invest in Criteria

    • Educate Staff


Identify goals

Identify goals

  • Therapy

  • Nursing


Confronting barriers and producing outcomes

Implementation: CCMU Nursing Interventions


Confronting barriers and producing outcomes

Implementation: CCMU Physical Therapy Interventions


Confronting barriers and producing outcomes

Assistive Staff – Rehab Tech

  • Rehab Tech as an important part of the multidisciplinary team.

  • Increased Safety

  • Improved Teamwork w Nursing

  • Increased Activity/Progression

  • Increased Awareness


Confronting barriers and producing outcomes

Access to PT

  • Adding PT consult to order set.

    • Full PT team buy in and support

  • Realignment of PT coverage.

    • Cross coverage and training

  • Rehab Tech to help with efficiency

1 pt per PT

(20 extra pts daily)

3 units per PT

(60 extra units daily)


Confronting barriers and producing outcomes

Standard Approach - Language

  • Actually wrote out our ‘typical’ steps we take when progressing a patient through the phases of mobility.

  • Educated Nursing staff on FIM documentation language to ensure common understanding of assistance level.

  • Posted Mobility Recommendations in each room.


Confronting barriers and producing outcomes

Timeline


Confronting barriers and producing outcomes

Outcomes: First 6 months


Confronting barriers and producing outcomes

Outcomes: Physical Therapy (6 months)


Confronting barriers and producing outcomes

Sustained Growth - demand

2010

2011


Confronting barriers and producing outcomes

July 2009

July 2010

July 2011


Confronting barriers and producing outcomes

July 2009

July 2010

July 2011


Confronting barriers and producing outcomes

Early Mobility Being Achieved

  • April 4 – July 30 2011

  • Nursing and PT data collection.

  • Visual system for team to follow progress

  • Moving Patients Forward!


Confronting barriers and producing outcomes

Mobility Barriers

  • April 4 – July 30 2001

  • Further inspection on barriers outside of exclusion criteria


Confronting barriers and producing outcomes

Multidisciplinary Secrets to Success

  • CULTURE CHANGE!!!

  • Add Physical Therapy Consult to the Admission Order Set

  • Change Champions to provide education/role modeling

  • Improve stable staffing from Physical Therapy

  • Re-education of Spontaneous Awakening Trial/Change time

  • Build Multidisciplinary relationships throughout

  • PT to provide on the spot education/dialogue with staff

  • Increased respect and understanding of our roles, and how we work together


Confronting barriers and producing outcomes

Secrets to Success

  • Therapy and Nursing onboard and working together. Need to have an understanding to support each other.

  • More than just talking about it. DO IT – and have others see it. Invite senior management – and make sure to follow up yourself!

  • Keep data and information visible for all to see.

  • ULTIMATELY, keeping the patient’s best interests in the spotlight.

  • CULTURE CHANGE!!!


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