Transforming Care and Cost at the Bedside

1. Transforming Care and Cost at the Bedside Jennifer Fogel, RN Director of Nursing Systems Eastern Maine Medical Center

2. TCAB Goals • Improve the quality and safety of patient care • Increase the vitality and retention of nurses • Engage patients and families and improve their patient care experience • Improve the effectiveness of the entire care team.

3. The Bonus!! Cost Savings Cost Avoidance Lower Healthcare Costs

4. Example 1: Nurse Servers Grant 6 TCAB Innovation Aim Statement To increase time at the bedside by bringing frequently used supplies closer to the bedside.

5. Nurse Servers – The Plan Organize the “Nurse Servers” (closets) outside each patient room with frequently used supplies and patient signs

6. Time Savings = Cost Savings • Each Nurse saved 4318 steps/week equaling 88 miles per year This Equates to • 43 minutes/week • 37 hours per nurse/year • $1,295/nurse/year • Total Cost Savings on Grant 6 $14,245.00/year

7. Example 2: Medication Safety Zone Grant 6 TCAB Innovation Aim Statement To decrease the number of interruptions during the medication preparation process.

8. Medication Safety Zone – The Plan A red box will be placed around each Pyxis medication station. No one will speak to or interrupt the nurse when standing inside the safety zone.

9. Interruptions = Cost Avoidance While only one piece in the battle against Medication Errors, following implementation, Medication Errors fell 37% Medication errors can increase length of stay by 8 to 12 days or costs $16,000 to $24,000 (IHI)

10. Example 3: 4-Eyed Assessment Grant 6 TCAB Innovation Aim Statement To increase the accuracy of skin assessments completed on high acuity, high risk patients.

11. 4-Eyed Assessment– The Plan 2RN’s will: • Complete a head to toe skin assessment on: • All transfers from Critical Care and outlying facilities • High Risk Patients admitted from home (i.e. limited mobility • Discuss and collaboratively document any skin issues • Immediately implement pressure ulcer prevention interventions

12. Accuracy = Cost Avoidance Since implementation Grant 6 reached 330 days and are currently at 223 days without a pressure ulcer. (One pressure ulcer broke their streak) This equates to a cost avoidance from between $2,000 and $40,000 per pressure ulcer (medscape.com)

13. Example 4: Red Box Cardiac Telemetry Aim Statement Improve patient and staff satisfaction while saving time (time of putting on and removing gloves and gowns) and money (cost of the gloves and gowns)

14. Red Box – The Plan A three foot box will be created inside each room using Red Tape. The Red Tape will removed with each patient discharge. Forms will be posted outside each room for staff to mark if they had to wear PPE or not with each patient encounter

15. Red Box – The Plan A three foot box will be created inside each room using Red Tape. The Red Tape will removed with each patient discharge. Forms will be posted outside each room for staff to mark if they had to wear PPE or not with each patient encounter

16. Satisfaction = Cost Savings Note: These cost savings are for a 30 day trial using the 4 precaution rooms. Using the average time to don and remove PPE of 70 seconds – 5.86 hours were saved The cost of gowns and gloves x the number of times PPE was not used = $157.50

17. Remember: • Staff driven innovations not only improve the quality and safety of patient care. They also decrease costs. So… • When creating metrics consider using the financial benefit as one of your measures. It is a great way to show additional value and your CFO will become your biggest supporter!

18. Questions?