What’s up with all this change?! Feel the ENERGY

What’s up with all this change?! Feel the ENERGY A Johnny Lightning Bolt Presentation

Global Focus On Education In Our Little Part Of The Universe Wait ‘til Johnny Lightning Bolt flashes you 00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000

Rrequired organizational practices Rsystem wide initiatives R.O.P.S.W.I.V.I.P.IHEP4O.M.G.!! Rvoiding, intake, pain we’ll get in to this

Accreditation The force driving the creation of ROPs “an external peer review process to assess and improve the services they provide to their patients and clients based on standards of excellence.” “comprehensive international literature reviews, field experts and front line workers provide input”

It’s like how you may need…a driver’s licensenurses certificationIV certificationCPR certification Without these you cannot perform those functions. Same goes for VIHA We are all VIHA

ROPs – required organizational practices Goals that VIHA,Canada and in fact many other countries use to develop and grow thus identifying best practices for patient safety. Seems like a big obstacle in the way of getting on with the care of the patient. Ignore it?? It ain’t goin’ anywhere!!

Hulk out and move it away Remember?...It ain’t goin’ anywhere. We may not like change but there is no escaping it. Required is the key word. Just like required to do vitals, promote mobility and have a break. These have become must do’s for VIHA.

Depends on how you look at it… Quality & Safety Obstacle or part of the path??!!?

System Wide InitiativesSolutions For Patient Care Development Problem Solution ROPs SWIs 35 of them in 6 groupings called Quality and Safety Goals • Communication • Infection prevention and control • Culture of safety • Risk assessment • Medication management • Worklife/Workforce

VIHA puzzled and puzzled until it could puzzle no more. ??? What could we create? What blow could we make?Be proactive and don’t trust fate For quality care For the patient’s sake. -2 Client identifiers for procedures -Hand hygiene education and compliance -Falls prevention (hourly rounding) -Medication reconciliation on admit & DC -Violence prevention & MSIP training SWIs

Developmentally ExplosiveInitiatives So………….. now you see why we have to initiate these initiatives. Hand hygiene education, compliance and surveillance. Infection Control The white boards at the sides of the beds. Communication Huddles Communication Hourly rounding Patient Safety Violence prevention training Worklife/Workforce Musculoskeletal injury prevention Worklife/Workforce New discharge follow up appointment sheets Communication Post-op assessment sheet Communication Daltaparin teaching sheet Communication

When do we get started? We already have as you may have guessed… So what do we do next? Well….we already dipped our toes in the water with the VIP rounds and now it is slightly changed, it is to become a standard. Just like vitals, mobilization, etc. Water’s fine, jump in

ROP Number oneCulture of Safety • Staff Safety and Injury Prevention in all work processes • Hourly care rounds • Supporting patient safety through the work of the Infection Prevention and Control SWI. (hand hygiene, outbreak management, prudent antibiotic use.)

Quality Question 1 Does the Vancouver Island Health Authority have a disclosure process and policy? How does the policy and process support patients, families and staff members? Yes Absolutely, Look on the Safety board for the policy. It is also online http://apps.viha.ca/pnp/pdf/9.2.1Disclosure_Policy_vxxx2.pdf

SUPPORT Prompt information+ Respect for patients’ right to be informed =Maintenance of trust The policy gives instructions to the health care team about how to deal with Adverse Events as they happen. Who to contact, what to chart, how to communicate and what resources are available. Additionally, the situations are analyzed individually and globally in an effort to improve care quality.

Quality Question 2 What do you do to report an incident? For patient safety incidents, use the Incident Report Form. Patient Safety Learning System is on the way (online reporting) For staff incidents, use the Call Centre number located at the main desk. 1-877-347-8442

Quality Question 3 Are you aware that VIHA provides regular reports on client safety to appropriate authorities? Reporting System = Learning System All in the interests of patient safety Yes a quality committee which receives quarterly reports on patient safety from the incident reporting system. These reports will be produced more quickly and effectively as the Patient Safety Learning System is implemented.

Quality Question 4 What safety related proactive quality related activities have we been involved with and how is this information shared with the health care team? SWI CDMR is the answer. It is the driving force behind the soon to be reinitiated hourly rounding and it is responsible for a lot of the changes in the recent past, present and future. There is a CDMR binder on the unit to peruse the changes.

Quality Question 5 What is your role in ensuring client safety? Pretty much everything you do is ensuring client safety. Hand hygiene, C.Difficile management, swabbing changes and infection control updates have got bacteria on the run through evidence based practice updates.

Almost all the changes lately are centered around patient safety and being elder friendly… • Think about it… • Infusion pump training. • Verification processes are in place for high risk activities like insulin, PCA/Epidural changes, blood administration, etc. • 2 client identifiers for any procedures or services. • Falls prevention – assessments, mobilization techniques, rounding, history, family info., home checks, mobility aids, etc. HMMMM…

Transition point transfer of information admit, DC, kardex, report checklist, huddles • Reconciliation of medications at transition points (pharmanet, history, patient, family, doctor, etc.) • Informing the client and family about their role in promoting safety. They will often provide information crucial to preventing adverse events. Head getting full? Information Transfer is Crucial OF THE WATER LET’S GET OUT

Woodinchanowit!!!!The lightning bolts of change are all around us!!!!!! We are re-engaging and initiating hourly rounding. We have to…..Hourly rounding is a SWI that will not go AWI er..I mean AWAY. But Johnny we already do that. We are in the client rooms more than hourly. We are proud of our nursing practice and consider ourselves excellent professional nurses providing optimum care in a hospital setting. I Agree but we need to formalize this. Oops I mean “must” formalize this.

Hourly Rounds • Call light reduction • Falls reduction • Better communication • Increased patient satisfaction • Increased staff and patient safety

We have to make our lives perhaps a little easier and the client care perhaps a little safer. The research is there, it’s multinational and best practice. Besides you do it already.Let’s Just Get It Documented

So let’s take a step back We have several ROPs that have been addressed using a SWI. HOURLY ROUNDING Practice may change but.. We respect your good care and nursing practice and most of all….we will Keep It Simple Sugar

LET’S MAKE THIS EASY TO… SWALLOW. We are required to do hourly rounds We do this sort of already so now we make it formal. Easy The rounds have various components No worries… we’ll be going over that next. IHEP4 is the key. Easier There must be documentation of these rounds. A dedicated row on the flowsheet or notation on the caremaps does the trick. Easiest GAYLE C’mon I’ll show you!! I

IHEP4There’s an easier way?! LOOK AT ALL THIS STUFF • Ask about comfort/ positioning: • Do you have any pain/ may I help you change position? • Offer non-pharmalogical and other pain relief if applicable. • Before leaving, as always, ask: ‘Is there anything else you need right now?’ • Oh…remember to introduce yourself. • Do you need to use the commode/ washroom? (assist if needed) • Check IV intake -IV (rate, solution, site) if applicable (as usual) • Ensure fluids are in reach, and encourage or assist with intake • Review daily goals • Ensure bed is in lowest position, brakes are on and the required side rails are up. • Ensure there are no fluids or objects on the floor that would lead to a fall Blah, blah, blah.

I remembered all of those checks with just remembering . Know Why? I’m also a nurse who takes pride in quality care. Most of it comes naturally . I had to remember the last P. Proactive. Remember “ The key to best practice” not IHOP IHEP4 IHEP4

IHEP4 It’s easy Here is the relative size and ease of reading for the revised reminder card. We honor your expertise and experience. You know all of these things. You don’t have to carry it around…but do what you always do. That includes self-assessment of your practice. Take the IHEP4 challenge and see if you do what the yellow card says we need to do. If you’re not familiar then maybe it would be wise to carry the card

Yup..for flow sheets that’s it CAN’TCHA FEEL THE LOVE

One Line at Safety Then Just Initial

Halloo…I’m Prudence Pennypacker and I would have to concur that these are the steps necessary to effective hourly rounds Hourly Rounds Proactive Positioning Potty Pain Assessment Environment Check Hydration Check Introduce Self

In summary ROPs have compelled us to change. The engines which drive the change are SWIs CDMR is a SWI Hourly rounding is a SWI and is now a standard of care. We gotta do hourly rounds formally. IHEP4 We gotta document this in the chart. Remember that boulder? Turns out the dynamite could only move the rock. Good thing too…………..

Good thing the SWIs just moved the boulder We need these ROPs to bridge the gap. Bridge the void between health care provider and health care receiver

Consider yourself flashed

What’s up with all this change?! Feel the ENERGY