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The NKEplus Toolkit

in the following pages you will find a collection of posters, guides, flyers, and other tools that were called out in the Playbook to help you successfully implement NkEplus. These tools will help you plan, educate, reinforce behaviors with staff, and sustain NkEplus for years to come.

You will find the tools in digital form at the end of this book. Many of them are ready to print right away, while others are templates meant to be customized to the unit before being printed and are marked as such.

Tools, Tools, Tools!

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Tools by stage

PREPARE

• U1: Unit Self-Assessment Tool

Having the right tools when you need them can make all the difference.

in the following pages, you will fi nd all the tools called out in the Playbook as well as a few more. For simplicity, tools are grouped by the stage in which they may fi rst be useful, but many of the tools will come in handy more than once as you implement NkEplus on your unit. Feel free to use any tool wherever and whenever you need it. They are here for you!

PLANNING

• P1: Role Coordination Worksheet

• P2: Pi Planning form

• P3: Project Snapshot worksheet

• P4: Workfl ow cards

KICKOFF

• K1: Roll-out Schedule poster

• K2: NkEplus Think tank poster

• K3: NkEplus Goals poster

• K4: NkEplus overview poster

• K5: interview guide (cards)

• K6: Walk-through guide (cards)

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EVALUATE AND SUSTAIN

• S1: NkEplus Tracker Tool

• S2: Charge RN checklist

• S3: NkEplus fl oat tool

• S4: Bedside Tidbit cards

• S5: Call-light dashboard

• S6: Create your own dashboard

• S7: Further sustainability tips

ROLL OUT

• R1: NkEplus Badge Cards

• R2: imagine your day worksheet

• R3: Cards of various uses.

• R4: Pop-up Video library

• R5: Tips for HiPAA compliance

• R6: Manager sign-up calendar

• R7: “We made it ours” tags

• R8: Patient-RN Appreciation clips

TRYING THINGS OUT

• T1: “Things we’re trying” sheets

• T2: “Trying new things” tags

• T3: Question Card

• T4: Preparing Hot Towels Card

• T5: UA Message Pad

• T6: UA Call Triage Protocol

• T7: UA Checklist

• T8: Final Hourly Round Times fl yer

• T9: Question of the Day

NKEp

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Prepare

HOW TO USE IT

Use this self-assessment tool to see how ready the unit is to introduce NkEplus.

SELF-ASSESSMENT TOOLU1

Note: “Prepare” is not a stage in the Playbook, but this tool is so useful, we couldn’t stand to leave it out! Use it to make sure a unit is ready to start rolling out NKEplus.

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Kickoff Tools• K1: Roll-out Schedule poster

• K2: NkEplus Think tank poster

• K3: NkEplus Goals poster

• K4: NkEplus overview poster

• K5: interview guide (cards)

• K6: Walk-through guide (cards)

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HOW TO USE IT

Put up a big poster to communicate project schedule. Use this to help set expectations with staff regarding timing and roles.

ROLL-OUT SCHEDULE POSTERK1 NKEPLUS THINK-TANK POSTERK2

HOW TO USE IT

Use this fun poster to build excitement about NkEplus and convey that the unit is “making it theirs”. Put the poster up on a conference room door or somewhere that marks a designated space where the champions team can explore and immerse themselves in NkEplus, make decisions, hold diagnostic workshops, and create additional posters to put up on the unit.

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NKEplus GOALS POSTER

HOW TO USE IT

Use this poster to communicate the goals of NkEplus. Point to it during training, post it up on the walls, keep it around for reference throughout the soft-start process. Having everyone understand the overarching goals of NkEplus will keep the unit striving for the same outcomes while allowing individuals to be fl exible in their approach.

it around for reference throughout it around for reference throughout

NKEplus OVERVIEW POSTERTemplate

6. Unit Support

Nurse RoleSupporting Staff Roles

1. Last Hourly Round

5. Pre-shift Assignments

During End of shift

During handoff

*

In-Room Nurse-Patient EngagementNurse invites patient to participate in exchange of information.*

2. In-Room SBAR

3. In-Room Safety Check

4. Careboard with Shift Goals &

Teachback

**

NKEplus 6 Essential Parts

CUSTOM FITS: Customize these parts of NKEplus based on the unit’s unique needs and dynamics.

*

HOW TO USE IT

Use this poster to share a summary of NkEplus with the unit.

Post it up in one or more obvious places where staff can see it an get familiar with it. Staff bathrooms, staff conference rooms, nurse stations, computer carts, and hallways are all good places for this information.

K3 K4

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WALK-THROUGH GUIDEK6

HOW TO USE IT

Use these cards as guides for what to look for while performing a walk-through of the unit. The prompts are meant to help the observer see fi rst-hand and better understand the issues on the unit around shift-change.

INTERVIEW GUIDEK5

HOW TO USE IT

Use these cards as guides for interviewing patients and peers about shift changes to discover and understand the issues and concerns fi rst-hand.

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• P1: Role Coordination Worksheet

• P2: Pi Planning form

• P3: Project Snapshot worksheet

• P4: Workflow cards

Planning Tools

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ROLE COORDINATION WORKSHEETTemplate

HOW TO USE IT

Use this sheet to help staff coordinate roles on the unit during shift change. Using initial input from nurses, make a sheet that shows who might do what at different times during the shift change.

letting the unit decide how to coordinate roles helps them feel ownership of the process and gets them thinking critically about how to get things done in a way that works for everyone.

HOW TO USE IT

Use this form to help think about and set specifi c goals around how NkEplus will positively impact the unit.

PI PLANNING FORMP1 P2

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WORKFLOW CARDSTemplate

HOW TO USE THEM

Capture and communicate what staff will be trying (NkEplus processes & behaviors) using these half-sheets. Tack them to computer carts or hand them out directly to provide staff with the specifi cs they need.

P4PROJECT SNAPSHOT WORKSHEETS

HOW TO USE IT

Provide this tool to nurses to help them think through problems and ideas they want to try out and communicate them clearly to each other. This sheet can also be used for future projects that involve getting nurses involved in making changes they want to see on the unit.

P3

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“Trying Things Out” Tools• T1: “Things we’re trying” sheets

• T2: “Trying new Things” tags

• T3: Question Card

• T4: Preparing Hot Towels Card

• T5: UA Message Pad

• T6: UA Call Triage Protocol

• T7: UA Checklist

• T8: Final Hourly Round Times flyer

• T9: Question of the DayNK

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“TRYING NEW THINGS” TAGS

HOW TO USE THEM

Post these cultural reminder tags up on the unit during the “customize and try” phase to indicate ideas the unit is trying out and needs feedback on.

“THINGS WE’RE TRYING” SHEETS

HOW TO USE THEM

Fill out these half-sheets and post them on the unit, or hand them out to staff directly. This sheet is a good place to write down specifi cally what you want people to try. The written instructions can easily be communicated between shifts.

You can never have enough communication materials when it comes to trying new ideas. Staff will be able to provide better feedback about their experience when they are clear about what they are being asked to try.

T2T1

you want people to try. The written you want people to try. The written

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QUESTION CARD

NKEplus Essentials

HOW TO USE IT

For patients who have a lot of questions during shift report, nurses can give them this card to write things down and remember for later.

This allows the nurse to stay on track getting the rest of reports and follow up on patient questions when he or she returns during assessments.

Sample introduction:

“I have to take report on my other patients right now, but I defi nitely want to know about any questions or concerns you have.

I’m going to give you this card to down any questions you might have for me.

I’ll be back within an hour to assess you. And that’s the perfect time for us to talk about any questions you might have.”

Questions/Notes

Questions/Notes

CAPTURE QUESTIONS FOR YOUR RN/DOCTOR

CAPTURE QUESTIONS FOR YOUR RN/DOCTOR

A hospital can be a confusing place. Often it can

be hard to remember what you want to ask!

Use the space below to write down questions

you have (or anything else you want to

remember). Check out the back of this card for

questions you might not have thought about.

A hospital can be a confusing place. Often it can

be hard to remember what you want to ask!

Use the space below to write down questions

you have (or anything else you want to

remember). Check out the back of this card for

questions you might not have thought about.

T3

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NKEplus Essentials

UA MESSAGE PAD

HOW TO USE IT

Use these brightly colored, self-stick message pads to ensure nurses get messages passed to them about family, patient, and other clinician needs during shift change. Stick them to computer carts where nurses won’t miss them.

Pads pictured here are available at most offi ce supply stores.

T5PREPARING HOT TOWELS CARD

NKEplus Essentials

HOW TO USE IT

Tack this to the hot towel cart when fi rst starting NkEplus. instructions like this may seem unnecessary, but they can go a long way to helping make the transition as easy as possible in the early stages of a new process.

T4

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UA CALL TRIAGE PROTOCOL

NKEplus Essentials

UA CHECKLISTTemplate

NKEplus Essentials

HOW TO USE IT

Post this checklist near unit assistants/clerks workstations to provide clear instructions for what they can do to support nurses during shift change. The goal is for any unit assistant, including fl oats, to be able to see it and understand it easily.

Bright colors will help it stand out and maintain a fun feel.

HOW TO USE IT

Provide this to the Unit Assistant to help establish a consistent way to triage calls from different parties (family members, doctors, patients, etc.).

clear instructions for what they can do clear instructions for what they can do

T6 T7

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FINAL HOURLY ROUND TIMES FLYERTemplate

HOW TO USE IT

Use this tool to encourage staff to complete their fi nal hourly round within the last hour of their shift by calling out a specifi c time for staff to start fi nal rounds.

other good reminders include: sending automatic text messages to nurse Spectralink phones, calling all nurses directly (UA), manager rounding, dimming lights or turning lights back on. Make up your own!

HOW TO USE ITHOW TO USE IT

T8 QUESTION OF THE DAY BOARD

HOW TO USE IT

Make your own board and solicit feedback from the staff. The key is to create a public forum that gets people’s attention with a way for them to answer privately. Some tips:

• Post board on staff-room door to get people’s attention.

• Hand out strips of paper at huddles.

• Display answers in a fun format.

HOW TO USE ITHOW TO USE IT

T9

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Roll-Out Tools• R1: NkEplus Badge Cards

• R2: imagine your day worksheet

• R3: Cards of various uses.

• R4: Pop-up Video library

• R5: Tips for HiPAA compliance

• R6: Manager sign-up calendar

• R7: “We made it ours” tags

• R8: Patient-RN Appreciation clips

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NKEplus BADGE CARDSTemplate

HOW TO USE THEM

Provide these cards to nurses and PCTs to attach to their badges as a reminder of the process. This will serve as a reference they can always have on hand.

R1 IMAGINE YOUR DAY WORKSHEET

HOW TO USE IT

Use this worksheet to help staff think about the general schedule of their day now and any adjustments they might make adjustments to make NkEplus work for them.

R2

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CARDS OF VARIOUS USESTemplate

R3

HOW TO USE THEM

Use this card template to make fun cards that can be used in multiple settings. Here are two occasions where cards can be useful:

1) Story Capture during training

The training kickoff meeting should involve a lot of listening and sharing. Help nurses build excitement around NkEplus by sharing stories that highlight the issues that NkEplus is trying to address. Capture these stories on cards so they can be easily shared across shifts.

2) Quiz Cards

Make meetings fun with quizzes. Ask questions to get staff thinking more deeply about the process. The goal is to get them thinking about why you are doing this and asking themselves, “How well do i know this?”

Throw in questions that are obvious, don’t matter, or don’t have a right answer to keep it from feeling like a test. Provide candy or small prizes to winners.

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HOW TO USE IT

Use any one of this series of tips and tricks videos to demonstrate nursing best practices during shift change to staff. Videos are taken from real nurses with real patients in a live setting. Topics include: engaging patients during shift change, showing as a way of telling, dealing w/ doctors and family members during shift-change, etc.

POP-UP VIDEO LIBRARY TIPS FOR HIPAA COMPLIANCE R4 R5

HOW TO USE IT

Use this document to help nurses understand and practice protecting patient privacy while involving them in shift change in cases where others are in the room during the bedside handoff.

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MANAGER SIGN-UP CALENDAR

HOW TO USE IT

Use this sign-up calendar to help managers commit to seeing NkEplus in action during implementation.

R6 “WE MADE IT OURS” TAGS

HOW TO USE THEM

Use these tags on handouts and giveaways during the Go-live to remind nurses that NkEplus is a process designed by them and customized for them.

R7

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HOW TO USE THEM

Hand out these cards and clips to patients on the fl oor to get them engaged in the process of going live with NkEplus. Hold a contest to see which nurse can get the most clips for involving their patients in the bedside handoff.

PATIENT-RN APPRECIATION CLIPSR8

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Evaluate and Sustain Tools• S1: NkEplus Tracker Tool

• S2: Charge RN checklist

• S3: NkEplus float tool

• S4: Bedside Tidbit cards

• S5: Call-light dashboard

• S6: Create your own NkEplus dashboard

• S7: Further sustainability tips

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NKEPLUS TRACKERS1

HOW TO USE IT

The NkEplus tracker consists of three tools. The details for how to use each of these tools are outlined on the following pages. --->

Data collection tool Period worksheet Dashboard (Tables and charts)

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NKEplus TRACKER: Data Collection Tool

Use the data collection tool during period observations to see how NkEplus is going. it is meant to be printed and photocopied so it can be fi lled out by hand.

FREQUENCY: To get a suffi cient read on how NkEplus is going, you will need to collect 30 data points per month -– ideally in the same week per month. one data point equals one shift change on one patient.

if you have 2 shifts, collect 15 med passes from AM and 15 from PM. if you have 3 shifts, collect 10 from morning, 10 from afternoon, and 10 from the night.

HOW TO USE IT: The observer tracks the number of interruptions using hash marks and use an X or o to mark which steps of NkEplus have been completed.

Use three codes to collect the data properly:• X = the task was completed

• o = the task was not completed

• N/A = not applicable...the task could not be completed.

X X X

O O N/A

X O X O

X N/AX X XO

X OX X N/A

3 3 1

in the example above, for Data Point #1, the oncoming nurse

was not introduced to the patient so an “o” was placed into

the box since this step should have been performed.

S1

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NKEplus TRACKER: Period worksheet

After the 30 data points are collected they need to be entered into the correct Period worksheet (see Excel fi le). The correct Period is the next Period that is blank.

For example, if Period 2 is fi lled out, and Period 3 is empty, then the period to enter the data is Period 3. To enter the data, use an “x” to indicate the process step was completed, “o“ (not a zero!!) if it was not, and blank if the nurse was unable to complete it.

This should be direct data entry from the Data Collection Tool to the Period worksheet.

S1

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NKEplus TRACKER: Dashboard (Tables and charts)

The Table and Charts worksheet is your guide to understanding the state of NkEplus on the unit.

lucky for you, this worksheet automatically tabulates and creates the charts based on your data entry in the period worksheet. Therefore, the Table and Charts worksheet is only for viewing and printing, so no data should be entered here.

PART 1: DASHBOARD TABLE

The fi rst section is the “Green light” table. Based on the data, the table will calculate a result and automatically turn it red, yellow or green.

GREEN indicates success- the task was completed ≥90% of the time or time in the room is between 3 and 5 minutes.

YELLOW indicates that more work needs to be done -– the task was completed between 80% and 90% of the time, or time in the room is between 1 and 3 or between 5 and 7 minutes.

in this example, see the unit moving from

red to yellow/green, meaning that they are

showing improvement!

S1

RED indicates that a “more heroic” intervention may be needed. The task was completed < 80% of the time or time in the room is less than 1 or greater than 7 minutes.

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NKEplus TRACKER: Dashboard (Tables and charts)

PART 2: CHARTS

The second section of the Table and Charts worksheet is composed of four charts to make it easier to visualize the state of NkEplus.

Remember that all data points in the future are zero, thus the charts “plunge” to zero after the last entered data point.

S1

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CHARGE RN CHECKLISTS2

HOW TO USE IT

Have Charge RNs and managers use or modify this checklist of daily activities that includes top things each person can do to support NkEplus. The goal is to help them build supporting the unit into their daily workfl ow.

HOW TO USE IT

Having fl oat RNs that don't know how to participate in NkEplus can be disruptive to the process. For a good implementation, use this tool to walk your fl oat RN through what NkEplus is about and help them understand that at the bare minimum they are expected to participate as a member of the frontline staff in your unit.

NKEplus FLOAT TOOLS3

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HOW TO USE IT

Having trouble with your fi nal hourly round and call lights during shift change?

Put this up on the unit to give a live readout of “how we’re doing” on NkEplus during your roll out.

Track call lights to show how well your fi nal hourly round is impacting call lights during shift change.

NKEplus... GOOD NEWS! Call lights during shift change Average # of calls before NKEplus: 12 -

11 -10 -9 -

8 -7 -

6 -5 -

4 -3 -

2 -1 -

0 -Sunday

AM PM EVE

Monday

AM PM EVE

Tuesday

AM PM EVE

Wednesday

AM PM EVE

Thursday

AM PM EVE

Saturday

AM PM EVE

Other reasons toCelebrate...Friday

AM PM EVE

CALL-LIGHT DASHBOARDBEDSIDE TIDBIT CARDSS4 S5

HOW TO USE THEM

Use these cartoons to convey the “whys” of bedside reporting in a refreshing and fun way. Post them up on the unit, hand them out to nurses, place them around in conspicuous places, etc. This is especially useful as reminders as you’re trying to sustain NkEplus.

Use them a few at a time and make them last. Pick one that’s relevant to what you’re working on.

You can also use them as a fun way to get staff to share stories that are related to these topics.

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CREATE YOUR OWN NKEplus DASHBOARDS6

HOW TO USE IT

When sustaining NkEplus, pick a few focus areas that you want to put in front of your staff as reminders of what the unit is working on.

Here’s a fun way to show the data you’ve collected:• Go to a fundraiser thermometer generator on the internet.

This one is good: http://www.entropyfarm.org/software/thermo/

• Create a thermometer chart using data you have pulled from NkEplus Tracker that you want to show your unit. Pick and choose the area you want your unit to focus on.

• Enter the number from your NkEplus Tracker data as “current” and use 100 as “goal”.

• Click on “Save Graphic” and save it to your computer. it will save as JPG. Paste it into Powerpoint or Word, and make a poster out of it.

• label your thermometer so that it’s clear, along with messages you want to convey to the staff.

FURTHER SUSTAINABILITY TIPSS7

HOW TO USE THEM

Use these tips to help guide you as you sustain NkEplus on different units. Many of these tips are can be applied to sustaining other initiatives as well.

Sust

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Make slippage uncomfortable: Don’t let slippage become the norm.

• React at fi rst signs to make it clear that returning to old ways in not desirable.

• Be careful not to be too negative, but at the same time don’t shy away from giving

feedback where it is needed.• Remove old structural supports associated with the old way.

Keep up the attention: Don’t let the attention slip away, keep it on people’s minds.

• Keep on measuring and feeding back: Measurement communicates that something is

a priority. Set up a system that assures automatic re-measure. Make it a continuous

improvement effort, never really let it settle into simple maintenance mode.

• Recognize and celebrate maintaining performance.

• Set the bar even higher, try to improve even more. e.g. Create friendly competition between units to

improve even more.• Re-train, re-educate, re-campaign• Educate new staff. Quickly educate fl oat RNs or staff unfamiliar with NKEplus using the

NKEplus Float Tool.• Continue to create the positive emotional story of what NKEplus has brought to the

unit.• Use the excitement of improvement to keep up the attention.

• Continue to listen to staff, leadership, and champions to ensure that their stories are

being heard. e.g. Share stories in huddles or post them up on the wall. Try to share stories every other week or so.

Keep messages fresh with humor.

Structure it: Build the improvement into the fabric of daily work and systems

• Standardize: Incorporate the new way into policies and procedures.

• Establish on-going training.• Create new roles and responsibilities that support the new process.

• Make someone accountable to see that the new process does not degrade back to

previous levels.• Have bite-size but consistent tasks everyday to support NKEplus.

• Make processes clear and transparent. e.g. Outline the unit support responsibilities and post it on the

unit.

Engage others to support: The change should not rely on just one person for

success.

• Involve other people in it so they constantly remind each other to keep up the work.

• Support champions to develop their role. Continue to include them in where to focus

for sustaining NKEplus.• Work with local organization management experts to get insights on creating change.

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122 GloSSARY

ANM- AssistANt Nurse MANAger

CAreboArd- A pAtieNt-CAregiver CoMMuNiCAtioN boArd thAt lives iN eACh pAtieNt rooM.

CNo- Chief NursiNg offiCer

Coo- Chief operAtioN offiCer

evs- eNviroNMeNtAl serviCes

iA- iMproveMeNt Advisor

NKe- Nurse KNowledge exChANge

pCt- pAtieNt CAre teChNiCiAN (sAMe As CNA, Nurse Aide, NursiNg AssistANt, etC)

pi- projeCt iMproveMeNt

pM- projeCt MANAger

rN- ANy Certified Nurse

sCl- sANtA ClArA KAiser perMANeNte hospitAl

sAC-sACrAMeNto KAiser perMANeNte hospitAl

ubt/dbt- uNit bAsed teAM/depArtMeNt bAsed teAM

uA- uNit AssistANt (sAMe As uNit ClerK)

Glossary of Terms

Congratulations & good luCk!