presented by: lori zinnecker hoener, karen schumacher & andrew rich
TRANSCRIPT
Presented by:Lori Zinnecker Hoener,
Karen Schumacher & Andrew Rich
Safe Patient Movement & Handling at NMH
Northwestern Memorial Healthcare CorporationNMH Chicago Campus:
8000+ Employees 894 Bed Acute Care, Academic
Medical Center
Lake Forest Campus: 1862 Employees 215 Bed Community Hospital
Diligent Services30+ Clinicians (OT, PT &
RN’s)Partner to drive Safe
Patient & Handling Program Success
We have collaborated in over 600+ facility success stories
ObjectivesThis workshop is designed for anyone who is faced with the responsibility of
implementing a SPH Program in their facility. The objectives are to:
Discuss factors that influence the success of safe patient handling programs Define where you are in the continuum of implementing a program:
Brainstorming to Sustaining
Look at common hurdles at each stage: Technical (processes, policies, etc.) Financial Cultural
Reinforce Use of Tools & Techniques to apply to all levels in order to anticipate challenges/obstacles and change beliefs.
Begin/Create a strategy for your facility
Where You Are Now?
Sustainability Plan
Anticipating Hurdles at Each Stage
Technical Considerations Engineering
Equipment/Sling Solutions Installation Considerations Laundry Storage
Administrative Define Problem Create Processes Develop Team Problem Solve Obstacles Training Metrics
Financial Considerations
Budgeting: Initial, On-Going Staff Time: Training Off Unit,
etc. Consultants Support Service Costs
Cultural Considerations Communication to All Levels•Compliance, Expectation & Accountability
Buy In & Culture Change•Patient & Family •Employee s
•Early Adopters•Late Adopters
Training
Marketing
Resources
Beginning: Proposal Stage
Implementation StageSpending more time on
technical and financial aspects: Defining the problem, Getting support and
funding, Determining who you
are communicating tooExploring the options.
By this point, process is defined, now focus is on communication:Training employeesGetting buy-in
Problem Solving Obstacles:Financial – still need to
replace / purchase/repair items.
Getting laundry done/turned around
Anticipating Hurdles at Each Stage
What stage are you in the process?What challenges are you facing in this stage?
Technical:
Financial:
Cultural:
STOP: Workshop 1
Tools & Techniques Have a Road Map
How did we tell our story?
What did we use?Process Improvement Tool: DMAIC/Six SigmaProject Management Tools: Timelines, Project Plan &
ResponsibilitiesInternal and External Experts
DMAIC = Interstate Highway6-Sigma, Lean, and Rapid Improvement Workshops = LanesProject Management and Change Acceleration = Support StructuresTools (Excel, toolkits, templates) = Side Rails and LinesProjects = Cars
Patient Movement & Handling Patient Movement & Handling OverviewLinkage to Best Patient Experience/Best People and Exceptional Financial Performance Best People: Assure a meaningful work experience for each employee.
Problem Statement:.1. From FY00-FY04:
• xxx NMH employees have been hurt moving/handling patients, resulting in:• xx lost & restricted days/employee incident, and • $ xx million cost to the organization • Caregivers lift/move/transfer 1500-3000# per shift
2. Bariatric Demographic• NMH admits xx patients/day that weigh > 500#,• NMH does not have equipment readily available for patients > 400-500# • There is no clear protocol for moving/handling dependent &/or bariatric patients.
3. Triggering Mechanism• There is no ‘trigger’ to cue staff to consider weight limits and patient dependency level to
ensure patient and employee safety. 4. Staff Surveys:
• xx% staff unsatisfied with their options to get physical or mechanical assist to move heavy, dependent patients.
Executive Sponsor: VP Sponsor: Nursing Director Project/Process Owner: Nurse Manager Improvement Leader: Safety Leader
Goal: By xx/xx/xx 1) Equipment to move patients that weight > 500# will be readily available (within 5-10 minutes) upon a “trigger” activating an equipment protocol. 2) Patient lift equipment will be compatible with NMH beds/carts. 3) Within 1 year of a hospital-wide implementation of a comprehensive patient ‘lift’ program, there will be a xx% reduction in both workers’ compensation costs and in lost & restricted work days that result from patient handling injuries (see projections on graph above).
Scope: Initially implement a patient movement initiative on 4 Pilot Units , then if goals are achieved, plan to roll out facility-wide in FYxx.System Capabilities (see Key Metrics)
1. Safety Loss Runs: Lost and Restricted Work Days, Workers’ Compensation Costs2. Pt escort record time Escort gets request for patient to be transported and time patient is delivered to destination
(includes delivery of equipment to transport)3. Documentation: measure percent of time patient weight, height and BMI is recorded & when trigger for
equipment is sent out.4. Employee Satisfaction Surveys/Cornell Symptom Survey
Key Metric(s)
Date #1 Define Jan.#2 Measure Feb#3 Analyze March#4 Implement April,#5 Control Aug,#7 House-wide Proposal December
Date
#1 Define Jan.#2 Measure Feb#3 Analyze March#4 Implement April,#5 Control Aug,#7 House-wide Proposal December
Milestones:
Total Patient Handling Cost Projections: Future Costs with No Intervention Versus With Program Implementation
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
FY 00 FY01 FY02 FY03 FY04 FY05* FY06* FY07* FY08* FY09* FY10* FY11*
Pat
ien
t Han
dlin
g C
ost
s
Projections with No Interventions
20% Cost Savings Projection with Comprehensive Program Intervention
Defining your Problem
Who are your stakeholders? What roadmap will you use?
STOP: Workshop 2
Measure: Key Metrics Safety Loss Runs:
Lost and Restricted Work Days, Workers’ Compensation Costs
Patient Handling Financial Assessment Tool: Calculates replacement costs.
Patient Escort Database: record time Escort gets request for patient to be transported and
time patient is delivered to destination (includes delivery of equipment to transport)
Documentation: measure percent of time patient weight, height, BMI and patient
handling equipment recommended is recorded in EMR.
Staff Surveys: Measure pre- and post-implementation: staff satisfaction
Improve: Improvement Initiatives
Strategy recommended and implemented by the team:
5 Pilot Unit Plan:• Capital Budget approved w/Consultant component
• Identified Unit Needs, Purchased equipment • Installation • Equipment Delivery to Units
• Pilot Protocol: Draft Written• Logistics
• Laundry &Inventory Mgmt• Documentation & Metrics established
• Training - Prevent provided training March to staff and super-users.
• Marketing & Communication: • Communications on Intranet and in electronic
documentation • Future: Nursing and Physician Newsletters
• Metrics:• OSHA Logs and Loss Runs• Documentation – Documentation Query: BMI,
Dependency Level & Width Triggers vs Actions Taken
Improve: Loss Run Data
GOAL MET!!!
Goal: 20% reduction in employee movement and handling incidents, lost and restricted days
FY05:
Q1 & Q2
FY06:
Q1 & Q2# of Patient Handling Injuries 22 2
# of Restricted & Lost Days
430 0
Cost
(Incurred + Replacement)
$124,305
($217,185)
$500
($500)
How will you measure success?Who will monitor? What will be your control?
STOP: Workshop 3
Program SustainabilityHow will you know when there is a problem?Who is responsible?How will it get fixed?
Control: Based on Pilot Success - Go House Wide & Program Effectiveness To Date
Pilot: 4 Units
Rollout Hospital Wide
Note upward trend – Create Spc Teams
Policy Approved
Gap Analysis & Recs
How will you build in sustainability?
A Department Perspective
We’ve discussed technical, financial and culture challenges that come along the way from a global perspective – let’s see how it
impacted a Department
…lessons learned…from overcoming obstacles to unexpected
surprises
Department Application
Benefits of Early AdoptionFree stuff! Lots of one-on-one attention Recognition Opportunity to provide feedback
Meeting with manufacturer to discuss R&D“Expert” status
Department Application
Technical Barriers: Ceiling lift installation Sling storage locations Securing laundered slings
Make friends with materials handling folks Availability of floor based equipment Troubleshooting broken or malfunctioning
equipment
Department Application
Financial Barriers:No initial upfront cost for individual
departmentEarly Adopter “Benevelance Stash” Sling replacement cost Repair costs Residual workman’s comp costs
Department Application Cultural Barriers:
Nursing Culture Is the equipment most used by therapists conveniently located on
the nursing units Do nurses still “wait” for therapy to 1st mobilize pts?
Physician Culture Are the physicians willing to allow their patients (mostly post
operatively ) use lift equipment? Eg: ortho patients, gym patients
Patient Culture Are patients willing to use the lift equipment? What happens when they refuse?
Marketing to patients, physicians and other HCPsDecreased decubiti
Potential for decreased hospital acquired “super bugs” due to decreased length of stay from faster mobilization
Decreased falls, particularly with bedside transfers
Increased level of independence in all ADLs and mobility at time of D/C due to faster mobilization/decreased time spent in bed
Continuity with all health care workers involved in care of patient
Increased dignity for the patient with fewer caregivers required to assist, especially for personal hygiene.
Department Application Cultural Barriers for Rehab (con’t):
Therapist Culture Overcoming therapists’ need to “assess” AND “treat”
Recognizing how nursing and therapists use lift equipment differently Functional Mobility Assessment for Nursing vs
Therapist’s Reference Guide for OT/PT
ROM Sitting Standing Ambulation
Ceiling Lift with total lift sling or
repositioning sheet
Total Lift Sling Support Vest Master Vest
Support Vest Master Vest Lift Pants
Master Vest Lift Pants
Department Application Cultural Barriers
Changing the way we document
Documenting patient’s function (and progression)despite use of lift equipment
Providing documentation that patient is using a mechanical lift in addition to physical assistance for functional activities
Assuring documentation does not prohibit patient from going to next level of care
Excerpt from Therapist DocumentationPatient required minimal assistance to ambulate 30 feet with his rolling walker WBAT on the LLE . Lift equipment in place for safety, balance, and d/t history of knee buckling; however, patient was not dependent on lift equipment for ambulation.
Excerpt from Therapist DocumentationPatient required minimal assistance to ambulate 30 feet with his rolling walker WBAT on the LLE . Lift equipment in place for safety, balance, and d/t history of knee buckling; however, patient was not dependent on lift equipment for ambulation.
Department ApplicationFinal thoughts on Culture…
HR Opportunities Preventing injuries in the tenured
employees and the (yet uninjured) new hires
Using safe patient handling program as a recruitment opportunity
Supporting the next generation of health care providers
Department Application “Staying the course” and keeping momentum…
Ongoing annual competencies
Training new staff and students after go-live
Addressing department injuries Post incident follow up Having an action plan for change
If you know ahead of time where the obstacles will be…
Why not- move them
We know…Word of mouth is electric
You don’t get many chances to screw up
If you don’t risk screwing up – you will fail
That’s all great but
BUT PLEASE
Wake me when the data is over
Wake me when the data is over
Story Time Facts inform- stories resonate & make you feelStories inspireStories spread
Safe Patient Handling is an IDEA VIRUS
0
50
100
150
200
250
300
350
400
Transfers Toilet Transfers Lower ExtremityDressing
Locomotion Total
Tot
al D
iffer
ence
in F
IM s
core
FIM Function
Total Difference in FIM scores Pre-and Post-SPHM Program at Bay Regional Medical Center
Pre-Program Difference (60 patients)
Post-Program Difference(52 patients)
What is the story here
http://www.youtube.com/watch?v=JXv262YKzc8
Mission Statement: Medical Center Hospital is a community-based teaching health system, providing high quality healthcare to all residents of the Permian Basin.
JoeS7264 (8 months ago)
I'm the one kneeling in gray scrubs. Hope you know how miraculous this video is. Only sat up for 10 seconds exactly 1-wk ago for first time in almost 3 months.
yesican32 (8 months ago)
Wonderful...but no matter your outstanding & unbelievable improvement, I'll still dance better than you.
TxTechKami (8 months ago)
OMG this is ABSOLUTELY AMAZING!!! Joe, you area true inspiration. Love you!
From YouTube
91.83% 99.86%
“Taking the class as a refresher really helped. I feel I can use the equipment now in any situation”
“What an impact this have on my ability to care for my patients and myself”
Despair.com
Safe Patient Handling, the idea is spreading!
What are the stories here
Dealing with storage: Where’s Waldo?
Recognition
Minimal Lift Ribbon Cutting Ceremony November 24, 2004
Are you a purple cow
How do you make your program remarkable?
STOP: Workshop 4List 3 actionable steps to change current challenges?
Take Away Message Effective safe patient handling programs include: Financing – short & long-term Culture Change Requires
Visible administrative support Active engagement of nurses and other health care workers Culture shift to integrate equipment into best practice – Patient Care &
Support Areas
Patient Care – Ownership and Engagement Establish Policies/Procedures, including interdepartmental collaboration Equipment Selection Training that supports proper use of patient handling equipment & culture
change Clinical tools and patient assessments for safe patient handling Resources: ‘superusers’/‘champions’, Intranet, Posters
Support Department – Ownership & Engagement Laundry Preventive Maintenance & Repairs
‘Map’ & Metrics to keep you on track
Questions / Discussion