quality care improvement project 4d trauma unit
DESCRIPTION
Quality Care Improvement Project 4D Trauma Unit. Kelly Quinn RN, MS , CNS Allison Morton , RN, BSN Jignasa Pancholy, RN Holland Stephen s , RN, MSN, CNL. HCAHPS. ( Hospital Consumer Assessment of Healthca r e Providers and Systems). - PowerPoint PPT PresentationTRANSCRIPT
Quality Care Improvement Project4D Trauma Unit
Kelly Quinn RN, MS, CNSAllison Morton, RN, BSNJignasa Pancholy, RNHolland Stephens, RN, MSN, CNL
HCAHPS(Hospital Consumer Assessment of Healthcare Providers and Systems) Designed to elicit comparable
& measurable data based on perceptions of patients’ experience of hospitals nationally.
Results are ranked & hospital reimbursements can be affected based on our performance
SFGH lags just 4 percentage points behind the national average when patients are asked to rank hospitals worst to best.
HCAHPS 10 Composites
Communication about medication
Communication with doctors
Communication with nurses
Discharge information
Pain control
Rate hospital
Responsiveness of hospital staff
Room kept clean
Room quiet at night
Would recommend the hospital
HCAHPS RESULTS
4D Patient Survey Questions
I am receiving sufficient teaching about my condition.
I feel confident I'll be able to manage my condition at home.
My nurses always explain things clearly to me.
My nurses always tell me about side effects of new medications.
My doctors always explain things clearly to me.
I always receive help when I need it.
My pain is always well-controlled.
My room is always clean.It's always quiet at night so that I can rest.
Overall I've had a good experience at this hospital.
Project to Improve Noise at Night on 4D
Based on the HCAHPS: the lowest score was patients' perceptions of noise at night
Aim Statement: Goal is to reduce noise at night by 10% by April 20th 2012
Baseline: Patient survey done January 2012 on 4D
Interventions SILENT campaign to
remind nurses to be noise conscience after 11p
Shhhh in the hallway
It's nighttime
Low TV volume ( TV Signs)
Earplugs can be offered!
No loud voices
Turn down nursing station phone ringers
Supportive Interventions
Volunteers educate patients on what to expect at night (e.g. VSQ4H, AMLs, early MD rounds)
Bi-weekly patient survey conducted
Noise audits performed to identify noise-prone areas of the unit
Nurses Station phone
14%
Call Light18%
Hallway 110%
Hallway27%
Break Room5%
Nurses Talk7%
Patient TV16%
Equipment19%
Other3%
Noise Data Graph
1/5-
1/11
/12
1/12
-1/2
0
1/23
-1/2
7
1/30
-2/4
2/6-
2/10
2/13
-2/2
4
2/27
-3/9
3/12
-3/1
9
4/18
/201
2
1.0
1.5
2.0
2.5
3.0
3.5
4.0
It's always quiet at night so that I can rest.
Dates
1=S
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ly D
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2=
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3=A
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4=S
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Future Projects Impacting Patient
Experience Nurse to patient communication regarding
side effects of medications Cheat sheet on COWs Signs (e.g. pt
rooms/hallways/med room)
CALNOC med pass audit
"Med of the week" M/S AIM: Increase
“communication about medicine” score by 10% (from 55-65%)
Medication Communication Graph
_x00
0b_1
...
1/12
...
1/23
...
_x00
08_.
..
_x00
08_.
..
2/13
...
_x00
08_.
..
3/12
...
_x00
05_.
..
1.00
1.50
2.00
2.50
3.00
3.50
4.00
My nurses always tell me about side effects of new medications.
1=
Str
on
gly
Dis
ag
ree
, 2=
Dis
ag
ree
, 3=
Ag
ree
, 4=
Str
on
gly
Ag
ree
Future Projects Impacting Patient Experience (cont):
Organizing education material and accessibility
Music therapy available for patients to decrease pain
Increasing responsiveness to patient needs
Increasing communication with MDs/NPs
Staff Communication Focus placed on increasing staff
communication and disseminating knowledge about unit changes
Emails Monthly meetings Communication
binder Open forum board for
suggestions/feedback Positive Recognition
Board
Roles and ResponsibilityOf Quality Care Coordinator
Nurse
Provides patient centered care.
Educates patients and professionals.
Enhances care and work environs.
Develops systems to support quality nursing and quality care.
Provides assistance to patients throughout care transitions.
However, this is a nurse among nurses. Our goal is to support you in your role as med-surg nurses.
Sustainability Continue to create immediate,
visible, flexible and unit-specific changes that address the unique needs of the unit
Unit shared governance based project
Continue to promote nursing excellence
Continue to improve patient experience by providing support and voice for the nurses
Spreading Change through the SG
Structure