Mandy Sandford - The Alfred -Planning and Implementation of a Pilot Project – Let Me Know
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Transcript of Mandy Sandford - The Alfred -Planning and Implementation of a Pilot Project – Let Me Know
Let Me Know
Planning and Implementing a patient
and family activated escalation
response
Mandy Sandford
Clinical Service Director
September 22nd 2014
AIM of PRESENTATION
• Describe the planning process for the service
• Engagement of consumers and staff
• Present the pilot model for Alfred Health
• Highlight communication strategies
• Discuss the results of three-month pilot
• Take home messages
No of Met calls per year
ACHSQC National Standard 9
•Communicating with patients and carers : Patients, families and carers are informed of recognition and
response systems and can contribute to the processes of escalating care.
•This criterion will be achieved by:
– 9.7 Ensuring patients, families and carers are informed
about, and are supported so that they can participate
in recognition and response systems and processes
– 9.9 Enabling patients, families and carers to initiate an
escalation of care response
Global initiatives
Many hospitals have now implemented a process to
enable patients and family activated escalation.
– Australia – REACH, PACE, CARE
– United States - Condition H, Partners in Care
– United Kingdom - Call 4 Concern
Overseas experience
This process is used sparingly. • Literature report 2-5 calls/month or less
• Others reports 5-6% of all Rapid Response calls
• No overload of false positives
• Calls have resulted in pain medication intervention
Other medications, IV fluids, diuretics
revision of discharge plan,
support to anxious pt/family,
some cases - returns to theatre or ICU
Planning
– Project Brief – 2 years ago
– Executive Support
– Reps from 3 sites (doctors & nurses)
– Interviewed & selected consumer reps
– Fortnightly meetings
– Briefings for consumer understanding
– Reviewed current models
– Scope of service – ED ICU M/health Opts
Brainstorming
– What would patients/families want to escalate?
– What calls should not come through this service?
– What characteristics of responders?
– Who could respond 24/7 and at three sites?
– Draft models to test with committees/sites
– Regular meetings with sites
Criteria for calls
– Change in behaviour/condition
– Patient not quite right and no-one listening
– Drowsy/confused – a new change, alarming
– Patient looks different, causing concern
– Patient in pain – unresolved
– Physical distress
– Concerns about treatment
– Anxiety (of patient/relative)
Patient / Family
concern
Nurse talks to patient/family
and assesses patient
Appropriate action/response taken and
inform NIC/HMO
Talk to Nurse looking
after patient
Ask to speak with
doctor/NIC Appropriate action/response
taken
Patient / Family call
Response team
1800 no
Patient/family still concerned
Patient/family still concerned
Draft Model
Press ‘1’ for Alfred Press ‘2’ for Caulfield Press ‘3’ for Sandringham
Responder Responder Responder
Project work
– Marketing: a big piece of work
• Engaged Public Affairs
• Name of program – aligned in-house programs
• Tested with consumers and patients
– Communication Strategy
• Who what when where and how
• What is the key message
– Education strategy
• For responders – skills and tools
Key Messages
• Most health care professionals listen and respond to patient and family
concerns when raised. This is about “casting the safety net” a
little further.
• Patients and families know their loved ones better than us.
• It is important that patients and families know we take their
concerns seriously. Some might fear a decline in the quality of
their subsequent care if they activate this process.
• Staff need to reassure patients and families that they are considered
valued members of the care team and activating this
process is not considered a criticism of staff.
Project timelines
– Sign-off: pick a date
– Information sessions
> Leadership committees to endorse
> Everyone – doctors, nurses, allied health, ward
clerks, cleaners (Switch)
> Nurses Forum
> FAQs
– Amazing response from staff and patients
Communication to the team
Let Me Know sticker in MR with call & actions
If serious, unit are involved
Exploring Riskman email
Evaluation audit of calls
Feedback
Implementation
– Launched July 1st
– CEO message to all staff
– Screen savers
– Patient TVs
– Brochures, posters, badges
– Intranet & Email address for feedback
– Consumers help
Pilot & Results
– 3 month pilot on The Alfred Site July-Sept
– Results so far: 10 calls in 8 weeks
– Types of calls
> Deterioration
> Care & Communication
> Complaint
> Other
0
1
2
3
4
5
July August Sept
Number of Calls / Month
0
1
2
3
4
Det/NQR Care issue Complaint Other
Reason for calls
Next Steps
– Review pilot results
– Refine model for Caulfield & Sandringham
– Pick a date
– Information sessions
– Message for staff
– Survey patients & families re awareness of service
Take home messages
– Executive support
– Engage consumers early
– Engage PR department early
– Pick a date and work towards it
– Message for all – communicate
– Follow-up call with patients & families
– Have fun and celebrate
Thank you