Operationaliin NCH at a ieHospital arly pleenter Sitenicheconference2012.s3.amazonaws.com ›...
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Celia Oxley, RN, MS; Kristina Loeffler, RN; Melissa Huckabone, RN Bassett Medical Center, Cooperstown, NY IDENTIFICATION OF NEEDS The first network-wide NICHE Team meeting identified fall prevention as our primary focus. We analyzed Bassett Medical Center’s accomplishments with pressure ulcer prevention, as well as O’Connor Hospital’s exemplary achievements regarding fall prevention. After discussing these successes, our team identified three components necessary for hardwiring a network-wide com- prehensive fall prevention program: 1) champions who doggedly pursue the cause, 2) feedback for staff members to chart progress, and 3) resources readily available to get the job done. GOALS • Improve fall rate at all facilities to exceed NDNQI benchmarks • Rewrite fall prevention protocols to create one network-friendly tool • Build a functional ability assessment tool into electronic medical record (EMR). Assessment performed upon admission to establish current functional status, as well as status two weeks prior to admission. Research shows that functional ability declines commencing ten days prior to admission. The patient’s prior functional status is used as the goal for discharge. • Educate and empower RNs and support staff to be effective members of the patient care team • Educate and empower caregivers to provide optimal care at home while simultaneously re- ducing their stress IMPLEMENTATION AND COMPONENTS • Network CNO group gave NICHE Team the responsibility of guiding Fall Committee protocol development and safety equipment acquisition • Focus of Fall Committee revitalized and now inclusive of all affliates. Representatives from all facilities have returned to the table. • Principles of NICHE used to build network-wide fall prevention protocol. • Fall Prevention Blitz slated for February 2012. Unit-based Fall Champions to introduce the post-fall assessment tool via posters, huddles, spot-checking on adherence to policy, daily safety rounds, one-on-one education, literature review and journal club. Visual cues have been instituted to properly and easily identify high fall risk patients to all staff. • Inclusion of all departments in fall prevention. “No Passing Zones” implemented on inpatient floors. Specifically, no staff member regardless of depart- ment can turn a blind eye to a safety alarm. • Monthly feedback reflecting fall rate provided to staff via the “Weeble Wobble Calendar” posted at nurses’s station. Serves as a visual reminder of need to consistently continue fall prevention efforts. • GPCA classes were offered to strengthen the care aides’ understanding of age appropriate care. This group was chosen as they are the backbone of direct patient care. A total of thirty care aides representing all five affliates were in attendance. To acknowledge this accomplishment all attendees were award- ed NICHE lapel pins. A.O. Fox continued to take this one step further by requiring CNA training for all aides. The NICHE GPCA training components are also now incorporated into the BMC new employee orientation classes. • GRN and GPCA coursework will be opened at all respective staff in Spring 2012. • Post Fall Assessment tool incorporated into network-wide protocol in January 2012. • Post Fall Assessment and Functional Ability Assessment added to EMR build with roll-out date of August 2012. • Patient Activity Cart continually stocked through staff donations • Work initiated on caregiver support program including revised and expanded discharge educational materials. Currently considering institution of commu- nity phone tree for elders living alone. The Real of New York December 2010 LTP 1st Network-Wide NICHE Team Meeting March 2010 NICHE National Conference Las Vegas - 12 members attend April 2011 GPCA classes 30 Attended Pin Awarded to Participants April-May 2011 Activity Cart Created at BMC Stocked Through Staff Donations May 2011 Participation in build of EMR May 2011 New Post Fall Assessment Functional Ability Assessment Network-Wide Fall Protocol Patient’s Plan of Care NICHE Team Begins Advising BMC Fall Committee August 2011 Committee Focus Becomes Network-Wide Post-Fall Assessment Added to Network-Wide Protocol September-October 2011 Implementation Goal for Network-Wide Protocol February 2012 First MD NICHE Consult Ordered At BMC BMC NICHE Attends NY State Caregiver and Respite Coalition Conference November-December 2012 Nursing Grand Rounds at BMC Public TV Ad Promoting NICHE at BMC NICHE Produced Film with AJN and AARP for Family Caregivers Cooperstown Annual Pumpkin Festival Senior Resource Fair at BMC Presentations at all Annual Nursing Networking Meetings July-December 2011 2012 Goals Development of Community Caregiver Support Program GRN/GPCA Training Open to all Units at All Network Hospitals Fall Prevention Education Blitz at all BMC Departments Little Falls Hospital, a proud partner of The Bassett Healthcare Network, is Herkimer County’s sole provider of 25 acute, swing and special care beds. Little Falls Hospital offers 24/7 Emergency Services with physicians from Bassett providing medical coverage. Cobleskill Regional Hospital is a 40-bed not- for-profit hospital founded by the people of Schoharie County in 1956. Bassett Medical Center, the foundation for the Bassett Healthcare Network, is a 180-bed, acute care inpatient teaching facility in Cooperstown, New York. Bassett of- fers 24-hour emergency and trauma care, comprehensive cancer and heart care, dialysis, and most medical and surgical specialties. The Bassett Clinic is located on the same campus as the medical center and provides outpa- tient primary and specialty care. The medical center also provides postgraduate residency training programs in Medicine and Surgery and maintains a strong academic program through its affiliation with Columbia University College of Physicians and Surgeons (P & S). In 2009, Bassett became a medical school campus of Columbia P & S. The Bassett Research Institute, located on the med- ical center campus, conducts programs in basic and clini- cal science, and population and public health studies. A. O. Fox Hospital Providing a broad spectrum of healthcare, with re- nowned specialties in emergency, cancer, cardiac and primary care, Fox treats the youngest of patients in pediatrics to the oldest with many services for seniors. O’Connor Hospital has been a member of the Delhi community since 1922, and affiliated with Bassett Healthcare since 1988. O’Connor is des- ignated as a Critical Access Hospital licensed for 23 acute care medical/surgical beds, including extended care “swing” beds for patients await- ing home-based skilled nursing care or nursing home placement. INTERDISCIPLINARY/INTERAGENCY COLLABORATION • Otsego County Long Term Care Council • Otsego County Office for the Aging Advisory Council • Geriatric Services Committee – Bassett Healthcare Network • Care Transitions Committee – Bassett Healthcare Network • Better Outcome for Older Adults through Safe Transitions (BOOST) • At-Home Care nursing agency and local public health offices • Hospice • NY State Caregivers and Respite Coalition DISSEMINATION, PROMOTION AND HARDWIRING • Network-wide NICHE meetings evolved into members working in smaller groups with quarterly network-wide meetings • Telephone conferences addressing currents plans and progress. Literature reviews and mini-educational seminars per team members’ requests – i.e. Hospital Related Sleep Disturbances which led to presentation of Crouse Hospital “Physician’s Order: Sleep Order” to BMC Director of Pharmacy. To date, this is being discussed at network-wide pharmacy meetings. • Post-fall huddles and care plan updates now required after every fall EVALUATION/RESULTS • O’Connor Hospital held up as exemplar by JCAHO • NICHE asked to present at all Annual Networking Meetings as a working example of fostering a bridge among our network’s nurses by standardizing nursing practices • MD ordered NICHE consult at BMC for aggressive, demented patient • Multiple administrators throughout the network verbally hold the NICHE team in high regard • The number of GRNs and GPCAs continues to increase monthly REFERENCES • Graf MS, APRN, BC, Carla. (2007). The Lawton Instrumental Activities of Daily Living (IADL) Scale. Retrieved from www.ConsultGeriRN.org, try this series. • Kresevic, RN, Denise M. (January 2008). Nursing Standard of Practice Protocol: Assessment of Function in Acute Care. Retrieved from www.ConsultGeriRN.org. • Rhalimi M, Rafik H, Jaecker P. Medication Use and Increased Risk of Falls in Hospitalized Elderly Patients. Drugs Aging 2009: 26(10); 847-852 • Heinze, Cornelia RN MSc; Halfens, Ruud J.G. PhD FEANS; Roll, Stephanie MSc; Dassen, Theo PhD FEANS. Psychometric Evaluation of the Hendrich Fall Risk Model. Journal of Advanced Nursing 2006: 53(3); 327-332 Bassett Healthcare NICHE Team, March 2011
Transcript of Operationaliin NCH at a ieHospital arly pleenter Sitenicheconference2012.s3.amazonaws.com ›...
Operationalizing NICHE at a Five-Hospital Early Implementer SiteCelia Oxley, RN, MS; Kristina Loeffler, RN; Melissa Huckabone, RN
Bassett Medical Center, Cooperstown, NY
IDENTIFICATION OF NEEDSThe first network-wide NICHE Team meeting identified fall prevention as our primary focus. We analyzed Bassett Medical Center’s accomplishments with pressure ulcer prevention, as well as O’Connor Hospital’s exemplary achievements regarding fall prevention. After discussing these successes, our team identified three components necessary for hardwiring a network-wide com-prehensive fall prevention program: 1) champions who doggedly pursue the cause, 2) feedback for staff members to chart progress, and 3) resources readily available to get the job done.
GOALS • Improve fall rate at all facilities to exceed NDNQI benchmarks• Rewrite fall prevention protocols to create one network-friendly tool • Build a functional ability assessment tool into electronic medical record (EMR). Assessment
performed upon admission to establish current functional status, as well as status two weeks prior to admission. Research shows that functional ability declines commencing ten days prior to admission. The patient’s prior functional status is used as the goal for discharge.
• Educate and empower RNs and support staff to be effective members of the patient care team• Educate and empower caregivers to provide optimal care at home while simultaneously re-
ducing their stress
IMPLEMENTATION AND COMPONENTS• Network CNO group gave NICHE Team the responsibility of guiding Fall Committee protocol development and safety equipment acquisition• Focus of Fall Committee revitalized and now inclusive of all affliates. Representatives from all facilities have returned to the table.• Principles of NICHE used to build network-wide fall prevention protocol.• Fall Prevention Blitz slated for February 2012. Unit-based Fall Champions to introduce the post-fall assessment tool via posters, huddles, spot-checking on
adherence to policy, daily safety rounds, one-on-one education, literature review and journal club. Visual cues have been instituted to properly and easily identify high fall risk patients to all staff.
• Inclusion of all departments in fall prevention. “No Passing Zones” implemented on inpatient floors. Specifically, no staff member regardless of depart-ment can turn a blind eye to a safety alarm.
• Monthly feedback reflecting fall rate provided to staff via the “Weeble Wobble Calendar” posted at nurses’s station. Serves as a visual reminder of need to consistently continue fall prevention efforts.
• GPCA classes were offered to strengthen the care aides’ understanding of age appropriate care. This group was chosen as they are the backbone of direct patient care. A total of thirty care aides representing all five affliates were in attendance. To acknowledge this accomplishment all attendees were award-ed NICHE lapel pins. A.O. Fox continued to take this one step further by requiring CNA training for all aides. The NICHE GPCA training components are also now incorporated into the BMC new employee orientation classes.
• GRN and GPCA coursework will be opened at all respective staff in Spring 2012.• Post Fall Assessment tool incorporated into network-wide protocol in January 2012.• Post Fall Assessment and Functional Ability Assessment added to EMR build with roll-out date of August 2012.• Patient Activity Cart continually stocked through staff donations• Work initiated on caregiver support program including revised and expanded discharge educational materials. Currently considering institution of commu-
nity phone tree for elders living alone.
The Real of New York
December 2010
LTP
1st Network-WideNICHE Team Meeting
March 2010
NICHE National ConferenceLas Vegas - 12 members attend
April 2011
GPCA classes30 Attended
Pin Awarded to ParticipantsApril-May 2011
Activity Cart Created at BMCStocked Through Staff Donations
May 2011
Participation in build of EMRMay 2011
New Post Fall AssessmentFunctional Ability Assessment
Network-Wide Fall ProtocolPatient’s Plan of Care
NICHE Team BeginsAdvising BMC Fall Committee
August 2011Committee Focus Becomes
Network-Wide
Post-Fall Assessment Added toNetwork-Wide Protocol
September-October 2011Implementation Goal for Network-Wide Protocol
February 2012
First MD NICHE Consult Ordered At BMC
BMC NICHE AttendsNY State Caregiver and Respite
Coalition ConferenceNovember-December 2012
Nursing Grand Rounds at BMC Public TV Ad Promoting NICHE at BMC
NICHE Produced Film with AJN and AARP for Family Caregivers
Cooperstown Annual Pumpkin FestivalSenior Resource Fair at BMC
Presentations at all Annual Nursing Networking MeetingsJuly-December 2011
2012 GoalsDevelopment of Community Caregiver
Support ProgramGRN/GPCA Training Open to all Units
at All Network HospitalsFall Prevention Education Blitz at all
BMC Departments
Little Falls Hospital, a proud partner of The Bassett Healthcare Network, is Herkimer County’s sole provider of 25 acute, swing and special care beds. Little Falls Hospital offers 24/7 Emergency Services with physicians from Bassett providing medical coverage.
Cobleskill Regional Hospital is a 40-bed not-for-profit hospital founded by the people of Schoharie County in 1956.
Bassett Medical Center, the foundation for the Bassett Healthcare Network, is a 180-bed, acute care inpatient teaching facility in Cooperstown, New York. Bassett of-fers 24-hour emergency and trauma care, comprehensive cancer and heart care, dialysis, and most medical and surgical specialties. The Bassett Clinic is located on the same campus as the medical center and provides outpa-tient primary and specialty care. The medical center also provides postgraduate residency training programs in Medicine and Surgery and maintains a strong academic program through its affiliation with Columbia University College of Physicians and Surgeons (P & S). In 2009, Bassett became a medical school campus of Columbia P & S. The Bassett Research Institute, located on the med-ical center campus, conducts programs in basic and clini-cal science, and population and public health studies.
A. O. Fox HospitalProviding a broad spectrum of healthcare, with re-nowned specialties in emergency, cancer, cardiac and primary care, Fox treats the youngest of patients in pediatrics to the oldest with many services for seniors.
O’Connor Hospital has been a member of the Delhi community since 1922, and affiliated with Bassett Healthcare since 1988. O’Connor is des-ignated as a Critical Access Hospital licensed for 23 acute care medical/surgical beds, including extended care “swing” beds for patients await-ing home-based skilled nursing care or nursing home placement.
INTERDISCIPLINARY/INTERAGENCY COLLABORATION• Otsego County Long Term Care Council• Otsego County Office for the Aging Advisory Council• Geriatric Services Committee – Bassett Healthcare Network• Care Transitions Committee – Bassett Healthcare Network• Better Outcome for Older Adults through Safe Transitions (BOOST)• At-Home Care nursing agency and local public health offices• Hospice• NY State Caregivers and Respite Coalition
DISSEMINATION, PROMOTION AND HARDWIRING• Network-wide NICHE meetings evolved into members working in smaller groups with quarterly network-wide meetings• Telephone conferences addressing currents plans and progress. Literature reviews and mini-educational seminars per team members’ requests – i.e.
Hospital Related Sleep Disturbances which led to presentation of Crouse Hospital “Physician’s Order: Sleep Order” to BMC Director of Pharmacy. To date, this is being discussed at network-wide pharmacy meetings.
• Post-fall huddles and care plan updates now required after every fall
EVALUATION/RESULTS• O’Connor Hospital held up as exemplar by JCAHO• NICHE asked to present at all Annual Networking Meetings as a working example of fostering a bridge among our network’s nurses by standardizing
nursing practices• MD ordered NICHE consult at BMC for aggressive, demented patient• Multiple administrators throughout the network verbally hold the NICHE team in high regard• The number of GRNs and GPCAs continues to increase monthly
REFERENCES• Graf MS, APRN, BC, Carla. (2007). The Lawton Instrumental Activities of Daily Living (IADL) Scale. Retrieved from www.ConsultGeriRN.org, try this series.
• Kresevic, RN, Denise M. (January 2008). Nursing Standard of Practice Protocol: Assessment of Function in Acute Care. Retrieved from www.ConsultGeriRN.org.• Rhalimi M, Rafik H, Jaecker P. Medication Use and Increased Risk of Falls in Hospitalized Elderly Patients. Drugs Aging 2009: 26(10); 847-852• Heinze, Cornelia RN MSc; Halfens, Ruud J.G. PhD FEANS; Roll, Stephanie MSc; Dassen, Theo PhD FEANS. Psychometric Evaluation of the Hendrich Fall Risk Model. Journal of Advanced Nursing 2006: 53(3); 327-332
Bassett Healthcare NICHE Team, March 2011
