Time to Care: Common Ways Nurse Time Is Wasted
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Transcript of Time to Care: Common Ways Nurse Time Is Wasted
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Time to CareCommon Ways Nursing Time Is Wasted
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Introduction
Brad White– Title: Operations Improvement Engineer– Description: Implements Lean Six Sigma at Baptist
Health System
Time to Care: Common Ways Nurse Time Is Wasted
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Project Definition
Defect– High nurse turnover & low employee morale
Background– The tele units at BMC were experiencing high
turnover– Nurses said the floor was stressful– Nursing grid was changing from 1-5 to 1-6
Goal– Retain tele nurses
Time to Care: Common Ways Nurse Time Is Wasted
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Observation
• First step in observation is learning what to observe
• Be prepared for the first round of observations to yield little data
• Find a structured yet flexible way to capture data
Time to Care: Common Ways Nurse Time Is Wasted
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Observation FormTime to Care: Common Ways Nurse Time Is Wasted
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Convert to Data
• Two basic forms of observation data:– Process– Work-Time Study
• Convert observation notes into applicable data• Categories the times into various bins• Ask, is this of value?
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CategorizationTime to Care: Common Ways Nurse Time Is Wasted
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Analysis
Time Analysis
Shift Day Night Day Night Average
VA 13.5% 52.8% 7.9% 61.9% 34.0%
Flex 14.0% 7.1% 31.4% 5.4% 14.5%
NVA 72.5% 40.1% 60.7% 32.7% 51.5%
Cost of the Waste $1,530,395/yr
Time to Care: Common Ways Nurse Time Is Wasted
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Spaghetti DiagramTime to Care: Common Ways Nurse Time Is Wasted
• Nurses were walking 750 mi. a year
• That’s like walking from here to Memphis, TN!
• Represents over $10,000 per nurse each year
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Other Data
• What else can be collected?– Staff opinion– Photos– Video– Audio– Anything that can put the environment into
context for your audience
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Waste Pareto
• Detailed analysis will generate a “Waste Pareto”
• This becomes the action items for improvement
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Data AnalysisTime to Care: Common Ways Nurse Time Is Wasted
Med Draw
Discharge
Charting
SupplyAdmit
Monitor T
ele
Chart Search
Chart Review
Error C
orrecti
on
Decypher
Schedule
Call Button
Board
Phone Re-Calls
Call Transfe
rOther
0
20
40
60
80
100
120
140
160
180
200
Wasted Time Analysis(In Hours, per nurse each year)
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Data AnalysisTime to Care: Common Ways Nurse Time Is Wasted
Med Draw
Discharge
Charting
SupplyAdmit
Monitor T
ele
Chart Search
Chart Review
Error C
orrecti
on
Decypher
Schedule
Call Button
Board
Phone Re-Calls
Call Transfe
rOther
$-
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
Wasted Time Analysis(In Dollars, per nurse each year)
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Med Draw Analysis
• Pulling medication was the #1 time waster (tied with discharging)
• The observed reason for delays:– Multiple machines required multiple logins– Centralized location required travel and resulted in
batching– Medication in bins required the nurse to fill the
prescription
Time to Care: Common Ways Nurse Time Is Wasted
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Med Draw Solutions
• Re-balance machines to be patient-centric not drug-centric
• Disperse machines throughout the floor instead of a central location
• Have pharmacy fill each med pass by patient• Install med boxes outside each room
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Discharge Analysis
Admit TimeOrdersto Start
Start to End
End to Leave Total
Mean 77 Mean 125 59 36 220Std. Dev 59 Std. Dev 146 42 63 251
Min 13 Min -155 -55 -10Max 250 Max 665 205 250
N 22 N 58 80 24
Time to Care: Common Ways Nurse Time Is Wasted
7:008:00
9:0010:00
11:0012:00
13:0014:00
15:0016:00
17:0018:00
19:0020:00
21:0022:00
23:0023:59
1:002:00
3:004:00
5:006:00
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Expected Admission Done
Expected Discharge Start
Admit Done
Discharge Start
1
2
3
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Discharge Solutions
• Collect proper information early in the process• Prepare for discharge by completing patient
education prior to discharge orders• Eliminate unnecessary paperwork in the
discharge process
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Key Lessons
• Nurse time not spent at the bed time is waste– Nurses aren’t happy– Patients aren’t happy– Management isn’t happy
• Poor staffing is concealed with busy work so cost are hidden and a paper profit is shown
• High turnover is expensive, drains morale, and decreases patient satisfaction and safety
• The answer is rarely more staff or more equipment, but rather better layout and processes
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Is This of Value?Time to Care: Common Ways Nurse Time Is Wasted
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• Questions?