Modified Modular Nursing10 West Care Delivery Model

ByEllen Babilon, ADN, RN, CMSRN

and Lisa Evert BSN, RN

Modified Modular Nursing

A method of making patient assignments based on geographical location with consideration given to the acuity level of each module assignment.

Implemented September 28, 2012 day shift!

Why go to Modified Modular nursing?

• Increase in patient safety• Increase in patient satisfaction• More continuity of care• Addresses all components of our HCAHPS

scores! ie nurse responsiveness, call bell answered, pain managed, less noise, etc

• Less area to travel• Less people to have to wait to give and

receive report• Assignments address acuity

Why go to Modified Modular nursing?

Increases staff accountability

Modified Modular nursing demonstrates a model of excellence in which the “it’s not my

patient!” mentality is no longer tolerated.

Why go to Modified Modular nursing?

The numbers don’t lie………

During the original pilot of Modified Modular nursing beginning November 2011, fall rates on 10 West dropped from approximately 6 falls per 1000 patient days to <1 fall per 1000 patients days only to have them rise again to >4 falls per 1000 patient days after the pilot ended.

Why go to Modified Modular nursing?

Why go to Modified Modular nursing?

• The institutional goal is 3 falls or less per 1000 patient days.

• Modified Modular nursing is one component in an overall fall prevention initiative on 10 West.

• Modified Modular nursing allows you to be closest to your patients enabling quick response to chair and bed alarms.

Why go to Modified Modular nursing?

• Purposeful hourly rounding is an MUSC standard. Modified modular nursing keeps you close to your patients, making rounding easier.

10 West Fall Prevention Initiatives

• Education of patients and their families

• Staff accountability, signing attestations stating the understanding of the FIRM Ground Program

• Modified Modular Nursing

• Signage strategically placed in patients rooms reminding our confused patients to call for assistance

MODIFIED MODULAR NURSING ASSIGNMENTS - RN

MODIFIED MODULAR NURSING ASSIGNMENTS - RN

MODIFIED MODULAR NURSING ASSIGNMENTS - RN

MODIFIED MODULAR NURSING ASSIGNMENTS - PCT

MODIFIED MODULAR NURSING ASSIGNMENTS - PCT

Buddy System……

Implement the buddy system between RNs and PCTs. The module with the highest acuity will be ‘buddied’ with the module with the lowest acuity. RN and PCT will directly call their ‘buddy’ for help.

Buddy System…

• RNs and PCTs will cover their ‘buddy’ for breaks and lunch.

• Buddy assignment will be written on the white board across from the nurses station.

• All breaks recorded on white board with one 30 minute lunch break allowed. Breaks are to be taken away from the nurses station to cut down on traffic and noise.

Assigning Acuity to Each Module

MODIFIED MODULAR NURSING ASSIGNMENTS

RECOMMENDATIONS The expectation is for the RN and PCT to be continually

positioned at their ‘Anchor Station’ during their shift. This will improve visibility to patients and families and improve call bell response time. Stations will be assigned according to team assignment. The charge nurse’s anchor station will be the nurses station. On night shift, Module B’s anchor station will also be the nurses station to assist with answering phones and call bells.

10 West Anchor Stations

Lessons Learned• Resistance from the staff when this Care Delivery Model first presented by

Shared Governance, not a lot of buy-in.

• Major staff concern included equity of assignments.

• Staff able to voice concerns via an anonymous survey after this model was in place for 5 months.

• Although not as popular with the staff as envisioned, 82% of staff agreed, based on this survey, that this care delivery model affords greater access to nursing staff by patient, families and other disciplines and 59% agree that it provides for greater efficiency.

• 50% of staff surveyed also felt the MMN was instrumental in reducing falls.

Lessons Learned• Based on survey results, a dialogue was initiated between leaders

and staff members soliciting suggestions for improving this Care Delivery Model.

• Per staff suggestions, small changes were made in how future assignments were made, i.e. swapping empty rooms with occupied rooms in adjacent modules, coaching staff members in lateral delegation, etc.

• A change in culture was necessary that focused on patient centered care and required staff being comfortable with lateral delegation (buddy system)

• New survey administered 17 months after the implementation of MMN.

And the culture changed……• 94% of staff surveyed stated that Modified Modular

Nursing provides greater safety for their patients as opposed to 47 % on the original survey.

• 100% stated that they enjoyed practicing MMN as opposed to 29%.

• 69% stated that they were comfortable in delegating to their buddy as opposed to 41%.

• 69% stated that delegating to their buddies helped to provide equality in work assignments as opposed to 23%.

HCAHPS

Although it in theory it would seem that certain components of our HCAHPS scores would improve, this proved not to be the

case.

Where Are We Now?!?!?

• In the 3 months prior to implementation of Modified Modular Nursing, fall rates on 10 West were approximately 2.1 falls per 1000 patient days.

• In the 3 months following the implementation of Modified Modular Nursing, fall rates have decreased to 1 fall per 1000 patient days.

Where Are We Now?!?!?

17 Months Later……

Since June of 2013, 10 West fall rates have remained low at 1.22 falls per 1000 patient days

17 Months Later……

ConclusionsIMPROVED:•Decrease in patient falls

•Greater availability of staff to patients, families, and other interdisciplinary team members

•Greater ease in purposeful hourly rounding which is an MUSC standard.

•Less noise and traffic at the nurses station

•100% compliance with blood glucose rechecks

MUSC Nurses Professional Practice Model

Questions or comments???

Copies of presentation can be emailed to interested parties.

babilone@musc.edu