Potty training pants, infant potty training, toilet training chart, how to potty train a child
C716 Laurie Smith• Hourly Rounding with a Purpose • Four P’s- Pain, Potty, Position, Personal...
21
09/09/2013 1 Session C716 2013 ANCC National Magnet Conference® October 4, 2013 0930-1030 Laurie L. Smith, MSN, RN, CEN, CNML Jennifer Tafelmeyer, BSN, RN, PCCN Robin Wicks, MSN, RN, PCCN Billings Clinic, Billings, MT • Hospital Wide and Unit Fall Prevention Program • Liberating Structures • Our Unit Results • Questions Overview Billings Clinic • Multi specialty – integrated organization • Largest healthcare organization in the region • 272-bed hospital • Certified Chest Pain Center • Joint Commission Accredited Advanced Primary Stroke Center • ANCC Magnet Recognition® in 2006
Transcript of C716 Laurie Smith• Hourly Rounding with a Purpose • Four P’s- Pain, Potty, Position, Personal...
09/09/2013
1
Session C7162013 ANCC National Magnet Conference®
October 4, 2013 0930-1030Laurie L. Smith, MSN, RN, CEN, CNML
Jennifer Tafelmeyer, BSN, RN, PCCNRobin Wicks, MSN, RN, PCCN
Billings Clinic, Billings, MT
• Hospital Wide and Unit Fall
Prevention Program• Liberating Structures• Our Unit Results• Questions
Overview
Billings Clinic
• Multi specialty – integrated organization• Largest healthcare organization in the region• 272-bed hospital• Certified Chest Pain Center• Joint Commission Accredited Advanced
Primary Stroke Center• ANCC Magnet Recognition® in 2006
09/09/2013
2
• 29 bed telemetry/step down unit
• Staff: Patient ratio• RN Days 1:3-4, Nights 1:4-5 • CNA Days 1:9, Nights 1:14
Ambulatory Telemetry Unit (ATU)
Our Fall Reduction Journey
• Interdisciplinary team• Fall assessment tool
• Completed on admit and every shift• Interventions related to each score
• House wide education, direct care providers and ancillary staff
• Identify patients at risk- signs, wrist bands, slippers
• Post Fall Huddles
Our Fall Journey 2008
09/09/2013
3
• Clarified definition of a “Fall”• “Call Don’t Fall” signs in rooms• Patient and family education• Accessibility of equipment• Hourly Rounding with a Purpose
• Four P’s- Pain, Potty, Position, Personal items
• Pizza party if 45 days without a fall
Our Fall Journey 2009
09/09/2013
4
• Standardized whiteboards in rooms• Increased unit staffing• Added a 5th “P”- Protection
Our Fall Journey 2010
• Reducing Unit Falls (RUF) Team• Reviewed and categorized every fall
• Anticipated, Unanticipated Physiological, Accident, Intentional
• Increased availability of safety equipment• Developed RUF Award
Our Fall Journey 2011
09/09/2013
5
Comprehensive Fall Prevention Program
Falls prevention program• Interdisciplinary team
Accurate and concurrent reporting
Staff education• Clinical and non-
clinical
Education for patients and families
Fall risk screening
Linked interventions• Hourly Rounding
Learn from events• Post Fall Huddles
Safe environment• Accessible equipment
• Karaoke deal
• Donna Wright’s Ongoing Competency Model• Partnership Council selected fall prevention• RN’s and CNA’s• Modality for validation
Going to the next Level
09/09/2013
6
What…just…happened?
• A “menu” of 33 microstructures • Adaptive• Innovative• Unconventional• Simple• Cost efficient
Source: Liberatingstructures.com
What are Liberating Structures?
09/09/2013
7
http://www.liberatingstructures.com/ls-menu/
• Co-Founder Social Invention
Group• 1992-2000 Health Forum (HF)-
San Francisco• Executive Director-Foundation
for Health Care Quality-Seattle• Masters in Management of
Human Services
Keith McCandless
Source: http://www.liberatingstructures.com/keith-mccandless
• Retired from Merk-1998-President of
Intercontinental Region and Japan• 2000-Co-founded Plexus Institute (Chairman
of Board until 2010)• MS-Industrial Engineering & Management• MS-Chemical Engineering
Henri Lipmanowicz
Source: http://www.liberatingstructures.com/hl-about/
09/09/2013
8
• Breaking through orthodox methods• Encouraging innovation• Small changes=big results
Disruptive Innovations
Source: http://www.liberatingstructures.com/ls-disruptive-innovation/
• Wise Crowd• Fish Bowl• TRIZ• ATU
• Carnival theme for skills day• Karaoke deal• TRIZ
Billings Clinic
“Voices emerge that otherwise are not heard.”
~Carlos Arce, Chief Learning Officer, Billings Clinic
To be heard…
09/09/2013
9
• Cultural foundation
• In conjunction with quality improvement programs
Foundation
• “Creative Destruction”• Russian acronym for “Theory of Inventive
Problem Solving”• Teoriya Resheniya Izobretatelskikh Zadatch• Developed between 1946 and 1985• Study of patterns
TRIZ
Source: http://www.liberatingstructures.com/6-making-space-with-triz/http://www.mindtools.com/pages/article/newCT_92.htm
TRIZ
09/09/2013
10
• Make the list individually first
• Then list together• Everyone contributes• Groups of 2-8
TRIZ
Source: http://www.liberatingstructures.com/6-making-space-with-triz/
• 3 segments of 10 min each
1. Worst result possible2. How does this compare?3. Steps to stop the madness
Source: http://www.liberatingstructures.com/6-making-space-with-triz/
Timing
09/09/2013
11
• “Speak the unspeakable”• Promote creativity and innovation• Fun!• Helps to remove barriers
Why TRIZ?
Source: http://www.liberatingstructures.com/6-making-space-with-triz/
• “Enter with the spirit of fun”• Not to start new things• Gain insight to removal of barriers• Begin with the undesired result• Open dialogue• Include front line staff
Tips from Keith & Henri
Source: http://www.liberatingstructures.com/6-making-space-with-triz/
Tip from
Laurie~Be
Patient!
09/09/2013
12
• What is it that WILL be stopped?
• List those decisions
• Use other exercises
Commit
Source: http://www.liberatingstructures.com/6-making-space-with-triz/
• Keep results alive
• Ongoing data review
• Ownership of data
• Involve front-line staff
• Long term plan
Control Plan
09/09/2013
13
How does it feel when your patient falls?
• “Assessment, Plan of Care, and Appropriate
Interventions in Effective Fall Prevention”• Modality
• Mock scenarios, discussion droup, TRIZ
• Staff sign up, 6 per group• Empty patient’s room on our unit
Annual Competencies
Patient Room
09/09/2013
14
• Identify patients at risk for falling
• Diagnoses• Medications• Environmental• Other Factors
• TRIZ• “If you wanted your patient to fall, what would
you do?”
Fall Competency
Call light out of reach
Tangled cords
Dark Room
Cords
Tripping hazards
Safety Equipment
09/09/2013
15
Bed in the air
Water
Urinal
Linen on floor
Clutter
Water
No information
09/09/2013
16
Fall Competency
• Physically made the patient room unsafe
• Verbalized other factors
• Verbalized scenario additions
• The big question:
“Have you ever done any of these?”
Fall Competency
• Hurrying• Not enough time• Diligent• Multitasking• Not being present• Not noticeable
How does this happen?
09/09/2013
17
• Have you had a patient fall?
• How could this have been prevented?
• Valuable-self discovery leads to change
Staff Stories & Solutions
• 42 y.o. male• Admit diagnosis: CVA• Left side flaccid• A&O• Needs to have a bowel
movement• Wants privacy
Case Scenario
Fall Competency
• Staff identified barriers• Staff discussed their fall
experiences• Staff identified
solutions• Discussed difficult
situations• Reviewed fall
precautions, 5 P’s
09/09/2013
18
“It was a fun & engaging way to make us aware of what our
patient’s fall risks are.”
“Doing the Fall Competency was a great way to visualize
fall risks that we don’t realize are there & made us more
aware.”
Megan Verseman, BSN, RN, PCCN
Kendall Eliasson, BSN, RN
Angela Wong, BSN, RN, PCCN
“It was helpful to take time to discuss our ATU specific barriers that exist in regards to patient falls. By setting
up a mock scenario, we were able to brainstorm & collaboratively point out
those barriers.
Jessica Knickerbocker, CNA
“Doing our fall competency in an actual patient’s room was very beneficial as we could see real hazards to look out for and avoid that would most likely be unseen if we were just to talk about them in a roundtable discussion. This is because we are more aware of real life scenarios on our floor rather then just written ones.”
Darrin Peplinski, BSN, RN, PCCN
“The Fall Competency increased my observation
skills of what puts my patients at risk for falling.” Teneka MacKensie, CNA/MC
“The actual visualization & doing in the room was a good
learning tool for me.”
09/09/2013
19
• Fun & interactive
• Self reflection
• Barrier awareness
• Practical solutions
Staff Feedback
Patient Falls: Results
0
1
2
3
4
5
6
Patient
Falls
ATU Falls
Series1
Linear (Series1)
• Maintaining
• Reviewing falls & continued celebration• Staff ownership
• Identified opportunity-new staff• Implement initial • Ongoing clinical narrative
The Plan
09/09/2013
20
• Organizational Journey for Effective Fall
Prevention
• Use of Liberating Structures
• Unit Competency
• Staff Involvement & Think Outside the Box!!
Summary
Questions?
• Lipmanowitz, H., & McCandless, K. (n.d.).
Liberating Structures. Retrieved July 24, 2013, from www.liberatingstructures.com
• Wright, D. (2005). The ultimate guide to Competency Assessment in health care. (3rd
ed.). Minneapolis, MN: Creative Health Care Management, Inc.
References
09/09/2013
21
• Laurie L. Smith, MSN, RN, CEN, CNML
Manager, ATU-Billings Clinic (406) [email protected]
• Jennifer Tafelmeyer, BSN, RN, PCCNClinical Coordinator, ATU-Billings Clinic(406) [email protected]
• Robin Wicks, MSN, RN, PCCNNurse Clinician, ATU-Billings Clinic(406) [email protected]
Thank you!
