COMPASSIONATE CARE MODEL

Carole Siegfried MS RN NEA-BC

HOW WE BEGAN

Our Team

Nurses and Managers from each unit wanting to participate (11west, 10 east, 10 west, 8 east)

CNO

Education

Director of Nursing

Ad Hoc as necessary

Reviewed literature summary

IDENTIFIED WHAT WAS NOT WORKING:

Ratios

Team work

Communication

Inconsistencies in processes

Fragmentation in care r/t staff schedules

Nurses not doing nurses work

Gaps in documentation

Med errors

Med delivery

Falls

Harm Index

Competency

Complete documentation

IT support for learning and problem solving

Increased LOS

Throughput

Pain management

TRIAD MODEL

Discussed and defined the model as a triad of

staff caring for a subset of patients within each

unit.

This subset of patients would be geographically

located within the unit

The team would be centralized in the geographical

location of the subset of patients.

Defined work needs to be done by whom

RN Care Provider

Support Care Tech

RN Care Coordinator

Case Management

Physicians

Supply

Respiratory

Dietary

Environmental

Engineering

Chaplaincy

Information Technology

Radiology

Laboratory

Surgery

Volunteers

Pharmacy

The Compassionate Care Model “Partners in Care”

Patient

Compassionate Care Model: A modernized team approach to care.

Charge Nurse does not have a patient assignment and will continue to function as current model

Special Notes RN Care Coordinator RN/LPN Care Provider Support Tech Care Provider

Team goal: Provide patient centered care as a team. Team covers each other in the scope of their role. Each member is responsible for documentation Shift start: All shifts start at 7 Report: Report at bedside using cerner tools. Team introduced to pt at report. White Boards: Team info added at report time. Lunch: 3 separate 30 minute time periods Hourly Rounding All staff participate in hourly rounding

PLAN for the DAY and STAY Utilizes the nursing process to coordinate, plan, and evaluate care needs of patient. Partners with the interdisciplinary team to deliver on the promise of world class care Assessment (initial and ongoing) of patient and plan of care; Completes Med by History/Med Rec Ensures PowerPlans are initiated and completed. Ensures communication types are correct Ongoing assessment and evaluation of quality care/initiatives (quality dashboard/lighthouse), patient needs; updating plan of care Safety and Risk assessments; Restraint plan of care Interdisciplinary team coordination Discharge Education Evaluate readiness for discharge MD rounding; Consistent rapport with physicians Primary communication link to charge nurses re: patient needs

PROVISION of CARE Partners with the RN care coordinator to deliver care and gather data Functional Roles Coordinated Ensure vital signs and waive testing is completed Reviews labs Medication Delivery**

- Ensures IV guardrails are used Pain Management Tube Feedings Treatment/Procedural

- Wound care - Line dressings (peripheral and

central**)

- Device changes - Blood administration**

Attends patient transports when nurse required Discharge Education

- Medication - New equipment

PROVISION of CARE Assistive support; Functional assistive assignments; Gathers data for care team Intake and Output Simple Procedures

- Application of heat/cold - Simple dressings - Blood glucose - Vital signs - Phlebotomy (as defined by the unit)

ADL tasks

- Feeding - Ambulation - Elimination - Positioning/Turning - Baths

Environmental Rounds; Maintains Safe Environment; (bed alarms, bedside tray, call bell in reach, phone…) Cleans equipment Stocks rooms/gather supplies; Run patient errands Assists with patient transports Provide world class service

- Pass ice - Alarm silence - Keeps patient awake during the day - Implement activities to reduce delirium like

companionship - Implement activities to help with relaxation

like back rubs

- Meal/snack delivery

**If LPN - IVP meds, central line drsg, blood administration completed by RN care coordinator Float Nurse (used with uneven teams) Assignments will be based on patient needs and staffing

STAFF EDUCATION AND COMMUNICATION 8 hours education per staff

Professionalism and lateral violence

Teamwork and Communication

The Model of Care

Role and Responsibilities

Communication Nursing Congress

Leadership

Unit Based

Fliers

Med Notes

Nursing News Letter

Physician Department Meetings

Posters

Coordination team

LOGISTICS

Medication Administration at point of care

Testing servers and med drawers on COWS (BMW)

Developing staffing grid; remaining staff neutral or

gaining some efficiencies

Identifying roles of each team member

WIFM

Time and Motion study

Determining what if’s

Day Shift

6132 - 3rd 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

7AM

SHIFT

12 RN

Charge 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

12 RN

care coordinator 1 1 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 3

12 RN

care

Provider 1 1 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 3

12 RN

Float 1 1 1

12 hr

NT/PCA 0.7 1 1 1 1 1 2 2 2 2 2 2 2 2 2 3 3 3

Sec 0.5 0.5 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Night Shift

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

RN Charge 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

RN care

coordinator 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 3 3 3

RN care

Provider 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 3 3 3

RN Float 1 1 1 1

NT/PCA 0.5 0.5 1 1 1 1 1 2 2 2 2 2 2 2 2 3 3 3

Sec 0.7 0.7 0.7 0.7 0 0 0 1 1 1 1 1 0 0 0

REPORT

Off-Going shift

RN Care Coordinator

On-Coming shift

RN Care Coordinator

RN Care Provider

RN Care Tech

At the bedside

Review Mpages

Nurse Summary

Communication

Orders

Visual of patient

Message to patient

We are your care team for

today. Our goal is to provide

extraordinary care to you...

Update Whiteboard

TIMELINE Topic Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

Begin discussions of model of care X X X

Bring team together in MSS X X

Determine roles of model team memebers X X

Develop survey for staff X

Identify Equipment and Order X X

Begin development of Marketing Plan X X X

Begin development of education plan X X X

Implement marketing and education Plans Unit 1 Unit 2 Unit 3 Unit 4

Implement Survey X unit 1 X unit 2 X unit 3 X unit 4

Implement Model Pilot X unti 1 X unti 2 X unti 3 X unti 4

Re survey staff X unit 1 X unit 2 X unit 3

MEASURES OF SUCCESS

Quantitative Call light study

Staff survey

Time and Motion

Qualitative Harm Index

HCAPS

Response to call light

Nurses communication

DISCOVERY CONSISTS OF SEEING WHERE

EVERYONE HAS BEEN AND THINKING WHERE NO ONE HAS THOUGHT