Includes

Pitt County Memorial Hospital Greenville NC

Brody School of MedicineEast Carolina University

Six communityhospitals in eastern NC

Pitt County Memorial HospitalTotal beds - 761 with CON approval to add 116 more beds(includes adult floors)

Women’s – 38 beds for postpartum 8 beds for antepartum

Labor & Delivery – 23 beds

New Born Nursery – 42 beds

Convalescent newborn unit – 16 beds

Pediatrics – 32 beds

PICU – 12 beds

NICU – 50 beds

Pitt County Memorial Hospital, is a not-for-profit, tertiary care centercovering the 29 counties of eastern North Carolina and is one of five academic medical centers in North Carolina. PCMH is the teaching hospital for Brody School of Medicine at East Carolina University.Many of our counties are living at or below the poverty level.The state poverty rate is 12.3 while most of eastern NC is at15 to 24%.

NC prosperity is threatened by having a region (eastern NC)that has 10 of the poorest counties of the nation’s top 20 poorest counties.

NC – 1 in 4 have a college degreeEastern NC – 1 in 6 has a college degree

Eastern counties are dependent on agriculture and there are fewer high paying manufacturing job opportunities inthe east.

Common barriers to health care in eastern NC

Economically underserved

• Medically underserved

• High health care cost

• No insurance or under-insured

• Literacy rate

• Transportation

Measuring the region by years of life lost before age 75, if eastern North Carolina were a state,it would rank 49th.

Infant Mortality Rate

NC rate – 8.8 per 1,000 live births

Minority infant mortality rate dropped by 4.5%, from a rateof 15.6 deaths per 1,000 births in 2004 to 14.9 in 2005.

The minority rate is still more than double the Caucasian rate.

Caucasian mortality rate increased from 6.2 in 2004 to 6.4

Pitt County – 9.4 per 1,000 live births

Bertie County – 17.4 per 1,000 live births

Edgecombe County – 15.3 per 1,000 births

Greene County – 14.9 per 1,000 births

Halifax County – 13.0 per 1,000 births

Lenoir County – 15.5 per 1,000 births

Martin County – 24.6 per 1,000 births

Washington County – 17.5 per 1,000 births

Prematurity and low birth weight accounted for 20% of deaths ofinfants under 1 year old.

28% of the deaths of babies were under 28 days old.

17% of infant deaths were due to birth defects.

Sudden Infant Death Syndrome (SIDS) accounted for nearly 10% ofthe deaths.

High quality prenatal care cannot compensate for a lifetime of poor health, for unhealthy behaviors such as smoking, poor nutrition orpoor physical fitness and limited access to ongoing high quality health care.

NC has a high rate of:

Heart disease

Stroke

Diabetes

Obesity

Other chronic health problems

NC per capita spending for public health is among the lowest in the nation.

Ways we have implemented PFCC

Child Life Mission

To provide developmental and emotional support to children and families facing a

healthcare experience.

Child LifeAreas Serviced

• Pediatric Unit• Pediatric Intensive Care Unit• Neonatal Intensive Care Unit• Sedation Services• Emergency Department• C5 Clinic• Radiology• Convalescent Newborn Nursery• Women’s Services• Consults to adult areas

Child LifeStaffing

• 11 FTE Certified Child Life Specialists• 1 PT CCLS• 3 PT Child Life Assistants• 1 FTE Supervisor• Volunteers, students

Child LifeImplementing PFCC into Practice

• Family presence during procedures• Positioning for Comfort• Sibling involvement in hospital experience• Patient/Family participation (daily schedules,

interventions, pain, etc.)• Liaison with communication • Child advocate in adult areas

Family Support Network Eastern NC, Inc.

Providing emotional support and resource information for families who have a child with a disability, chronic illness, premature birth and for

families who have experienced the death of a child.

* 1987 – Parent support began in local community 20 hours a week

* 1990 – Parent hired to provide support to other families in Neo-natal Intensive Care Unit (15 hours a week)

* 1991 – Expanded services to include all of Children’s Hospital (25 hours a week)

* 1992 – Expanded services to include mom’s on bedrest at risk for premature delivery (Hired 2nd hospital employee)

* 1994 – Bereavement Support

Family Support Network Eastern North Carolina

Family Support Network Eastern North Carolina

* 2007 coverage includes Children’s (NICU, Peds, PICU, NBN)

Women’s Trauma (referrals) Emergency Department (referrals)

Adult floors (consults cardiac, cancer, trauma) Continuum of Care from Hospital to Home

* 11 employees (parents) 5 - full time

4 - thirty (30) hours a week2 – less than 20 hours a week

Volunteers and Student Interns

* National Pierson Award Recipient for exemplary services for children with disabilities.

Pediatric Asthma Program * 1994 High School senior with a 12 year history of asthma collapsed after band performance during football game. Inadequate access to rescue inhaler.

* Pediatric Nurses and parent of student took the message to officials at the Administrative Office

* Asthma Education and access to medications mandatory in all Pitt County Schools

* 2006 Recipient of “Emerging Champion of Change in North Carolina Medicine”

Bereavement Support

* 1994 – Families shared their stories

* 1995 – Our Children’s Garden Cherished Lives Memorial Service

* 1996 – Quilt of Memories

* 1997 – Memory boxes

* 2007 – Palliative Care Room

C5--The Center for Children with Complex and Chronic Conditions

The mission of C5 is to promote optimal health, growth, development, safety, comfort and overall well-being for children with special health care needs. Respecting the central role of the family in a child’s life, C5 provides resources and supports systems of care that link the child, family, primary care medical home, appropriate medical specialists and the community in which the family lives.  

C5--The Center for Children with Complex and Chronic Conditions

• Started with input from families.

• Involved in development of pre-visit contact, care plans and satisfaction survey.

• Patients and families participate in quality improvement.

C5--The Center for Children with Complex and Chronic Conditions

• Pre-visit contact---frames visit to address patient/family concerns, goals (home, school, transition, activities, etc.)• Care plan—developed collaboratively • Satisfaction survey—open, clear communication, adequate time to discuss concerns and questions, equal partner, etc.

What kind of directions are given?

We need to hear from our familiesto make sure we are going in the

right direction.

Family Involvement

* Family Resource Room (co-chair)

* Cherished Lives Service

* Palliative Care Room

* Visitation - 24/7 open unit to parents in NICU, Peds, PICU, Newborn nursery

* Hospital PFCC Steering Committee

* Infection Control

* Rehab committees

* Children’s hospital design and remodeling

* Presence during resuscitation (Children’s) Adult ICU sporadic

* Free parking for bereaved families

* Cardiac Intensive Care Developing Family Advisory Council

* Hematology/Oncology beginning to incorporate family input into their practice.

Due to having such a large geographical area and the many variablesto participation we have families serving in the following ways:

• Attending meetings

• Email participation

• Phone calls

• Surveys

• Reading over materials and submitting their comments

Pediatric Intensive Care Unit Sentinel EventMom – hospital employeeDad – police officerChild – under 1, history of developmental delays muscle weakness

Admitted to hospital unknown diagnosis- didn’t want to mask symptoms - involuntary movements causing loss of lines- steroids and pain medicines over 2 months

* Infant restraints – new bed and restraints were too short to tie under mattress, so tied to side rails

* Injury- wrist broken and not noted until weeks later

* Transparency- family involved in determining when and

how the wrist was broken - child had been transferred to another

hospital in another state and back to PCMH during the two months of being hospitalized

- Dad remembered the restraints

Restraint Company called – no one made infantrestraints long enough for the new type bed.

* Results - changes in infant restraints nationally - infant restraints are being made 6

inches longer

How do we know if we are making a difference with staff and families?

How can we measure the results?

Many hours of research and documentation.

Staff Survey: Patient- and Family-Centered Care IndexOverall Summary Results from Fall 2005 and Fall 2006

2005(n)=268 / 2006(n)=257

 Theme

 Current Practice

2005

 Current Practice

2006

 Desired Practice

2005

 Desired Practice

2006  

Mission 

4.93 

5.22 

7.02 

7.12 

Collaboration 

4.72 

4.96 

7.13 

7.23 

Plan of Care 

4.80 

5.08 

7.04 

7.18Patient/Family

Strengths  

4.69 

4.89  

7.06  

7.16

Meetings/rounds

 3.63

 4.06

 6.35

 6.76

Staff Education

 3.94

 

 4.48

 6.75

 7.06

 Theme

 Current Practice

2005

 Current Practice

2006

 Desired Practice

2005

 Desired Practice

2006

 Visitation

 5.22

 5.72

 6.78

 7.08

 QI

 3.56

 4.09

 6.59

 6.76

 Medical Record Access

  

3.78

  

4.22

  

5.85

  

6.24

 Cultural

Competence

  

4.48

  

5.01

  

6.99

  

7.27

 Environmental

Design

  

3.55

  

3.86

  

6.87

  

7.06

• Current and desired practice levels increased from 2005 to 2006 in all themes.• Visitation and mission identified as our strongest current practices.• The highest “desire to change practice” themes for 2006 are pt/family involvement in environmental design and rounds/discharge planning.

The table below represents responses to the following question: How familiar are you with the elements of patient and family-centered care as defined by the Institute of Family-Centered Care?

Response 2005 2006

 No answer

 2.24%

 3%

 No knowledge

 13.06%

 7%

 Some knowledge / not

applied to practice

  

.37%

  

.5%

 Knowledgeable / concepts

sometimes applied

  

55.23%

  

45%

 Knowledgeable / concepts

regularly applied

  

29.10%

  

44.5%

 • Decrease in “no knowledge.”• Significant increase in “concepts regularly applied.”

Patient/Family Survey: Children’s and Women’s Patient Satisfaction ResultsApril 18, 2006 thru September 26, 2006 (N=227)3.00-3.99=Satisfied Most of the time / 4.00 = Satisfied Completely

 

Patient/Family member perception

Overall average

Patient/Family member perception

Overall average

Kept Informed about condition/status

3.86 Talked about goals with providers

3.82

Felt Welcomed 3.90 Staff professional and prepared

3.84

Treated with courtesy and respect

3.89 Staff cared about patient 3.88

Assured Privacy 3.89 Patient needs were met 3.81

Doctor was available 3.84 Treated or had pain relief 3.83

Patient was a partner in his/her care

3.85 Provided education and support for discharge

3.91

This survey tool has been shared with the Perinatal Quality Collaborative of North Carolina(PQCNC) and is being considered as a toolfor NICU’s across the state that are involvedin PQCNC.

PQCNC is looking at PFCC for all hospitals in NC* Discussions are taking place around the following areas:

- Families on rounds- NICU Advisory Councils- Visiting hours- Sibling access to visit- Kangaroo Care, etc.

We are still on the journey.

We learn daily from patients and families.

Hospital administration - making changes to ensure families, patients and visitors leave our hospital satisfied.

PCMH Admission book now titled “Information for Patients, Families and Visitors”

Opening of PCMH Admission book reads:

“At PCMH, we believe that caring for you means involving your family. Therefore, we encourage family members to take an active role in the care of their loved ones whenever possible.”

Regional Rehabilitation Center at PCMH

“The process of rehabilitation requires the best efforts of an experienced, integrated patient care team. Patients and their families form the core of our teams.”

PCMH Rapid Response Team—Team H

“Team H is a program that includes family members as part of the care team….. When a nurse or family member is concerned about a serious medical change in the patient such as bleeding, difficulty breathing or when something doesn’t seem right, they can call Team H….We appreciate family participation as we strive to care for your loved ones.”

The Ride Home

“As a tertiary care hospital in rural eastern North Carolina, many of our patients and their families have a long ride home at the end of each stay. Imagine what that ride must be like and what the patient and their family are talking about. They are talking about their experience at our hospital. On that ride home, they are talking about you and me. Are we doing everything possible to make sure that as our patients and their families remember their experience at PCMH that their story is positive? We have a great hospital and an opportunity to create a wonderful story of caring, healing, compassion and service for our patients and families.”

Stephen LawlerPresident, PCMH

Contact information:

Brenda Boberg252-847-5120bboberg@pcmh.com

Amy Jones252-847-6836amjones@pcmh.com