Implementing Proactive Care Rounding in a Skilled Nursing Facility

1. Implementing Proactive Care Rounding in a Skilled Nursing Facility Bryan K. Lindsay University of Kentucky Martin School of Public Policy and Administration Masters in Health Administration Capstone Project Spring 2008

2. Introduction • Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction and Safety – Dr. Christine Meade • Desirable outcomes Call light use Falls and skin breakdown episodes Higher patient (and employee) satisfaction • Proactively meeting routine needs at routine intervals

3. Organizational Setting • Pine Meadows Health Center • 120-bed skilled nursing facility in Lexington, Kentucky • A well-established environment for change

4. Background Information

5. Challenges for Change in a Skilled Nursing Facility • High turnover • Quality improvement efforts disconnected • Lack of education • Lack of experience with best practices and the scientific method • Lack of initiative to improve skills • High regulatory environment • Almost derailed our project after one week

6. Plan of Attack • Review other successful change attempts in long term care: • Reduce falls • Skin breakdown • “Sun-downing” behaviors • Need to find a way to SUSTAIN proactive care rounding

7. Plan of Attack • Take it slow – take time to develop necessary support • Data Collection Tools • Care Giver Interviews • Call Light Tracking • Quality Indicator Reports • Care Giver Surveys

8. Data Collection Tool

9. Problem: Too many call lights to attend to and not being able to get to them quickly enough. Lack of teamwork Meal time mayhem Under- staffed Constant interruptions Always the same people Can’t care for truly needy Fishbone Diagram Data Collection Tool These are now “their” problems and not “my” problems

10. Data Collection Tool Force Field Diagram

11. Results

12. 45 % of all call light usage Results Butonly 25% of the day

13. 65 % of falls Results 50 % of the day

14. Implementation Methods

15. Implementation Methods • Development of a Steering Committee • Nurse aides Licensed nurses Dietary aides Housekeeping aides Unit coordinator Activities director Admissions coordinator Director of nursing Facility administrator Nursing home residents • This is my “power group” with the ability to make decisions and effectuate change

16. Implement a proactive care rounding team, incorporating principles associated with resident centered care Cross train every employees so that everyone helps Recommendation 1

17. Adjust diuretic residents’ eating and toileting schedule to remove potential for care giver overload The current system perpetuates problems of increased demands at busy times of the day Recommendation 2

18. Recommendation 3 • Add a few questions to the already practiced “turning schedule” - Proactively address routine needs when the care giver is already in the room

19. Focus on individuals with increased demands “Sundowner” solution Recommendation 4

20. Increase communication with residents regarding their care schedule Residents should know when to expect help Recommendation 5

21. Hire an additional nurse aide for the busier hours of the day or allow shifts to overlap Give specific instructions to provide care rounding and additional help at strategic times and places Recommendation 6

22. Recipe for Success Ability to Sustain the program over time Steering Committee Decisions: Individuals who have the ability to make changes and see the project through until completed Care Giver Suggestions: Discovery of the real problems My Ideas: Collected and Communicated data

23. Lack of time – The actual Proactive Care Rounding was not actually implemented Accuracy of call light tracking cannot be guaranteed Results were presented as percentages rather than actual numbers “Other” category could be more specific in the future It will be difficult to prove that the number of call lights was actually reduced Hospitals had better success with this because of built in call light tracking systems Limitations

24. Acknowledgements • Dr. Sarah Wackerbarth – Capstone Committee Chair • Dr. Joseph Fink – 2nd Committee member • Dr. Martha Riddell – Committee Member/Reader • Joni Gosser – Director of Operations of Louden & Co, Inc • Scott Stanton – Manager of Service Excellence – Kosair Children's Hospital • Matt Sevier – Paragon Healthcare Group

25. Courses Used in Completing This Project • HA 602 – Managing Change and Strategic Planning • HA 628 – Human Resource Management • HA 642 – Organizational Leadership • HA 601 – Introduction to Health Care in the USA • HA 623 – Decision Analysis • HA 604 – Health Law • HA 624 – Health Information Systems

26. Questions