1. © The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 The Expert In The Room: Engaging Family in Direct Care The Johns Hopkins Armstrong Institute for Patient Safety and Quality Rhonda Malone Wyskiel rmalone1@jhmi.edu

2. How many of you have been a patient or had a loved one in the hospital? What kinds of things did you do while you were visiting? –Likely watched T.v, read newspaper, computer Armstrong Institute for Patient Safety and Quality 2

3. What could have improved the experience? What if the nurse had invited you to help? What if you built a relationship where you were a trusted member of the healthcare team? Armstrong Institute for Patient Safety and Quality 3

4. Why are you doing this? Exercise: Imagine your mother, father, loved one in this ICU. What would you want for them? For you as a family member?

5. 55 Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005 “endorsement of a shared decision-making model, early and repeated care conferencing to reduce family stress and improve consistency in communication, honoring culturally appropriate requests for truth-telling and informed refusal, spiritual support, staff education and debriefing to minimize the impact of family interactions on staff health, family presence at both rounds and resuscitation, open flexible visitation, way-finding and family-friendly signage, and family support before, during, and after a death.”

6. What do we have in place currently? What are current patient-centered care practices? –what patient-centered care practices or behaviors have you witnessed or participated in? –practices/behaviors as either active or passive engagement. Armstrong Institute for Patient Safety and Quality 6

7. Family Involvement Menu Rhonda Wyskiel, RN, BSN 7

8. Development of Menu Developed the Family Involvement Menu using results from nurse exercise and family survey. Educated nursing staff on the availability and intended uses of the Menu Displayed the Family Involvement Menu on a reusable white board in each patient room and encouraged its use. Armstrong Institute for Patient Safety and Quality 8

9. Development of Menu Engaged staff and family members in the concept of the Family Involvement Menu Educated nursing staff on the value and intended uses of the Menu Executed the Family Involvement Menu on a reusable white board in each patient room and encouraged its use. 9

10. Barriers and Early Wins Early adopters vs late adopters (never users). Nursing Perspective Patient-Provider relationships Documentation Sharing Armstrong Institute for Patient Safety and Quality 10

11. Next Steps Evaluation Process/Research National Recognition Betty and Gordon Moore Foundation Support –Project Emerge Development of toolkit for implementation Armstrong Institute for Patient Safety and Quality 11

12. Remember your experience Armstrong Institute for Patient Safety and Quality 12

13. 13 Making families part of patient-centered care An example: Family involvement menu (developed by Rhonda Wyskiel, RN) Implementation strategies: What might your team put on the menu?

14. References 14 Mahoney D. Nurturing a collaborative culture. Partners 2014 Oct/Nov: 20-23. Wyskiel RM, Weeks, K, Marsteller, JA. Inviting Families to Participate in Care: A Family Involvement Menu. The Joint Commission Journal on Quality Improvement. 2015. 41(1):43-46 Wyskiel RM, Chang BH, Alday AA et. Al. Towards Expanding the Acute Care Team: Learning how to involve families in care processes, in preparation to be submitted to Families, Systems, and Health. Mitchell ML, Chaboyer W. Family Centered Care—A way to connect patients families and nurses in critical care: A qualitative study using telephone interviews. Intensive and Critical Care Nursing. 2010;26:154-160. Davidson JE. Family-Centered Care: Meeting the needs of patients’ families and helping families adapt to critical illness. Critical Care Nurse. 2009;29(3): 28-34