Thought Leader Learning Series It’s Critical – What YOU Should Be Doing in Your ICUs Cheryl Ruble MS, RN, CNS, Improvement Advisor Maryanne Whitney MSN, RN, CNS, Improvement Advisor www.cynosurehealth.org

Welcome www.cynosurehealth.org www.cynosurehealth.org

Agenda Setting the Stage for Safety Hospital Journeys Wrap up CE’s - Provider approved by the California Board of Registered Nursing, Provider Number 15958, for 1.0 contact hour www.cynosurehealth.org www.cynosurehealth.org

Objectives Develop an understanding of the synergy between patient and staff safety. Establish a strategy to engage bedside care providers in a commitment for safety. Identify the critical value of patient and family engagement in overall departmental safety. www.cynosurehealth.org

Critical Elements for Excellence Establish a vision making safety a CORE departmental value “Safety Huddles” Integrate efforts of patient safety and employee safety Timely debriefings of adverse patient and worker Events-intent for learning Encourage the voice of patients & families Equipment selection and trials, HAPU- nasal bridal, TAP system Delirium reduction and decrease harm from combative patients www.cynosurehealth.org www.cynosurehealth.org

Creating an Umbrella of Safety Think of each umbrella as a shield of safety each one for a different initiative when combined create a shield protecting patient and employee alike HAPU and safe pt handling- finding the right equipment www.cynosurehealth.org www.cynosurehealth.org

Make it stick when YOU commit! Enhance Reliability Efficiency & Outcomes Create a vision Leaders are highly visible & “Walk the walk” Physician champions & nursing champions modeling teamwork Learn, motivate, educate & celebrate Use stories to engage the hearts and minds of of all in the department Communicate successes Align patient and worker safety initiatives to have common goals www.cynosurehealth.org www.cynosurehealth.org

Untapped resources within your ICU, where are they? Patients Family How do we invite their voice? Open visitation Multidisciplinary Rounds Presence during resuscitation Family meetings www.cynosurehealth.org

Angie Sokal RN BSN Critical Care Manager Kaiser Permanente Making Safety Stick Angie Sokal RN BSN Critical Care Manager Kaiser Permanente www.cynosurehealth.org

About Us Santa Clara Facility Serving California’s Silicon Valley Santa Clara Facility Features a medical office building, opened in 2005, and a 327-bed acute care hospital, which opened in August 2007 20-bed MICU, 10-bed CVICU More than 700 physicians and 4300 staff care for members in the service area www.cynosurehealth.org

Creating a Vision for Safety Proclamation Leadership Huddles Debriefing www.cynosurehealth.org

Safety Proclamation www.cynosurehealth.org

Leadership Set the department goals Highly visible Ensures employee involvement Ensures accountability on all levels www.cynosurehealth.org

Huddles for Safety Patient concerns Environmental concerns Stretch and train Transparency about risks Review adverse events www.cynosurehealth.org

Debriefing/ Mini RCA’s Med error Employee injury  Accidental extubation CLABSI VAP C-Diff discovery HAPU Events will happen Approach with curiosity Life long learners www.cynosurehealth.org

Work in progress Multidisciplinary Rounds- family involvement Open visiting hours White board PI work- in the department-(real-time planning with staff) www.cynosurehealth.org

www.cynosurehealth.org

Daily Hospital Safety Huddle October 21, 2014 Karra Heggen, MSN RN, Vice President of Nursing Leigh Poeppelman, MSN RN CCRN, Director of Critical Care Center and IV Team

Located on the St. Joseph River in Elkhart, Indiana Beacon Mission & Vision Opened in 1909 257 licensed beds Located on the St. Joseph River in Elkhart, Indiana Strong Heart and Vascular Service Line: Only hospital in Northern Indiana to provide Trans Aortic Valve Replacement (TAVR) procedures Heart Failure Certification by Health Care Colloquium Recognized by Health Grades for Excellent Cardiac Surgery outcomes 23 Critical Care Beds www.cynosurehealth.org www.cynosurehealth.org

Quality Nursing Purpose: Ensure safe, compassionate, innovative patient centered care Promote and engage in the advancement of evidenced-based nursing practice Create a culture of collaboration, professionalism and a healthy work environment www.cynosurehealth.org

Leadership Safety Huddle Safety Huddle initiated October 15 2012 Purpose: To communicate patient safety issues identified in past 24 hours hospital wide, look forward next 24 hours, to promptly resolve safety issues, and to have continuous follow up until resolved. Builds teamwork throughout the hospital Time of networking Mon-Friday 0900: Standing Room only Every department is encouraged to send leadership representative. www.cynosurehealth.org

Original Safety Huddle Form Daily Stats www.cynosurehealth.org

Past 24 hours www.cynosurehealth.org

Anticipated next 24 hours www.cynosurehealth.org

Added information in 2013 & 2014 www.cynosurehealth.org

Huddle Highlight Standardized succinct safety information will be sent out to all management including charge nurses to review at shift huddles. Start and stop date; requires associate to sign form and unit keeps in binder. Developing criteria for use of Huddle Highlights www.cynosurehealth.org

Huddle Highlight www.cynosurehealth.org

Appreciative Inquiry & Inspiration To close the huddle, stories are requested that related to teamwork or patient experience that resulted in positive outcomes Inspirational readings from “Healing with Heart” Martin Helldorfer & Terri Moss Huddle can last 5-15 minutes www.cynosurehealth.org

Critical Care “Huddles” Critical Care does a “short” report at 0700 and 1900 each day – the charge nurse gives the whole team an overall picture of the patients and the plan for the shift. During this time there is also discussion and sharing of any safety concerns – issues that have arisen from housewide safety huddles, Huddle Highlights, issues from the previous shift, etc. This all occurs in 5-7 minutes. Staff then get bedside report from the off-going RN. Safety concerns are also posted in bathrooms or communicated 1:1. Director or designee communicates safety concerns at Leadership Huddle www.cynosurehealth.org

EGH Safety Net Frontline safety concerns are escalated to unit leadership to share at Leadership Safety Huddle. Knowledge Transfer Culture of Safety encourages associates to speak up related to potential or actual safety concerns Shift huddles and Leadership Safety Huddle improves communication and teamwork for improved outcomes. www.cynosurehealth.org

Questions Karra Heggen VPN – kheggen@beaconhealthsystem.org Leigh Poeppelman Director of Critical Care/IV Team lpoeppelman@beaconhealthsystem.org www.cynosurehealth.org

Contra Costa Regional Medical Center Martinez, CA Stuart Forman, MD Director of Critical Care Services Contra Costa Regional Medical Center www.cynosurehealth.org

Safety Initiative /ABCDE Bundle Departmental goals Identify champions Use all types of reminders Post progress Recognize & Reward Stu Foreman www.cynosurehealth.org www.cynosurehealth.org

Giving a Voice to the Family Stay Connected protocol 24 hours a day visitation- if they want to stay they will be able to accommodate Family meeting 48-72 hours post admission/ social workers Stu Foreman www.cynosurehealth.org www.cynosurehealth.org

Creating an Umbrella of Safety www.cynosurehealth.org

Objectives Develop an understanding of the synergy between patient and staff safety. Establish a strategy to engage bedside care providers in a commitment for safety. Identify the critical value of patient and family engagement in overall departmental safety. www.cynosurehealth.org

Creating an Umbrella of Safety: Kaiser Safety proclamation Synergy between work place safety and patient safety Real time debriefings for adverse events- HAPU-CLABSI-C-Diff- Workplace injuries Safety Huddles- sharing risks identified in ICU & with individual patients Multidisciplinary Rounds – adding value from family involvement Open visiting White board PI work​ www.cynosurehealth.org

Creating an Umbrella of Safety: Elkhart Leadership role modeling Leadership safety huddles Critical Care huddles Closing the loop – communication back to staff Synergy of communication supporting a safety net for staff, patients, and families www.cynosurehealth.org

Creating an Umbrella of Safety: Contra Costa Clear departmental goals Identification of champions Giving voice to the family Stay Connected Family meeting within 48-72 hours post-admission www.cynosurehealth.org

Resources “Implementing the ABCDE Bundle: ABCDE Bundle at the Bedside” from AACN at http://www.aacn.org/dm/practice/actionpakdetail.aspx?itemid=28328 Debriefings: Great resource from AHRQ on the usefulness and how to conduct a debrief: http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/essentials/pocketguide.pdf Open Visiting Hours: AACN Practice Alert on Family Presence: Visitation in the Adult ICU” from AACN at: http://www.aacn.org/WD/practice/docs/practicealerts/family-visitation-adult-icu-practicealert.pdf Safety Huddles: Great resource from AHRQ on the usefulness and how to conduct a safety huddle: http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/essentials/pocketguide.pdf Family included in MDRs: A great resource from Institute for Patient- and Family-Centered Care: http://www.ipfcc.org/advance/topics/PH_RD_Applying_PFCC_Rounds_Pediatric.pdf Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation from TJC at: http://www.jointcommission.org/assets/1/18/TJC-ImprovingPatientAndWorkerSafety- Monograph.pdf Yassi, Annalee, and Tina Hancock. "Patient Safety - Worker Safety: Building a Culture of Safety to Improve Healthcare Worker and Patient Well-Being." Healthcare Quarterly 8.Sp (2005): 32-38. Web www.cynosurehealth.org www.cynosurehealth.org

Continuing Education Credit! Evaluation window will open as soon as we close the meeting Provider approved by the California Board of Registered Nursing, Provider Number 15958, for 1.0 contact hour. All RNs requesting CEUs must be registered, provide their RN license #, sign-in to the webinar under their full name, and attend at least 50 minutes. CE Certificates will be emailed to you, directly www.cynosurehealth.org

Upcoming Offerings Join us! Are you in need of a Physician Champion for your Improvement Initiatives? Tune in for our free webinar on November 13th, 12-1pm PST “Accelerate Change with Physician Champions: Tried and True Ways to Find and Engage Effective MD Leaders” AND December 18th, 12-1pm PST “Infection Prevention: Is It a Show?” We will explore a provocative report about human behavior and infection prevention. Don’t miss either opportunity register now! www.cynosurehealth.org www.cynosurehealth.org

Cheryl Ruble MS, RN, CNS, Improvement Advisor cruble@cynosurehealth.org Maryanne Whitney MSN, RN, CNS, Improvement Advisor mwhitney@cynosurehealth.org