1. Strategies for Success: Improving Patient Experience and Fall Injury Outcome Utilizing an Innovative Approach
Rita Fisher, BSN, RN
Quality Improvement Specialist
Stacy Nagel, MSN student, BSN, RN
Critical Care Clinical Staff Nurse
Good Samaritan Hospital Dayton, OH

2. Disclosures
The presenters have no relevant financial relationship(s) or relevant nonfinancial relationship(s) to disclose.

3. Objective
Describe a creative strategy to improve patient safety and experience utilizing a concentrated education program
Discuss outcomes and limitations of the “Chutes and Ladders®” quality improvement initiative

4. Just Two Nurses on a Mission
Who we are
Associate Nurse Manager
Nursing Clinical Educator
Our observation
Competing initiatives
Staff Burnout
What we sought to do
Challenge staff to maintain high standards of patient care while incorporating new and familiar initiatives

5. Good Samaritan Hospital
560 bed facility
Member of Premier Health
GSH has been providing quality health care to the Dayton community since 1932
Member of Catholic Health Initiatives
Achieved Magnet® designation in 2009 for excellence in nursing services
Uses electronic medical record (EMR)
Recipient of HealthGrades awards

6. Nursing Unit Profile Medical-Surgical Neuroscience Unit
Provides a multidisciplinary approach to treating and managing disease or injury involving the nervous system.
Care for more than 5,000 patients annually with stroke or other vascular disorders
Certified as primary stroke center by The Joint Commission
Common Diagnosis
Mental Status Changes
Stroke
Seizure
Migraine
Neurodegenerative & Neuromuscular disorders

7. Staff Profile 4.5: 1 patient to nurse ratio Experience levels
Certified nurse
Leadership
Nurse Manager
Three Associate Nurse Managers
Nurse Educator
Neuroscience CNS
Team leaders
Experience levels varied from the novice nurse to expert. At the time of our project there were ## RN’s and 20% of them had a bachelors degree and 2 that were certified in geriatric care
In 2010, 20% BSN and 80% Associate degree. Since then, GSH has made strides to increase the BSN percentage.

8. Quality Improvement Project
Goal
To improve care related to fall prevention and patient satisfaction
Methods
Concentrated cost-effective educational plan
Focus on best practices to improve care related to fall prevention and patient satisfaction.
Collaboration with clinical experts
Metrics
NDNQI Fall data
HCAHPS
Audits
Leadership rounding

9. The Chutes & Ladders® Project
12 week trial
October 17, January 14, 2011
Concentrated foci
Switched every 2 weeks
Introduced to staff
Verbally: staff meetings, staff huddles
Written: posters, fliers, bulletin boards, weekly update
Champions
ANM, Educator, Team Leaders

10. Chutes & Ladders® Patient Satisfaction Foci
Top 3 Patient Complaints
Attitude
Communication
Follow up
Three Pillars to Success
Warm welcome
Anticipation of needs
Fond farewell

11. Chutes & Ladders® Patient Satisfaction Foci
5 Fundamentals of Service Excellence
A = Acknowledge the customer
I = Introduce yourself
D = Give duration reference
E = Explain the plan of care to the patient
T = Thank the customer and ask is there anything else you can do for them
– you have the time.

12. Chutes & Ladders® Patient Satisfaction Foci
Patient Rounding
Modeling Customer Service Expectations
Mirrors leadership rounding
Assist staff to gain insight to our patients needs
Support customer service needs and expectations
Method
Select 2 patients outside of assignment
Use AIDET to initiate conversation
Ask patient the “question of the week”

13. Chutes & Ladders® Patient Satisfaction Foci
New Initiatives
Tuck in Time: 11pm
All medications passed
Elimination
Pain assessed
Positioned for body alignment and comfort
Provide warm blanket
Wake up Time: 6am
Essential for hemodialysis patients
Provide morning care
Elimination
Breakfast
Safety rounding prior to shift change

14. Chutes & Ladders® Fall Reduction Foci
House Wide Initiatives
Provided printed pocket cards
Proactively placing bed alarms
Safety trumps privacy
Standardization of safety huddle
Purposeful rounding

15. Chutes & Ladders® Fall Reduction Foci
“Moving Safely” Score
Orthostatic Blood Pressure Assessment
Safety Sitter Algorithm
Patient Mobility Algorithm

16. Chutes & Ladders® Incorporating Evidence-Based Articles Process
Distributed by and hardcopy in nurses’ station
On the subject of assigned foci
Level 2 of evidence

17. Chutes & Ladders® Goals Expectations Stimulate critical thinking
Improved professional dialogue between colleagues
Promote professional nursing
Expectations
Return corresponding questions for discussion

18. Chutes & Ladders® Questions with Staff Responses
Fall Articles
Question:
Have you ever had a patient state…
Responses:
“I tell them to use the call light….”
“I explain that we want to be called…”
“I reassure the patient…”

19. Chutes & Ladders® Questions with Staff Responses
Patient Satisfaction Articles
Question:
How can a member of the stroke interdisciplinary team assist in improving patient satisfaction?
How can communication between licensed and unlicensed staff improve patient satisfaction?
Response:
“PT/OT is very knowledgeable…”
“Communication to create a game plan…”
Communication of baseline patient status…"

20. Chutes & Ladders® Unit Bulletin Boards
Keeping You Safe
“Did you know?”
Patient mobility
Polypharmacy

21. Chutes & Ladders® Project Outcomes
Robust quantity of article responses returned
Positive post survey response
Marked increase in patient experience scores
Variable decrease in fall rates

22. Chutes & Ladders® Project
Results
Proved that the Neuroscience Unit staff was open to learning topics in new and innovative ways
Discussed with shared governance unit councils
Future Plans
Discussed trialing project on other units
Incorporate into unit specific orientation

23. Chutes & Ladders® Project Fall Outcomes

24. Chutes & Ladders® Project Fall Outcomes

25. Chutes & Ladders® Project Patient Satisfaction Outcomes

26. Chutes & Ladders® Project Limitations
Need for additional man power
Assistance with rounding, auditing, and sharing project data to employees
Threats to External and Internal Validity
Low hospital census
Changes in administration
Change in distribution method of patient experience surveys
Implementation of new model of hospital beds

27. Conclusion
Low-cost, creative, educational strategies can be used to improve current programs
Share data with staff
Celebrate your successes!!!!

28. Special gratitude Michele Marshall, DNP(c),RN, CNS,NE-BC,CPHQ
Clinical Outcomes Manager, Grant Medical Center
Kim Sadlier, MS, RN, CNS
Geriatric Clinical Nurse Specialist, Good Samaritan
Hospital
Denise Ressler, MSN, RN
Neuroscience Nurse Manager, Good Samaritan Hospital

29. Questions? Contact Rita M. Fisher, BSN, RN
Stacy A. Nagel, MSN student, BSN, RN

30. References
Bisaillon, S., Douloff, C., LeBlanc, K., Pageau, N., Selchen, D., Woloshyn, N., & Woloshyn, N. (2004). Bringing innovation to stroke care: Development of a comprehensive stroke unit. 25(4),
Campbell, G.B. & Breisinger, T.P. (2006). Stroke unit fall prevention: an interdisciplinary, data-driven approach. Rehabilitation Nursing, 31(1), 3-9.
Carroll, D.L., Dykes, P.C., & Hurley, A.C. (2010). Patients’ perspectives of falling while in an acute care hospital and suggestions for prevention. Applied Nursing Research, 23,

31. References
Mangset, M., Dahl, T. E., Forde, R., & Wyller, T. B. (2008). “We're just sick people, nothing else":..factors contributing to elderly stroke patients' satisfaction with rehabilitation. Clinical Rehabilitation, 22(2008),
Mazer, S.E. Hospital noise and the patient experience: seven ways to create and maintain a quieter environment [PDF document]. Retrieved from ospital_noise_whitepaper.pdf
Premier Health Partners. (2013). About GSH neurosciences. Retrieved from efault.aspx?id=22514
Tzeng, H. M., & Yin, C. Y. (2010). Nurses' response time to call lights and fall occurences. MedSurg Nursing, 19(5),