1. Modified Modular Nursing 10 West Care Delivery ModelBy
Ellen Babilon, ADN, RN, CMSRN
and
Lisa Evert BSN, RN
Title Page

2. Modified Modular Nursing
A method of making patient assignments based on geographical location with consideration given to the acuity level of each module assignment. Implemented September 28, 2012 day shift!

3. Why go to Modified Modular nursing?
Increase in patient safety
Increase in patient satisfaction
More continuity of care
Addresses all components of our HCAHPS scores! ie nurse responsiveness, call bell answered, pain managed, less noise, etc
Less area to travel
Less people to have to wait to give and receive report
Assignments address acuity

4. Why go to Modified Modular nursing?
Increases staff accountability Modified Modular nursing demonstrates a model of excellence in which the “it’s not my patient!” mentality is no longer tolerated.
I would like to reiterate staff accountability. If you talk with anyone who has worked in a Magnet Hospital, they will tell you that there is an increased level of personal accountability.

5. Why go to Modified Modular nursing?
The numbers don’t lie……… During the original pilot of Modified Modular nursing beginning November 2011, fall rates on 10 West dropped from approximately 6 falls per 1000 patient days to <1 fall per 1000 patients days only to have them rise again to >4 falls per 1000 patient days after the pilot ended.

6. Why go to Modified Modular nursing?

7. Why go to Modified Modular nursing?
The institutional goal is 3 falls or less per 1000 patient days.
Modified Modular nursing is one component in an overall fall prevention initiative on 10 West.
Modified Modular nursing allows you to be closest to your patients enabling quick response to chair and bed alarms.

8. Why go to Modified Modular nursing?
Purposeful hourly rounding is an MUSC standard. Modified modular nursing keeps you close to your patients, making rounding easier.

9. 10 West Fall Prevention Initiatives
Education of patients and their families
Staff accountability, signing attestations stating the understanding of the FIRM Ground Program
Modified Modular Nursing
Signage strategically placed in patients rooms reminding our confused patients to call for assistance

10. MODIFIED MODULAR NURSING ASSIGNMENTS - RN
6 RNs
Module 6A , 55,56, 58
Module 6B , 53, 59, 60
Module 6C , 65, 66, 67, 73
Module 6D , 70, 71, 72
Module 6E , 77, 78, 79
Charge Nurse takes one low intensity patient on Module 6C

11. MODIFIED MODULAR NURSING ASSIGNMENTS - RN
5 RNS
Module 5A , 54, 55, 56, 58
Module 5B , 59, 60, 64, 65
Module 5C , 67, 76, 77, 78, 79
Module 5D , 70, 71, 72, 73
Charge Nurse takes one low intensity patient on Module 5C

12. MODIFIED MODULAR NURSING ASSIGNMENTS - RN
4 RNs
Module 4A , 54, 55, 56, 58, 59
Module 4B , 60, 76, 77, 78, 79
Module 4C , 68, 70, 71, 72, 73
Charge Nurse , 65, 66

13. MODIFIED MODULAR NURSING ASSIGNMENTS - PCT
3 PCTs
Module 3A , 53, 54, 55, 56, 58, 59
Module 3B , 65, 66, 76, 77, 78, 79
Module 3C , 67, 68, 70, 71, 72, 73
In the event there are only 3 PCTs, the PCT requiring assistance will call the other 2 PCTs for help BEFORE calling the RN

14. MODIFIED MODULAR NURSING ASSIGNMENTS - PCT
2 PCTs
Module 2A
Module 2B
In the event there are only 2 PCTs and one of them is Meduflex, 1066 will be the “swing” bed to keep from giving the Meduflex PCT the extra patient.

15. Buddy System……
Implement the buddy system between RNs and PCTs. The module with the highest acuity will be ‘buddied’ with the module with the lowest acuity. RN and PCT will directly call their ‘buddy’ for help.

16. Buddy System…
RNs and PCTs will cover their ‘buddy’ for breaks and lunch.
Buddy assignment will be written on the white board across from the nurses station.
All breaks recorded on white board with one 30 minute lunch break allowed. Breaks are to be taken away from the nurses station to cut down on traffic and noise.

17. Assigning Acuity to Each Module

18. MODIFIED MODULAR NURSING ASSIGNMENTS RECOMMENDATIONS
The expectation is for the RN and PCT to be continually positioned at their ‘Anchor Station’ during their shift. This will improve visibility to patients and families and improve call bell response time. Stations will be assigned according to team assignment. The charge nurse’s anchor station will be the nurses station. On night shift, Module B’s anchor station will also be the nurses station to assist with answering phones and call bells.

19. 10 West Anchor Stations

20. Lessons Learned
Resistance from the staff when this Care Delivery Model first presented by Shared Governance, not a lot of buy-in.
Major staff concern included equity of assignments.
Staff able to voice concerns via an anonymous survey after this model was in place for 5 months.
Although not as popular with the staff as envisioned, 82% of staff agreed, based on this survey, that this care delivery model affords greater access to nursing staff by patient, families and other disciplines and 59% agree that it provides for greater efficiency.
50% of staff surveyed also felt the MMN was instrumental in reducing falls.
The fall data is impressive, but the nursing staff reaction was not.

21. Lessons Learned
Based on survey results, a dialogue was initiated between leaders and staff members soliciting suggestions for improving this Care Delivery Model.
Per staff suggestions, small changes were made in how future assignments were made, i.e. swapping empty rooms with occupied rooms in adjacent modules, coaching staff members in lateral delegation, etc.
A change in culture was necessary that focused on patient centered care and required staff being comfortable with lateral delegation (buddy system)
New survey administered 17 months after the implementation of MMN.
The fall data is impressive, but the nursing staff reaction was not.

22. And the culture changed……
94% of staff surveyed stated that Modified Modular Nursing provides greater safety for their patients as opposed to 47 % on the original survey.
100% stated that they enjoyed practicing MMN as opposed to 29%.
69% stated that they were comfortable in delegating to their buddy as opposed to 41%.
69% stated that delegating to their buddies helped to provide equality in work assignments as opposed to 23%.

23. HCAHPS
Although it in theory it would seem that certain components of our HCAHPS scores would improve, this proved not to be the case.

24. Where Are We Now?!?!?
In the 3 months prior to implementation of Modified Modular Nursing, fall rates on 10 West were approximately 2.1 falls per 1000 patient days.
In the 3 months following the implementation of Modified Modular Nursing, fall rates have decreased to 1 fall per 1000 patient days.

25. Where Are We Now?!?!?

26. 17 Months Later……
Since June of 2013, 10 West fall rates have remained low at 1.22 falls per 1000 patient days

27. 17 Months Later……

28. Conclusions IMPROVED: Decrease in patient falls
Greater availability of staff to patients, families, and other interdisciplinary team members
Greater ease in purposeful hourly rounding which is an MUSC standard.
Less noise and traffic at the nurses station
100% compliance with blood glucose rechecks

29. MUSC Nurses Professional Practice Model

30. Questions or comments???
Copies of presentation can be ed to interested parties.