Organization/Institution: INOVA Health Systems Principal Investigator(s): Mary Ann Friesen, PhD, RN, CPHQ: Project Title: Developing a Patient-Centered Approach to Handoffs
Always Event(s): Patients will always be included in the ISHAPED handoff shift-to-shift hand-off process at the bedside as this will add an additional layer of safety by allowing the patient to communicate potential safety concerns.
Overview: This project will build on previous research by the Inova Health System (IHS) to improve the quality and safety of patient care by enhancing communication and encouraging patient participation. Recent reviews of patient safety and satisfaction at Inova identified the shift-to-shift handoff as a process in need of improvement. Inova responded by convening a quality-improvement team to develop a new strategy for conducting the shift-to-shift handoff, one that standardizes procedures and incorporates a bedside component. Entitled “ISHAPED” (I=Introduce, S=Story, H=History, A=Assessment,
P=Plan, E=Error Prevention, and D=Dialogue), this strategy also provides patients and their families the opportunity to participate in the handoff process. The proposed project aims to 1) measure patient satisfaction and perceptions regarding the ISHAPED bedside handoff process, 2) use the patient feedback to optimize and standardize the bedside handoff process, and 3) develop a training video and companion toolkit to educate nurses on how to conduct a safe, effective and patient-centered bedside hand-off across multiple settings.
Organization/Institution: Iowa Health System Principal Investigator(s): Gail A. Nielsen Project Title: Always Use Teach Back!
Always Event(s): The Always Event is to always listen to the patient during hand-offs by encouraging teach-back opportunities—during hospitalization and upon arrival in the next care setting. Always use the Teach-back method.
Overview: IHS will develop and implement a “Always Use Teach-back!” toolkit for the three care settings encountered by patients being discharged from the hospital: hospital discharge, primary care follow-up, and home health support. The toolkit will include training modules with videos demonstrating effective use of teach-back. IHS will train and coach physicians and nurses on the “Always Use Teach-back!” approach.
The Always Events encompass Teach-Back (T-B) opportunities – during a patient’s hospitalization and upon arrival in the next care setting. Physicians and nurses will educate and discover (in a non-shaming way) what the patient or family caregiver understood using T-B. The aim is to have patients/family caregivers able to teach back in their own words:
danger signs and symptoms to watch for after discharge from hospital
action steps if signs or symptoms occur
key medications related to principal diagnosis
critical self-care activities
IHS has the ongoing benefit of patient and family advisors in developing appropriate T-B interventions through their HLC, partnership with the New Readers of Iowa7, and Reducing Readmissions Collaborative. IHS patient and family caregivers will be partners in developing and testing the most effective T-B learning system.
University of Pittsburgh Medical Center Innovation Center Principal Investigator(s): AnthonyM. DiGioia, III, M.D. Project Title: Care Team Twittering and Guardian Angels
Always Event(s): Always let the patient be the center of the care team… Care Team Twittering
Always keep patients and family members informed… “Guardian Angels”
Always know the discharge plan and beyond… Transitions in Care Experiences
Overview: Trauma Services and the Transplant Programs at UPMC have incorporated the PFCC Methodology and Practice (PFCC M/P) in their care delivery approach. The PFCC M/P approach enables Care Givers to deliver truly exceptional care experiences by refocusing existing resources through a six step process that brings patients and families directly into co-designing care delivery improvement. PFCC M/P will serve as the means by which the 2 always events will be incorporated, monitored, evaluated, disseminated, and accelerated locally and nationally so that accurate communication takes place in real time and transitions in care are seamless.
Jennie Chin Hansen, RN, MS, FAAN. CEO American Geriatrics Society
In March 2011, Picker Institute launched the Always Events℠ initiative to identify experiences that should always occur when patients and families interact with the healthcare system. Leaders in patient-centered care have been deeply involved in developing the program. Jennie Chin Hansen, CEO of the American Geriatrics Society, discusses the concept here.
Always Events Discussion
Jerod M. Loeb, Ph.D., Executive Vice President, Division of Healthcare Quality Evaluation, The Joint Commission
In March 2011, Picker Institute launched the Always Events℠ initiative to identify experiences that should always occur when patients and families interact with the healthcare system. Leaders in patient-centered care have been deeply involved in developing the program. Jerod M. Loeb, Ph.D.,executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, discusses the concept here.
Always Event Grantee: University of Minnesota Amplatz Children’s Hospital
Project: “My Story”
Always Event: Upon every admission and transition in care a questionnaire-based interview will occur between the intake nurse, the patient and the patient’s family or friends. The interview will specifically focus on the personality and interests of the patient, such as hobbies, nicknames, pets, and special interests. The “story” of each individual patient will be used as a consistent approach to involving the child in the delivery of patient care.
Health Care For All “Patients and Families Improving Hospital Discharge” Principal Investigator: Deborah Wachenheim
Always Event: This initiative will create, in partnership with the PFACs and STAAR teams at Massachusetts hospitals, a discharge process that consistently and meaningfully engages patients (and their caregivers) in identifying the patient’s needs at home. It is consistent with the criteria for selection of an Always Eventand is closely aligned with the principles of the Picker Institute.
Organization/Institution: University of California San Francisco
Principal Investigator(s): Carla Graf, RN, MS, PhD(c)
Project Title: Improving Patient and Family Centered Care for Hospitalized Persons with Dementia
Always Event(s): The Always Event will be that patients with dementia and their families receive care that is targeted to the patient’s type and stage of dementia.
Overview: This initiative is designed to improve the care of hospitalized patients who have dementia. Our overall goals are to enhance patient and family-centered care by partnering with families to guide patient care, improving family knowledge and readiness regarding the hospital experience, and fostering continuity across the different sites of care. The Always Event will be that patients with dementia and their families receive care that is targeted to the patient’s type and stage of dementia and to their specific care needs. Implementation of a “Dementia Bundle” that facilitates continuity of care and safety for the hospitalized patient with dementia. Components of the Dementia Bundle include a targeted assessment upon admission with the patient’s family regarding personal care routines of the patient (communication, hygiene, nutrition, and day/night activities) that will be used to guide hospital care. Families will be provided an educational video that details aspects of the hospital experience and strategies for prevention of negative sequela. Families will also be provided an educational packet focused on hospital and post-hospital concerns.
Debrea Rosen, RN, MPH discusses, ”Team Up for Health!” Their Always Events Challenge Grant Initiative that utilizes the Making the most out of your visit tool.
Always Event(s): Always help prepare our patients for their office visits through the Making the Most of Your Visit form. Spread utilization of the MMV tool from the pilot site to all 7 of their primary health clinics. Patients complete the form while in the waiting room prior to each visit. The 2 questions are: 1) How am I managing my health; 2) What do I want to ask my doctor today.
Debra Ness, president of the National Partnership for Women & Children, discusses Always Events℠
In March 2011, Picker Institute launched the Always Events℠ initiative to identify experiences that should always occur when patients and families interact with the healthcare system. Leaders in patient-centered care have been deeply involved in developing the program. Debra Ness, president of the National Partnership for Women & Families, discusses the concept here.