Organization/Institution: Quality Partners of Rhode Island Principal Investigator(s): Stefan Gravenstein, MD, MPH Project Title: Enhancing medication safety through PictureRx
Always Event(s): The family-patient team will always receive medication education using the teach-back method and then prior to discharge the patient will receive a visual medication schedule.
Organization/Institution: Massachusetts General Hospital
Principal Investigator(s): Richard H. L. Corder MHA, FACHE
Project Title: Always Know Your Caregiver/Always Responsive
Always Event(s): Ensure that our patients always know who is in charge of their care, and that providers are always responsive to the needs of our patients and their families and that our patients always get help when they need it.
Always Event(s): Patients will always have the opportunity across healthcare settings to utilize a portable personal health record embedded with actionable patient-driven information, to ensure patients, their healthcare providers and their family members are on the same page with regard to the patient’s healthcare needs, priorities, and lifestyle.
Organization/Institution: St. Jude Children’s Research Hospital Principal Investigator(s): Kathryn Berry-Carter
Project Title: Parent Mentor Program
Always Event(s): The Always Event™ is proposed as having four goals: 1) to offer each newly diagnosed family at St. Jude a trained parent-mentor, offering support and encouragement throughout the trajectory of the child’s treatment including the transition into survivorship or bereavement, 2) to provide the family the opportunity of acceptance, while facilitating coping mechanisms and hope, 3) empowering providers and the family as a partner and in their communication with St. Jude staff in their child’s treatment, and 4) providing a resource of services offered by St. Jude and the community.
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.
Organization/Institution: University of Pittsburgh Medical Center Innovation Center
Principal Investigator(s): Anthony DiGioia, III, M.D.
Project Title: Trauma Team Texting and Guardian Angels
Always Event(s): 1) Always let the patient be the center of the care team… Care Team Twittering, 2) Always keep patients and family members informed… “Guardian Angels,” 3) Always know the discharge plan and beyond… Transitions in Care Experiences.
Organization/Institution: Lahey Clinic
Principal Investigator(s): Elizabeth Collins, M.D.
Project Title: Transitions of Care Partnership Project
Always Event(s): Always listen to and involve the patient in their care transitions. This community partnership project ensures that patient-provider communication occurs and will improve the delivery of patient-centered care at each step in the discharge or transfer process from one setting to another.
Organization/Institution: Anne Arundel Health System Principal Investigator(s): Sherry B. Perkins, PhD, RN and Mitchell Schwartz, MD
Project Title: The SMART Discharge Protocol
Always Event(s): Always provide the patient with a SMART discharge process. With the involvement of patients and families providers will develop a simple, universal, 5 item checklist as a SMART Discharge ProtocolSM. (SMART is an acronym for: Signs, Medications, Appointments, Results, and Talk with me.) Providers will build on current evidence; create urgency and expectation for use with patients, families, and caregivers; disseminate findings, and promote as a national standard.
Organization/Institution: Saint Joseph Hospital Foundation Principal Investigator(s): Wendy Rockey
Project Title: Comfort & Pain Relief Menu
Always Event(s): Patients will ALWAYS be offered every option and/or combination of options for pain control and comfort. Nurses will ALWAYS have a more comprehensive conversation about pain & comfort with every patient.
Organization/Institution: Inova Health System
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.
Organization/Institution: University of California San Francisco Principal Investigator(s): Carla Graf, RN, MS, PhD
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.
Organization/Institution: Northeast Valley Health Corporation Principal Investigator(s): Ursula Baffigo, MD
Project Title: Team Up for Health
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 .
Organization/Institution: Yale-New Haven Children’s Hospital Principal Investigator(s): Janet Parkosewich, DNSc, RN, CCRN, FAHA
Project Title: Premature Life Transitions: A Patient- and Family- Centered End of Life Care Program for Neonates
Always Event(s): Our proposal for the Always Event TM Grant is aimed at the consistent use of an innovative, systematically applied end-of-life program by all members of our neonatal interdisciplinary team to support patients and families during the transition from curative to palliative care, infant demise, and bereavement.
Organization/Institution: University of Minnesota Amplatz Children’s
Principal Investigator:Cheristi Cognetta-Rieke, RN
Project Title: My Story
Always Event(s): 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.
Organization/Institution: Dartmouth-Hitchcock Medical Center Principal Investigator(s): Jonathan T. Huntington, MD, PhD &Suzanne C. Beyea, PhD, RN, FAAN.
Project Title: Implementation of a set of Always Events that will increase communication
Always Event(s): Always communicate with, inform and respect the patient through the following behaviors in every patient/family encounter: 1) Introducing yourself and describing the reason you are there at each encounter, 2) Addressing and referring to patients by the name that they choose; not by their disease, 3) Displaying your name badge at all times, 4) Treating those whom you serve with the same respect you would wish them to show you, 5) Encouraging patients and families involvement in decision making, 6) Welcoming and being respectful to those defined by the patient as “family.”
Organization/Institution: Vanderbilt University Medical Center Principal Investigator(s): Terrell Smith
Project Title: Effective Communication and Collaboration with Patients and Families for Falls Prevention
Always Event(s): Patients and families will always receive information and education to facilitate autonomy, self-care and health promotion. This communication strategy educates patients as to how they can partner with the health care team to prevent a fall during their stay.
Organization/Institution: Cleveland Clinic
Principal Investigator(s): Jennifer Ramsey, MD
Project Title: Unmet expectations regarding ICU patient outcomes: Identification and management of at risk families
Always Event(s): Always assure that MICU patients and families understand and participate in their care through: 1) Timely, ongoing, clear, consistent and compassionate communication, 2) Medical decision-making aligned with patient values, care goals, and treatment preferences, 3) Family care that includes liberal visiting and practical, emotional, spiritual and bereavement support.
Organization/Institution: March of Dimes
Principal Investigator(s): Liza Cooper, LMSW
Project Title: Close to Me
Always Event(s): March of Dimes considers kangaroo care, or skin‐to‐skin holding of the premature infant by the parent as an Always Event(s)™ that is discrete, affordable and measurable. It has numerous proven health benefits for mother and baby and is indicated as one of the most comforting activities by NICU families. Close To Me is the intervention program being implemented to increase the early onset and frequency of kangaroo care in NICUs.
Organization: American Academy of Pediatrics
Principal Investigator(s): Aditee Narayan, MD, MPH
Project Title: Family Feedback — Always! (FFA)
Always Event: To develop and assess a pilot program to facilitate communication strategies used by pediatric residents for eliciting feedback from the families they serve in continuity clinics — Family Feedback– Always!
Organization/Institution: Health Care For All Principal Investigator(s): Deborah Wachenheim Project Title: Patients and Families Improving Hospital Discharge
Always Event(s): 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 Event and is closely aligned with the principles of the Picker Institute.
Organization/Institution: Henry Ford Health System
Principal Investigator: Rhonna Shatz, DO
Project Title: Dementia Screening for Senior Patients
Always Event: HFHS will develop a new “Always Event” that will screen patients 70 years and older for dementia as part of their annual primary care health exams. This initiative will use a new Web-based cognitive assessment tool developed by the National Institutes of Health and modified for use at HFHS. Physicians will also utilize an NIH developed web-based smart survey tool to assess mood, behavior, daily living activities and review caregiver distress. Should the patient exhibit any signs of a neurological impairment following the cognitive screen, the doctor would initiate a full dementia assessment guided by EMR templates that can be downloaded or utilized and saved on-line as an office note.