STEP FORWARD JUNE 28TH, 2013 UNIT MEETING

Unit Meeting Objectives Discuss issues concerning staff Discuss what processes are currently working on the unit Brainstorm solutions to improve workflow on the unit / teamwork Vote on 3 initiatives to work on as a Unit

Guidelines Each discussion is designated 20 minutes Each person has 30 seconds to offer comment, no stories. (elaboration granted another 30 seconds) Raise your hand for comments, or write your comments on paper and pass to your left. Voting at end of meeting will take place Shared Decision will work voted initiatives.

Staff Concerns 20 minutes What is broken? What does not make sense? What would you like to change? What is missing?

Staff concerns More IP phones – carry IP phones Increase number of glucometers on POD 3 Increase number of computers on POD 3 More extra large BP cuffs Noise ear – for ongoing monitoring Physician champions – who has our back and part of the team (addressing patient needs/issues) – Physician/Nurse Communication Clarification/process to obtain order to step down (ie. Post PCI) – ICU level vs progressive care vs designated intervention POD Process to obtain staff during peak admission times: mass text (can be used to communicate – ie schedules done) Professionalism – code of conduct, healthy work environment, workplace bullying, teamwork. Voices/comments/professionalism in the hall – overhead by patients/families “Feel like I’m on my own.” TL assignments same as team member (number, acuity) – unable to fulfill the role – exhaustion, no reciprical help Physical cleanliness/neatness (customer service perception) I & O’s NA on night shift 6am duties - - - now done by RN (weights)

Staff Concerns Task list items Vital sign frequency – relook at guidelines/expectations Process of staff rotation: ICU – stepdown Preceptor/Preceptee assignments (ie being TL at same time as precepting, appropriate assignments)

Staff Successes 20 minutes What works well? What would you like to see more of? Examples of successful processes & solutions Other Comments

Staff Successes Number of nurse aides – helpful/nice Nurse aide on each POD Assistant manager rounding process – lead by example; taking an interest in staff/assignments/patients (plan: shift lead core team training) Orientation process: need to look at “young” new experience for professional and clinical development to build next generation of clinical leaders. Preceptee satisfaction – comments regarding teamwork/support/feeling welcomed Patient satisfaction – positive patient comments Discharge appointments – readmission reduction! QUALITY – focusing on quality initiatives with reduction of HAI’s (ie. CAUTI, VAP, CLASBI) = patient outcomes CLINICAL PHARMACISTS: approved for 2 additional positions Staff accomplishments – education, etc Medication availability DA role – improved unit audits – better utilization of time – “right person to do the right job” vs nursing doing and improved billing outcomes (7 periods in a row – under budget - $100,000) Improved stock/equipment – not running out of items (thanks to Kathy) Telemetry on the wall Other equipment needing to be visual? Available IV pumps/poles when needed and they are clean! Rising to the occasion on difficult shifts (assignments) and teamwork . What works: Care during emergency situations

Suggested Improvements NA role: add blood sugars (expand work load), on each POD, “team”; trial different shifts Clinical support: mentors (“double-layer”), patient quality, nurse burnout, safety Communication: between PODS, with shift lead, CPC Consider adding to annual review process: positive peer review teamwork/collaboration examples (or add to portfolio) Develop culture/tools (peer review) – develop card/box at KRONOS Staffing: text messaging (on call list, general communication); consider designated on-call ideas/guidelines to cover holes Unit social ‘activities’ – ideas, others interested? (new blood) CPC: getting NA down on 3-11 Develop Teamwork process: team nursing vs TL role vs charge vs ? Optimize care delivery Zero tolerance – unprofessional/unhelpful behavior (motivation/holding each other accountable/teamwork skills) Take care of each other – emotional support

CCU VOTE: Suggested Improvements Expand the NA role Develop clinical support structure (ie. Mentoring) Improve day-to-day shift communications Develop positive peer review teamwork processes Develop text messaging process Initiate staffing processes to address “holes” (on call) Optimize care delivery (ie TL, charge, team nursing) Re-energize unit “social” activities Develop a zero tolerance culture: unprofessional/unhelpful behavior

Other items discussed: Joint Commission visit/readiness expectations: July 26th Code Blue role Life Banc update Dialysis process NICHE – geriatric survey

Questions?