Delegation RN Education Kelli Erb

Agenda Why the change? Delegation basics? What is changing? When?

Why change is happening? Concerns about delegation and a decrease in teamwork shared at unit shared leadership Patients! Delegation/Teamwork committee started Erin, Yvonne, Kelly, Kelli, Pat, Olga, Megan

SBAR S: Effective delegation is an assumed RN job responsibility that is frequently misinterpreted and unsuccessfully implemented B: Application and utilization of delegation guidelines and principles is not consistent throughout the organization A: Inconsistent practice in delegation leads to potential gaps in care for patients and decreased overall staff satisfaction and teamwork R: Develop education and implement changes to current unit culture.

5 rights of Delegation Right Task- Is the task being delegated appropriately Right Person- Does the person have the skill or knowledge to perform task? Right Direction- has the person been given the 4C’s Clear direction Concise description Complete information Correct limits and expectations (Spectrum delegation toolkit, 2013). Right task-Is the task within the caregiver’s scope of practice? Right Person- Has the caregiver demonstrated competency? Ex straight caths? Right Direction- Did we make sure they understand what was being asked of them? Do they have all the information they need?

5 rights of Delegation (con’t) Right Feedback- Has the NT been provided the opportunity to participate in a mutual process of information? Right Supervision- Is the delegated task provided by ensuring that a follow up evaluation takes place? (Spectrum Health Delegation toolkit, 2013). Right feedback- Were they given the opportunity to ask questions? Right Supervision- Did we follow up?

Deciding to Delegate: Potential for Harm Complexity of the task Amount of problem solving and innovation required Unpredictability of outcome Level of Patient interaction Speed of Performance (Spectrum Health Delegation toolkit, 2013). Handout Deciding to Delegate… I thought this handout had great information.

RN Expectations Don’t assess your patients after BSR. Meet with NT RN completes 1 bath on assignment. Tell NT Make a plan with the Pt. Make plan with NT at am huddle for 2 person baths RN to take full set of vitals on q4 pt for BP med. Trust NT if they say they can’t do something when RN calls. -For everyone to get started on their day, RNs should make it a priority to meet with the team right after report. This keeps everyone on track. -RN will be responsible for 1 bath on assignment, which is not a change, but make sure you verbalize this to the NT during morning huddle. -Be intentional about making a plan with your patient. “Olga will be in to help get you washed up and walks….” -Plan with NT about 2 person baths. Try to come up with a time.

RN Expectations During mid-shift huddle, follow up with NT- who still needs a bath or walks? Feedback from NTs, RNs need to help with call lights Please no lunches during shift change It is ok to call the US for waters or if you need supplies while in a patient room. -Mid-shift huddle around 0945- Follow up with NT

Bundling Care Try to bundle care as much as you can. Anticipate the patients needs

Vitals Fresh Water Patient Room 6AM Meds IV bag Care not Bundled

Bundled Care Fresh Water 6AM Meds Patient Room IV bag Vitals Discuss plan with team Fresh Water 6AM Meds Patient Room IV bag Vitals Bundled Care

New Changes Huddle with team (2 RNs and NT) three times during the shift. Page will come out on phones to help remind us. 0745, 0945, 1700, 1945, 0100, and 0430 Communicating Hourly Rounds Make plan for return visit Remember 5 T’s? Power Hour?...What’s Power Hour? You should get your phone when you get your assignment. We can send out a page to off-going to nurse to pass the phone to the next person or they can be at the front desk. The midshift huddle on dayshift will be combined with TSM. The first few minutes, meet with your team then the last few minutes can be TSM Allows team to see who needs help. Who still needs baths, walks, who is going to accomplish those tasks, and try to plan for lunches.

POWER HOUR!!! Meet with team at 1330 days and 0430 nights. Dayshift will also have a mini power hour before shift change at 1730. Go into each patients room together with checklist Lead RN logs into computer and team does vitals, I &O, meds, waters, linens, trashes, etc… Team lunches need to be done by 1330 This is going to be a huge change but the hope is that it will improve patient care, patient and staff satisfaction and our unit teamwork. Power Hour is being done on 7N and 4H and staff like it. Remember how we all groaned about BSR, now I can’t imagine doing report any other way. Explain Power Hour….

Power Hour Before Power Hour, RNs will highlight on power hour sheet what tasks need to be completed. If a patient calls out, 1 member of the team will go answer and team will meet there next

When Does this Start? Go-Live October 7th@ 0700!!! Treats provided! October 20th-27th-Team call light competition everyday every shift! Details to come… Delegation team will be rounding making sure we are doing the right thing and giving candy for compliance

Questions/Concerns?