Culture Change: The Patient as the Priority Rush Memorial Hospitals Patient Safety Journey Linda Noble, CPUR, CRM and Deborah Hummel, RN, CNA, BC

RMH - Committed to You, Close to Home Rush Memorial Hospital Critical Access Hospital status in August full-time, part-time and PRN team members 25-bed Medical/Surgical Department houses all acute care, swingbed, and observation patients

RMH - Committed to You, Close to Home The Patient Safety Culture Survey Process And so it begins...

RMH - Committed to You, Close to Home Hospital Survey on Patient Safety Culture – Agency for Healthcare Research and Quality (AHRQ) Rush Memorial partnered with Health Care Excel to administer survey in April 2006 Participants evaluated statements on a 5- point Likert Scale This was considered baseline survey and will resurvey the same population in 2008

RMH - Committed to You, Close to Home 110 employees directly involved in patient care processes were invited to participate in the survey process 81% response rate No incentive was offered other than the opportunity to identify issues that affect the patients and their own work environment Patient Care Departments ONLY

RMH - Committed to You, Close to Home Who Participated? Medical/Surgical Home Health Emergency Surgical Services Cardiology Services Oncology/Hematology Pharmacy Rehabilitation Therapy Respiratory Therapy Laboratory Imaging Primary Care Physician Practices

RMH - Committed to You, Close to Home Survey Results and Key Findings

RMH - Committed to You, Close to Home Solid Foundation Over 90% of the respondents strongly agreed with the statement Hospital management provides a work climate that promotes patient safety

RMH - Committed to You, Close to Home Over 90% of the respondents strongly agreed with the statement When a lot of work needs to be done quickly, we work together as a team to get the work done

RMH - Committed to You, Close to Home However... 87% agreed staff will freely speak up if they see something that may negatively affect patient care 32% agreed staff worry mistakes they make are kept in their employee files 27% agreed problems often occur in the exchange of information across hospital departments

RMH - Committed to You, Close to Home Opportunities Identified Non-punitive work environment Frequency of patient safety event reporting Hospital handoffs and transitions Encouraging employees to speak up Improving teamwork across the hospital In other words...addressing the CULTURE!

RMH - Committed to You, Close to Home The Plan

RMH - Committed to You, Close to Home Crafting the Document All patient care department managers attended planning sessions to develop a simple 2-page document to be used as a guideline Managers were charged with the responsibility to discuss the plan and reinforce with teams Administration supported the efforts of the team and allocated resources necessary to implement

RMH - Committed to You, Close to Home Part 1 Continue to develop a work environment that is non-punitive in nature Survey results revealed employee concerns about the extent in which our work environment is non- punitive Corporate Compliance Officer Linda Noble and Human Resource Director Pam Rennekamp distributed a hospital-wide policy which includes the elements of a non-punitive work environment Department Managers are coached to reinforce the non-punitive work environment elements in their departments in partnership with their employees

RMH - Committed to You, Close to Home Part 2 Increase the frequency of patient safety event reporting to include both actual misses and near misses Survey results indicated misses and near misses are occurring, but were not all reported within the established system A review of the current event reporting system and associated documentation for possible improvements was completed – a Risk Variance Reporting Tool was created to capture near misses All employees receive training and education regarding proper use of the event reporting system

RMH - Committed to You, Close to Home Part 3 Improve hospital handoffs and transitions and associated communication Patient care department managers participated in a 3-part seminar on handoff communication utilizing the SBAR system Managers coached employees on appropriate handoff and transition communication expectations A universal documentation form for the top 3 invasive procedures performed in all clinical care areas was put in place (urinary catheterizations, peripheral IV initiation and blood collection/IV access via ports)

RMH - Committed to You, Close to Home Part 4 Encourage employees to speak up and develop ways managers can encourage and support their employees when questions arise Survey results indicated department managers support patient safety efforts and the work of their employees – however, some employees dont necessarily feel comfortable questioning decisions made by those in authority Department managers encourage employees to speak up and question during informal (day-to-day interactions) and formal (staff meetings) settings within their departments Department Managers develop department-specific strategies in partnership with employees to address this issue

RMH - Committed to You, Close to Home Part 5 Improve teamwork across departments The CQI Team which included managers of the departments with our largest patient volumes was the pilot group for teamwork initiatives The Human Resource Department has the responsibility for the creation and implementation of a hospital-wide teamwork program – R.U.S.H. – which stands for R espect and U nity S tart H ere

RMH - Committed to You, Close to Home Meanwhile...

RMH - Committed to You, Close to Home The Patient as the Priority Key patient care managers were challenged to put in writing how their department demonstrates their patients and their patients safety are the #1 priority

RMH - Committed to You, Close to Home Other Initiatives

RMH - Committed to You, Close to Home Banding Together for Patient Safety This patient safety program uses different colored bands worn by the patient to communicate a patients special needs to our multidisciplinary hospital team members DNR (BLUE) - Patient has a documented DNR order while a patient of Medical/Surgical Department Latex Allergy (PINK) - patient has a suspected or known latex allergy or sensitivity Fall Risk (YELLOW) - patient has been identified as having high potential for falls Go for Surgery (GREEN) - will be used in surgical services department only Allergy (RED) - patient allergies will be written directly on the band Patient Identification (WHITE or CLEAR) paper (outpatients) plastic (MS and surgery patients)

RMH - Committed to You, Close to Home Medication Administration Error Reporting Survey 1. In the last 6 months, have you witnessed an error in the administration of a medication, adult immunization, contrast and other diagnostic substance to a patient in your department? _____ Yes_____ No An error would include any of the following: the wrong medication, contrast, serum or substance was given the wrong dose was given the wrong route was used when given it was given to the wrong patient it was given at the wrong time the substance was missed and was not given the substance was given and there was no order for it to be given 2.If you answered Yes to question #1, please circle the choice that applies: The administration error(s) I have witnessed in my department within the last 6 months have been reported on Incident Reports ___ % of the time. a % b % c % d % e % f. < 50% 3.In the last 6 months, have you witnessed any near misses in your department where an error could have occurred, but action was taken before the error reached the patient? _____ Yes_____ No 4.If you answered Yes to question #3, please answer the following: Did you ever discuss how the near miss could be avoided in the future with your co-workers? _____ Yes _____ No Did you ever discuss how the near miss could be avoided in the future with your manager? _____ Yes _____ No Have changes been made in your department to help avoid similar near misses in the future? _____ Yes_____ No 5.The following is a potential/actual patient safety problem in my department and should be addressed (use other side if necessary):

RMH - Committed to You, Close to Home R.U.S.H. Initiative A position was created in Human Resource Department to assume responsibilities for sustaining the initiative – also coordinates hospital volunteer efforts, AHA Programs and performs other HR duties Begins with mandatory 1.5 hour introductory session for all employees Employee Entrance being renovated to include R.U.S.H. elements

RMH - Committed to You, Close to Home SBAR Communication S – Situation B – Background A – Assessment R – Recommendation Q – Questions? All patient care departments are included in the communication expectations – not just nursing departments

RMH - Committed to You, Close to Home Patient Safety Committee Membership now includes Patient Safety Officer (Chief Nursing Officer) Corporate Compliance Officer (Risk Management) Health Information Director Admissions Manager Pharmacy Director Medical/Surgical Manager Chief Executive Officer

RMH - Committed to You, Close to Home Leadership Development Includes communication skills review of administrative policies incorporation of shared governance elements implementation of peer review processes in the patient units

RMH - Committed to You, Close to Home Additional Changes Ancillary staff members speak directly to patients nurse – no messages Staffing adjustments in the Medical/Surgical department Goal development Developing consistency in all direct and indirect patient care processes from person-to- person and shift-to-shift New shift report system in both Respiratory Therapy and Medical/Surgical Departments Monthly Patient Care Roundtable

RMH - Committed to You, Close to Home Where do we go from here?

RMH - Committed to You, Close to Home Questions?

RMH - Committed to You, Close to Home We wish you success with your patient safety and culture initiatives Thank you!