Patient and Family Centered Care in Perianesthesia Arena: WELCOME AND COME ON IN!

Objectives Describe and discuss patient and family centered care in the perianesthesia setting Discuss approaches to encourage staff and promote patient and family centered care Identify opportunities to improve Patient and Family Centered Care by describing missed circumstances and successful patient stories

DEFINITION: Patient and family centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. It redefines the relationships in health care (Institute for Patient and Family Centered Care,n.d.).

DEFINITION Patient and family centered care is an approach to health care that shapes policies, programs, facility design and staff day-to-day interactions. It leads to better health outcomes and wiser allocation of resources, and greater patient and family satisfaction (Institute for Patient and Family Centered Care,n.d.).

Core Concepts Respect and dignity. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.

Core Concepts Information Sharing. Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete, and accurate information in order to effectively participate in care and decision-making.

Core Concepts Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose

Core Concepts Collaboration. Patients and families are also included on an institution-wide basis. Health care leaders collaborate with patients and families in policy and program development, implementation, and evaluation; in health care facility design; and in professional education, as well as in the delivery of care.

Family

Family “The word "family" refers to two or more persons who are related in any way—biologically, legally, or emotionally. Patients and families define their families.” “In the patient- and family-centered approach, the definition of family, as well as the degree of the family's involvement in health care, is determined by the patient, provided that he or she is developmentally mature and competent to do so. The term "family-centered" is in no way intended to remove control from patients who are competent to make decisions concerning their own health care. In pediatrics, particularly with infants and young children, family members are defined by the patient's parents or guardians.” (Institute for Patient -and Family- Centered Care ©)

Family A Definition of Family:   “Families are big, small, extended, nuclear, multi-generational, with one parent, two parents, and grandparents. Living under one roof or many, a family can be as temporary as a few weeks and as permanent as forever. We become part of a family by birth, adoption, marriage, or from a desire for mutual support. A family is a culture unto itself with different values and unique ways of realizing its dreams. Together, our families become the source of our rich cultural heritage and spiritual diversity. Our families create our neighborhoods, communities, cities, states, and our nations.” ( Christiana Care Health System, PFCC Sharepoint)

Family Definitions of Family Cont…, “When the patient can communicate, the ideal definition of family is whomever the patient defines as her or his family. When the patient is unable to communicate, a practical definition of family is anyone who shares a history and a future with the patient.” ( 2012-2014 Perianesthesia Nursing Standards and Recommendations)

Caring Patient Family Centered Care is: A philosophy of care A culture of care A change

ASPAN Practice Recommendation

ASPAN Practice Recommendation Pre-op phase~ 1.Pt is informed that family member may visit in immediate post op phase; 2.Asked if they would prefer visit and whom would like to visit; 3.The designated family member receives info about PACU environment and expected behavior of visitors 4. If the family member accepts the invitation to visit, they are told to wait for contact by PACU staff at appropriate time (pg. 63 of Perianesthesia Standards etc., 2012- 2014)

ASPAN Practice Recommendation Induction~ 1. Widely accepted and expected by many parents 2. Premedication effective in reducing child anxiety in some cases (pg. 63-64 of Perianesthesia Nursing Standards etc., 2012-2014)

ASPAN Practice Recommendation Postoperative Phase ~ 1. Appropriateness of family visitation is based on pt status/pt wishes/activity of unit/nurse ability to provide time with pt and family member 2. Primary nurse available to answer appropriate family questions and reassure patient and family members 3. Termination of visitation is at discretion of primary nurse and based upon patient/visitor/unit circumstances (Pg. 64 of Perianesthesia Standards etc., 2012-2014)

ASPAN Practice Recommendation Evaluation Phase ~ 1. Evaluation of the visitation practice begins when visitors arrive in PACU and lasts until postoperative phone calls are made to ambulatory patients or when patients are assessed for satisfaction related to visitation 2. Visitation guidelines should be re-evaluated per institution policy 3. It is helpful to have posted unit guidelines that specify expectations concerning family care. (Pg. 65 of Perianesthesia Standards etc., 2012-2014)

Citations: Family visitation in PACU first surfaced in mid 1980’s aligning with similar issues facing other specialty units Nurses personal experiences forced them to consider the traditional visitation policy of their unit One study in the late 1990’s showed that 89% of patients and 96% of families thought family presence was beneficial. Bonifacio and Boschma. Family visitation in the PACU, 1984-2006. Journal of PeriAnesthesia Nursing, April, 2008.

Citations: For Pediatrics: Pre-op programs began in the 1960’s ~ there are 100’s of articles on those programs and their benefits Parental anxiety has been associated with child anxiety. Parents need to be active targets of pre-op education and preparation. Chorney and Kain. Family centered pediatric perioperative care. Anesthesiology, March 2010

Citations: Pre-Op phase: Multimodal approach providing sensory and procedural information for parents and child Anxiety reduction= distraction, education, adding parents, no excessive reassurance, coaching Chorney and Kain. Family centered pediatric perioperative care. Anesthesiology, March 2010

Citations: Intra-Op phase: Facilitate and collaborate between families and healthcare professionals Major interventions include pre-medication with sedative and parental presence at induction Must be agreement between parent/family member/anesthesiologist Chorney and Kain. Family centered pediatric perioperative care. Anesthesiology, March 2010

Citations: Post-op phase: Most hospitals have a policy to allow parents in PACU Utilizing parental presence, distraction, instruction of coping skills are associated with less distress Studies show pain management and recovery at home is less than optimal Chorney and Kain. Family centered pediatric perioperative care. Anesthesiology, March 2010

Citations: Staff preferences and family preferences: Units that supported open visitation had increased job satisfaction of their nurses Study showed close family member preferred one single visit with verbal updates while distant family member preferred verbal update only DeWitt and Albert. Preferences for visitation in the PACU. Journal of PeriAnesthesia Nursing. October, 2010

Citations: Randomized control trial (RCT) evaluated impact of PACU visitation on anxiety levels of the family members, using a pre and post test design, and a convenience sample at a 400 bed community hospital Visits lasted 10 minutes Standardized Adult Anxiety Survey was used Conclusion~ brief visit can be beneficial to family member and increases patient/family satisfaction Carter, et al. Postanesthesia care unit visitation decreases family member anxiety. Journal of Perianesthesia Nursing. February, 2012.

Citations: Descriptive study: Staff feelings regarding visitation 83% of staff would want visitation of their family member before surgery 73% of staff would want family to visit after surgery Walls. Staff attitudes and beliefs regarding family visitation after implementation of formal visitation policy in the PACU. Journal of PeriAnestheisa Nursing. August, 2009.

Citations: Descriptive study: Conclusion ~education for family was needed ; education for the staff to interact and communicate with family in PACU Walls. Staff attitudes and beliefs regarding family visitation after implementation of formal visitation policy in the PACU. Journal of PeriAnestheisa Nursing. August, 2009.

Citations: Our patients are saying: “Family members are the eyes and ears of the patient” “Visiting hours are behind the time” “Exam rooms should have an extra chair for the family member” “There should be a support group for families” “There should be a family bill of rights” W. Leebov. Heartbeat on the quality patient experience. www.quality-patient-experience.com

“Yes, I am part of the medical team. Without me, you have nothing.”

Benefits of PFCC Trust and partnership Communication Patient and family satisfaction Staff satisfaction Improvement in patient safety

Christiana Care’s Journey

At Christiana Care: Perioperative Services Journey Envisioning a philosophy of PFCC within Periop Services Creating a Periop PFCC Steer Group Formation of the Perioperative PFCC Advisory Council represented by patients, families, physician partners, and CCHS employees Patient Experience Teams

At Christiana Care: Organizational Restructuring to Patient Experience Christiana Care Way Leadership Development Employee Engagement Implementation of AIDET No Pass Zone Quiet time Rounding

Sharing Experiences

A Positive Outcome…

Opportunity for growth…

Questions?

References: Bonifacio, N. and Boschma, G. (2008, April) Family visitation in the PACU, 1984-2006. Journal of PeriAnesthesia Nursing. Vol. 23, No. 2; 94-101 Carter, A. et al. (2012, February) Postanesthesia care unit visitation decreases family member anxiety. Journal of PeriAnesthesia Nursing. Vol. 27, No. 1; 3-9. Chorney, J. and Kain, Z. (2010, March) Family centered pediatric perioperative care. Anesthesiology. Vol. 112, issue 3; 751-755. DeLeskey, K. (2009, April) Family visitation in the PACU: the current state of practice in the United States. Journal of PeriAnesthesia Nursing. Vol. 24, No. 2; 81-85. DeWitt, L. and Albert, N. (2010, October) Preferences for visitation in the PACU. Journal of PeriAnesthesia Nursing. Vol. 25, No. 5; 296-301. http://depts/PFCC/default.aspx. Patient family centered care. Christiana Care Health Systems, I-Net, Newark, DE.

References: http://www.ipfcc.org Kamerling, S. and others. (2008, February) Family – centered care in the pediatric post anesthesia care unit: changing practice to promote parental visitation. Journal of PeriAnesthesia Nursing. Vol. 23., No. 1; 5-16. Leebov, W. HeartBeat on the quality patient experience. (2013) www.quality-patient-experience.com TripleAim@ihi.org Walls, M. (2009, August) Staff attitudes and beliefs regarding family visitation after implementation of a formal visitation policy in the PACU. Journal of PeriAnesthesia Nursing. Vol. 24, No. 4; 229-232. 2012-2014 Practice Recommendation #9: Visitation in the perianesthesia care unit. PeriAnesthesia Nursing Standards, Practice Recommendations, and Interpretive Statements. (©2012) American Society of PeriAnesthesia Nurses, Cherry Hill, new Jersey; 63-66.