Includes Pitt County Memorial Hospital Greenville NC Brody School of Medicine East Carolina University Six community hospitals in eastern NC

Pitt County Memorial Hospital Total beds with CON approval to add 116 more beds (includes adult floors) Women’s – 38 beds for postpartum 8 beds for antepartum Labor & Delivery – 23 beds New Born Nursery – 42 beds Convalescent newborn unit – 16 beds Pediatrics – 32 beds PICU – 12 beds NICU – 50 beds

Pitt County Memorial Hospital, is a not-for-profit, tertiary care center covering the 29 counties of eastern North Carolina and is one of five academic medical centers in North Carolina. PCMH is the teaching hospital for Brody School of Medicine at East Carolina University. Many of our counties are living at or below the poverty level. The state poverty rate is 12.3 while most of eastern NC is at 15 to 24%. NC prosperity is threatened by having a region (eastern NC) that has 10 of the poorest counties of the nation’s top 20 poorest counties. NC – 1 in 4 have a college degree Eastern NC – 1 in 6 has a college degree Eastern counties are dependent on agriculture and there are fewer high paying manufacturing job opportunities in the east.

Common barriers to health care in eastern NC Economically underserved Medically underserved High health care cost No insurance or under-insured Literacy rate Transportation Measuring the region by years of life lost before age 75, if eastern North Carolina were a state, it would rank 49 th.

Infant Mortality Rate NC rate – 8.8 per 1,000 live births Minority infant mortality rate dropped by 4.5%, from a rate of 15.6 deaths per 1,000 births in 2004 to 14.9 in The minority rate is still more than double the Caucasian rate. Caucasian mortality rate increased from 6.2 in 2004 to 6.4

Pitt County – 9.4 per 1,000 live births Bertie County – 17.4 per 1,000 live births Edgecombe County – 15.3 per 1,000 births Greene County – 14.9 per 1,000 births Halifax County – 13.0 per 1,000 births Lenoir County – 15.5 per 1,000 births Martin County – 24.6 per 1,000 births Washington County – 17.5 per 1,000 births

Prematurity and low birth weight accounted for 20% of deaths of infants under 1 year old. 28% of the deaths of babies were under 28 days old. 17% of infant deaths were due to birth defects. Sudden Infant Death Syndrome (SIDS) accounted for nearly 10% of the deaths. High quality prenatal care cannot compensate for a lifetime of poor health, for unhealthy behaviors such as smoking, poor nutrition or poor physical fitness and limited access to ongoing high quality health care.

NC has a high rate of: Heart disease Stroke Diabetes Obesity Other chronic health problems NC per capita spending for public health is among the lowest in the nation.

Ways we have implemented PFCC

Child Life Mission To provide developmental and emotional support to children and families facing a healthcare experience.

Child Life Areas Serviced Pediatric Unit Pediatric Intensive Care Unit Neonatal Intensive Care Unit Sedation Services Emergency Department C5 Clinic Radiology Convalescent Newborn Nursery Women’s Services Consults to adult areas

Child Life Staffing 11 FTE Certified Child Life Specialists 1 PT CCLS 3 PT Child Life Assistants 1 FTE Supervisor Volunteers, students

Child Life Implementing PFCC into Practice Family presence during procedures Positioning for Comfort Sibling involvement in hospital experience Patient/Family participation (daily schedules, interventions, pain, etc.) Liaison with communication Child advocate in adult areas

Family Support Network Eastern NC, Inc. Providing emotional support and resource information for families who have a child with a disability, chronic illness, premature birth and for families who have experienced the death of a child.

* 1987 – Parent support began in local community 20 hours a week * 1990 – Parent hired to provide support to other families in Neo-natal Intensive Care Unit (15 hours a week) * 1991 – Expanded services to include all of Children’s Hospital (25 hours a week) * 1992 – Expanded services to include mom’s on bedrest at risk for premature delivery (Hired 2 nd hospital employee) * 1994 – Bereavement Support Family Support Network Eastern North Carolina

* 2007 coverage includes Children’s (NICU, Peds, PICU, NBN) Women’s Trauma (referrals) Emergency Department (referrals) Adult floors (consults cardiac, cancer, trauma) Continuum of Care from Hospital to Home * 11 employees (parents) 5 - full time 4 - thirty (30) hours a week 2 – less than 20 hours a week Volunteers and Student Interns * National Pierson Award Recipient for exemplary services for children with disabilities.

Pediatric Asthma Program * 1994 High School senior with a 12 year history of asthma collapsed after band performance during football game. Inadequate access to rescue inhaler. * Pediatric Nurses and parent of student took the message to officials at the Administrative Office * Asthma Education and access to medications mandatory in all Pitt County Schools * 2006 Recipient of “Emerging Champion of Change in North Carolina Medicine”

Bereavement Support * 1994 – Families shared their stories * 1995 – Our Children’s Garden Cherished Lives Memorial Service * 1996 – Quilt of Memories * 1997 – Memory boxes * 2007 – Palliative Care Room

C5--The Center for Children with Complex and Chronic Conditions The mission of C5 is to promote optimal health, growth, development, safety, comfort and overall well-being for children with special health care needs. Respecting the central role of the family in a child’s life, C5 provides resources and supports systems of care that link the child, family, primary care medical home, appropriate medical specialists and the community in which the family lives.

C5--The Center for Children with Complex and Chronic Conditions Started with input from families. Involved in development of pre-visit contact, care plans and satisfaction survey. Patients and families participate in quality improvement.

C5--The Center for Children with Complex and Chronic Conditions Pre-visit contact---frames visit to address patient/family concerns, goals (home, school, transition, activities, etc.) Care plan—developed collaboratively Satisfaction survey—open, clear communication, adequate time to discuss concerns and questions, equal partner, etc.

What kind of directions are given?

We need to hear from our families to make sure we are going in the right direction.

Family Involvement * Family Resource Room (co-chair) * Cherished Lives Service * Palliative Care Room * Visitation - 24/7 open unit to parents in NICU, Peds, PICU, Newborn nursery * Hospital PFCC Steering Committee * Infection Control

* Rehab committees * Children’s hospital design and remodeling * Presence during resuscitation (Children’s) Adult ICU sporadic * Free parking for bereaved families * Cardiac Intensive Care Developing Family Advisory Council * Hematology/Oncology beginning to incorporate family input into their practice.

Due to having such a large geographical area and the many variables to participation we have families serving in the following ways: Attending meetings participation Phone calls Surveys Reading over materials and submitting their comments

Pediatric Intensive Care Unit Sentinel Event Mom – hospital employee Dad – police officer Child – under 1, history of developmental delays muscle weakness Admitted to hospital unknown diagnosis - didn’t want to mask symptoms - involuntary movements causing loss of lines - steroids and pain medicines over 2 months * Infant restraints – new bed and restraints were too short to tie under mattress, so tied to side rails

* Injury - wrist broken and not noted until weeks later * Transparency - family involved in determining when and how the wrist was broken - child had been transferred to another hospital in another state and back to PCMH during the two months of being hospitalized - Dad remembered the restraints Restraint Company called – no one made infant restraints long enough for the new type bed. * Results - changes in infant restraints nationally - infant restraints are being made 6 inches longer

How do we know if we are making a difference with staff and families? How can we measure the results? Many hours of research and documentation.

Staff Survey: Patient- and Family-Centered Care Index Overall Summary Results from Fall 2005 and Fall (n)=268 / 2006(n)=257 Theme Current Practice 2005 Current Practice 2006 Desired Practice 2005 Desired Practice 2006 Mission Collaboration Plan of Care Patient/Family Strengths Meetings/ rounds Staff Education

Theme Current Practice 2005 Current Practice 2006 Desired Practice 2005 Desired Practice 2006 Visitation QI Medical Record Access Cultural Competence Environmental Design Current and desired practice levels increased from 2005 to 2006 in all themes. Visitation and mission identified as our strongest current practices. The highest “desire to change practice” themes for 2006 are pt/family involvement in environmental design and rounds/discharge planning.

The table below represents responses to the following question: How familiar are you with the elements of patient and family-centered care as defined by the Institute of Family-Centered Care? Response No answer 2.24% 3% No knowledge 13.06% 7% Some knowledge / not applied to practice.37%.5% Knowledgeable / concepts sometimes applied 55.23% 45% Knowledgeable / concepts regularly applied 29.10% 44.5% Decrease in “no knowledge.” Significant increase in “concepts regularly applied.”

Patient/Family Survey: Children’s and Women’s Patient Satisfaction Results April 18, 2006 thru September 26, 2006 (N=227) =Satisfied Most of the time / 4.00 = Satisfied Completely Patient/Family member perception Overall average Patient/Family member perception Overall average Kept Informed about condition/status 3.86Talked about goals with providers 3.82 Felt Welcomed3.90Staff professional and prepared 3.84 Treated with courtesy and respect 3.89Staff cared about patient3.88 Assured Privacy3.89Patient needs were met3.81 Doctor was available3.84Treated or had pain relief3.83 Patient was a partner in his/her care 3.85Provided education and support for discharge 3.91

This survey tool has been shared with the Perinatal Quality Collaborative of North Carolina (PQCNC) and is being considered as a tool for NICU’s across the state that are involved in PQCNC. PQCNC is looking at PFCC for all hospitals in NC * Discussions are taking place around the following areas: - Families on rounds - NICU Advisory Councils - Visiting hours - Sibling access to visit - Kangaroo Care, etc.

We are still on the journey. We learn daily from patients and families. Hospital administration - making changes to ensure families, patients and visitors leave our hospital satisfied.

PCMH Admission book now titled “Information for Patients, Families and Visitors” Opening of PCMH Admission book reads: “At PCMH, we believe that caring for you means involving your family. Therefore, we encourage family members to take an active role in the care of their loved ones whenever possible.”

Regional Rehabilitation Center at PCMH “The process of rehabilitation requires the best efforts of an experienced, integrated patient care team. Patients and their families form the core of our teams.” PCMH Rapid Response Team—Team H “Team H is a program that includes family members as part of the care team….. When a nurse or family member is concerned about a serious medical change in the patient such as bleeding, difficulty breathing or when something doesn’t seem right, they can call Team H….We appreciate family participation as we strive to care for your loved ones.”

The Ride Home “As a tertiary care hospital in rural eastern North Carolina, many of our patients and their families have a long ride home at the end of each stay. Imagine what that ride must be like and what the patient and their family are talking about. They are talking about their experience at our hospital. On that ride home, they are talking about you and me. Are we doing everything possible to make sure that as our patients and their families remember their experience at PCMH that their story is positive? We have a great hospital and an opportunity to create a wonderful story of caring, healing, compassion and service for our patients and families.” Stephen Lawler President, PCMH

Contact information: Brenda Boberg Amy Jones