1. in outpatient rehabilitation
Implementing the
WeeFIM system
in outpatient rehabilitation
Chelsea Ratilainen, RN, MSN, CRRN, PHN
PROBLEM
METHODS
CONCLUSION
Outcome measure tools are used to evaluate baseline data and comparison data to represent progress and create measurable goals. For the Commission of Accreditation of Rehabilitation Facilities, the outpatient rehabilitation department must have 6 months to 1 year of verifiable outcome measure data to demonstrate program success and validate patient visits.
At the beginning of this project, no outcome measure tools were being used consistently and with the entire population of outpatient rehabilitation patients. The WeeFIM tool was chosen as the outcome measure tool most appropriate for the purposes of the department and met all accreditation standards.
Using Failure Mode Effects Analysis, the multidisciplinary team decided on the WeeFIM system and bargained for the purchase of the tool.
Problem: Outcome measure tools are not being used, data not being generated
Equipment: No outcome measure tool has been successfully implemented.
Outcome measure tools tried in the past have been inappropriate.
Process: no measurable data is being generated to compare baseline to.
Functional goals being cuurently developed are incomplete.
Materials: Tools tried in the past have been too clinically specific.
Management: Tools have not been consistantly enforced/encouraged.
People: Inconsistancy in outcome measures; too subjective.
The project was successful. There were a few barriers to overcome and a few new goals have been created for the future of this project. The system build in to the EMR was not possible within the specified timeframe and the tool was implemented manually which is time consuming and creates more variables for compliance. While the specific aim was met for the first month, the project is expected to fatigue without continued encouragement and support.
In order to achieve the specific aim in coming months, the staff concerns about time spent and time quality must be addressed. Project development will be continued.
Implementation of an appropriate outcome measure tool was determined to be the highest priority for CARF accreditation and the greatest benefit to patient care. Stakeholders and leadership enthusiastically supported the project.
SWOT
Excellent intrrater reliability, easy and efficient to administer, valuable predictor of function in children with disabilities.
Strengths:
Expensive, requires consistency of staff compliance, variables in subjective assessment.
Weakness:
Compare data to national data, demonstrate effectiveness of program and personal outcomes, elevate care to national standard.
Opportunities:
Non-compliance, discontinuation of use over time.
Threats:
OBJECTIVES
RESULTS
Specific aim: Implement the WeeFIM system with 98% staff compliance within the first month of use (July 2017).
Setting: Outpatient rehabilitation department in community hospital. The department serves an average of 93 clients per month. Clients are children with short term and permanent disabilities ranging from 6 months to 20 years of age.
The specific aim was exceeded, with 100% staff compliance in the first month of use.
Identifying tool
June 1, 2017-June 9, 2017
Researching variety of tools
June 9, 2017 Meeting with multidisciplinary team
Communicating with staff
June 12, 2017-June 16, 2017
Meeting and discussion about WeeFIM
June 16, 2017 Training dates assigned
Training
June 19, 2017-June 23, 2017 Training modules completed by team
June 23, 2017 Conclusion meeting, Calibration exam
EPIC Build
June 26, 2017-June 30, Integrate WeeFIM in to EMR
Using the tool
July 1, 2017-July 31, 2017 Use tool
Generate Data
July 31, 2017 Generate compliance data for WeeFIM system
The team purchased the tool, the appropriate staff were trained and the tool was implemented in the designated time frame.
REFERENCES
Shirey, M. R. (2013). Strategic Leadership for Organizational Change. Lewin's Theory of Planned Change as a Strategic Resource. Journal Of Nursing Administration, 43(2), doi: /NNA.0b013e31827f20a9
Uniform Data System for Medical Rehabilitation. (2011). UB Foundation Activities, Inc.
Educating staff about how and why project must be implemented
UNFREEZE
CHANGE
Active training and open discussion to prepare team
REFREEZE
System implementation