from patient to partner — engaging patients and …...from patient to partner — engaging...

From Patient to Partner —Engaging Patients and Families in CareKaren CurtissPartnerHealth, LLC

Mary E. Foley, PhD, RN, FAANUCSF School of Nursing

Presented by: Karen CurtissPartnerHealth

Mary Foley, PhD, RN, FAANClinical Professor, UCSF School of Nursing

From Patient to Partner: Engaging Patients and Families in Care

Making ConnectionsFeb 16-17CHA Center forPost-Acute Care

A little background about Karen and Mary

Co-Authors and Co-Presenters

Karen Curtiss

Mary Foley, PhD,RN, FAAN

After our hour together, our goal is for you to leave with

Practical strategies to Activate patients and

families Prevent readmissions

and support patient safety

A plan to act on these strategies

The case for family engagement to prevent HACs and readmissions

Engagement vs. activation

How to activate families to help you prevent HACs and readmissions

Take the Bossy Pants Challenge

Objectives Agenda

“ Bring someone with you.”

Karen’s Family Story:7 Months

Successful lung transplant. PF cured!FallVAPMRSAC diffDVTPEMRSA … againC diff … againStage 4 Bed Sore all the while

Bill Aydt, married to Margaret, 51 years6 children, 9 grandchildren (Lily, age 3, shown)

+ Best Intentions, No Information. Dad Paid the Price.

Who are Your Nearest and Dearest?

+ It’s Complicated

+ Patients Forget 80% of What You Tell Them

* Numerous studies in the U.S and U.K.

+ 3 out of 4 patients, age 64+, leave the hospital with an incorrect prescription or no understanding of their medication regimen. (Yale New Haven study, December 2012)

Yale New Haven study by Dr. Leora Horwitz of patients aged 64+ with heart failure, acute coronary syndrome or pneumonia, December 2012.

+ Preventable Round Trips 14

“We have trained, hired and rewarded people to be cowboys, but it is pit crews that we need —pit crews for patients.”

- Atul Gawande, MD

+We cannot solve our problems with the same thinking we used when we created them.

- Albert Einstein

+Your Allies for Safe Care

No one is more patient-centered. No one knows

your patient better.

Informed and Activated Care Partners 17

How to Engage Patients and Families in Care

Create Culture Inform Connect Activate

How to Engage Patients & Families in Care

Start With Culture1. Listen to patients2. Create Vision3. Acknowledge the pain of change4. Put “pain” on the table — and pivot! 5. Be curious6. Look up!

+ “I am the patient and I need to be heard!”

www.youtube.com/watch?v=iVt3eHAsdK4

+ “I Just Want a Milkshake.” 26

+Trends and/or RulesWhat are You Doing?

1. Provide planning checklists for patients and families who have scheduled admissions

2. Conduct shift change huddles and bedside reporting

3. Have a dedicated person or functional area for attending to patient and family engagement

4. Have an active PFAC (Patient and Family Advisory Council)

5. Have at least one patient/family member sit on your hospital’s Board of Trustees with full voting rights and privileges

6. Provide information and tools to patients and families to prevent HACs and readmissions. (from HEN 2.0)

+ Try These Thinking Caps On for Size

Why May NOT workWhy it WILL

Or CAN work

Feelings, Intuition

+ Informed by All Needs, All Viewpoints

FamiliesClerics

AidsPT, OT

LTC personnelQuality

MarketingPharmacists

Comm. RelationsDieticians

Any others

PatientsNursesDocsAdminsRegistrarsVolunteersParkingGift ShopEnvironmental StaffAdvocates

StrengthsStrengths WeaknessesWeaknesses

OpportunitiesOpportunities ThreatsThreats

Get in the Weeds 32

Activation Starts with Information

1. Use lay language, non-medical terms2. Speak, write in 6th grade literacy level or below3. Share simple checklists, 5-7 items4. Build trust. Be transparent. Talk about HACs,

build partnerships to prevent.

Share Facts:Simple info in simple terms

Connect to Motivate:Fuel connection, “We’re in this together!” Reasons why

Provide "To Do" Tools:

Engage? Safe & Sound Activation Rubric

35S a f e & S o u n d E n g a g e m e n t P r o c e s s Copyright to PartnerHealth, LLC, 2013

Essential: A Common Vocabulary35

Bed Sore

Make funeral arrangements

Infection, bad germs

Yellow

Drink more water

Main doctor (or … angel dust, a street drug)

What you say … What everyone else says/thinks Decubitus Ulcer

Heart failure

Isolation precautions

Jaundice

Up fluids

Translation Please!

+ Checklists: Simple Info Can Help Solve Complex Problems

Enlist Families with Checklists to Help Prevent …

Hospital Infections

Blood Clots

Bed Sores

Readmissions

Plan Ahead for Care Post-Discharge

Virtually eliminated CLABSIs in ICU’s in University of Michigan hospitals

Reduced mortality rate overall by 10%

“Safety Checklist Use Yields 10 Percent Drop in Hospital Deaths”,John Hopkins, Release Date Of 02/14.

Why?Checklists Work!

+ A Good Example

P LE A S E

Wash Hands!

AboutBloodst reamInfect ions:Germs can invade thebody through cuts orbreaks in the skin,resulting in seriousinfection that’scarried through thebody in thebloodstream.

Risk Fact ors: Use of a tube andbag system calledan “IV” or a “centralline” to deliverfluids because theskin has to bebroken for theselines to be inserted.

Use this Checklist to Help Prevent Bloodstream Infect ion

When a central line is inserted, ask: “Are you using acentral line bundle?"

Watch to make sure that nurses and doctors always:

I Wash their hands thoroughly before touching yourloved one

I Use sterile instruments and suppliesI Sterilize the skinI Choose the safest spot

Ask, “Why?” if groin is chosenI Use a clean sheet to drape your loved one's bodyI Wear a maskI Cover the area with a sterile pad

Make sure any openings in the skin are kept covered atall times.

Central line

IV lines often go here (but not always)

Central line can go inthe groin, but it’s not

the safest place

xxxshows example surgery sites

P LE A S E

Wash Hands!

AboutBloodst reamInfect ions:Germs can invade thebody through cuts orbreaks in the skin,resulting in seriousinfection that’scarried through thebody in thebloodstream.

Risk Fact ors: Use of a tube andbag system calledan “IV” or a “centralline” to deliverfluids because theskin has to bebroken for theselines to be inserted.

Use this Checklist to Help Prevent Bloodstream Infect ion

When a central line is inserted, ask: “Are you using acentral line bundle?"

Watch to make sure that nurses and doctors always:

I Wash their hands thoroughly before touching yourloved one

I Use sterile instruments and suppliesI Sterilize the skinI Choose the safest spot

Ask, “Why?” if groin is chosenI Use a clean sheet to drape your loved one's bodyI Wear a maskI Cover the area with a sterile pad

Make sure any openings in the skin are kept covered atall times.

Central line

IV lines often go here (but not always)

Central line can go inthe groin, but it’s not

the safest place

xxxshows example surgery sites

Quick information

6th grade literacy level

Active voice

Icons and pictures

+ Checklists Put Everyone on the Same Page for Patient Safety

Reactions: “Peace of Mind” is Common

*See more at: http://www.amazon.com/Safe-Sound-Hospital-Must-Have-Checklists/

“Since my husband and I are both in our middle 80's, probably one of us will be in the hospital sometime.

I carefully went through the checklists … these records would be very helpful!!

It will bring comfort and peace .” - Joanne Cerling

Connect

Invite families to partner with you with empathy and grace

+ The Power of Empathy

www.youtube.com/watch?v=1Evwgu369Jw

S a f e & S o u n d E n g a g e m e n t P r o c e s s Copyright to PartnerHealth, LLC, 2013

Alternative approach:

To do’s linked to safety and preventing readmission

Reasons why (motivation)

Empathy/Grace notes (art, heart, tone)

6th grade reading level

Activate

Share Tools with To Do’s

+ Example: Prevent VAP for Pennies

+ Checklists in Many Forms47

Infection? Not on My Watch!

Catherine: 42 Days

S a f e & S o u n d E n g a g e m e n t P r o c e s s Copyright to PartnerHealth, LLC, 2013

Take the Bossypants Challenge

+Quality ImprovementsWhat Will You Do Next?

1. Provide planning checklists for patients and families who have scheduled admissions

2. Conduct shift change huddles and bedside reporting

3. Have a dedicated person or functional area for attending to patient and family engagement

4. Have an active PFAC (Patient and Family Advisory Council)

5. Have at least one patient/family member sit on your hospital’s Board of Trustees with full voting rights and privileges

6. Provide information and tools to patients and families to prevent HACs and readmissions.

Be the Change You Want to See

For your familyFor your patients

For your peace of mind

+ Keep Us Posted: We’re Here to HelpKaren Curtiss karen@PartnerHealth.com PH:847.208.6074

Mary Foley mary.foley2@ucsf.edu

Questions?

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