Slide 1

AcceleratedReleasing Time to Care

National ForumProduction ProgrammesMay 2013Background

ADHB commenced Releasing Time to Care is 2009 with 33 Wards now underwayADHB investigated alternative delivery options for RTCAn accelerated approach was chosen with a pilot ward commencing in July 2012 Support resource was allocated to work with the team to deliver on a module a month until completion2Accelerated Programme Approach

Shift HandoverPatient ObservationsPatient HygieneMedicines Admissions and Planned D/CWard Rounds7-9 MonthsOngoingNursing ProceduresNursing ProceduresNursing ProceduresProcess ModulesKnowing How We are DoingWell Organised WardPatient Status at a GlanceFoundation ModulesMeals3Module Implementation Monthly timeline

Week 1LaunchPreparationWeek 2 & 3DevelopWeek 4ImplementFollow UpAgree team and confirm rosterCollect DataLearn from other WardsGenerate excitementPatient InterviewsStaff InterviewsProcess followsReview dataGo-seeIdentify opportunitiesDefine new processAgree implementation timeframe and communications planDevelop Process FlowchartDevelop SOPs Develop TemplatesEngage other stakeholdersOrder new equipmentPlan facilities improvementsStaff EducationGo Live with process improvementsNew equipmentFacilities improvementsAuditsCelebrate success

4Key PrinciplesSteal with pride - capitalise on the work done and improvements made by other wards Manage scope focus on specific areas of improvementCommunication, Communication, Communication use the Daily Ward Meetings as a key tool to ensure everyone knows what is happening, why and whenQuick fire keep energy, focus and motivation high by maintaining momentumShare the load utilise as many of the ward team as possible to implement changeBuild for the future develop resources to be utilised by other wards

Results - Overall

7 Process Modules deliveredDirect Care Time= 54%(38% Improvement) Patient Satisfaction = 91 %Staff Satisfaction = 84 %Reduction in Length of Stay >0.8 daysReduction in Pressure Injuries = 0 in 6 monthsSustained Acute Patient Flow >95%Sustained Smoking Cessation >95%3 Foundation Modules extendedIt really has increased the amount of time we can spend with the patients Staff Member 6Knowing How We are Doing

Revisited the Ward Vision with input from the Multidisciplinary teamImplemented Daily Ward MeetingsMaintained communications boards and safety crosses

The atmosphere on the ward has changed. You can feel it as you walk in, things are calm and organised. - Staff Member7Well Organised Ward

4 bedded RoomsEquipment RoomStaff BaseWhanau RoomEducation HubWard Meeting RoomSluice Room

I can find things! Everything has its place. Staff member

8Patient Status at a Glance

Electronic Whiteboards updated with required flagsNew wide screens to improve usabilityPatient Bedcards implementedStaff Status at a Glance BoardRapid Rounds maintained

9Shift Handover

ISOBAR Bedside HandoverPatient involvementImproved information transferSafety checksSignificant impact on direct care timeWhen the nurses change shifts they introduce who they are and that theyre our nurse- Patient

10Meals

Improved focus on patient preparationImplementation of a meal preparation bellNurses assisting patients to complete meal cards ensuring sufficient food is ordered and less meal call backs are requiredImproved use of assist flags for those patients needing any assistance at meal timesImproved timing of meal delivery

11Patient Observations

Improved observation trolley set up to reduce waste looking for additional equipmentRelocation of observation equipment to point of use (i.e. within 4-bedded rooms and outside single bedded rooms)Refreshed patient observation standards including education

The ward seems calm and everyone knows what they are doing.- Patient

12Patient Hygiene

Hygiene packsWhere am I posters for Commode and Wash Bowl TrolleyAgreed standards on patient hygiene requirements

The staff are fantastic! I would give them 100%. They work so hard and every single one of them took time for a chat and you were never rushed. - Patient

13Medicines

New layout and refurbishment of the medication room

Improved access to controlled drugs cabinetReduce stock levelsImproved education for patients

14Admissions and Planned Discharges

New patient welcome pack includingWard information BookletWard and hospital mapsWhat to expect informationTransition lounge brochureHospital ResourcesStaff Admission checklist Agreement that discharge summaries are written 24 hours before discharge to allow for review by the consultant and better discussion with the patient

15Ward Rounds

Agreed sequence and flowPortable laptop to be used during Ward RoundsPatient nurse to attend Ward RoundsWard Rounds information sheet for patients in the Welcome Pack including space to capture questions for the Medical TeamImproved signage and awareness around which teams are rounding and whenConsultant to sit down during Ward Rounds to enable better engagement with the patient and their support person(s)Junior doctor to read back plan to ensure clarity and correctness16Conclusion

Ward 72 has benefited from the combined impact of the Accelerated Releasing Time to Care programme, Rapid Rounds and daily ward meetingsThe ward is now better organised with clearly defined processes. The improvements have resulted in a calmer work environment that provides a better patient experienceThe fast pace of implementation along with the significant team involvement has resulted in a continuous stream of improvements on the ward keeping team motivation and engagement highGetting better every day! Great place to work! - Staff member17QuestionsDo you have any questions?

For future questions please contact Abbi Harwood-Tobin (abbih@adhb.govt.nz or 021 584 021)Marie Mata (mmata@adhb.govt.nz or 021 0825 7224)Sarah Wilson (sarahwil@adhb.govt.nz 021 397 553)

It means nurses can identify REAL problems and fix them!- Staff Member