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Summary of Action Period 1. TN Patient Safety Collaborative: Reducing Physical Restraints Learning Session 2 April 7, 8 & 9 th , 2009. When We Started. Learning Session 1, October 2008 Overview of collaborative process Teams developed goals Teams learned how to report monthly progress. - PowerPoint PPT Presentation
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Summary of Action Period 1
TN Patient Safety Collaborative: Reducing Physical Restraints
Learning Session 2
April 7, 8 & 9th, 2009
When We Started
• Learning Session 1, October 2008• Overview of collaborative process• Teams developed goals• Teams learned how to report monthly
progress
• Share common goals• Teach and learn from each other• Provides systematic approach
Why a Collaborative
Sample Aim Statement from a Senior Leader Report
• To reduce restraint use to no more than 2% of our population within 60 days. This will be accomplished by an interdisciplinary team whose focus is to address falls and fall risk and also to develop individual care plans to meet each resident’s personal needs.
Goals/AIM Statements
• To reduce restraints to 10% or less within a six month period
• To reduce and maintain physical restraints to 2% or less in three months by assisting and evaluating the residents currently with restraints and implementing new measures to eliminate these interventions. Will decrease to 1% or less in six months (by April 2009) with the long term goal of being restraint free.
Goals/AIM Statements, cont.
• Collect monthly data from measurement strategy
• Restraint process and outcome measures• Numerators and denominators entered into
data tracking tool
Approach
Data Tracking Tool
This is a Required Outcome Measure
Data Location: Restraint Log
Numerator Denominator Measure GOAL
MonitoringMonth
Number of residents physically restrained
on the LAST FRIDAY of the
month
Total number of residents in the census on the
LAST FRIDAY of the month
O3. Percent of residents who were
physically restrained on LAST FRIDAY of the
month# of Missed
Opportunities
INITIAL: 2%LONG TERM: 0%
November-08 9 75 12.00% 9 2%
December-08 8 78 10.26% 8 2%
January-09 9 78 11.54% 9 2%
February-09 5 79 6.33% 5 2%
March-09 6 79 7.59% 6 2%
April-09 #N/A 0 2%
May-09 #N/A 0 2%
June-09 #N/A 0 2%
July-09 #N/A 0 0%
August-09 #N/A 0 0%
September-09 #N/A 0 0%
October-09 #N/A 0 0%
November-09 #N/A 0 0%
December-09 #N/A 0 0%
January-10 #N/A 0 0%
• Data tracking tool shows opportunities for interventions
• Interventions tried/tested through PDSA cycles
• PDSAs are reported on Senior Leader Report
• Senior Leader Report and data tracking tool submitted to QSource monthly
Approach, cont.
• Plan - What is the situation or problem?• Do - What did I do about it?• Study - Did it work?• Act - Based on what I learned, what am I
going to do now?
Plan-Do-Study-Act (PDSA):What it Really Means
Plan-Do-Study-Act (PDSA):The Building Block for Change
“That’s too complicated; I don’t have time for things like that.”
“I’ve got patients to care for and situations to deal with.”
Curing PDSA Phobia
It’s simple as…
P I E
Plan Implement Evaluate
Plan:• Identify the problem.• What steps you will take to try
to fix the problem?• Different actions? • New interventions? • Different equipment?
Implement:• Put your plan into action.• Test your interventions.
Evaluate:• Did your plan work?• Yes? OK, what now?• No? Why not?• What else can we try?
Your answers will leadyou right back to…
Comparing PDSA with PIE
PDSA PIE What it Means
Plan Plan What are we going to do?
Do Implement
Put the plan in motion
Study
Evaluate Did the plan work?
Act Based on what we learned, what will we do next?
Senior Leader ReportIV. Brief Description of Key Changes (PDSA Cycles)
Plan: Who What When Where Why? Do: What actually happened during the test?Study: What did the test data show? What did we learn?Act: Are we ready to implement this change? What will we need to do before the next test cycle? 1. Plan:
Do: Study: Act:
2. Plan: Do: Study: Act:
3. Plan: Do: Study: Act:
4. Plan: Do: Study: Act:
Learning Session 2
Action Period 1: Activities
• Teleconference calls• SLRs and tracking tools• Onsite visit• Weekly team meetings• Distributed SLR newsletters• Completed 2 PDSAs a week• Discussion list serv
Action Period 1: Outcomes
• Teams test on a small scale• Teams establish measurement system
and begin to use data • Teams begin to use other collaborative
participants as resources
Challenges
• Time/staffing issues• Computer skills• Internet access• Complex PDSAs• Completing 2 PDSAs a week• Documentation • Inconsistent data collection
• Measurement strategy • Family and staff reluctance/opposition• Knowledge• Cost• Perception and attitudes
Challenges, cont.
Lessons Learned
• Education is key to change• Creative innovative ideas• Commitment • One person can’t do it all • Don’t assume a restraint is forever;
conditions and situations change • Easier to do things the ‘old way’
• Obtain staff input to increase buy-in when changing the plan of care
• Address individual needs/strengths of the resident and re-evaluate for least restrictive
• It can be done!
Lessons Learned, cont.
• Increased activities, time in group settings,and ambulation are tremendously helpful during restraint reduction
• Involve all disciplines• Diligence and reinforcement• Make it fun
Lessons Learned, cont.
• Look at resident’s behavior to determine personal agenda and respond to residentneeds
• New alternative devices must be tried under close staff supervision during a trial period with careful attention to resident circumstances
Lessons Learned, cont.
• Maintaining a restraint free facility is a daily battle requiring continual assessment and education
Lessons Learned, cont.
Successes
• Increased sharing • Success stories• CNAs take more ownership• Individualized care plans• No restraints upon admission• Using least restrictive device• Reducing restraint usage• Improving quality of life
O1. Proportion of residents physically restrained any time within two calendar days of admission
O2. Percent of residents with falls resulting in serious injury
Group Average: 4.1%
Goal: <10%
O3. Percent of residents who were physically restrained on LAST FRIDAY of the month
Group Average: 7.2%
Goal: 2%
P1. Proportion of residents physically restrained that received a re-evaluation to reduce or eliminate the restraint
Group Average: 68.8%
Goal: 100%
CMS Quality Measure Rate (Nursing Home Compare) Percent of long-stay residents who were physically restrained
QIES Quality Indicator Rate11.1 Residents who were physically restrained
Failure is the opportunity to
begin again more
intelligently
- Henry Ford
This presentation and related materials were developed by QSource, the Medicare Quality Improvement Organization for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services.Contents do not necessarily reflect CMS policy.QSOURCE-TN-PS-2009-05
Summary of Action Period 1 TN Patient Safety Collaborative: Reducing Physical Restraints Learning Session 2
April 2009
Thank You!