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12/1/2014
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A11/B11:Partnering with “Familiar Faces”
Embracing Diversity of ExpectationTiffany Christensen
Trevor Torres
Session Objectives
• Examine the variety of expectations held by chronically ill patients and their families
• Explore and discuss a variety of tools for improving communication and engaging patients in safety efforts
• Write action plans for personal and organizational improvement based on the information shared
The presenters in this session have nothing to disclose
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Where we’re going…
Today’s demands for culture change takes your skill set to the next level.
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Why the culture change?
*Pts with more access to information* Competitive markets* Questions about boundaries
And yet…Providers asked to do more with less money
So how do we keep up with shifting expectations?
How do we improve the patient experience while attending to so many other demands?
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The What:Person‐ and Family‐Centered Care is putting the patient and the family at the heart of every decision and empowering them to be genuine partners in their care
~Institute for
Healthcare Improvement
Trevor Torres
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You should getDiabetes!
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My story, and things I’venoticed as a patient
Just ask me!
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Great teachers adapt
Practicing PFCC
THE PLATINUM RULE
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I like to know what’shappening.
Allow me to now narrate my care…
My Upper Endoscopy
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Patient and Family Centered Care Guiding Principle:
Information Sharing
The “it’s cold outside”problem
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Trying to get an A1C
ChronicInconvenience
A.K.A.Red tapeoverdose
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Patient and Family Centered Care Guiding
Principle:
Dignity and Respect
I can haz video?
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Patient and Family Centered Care Guiding Principle:
Participation
My style:
The CEO metaphor
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Patient and Family Centered Care Guiding Principle:
Collaboration
Here come the
Millennials!
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Thank you.
It’s your turn!
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Group Exercise
Betty’s story…
Examine this story from
the perspective of PFCC.
Using the 4 Guiding Principles discuss:• How safe is if for Betty to go home today?
• How might the conversation have gone differently?
4 PFCC Guiding Principles
• Respect and dignity. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.
• Information Sharing. Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete, and accurate information in order to effectively participate in care and decision-making.
• Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.
• Collaboration. Patients and families are also included on an institution-wide basis. Health care leaders collaborate with patients and families in policy and program development, implementation, and evaluation; in health care facility design; and in professional education, as well as in the delivery of care.
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Another patient perspective
Diagnosed at 6 months old with the
gift of cystic fibrosis
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I had a relatively normal childhood
I had my first hospital stay at
Age 12
I had three weeks of intravenous
antibiotics and got my first taste for
the need to be an advocate
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This was just the beginning…
There would be countless more days spent in the hospital during my
lifetime
By age 21, I was sick almost all of the time.
I was attending the North Carolina School of the Arts and
I just couldn’t keep up.
I had to give up my Hollywood dreams and drop out.
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I was on oxygen getting tube feedings.
The doctors put me on the
list for a bilateral lung transplant.
I waited 4 years for my “call”
I was 95 pounds and my lung function was
25% of capacity
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Facing Medical Error
Surgical Error:
“Wet Run” and an apology
Ripple Effect of Reactions:
In the OR
In the Transplant Protocols
In Safety Procedures Hospital Wide
Patient and Family Centered Care Guiding Principle:
Information Sharing
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I waited 1 more year for my first set of donor lungs
Now, due largely to the surgical error,
I was 87 pounds and my lung function was
18% of capacity
April 4th, 2000
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Patient and Family Centered Care Guiding Principle:
Participation
I was healthier and puffier than ever before!
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In June of 2002, my lung function started to drop.
I was diagnosed with my second
terminal illness 6 months later. I had Chronic
Rejection.
Within two years, my lung function had dropped to 10% of
capacity.
I was 73 pounds.
I was dying and the doctors gave me 6 more months to live.
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Loss of Purpose and Worth
I asked my doctors if I
could have a second lung transplant.
They said no.
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After the stages of grief…the soft arms of acceptance
We got a new transplant
coordinator.
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Only 4 months after I was listed,I got “the call”
My fear was overwhelmingGoing into the OR, I was looking
for comfort
Patient and Family Centered Care Guiding
Principle:
Dignity and Respect
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On March 28, 2004
Despite my team’s
concern, the recovery was easier than
the first time.
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Unlike after the first time, I was not confused about what to do
with my life.
I felt a strong calling to reach out to others touched by illness.
I wanted to share what I had learned…
• Author• Public Speaker• Workshop Leader• Hospice Volunteer• TeamSTEPPS Master Trainer• Respecting Choices Instructor/Facilitator• Duke Patient Advocate
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I fell in love
love…again
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And…again
And…again
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Sister, Daughter, Friend
And working on that other thing...
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Collaboration: Duke PAC
Established in 2005 by Dr. Victor Dzau, Chancellor of Health Affairs. Used to advise DUHS on patient centered care initiatives and culture at Duke University Health System
Expansion/sustainability program:
Local Councils providing feedback to specific clinical specialties
Standardized Training for all staff and advisors
Strategic structure and implementation
Rigorous interview/approval process
A different kind of feedback!
Patient and Family Centered Care Guiding Principle:
Collaboration
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Duke PAC Collaboration: Safety
2009 to date:
12+ Duke Health System PAC members trained as TeamSTEPPS Master Trainers
The result:
Partnership with Patients to reduce Medical Errors using
TeamSTEPPS
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TeamSTEPPS• An evidence-based teamwork system to improve
communication and teamwork skills among health care professionals. (Based on the aviation model of safety)
• Scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles.
• Developed by Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality.
• Increases team awareness and clarifies team roles and responsibilities.
• Resolves conflicts and improves information sharing.
• Eliminates barriers to quality and safety.
Yes and….
Where is the patient?
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Sharing Tools
• SBAR (Partnering for time and clarity)
• CUS(S) (Partnering through frustration)
Partnering through Preparation
Symptoms
Background (relevant)
Assessment
Request (immediate)
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Partnering for Safety
Concerned
Uncomfortable
Scared
Safety
Every interaction is an opportunity to build a partnership
One Step at a Time Patient: One simple “job” at a time
Eager Patient and Family: Track own data and medicines
Expert Patient and Family: Trained in SBAR
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And sometimes, no matter what, people will be dissatisfied…
Thank You!
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It’s your turn!
Giving Your Patient a “Job”
Remember our lack of purpose and worth?
Help us by helping you! Give us a job to do to be proactive and safeguard our own health.
• Example: Next Slide
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Ed Johnson from TeamSTEPPS• Setting: Clinic
Ed Johnson, a 41-year-old patient with a history of hypertension, is seen in the Cardiology Clinic for a follow-up after his recent admission to rule out a myocardial infarction. His vital signs are normal except for a BP of 170/110. An EKG shows NSR without evidence of ischemic changes. He states that he has been having episodic chest pain since his release, so the physician decides to repeat his cardiac enzymes. His CPK is 201, and a Troponin I level is pending.
• Mr. Johnson's pain resolves, and he insists on going home. The Troponin I level is still pending when Mr. Johnson is discharged with instructions to call the office the next day if he is still having problems. Shortly after Mr. Johnson is discharged, the Troponin I level of 0.22 (normal <0.03), indicating myocardial ischemia, is called in to the nurse in the clinic. The nurse notifies the physician of the result. No attempt is made to contact Mr. Johnson. Later, he is found unresponsive and having difficulty breathing. His friend calls 911, and when the ambulance crew arrives, they find him apneic and they cannot detect a pulse.
Action PlanUsing the 4 guiding principles, the TeamSTEPPS tools and other key messages you heard today:
Write out 1 way in which
you plan to improve
the patient experience
within your practice
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Questions?
Contact us!
sickgirlspeaks.com
diabetesevangelist.com
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