Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
TN
615.309.6053
www.healthtechs3.com
5110 Maryland Way, Suite 200, Brentwood,2745 North Dallas Pkwy, Suite 100, Dallas,
TX
800.228.0647
www.gaffeythealthcare.com
Best Practices from Nurse Leaders
Preferred vendor to:
Currently provides hospital
management, consulting
services and technology to:
• Serving community, district, non-profitand critical access hospitals
MT. Ranked as a Top 100 Critical Access
Hospital for 8 years in a row
• Example technology and AR servicesclient includes two-hospital NFP system
in southeast GA with numerous
associated physician practices
• Example managed hospital client includes•
Barrett Hospital and Healthcare in Dillon,
• California Critical Access Hospital
Network
• Western Healthcare AlliancePartner with Illinois Critical Access
Hospital Network
• Vizient Group Purchasing Organization
Nationwide Client Base
• Executive management & leadership development
• Community health needs assessment
• Lean culture
• Executive and interim recruitment
• CEOs, CFOs, CNOs
• VP and Department Directors
• Performance optimization & margin improvement
• Revenue cycle & business office improvement
• AR outsourcing
• Continuous survey readiness
• Care coordination
• Swing bed consulting
Governance & Strategy
Recruitment Clinical Care & Operations
Finance
Areas of ExpertiseStrategy – Solutions - Support
4
HealthTechS3 hopes that the information contained herein will be informative and helpful on industry topics. However, please note that this
information is not intended to be definitive. HealthTechS3 and its affiliates expressly disclaim any and all liability, whatsoever, for any such
information and for any use made thereof. HealthTechS3 does not and shall not have any authority to develop substantive billing or coding
policies for any hospital, clinic or their respective personnel, and any such final responsibility remains exclusively with the hospital, clinic or
their respective personnel. HealthTechS3 recommends that hospitals, clinics, their respective personnel, and all other third party recipients of
this information consult original source materials and qualified healthcare regulatory counsel for specific guidance in healthcare
reimbursement and regulatory matters.
INSTRUCTIONS FOR TODAY’S WEBINAR
You may type a question in the text box if you have a question
during the presentation
We will try to cover all of your questions – but if we don’t get to
them during the webinar we will follow-up with you by e-mail
You may also send questions after the webinar to our team
(contact information is included at the end of the presentation)
The webinar will be recorded and the recording will be
available on the HealthTechS3 web site:
www.healthtechs3.com
www.healthtechs3.com
© HTS3 2019
Your Swing Bed Questions AnsweredDate: October 4, 2019 Time: 1:00 pm CSTPresenter : Carolyn St.Charles, RN, BSN, MBA, Regional Chief Clinical Officer HealthTechS3https://bit.ly/2l3pyAO
CMS Changes, CoPs and Discharge Planning Requirements – What do They Mean for Your Organization?Date: October 18, 2019 Time: 12pm CSTPresenter : Carolyn St.Charles, RN, BSN, MBA, Regional Chief Clinical Officerhttps://bit.ly/2pgVALy
Chronic Care Management Coding: How to Deal with Combo Codes and The Impact on RevenueDate: October 24, 2019 Time: 12:00 pm CSTPresenters : Faith M Jones, MSN, RN, NEA-BC, Director of Care Coordination and Lean Consulting, HealthTechS3Julianna Seaman, CCS, CCS-P, Coding and CDI Director, eCatalyst Healthcare Solutionshttps://bit.ly/2lLChZd
Best Practices from Nurse LeadersDate: November 1, 2019 Time: 1pm CSTPresenter : Carolyn St.Charles, RN, BSN, MBA, Regional Chief Clinical Officerhttps://bit.ly/2niijG7
Diversity and Inclusion at the Hospital Senior Leadership Team LevelDate: November 15, 2019 Time: 1:00 pm CSTPresenter : Peter Goodspeed, MBA, VP of Executive Search, HealthTechS3https://bit.ly/2ngdWvc
Understanding Lean and Using a Kaizen Event to Improve Multi-Department ProcessesDate: November 21, 2019 Time: 12pm CSTPresenters: Faith M Jones, MSN, RN, NEA-BC, Director of Care Coordination and Lean Consulting, HealthTechS3Tracy Clarno, PMP, CPHQ, Think Lean Consultinghttps://bit.ly/2nggbi6
Planning for a Successful Hospital SurveyDate: December 6, 2019 Time: 1pm CSTPresenter: Carolyn St.Charles, RN, BSN, MBA, Regional Chief Clinical Officerhttps://bit.ly/2mMPeCb
8 Critical Strategies for Interim ExecutivesDate: December 11, 2019 Time: 12pm CSTPresenter: Mike Lieb, Vice President – Interim Services, HealthTechS3https://bit.ly/2nbUgs9
Team-Based Care and Achieving Optimal PerformanceDate: December 19, 2019 Time: 12pm CSTPresenters: Faith M Jones, MSN, RN, NEA-BC, Director of Care Coordination and Lean Consulting, HealthTechS3Kara Beech, Beech Creative Grouphttps://bit.ly/2l7ZFzT
ALL WEBINARS ARE RECORDED
6
Carolyn began her healthcare career as a staff nurse in Intensive Care. She has
worked in a variety of staff, administrative and consulting roles and has been in
her current position as Regional Chief Clinical Officer with HealthTechS3 for the last
fifteenyears.
St.Charles conducts mock surveys for Critical Access Hospitals, Acute Care
Hospitals, Long Term Care, Rural Health Clinics, Home Health and Hospice. Carolyn
also provides assistance in developing strategies for continuous survey readiness
and developing plans of correction.
Carolyn also has extensive experience in working with rural hospitals to both
develop and strengthen SwingBed programs.
360-584-9868
Agenda
7
Rural Nursing Recruitment and Retention StrategiesApril Asbury, MSNVP Patient ServicesHeart of the Rockies Regional Medical Center
Nursing Bedside Shift Report: Enhancing Patient and Family Engagement to Improve Quality and SafetyLane Harrington, ARNP, MSNChief Nursing OfficerUpson Regional Medical Center
Strategies for Effective Nursing CompetenciesDebby A. Renner, PhD, MS, BSN, RNInterim Chief Nurse Executive
8
April Asbury, MSN
Asbury is Vice President of Patient Care Services of Heart of the Rockies Regional Medical Center, a
critical access hospital in Salida, Colorado since 2017.
April is a graduate of Western Governors University where she received a Master’s of Science in
Nursing Leadership. April has been an RN since 1995 and her leadership career launched in 2000,
where she was the manager of a 40 bed Emergency Department. In 2005, April advanced her career
to become the Chief Operations Officer for an Inpatient Acute Rehabilitation Hospital and Long Term
Acute Care Hospital. In 2009, April returned to acute care leadership as a Director for Emergency
Services and Acute Care Services. As the leader for patient care services, April has been able to make
an impact with systems through keeping the patient and needs of the community at the center of
each consideration and decision.
9
Lane Harrington, ARNP, MSN
Lane Harrington ARNP, MN. is the CNO for Upson Regional Medical Center, a 112 Bed acute care hospital in Thomaston, Georgia. Lane joined the URMC Leadership team in July of this year.Lane has over 30 years of Healthcare experience, with the last 16 years in Senior Leadership roles. Most recently, Lane served as Chief Nursing Officer at North Shore Medical Center in Miami, Florida. Lane has also held senior leadership positions with CHRISTUS Health in Alexandria, Louisiana Scotland Memorial Hospital in Laurinburg, North Carolina, and Lakewood Ranch Medical Center in Bradenton, Florida.
Lane’s leadership is diverse, ranging from the successful start up of a new 120-bed acute care hospital in Florida to creation of a safety net healthcare system in Central Louisiana. Lane’s leadership successes are uniformly focused on the provision of clinically excellent patient care, improvement of the patient experience, and support of employee engagement and satisfaction. Lane earned her Bachelor of Science Degree in Nursing from Barton College in Wilson, North Carolina and her Master of Nursing (ARNP) degree from the University of Florida.
.
10
Debby Renner, RN, BSN, MS, PhD
• Interim nurse leadership positions for 15 + years
• Has directed nursing operations for critical access to magnet teach hospitals of 1000+ beds to
multi-state/multi-facility systems
• Provides expertise in Institute for Healthcare Improvement patient safety initiatives as well as
policy/procedure development, training/education and leadership-change management
• Oklahoma native
• Living between Texas and Arkansas. (heard of the Razorbacks?)
R U R A L N U R S I N G R E C R U I T M E N T A N D
R E T E N T I O N S T R AT E G I E SA P R I L A S B U R Y , M S N
V P P A T I E N T S E R V I C E S
H E A R T O F T H E R O C K I E S R E G I O N A L M E D I C A L C E N T E R
HOME GROWN APPROACH
• New Graduate RNs on Med Surg
• Peri-Operative 101
• Limited Scope Competencies for Floating
• Scheduled Float Pool
• Maximize Resources available
NEW GRADUATE NURSES
• Hire New Graduate Nurses into PRN positions
• Train with a consistent preceptor for consistent hours for 12 weeks
• This RN is in the pipeline for any benefited Full-Time or PT opportunity
• Open Communication with nurses about their passion—Goal is to keep the RN employed with
the organization.
PERI-OPERATIVE 101
• Peri-operative Educator position
• Hire RNs specifically for the Peri-operative training
• 2-3 going through the course at any given time.
• Plan to train for a minimum of 6 months.
• Aging RN population in peri-operative services, strategy for planned retirements etc.
LIMITED SCOPE COMPETENCIES
• An RN with interest in another department can train through use of limited scope competencies during down time
• Once achieved, the RN can then consistently float to another unit as opposed to using their PTO or low census without pay when the unit is closed.
• RNs from our Family Birthing Unit all have limited scope competencies to assist with
– Same Day Surgery/Recovery
– Medical Surgical Unit
– Telemetry monitoring
– Infusion Center
– Sitters (ER for Behavioral Health and Med Surg).
• Several Med Surg RNs also have limited scope competencies to assist with FBC, ICU and ER.
CONTENT OF LIMITED SCOPE COMPETENCIES
• Allows for a helping hands approach:
– The role of this Limited Scope of Practice Statement is to maximize the collaborative effort of the registered nurse and clinical department in the provision of quality patient care. The goals of this process and duties include (MS example):
• Basic Nursing Skills: IV starts, Foley care etc.
• Accuchecks
• Pass Scheduled Medications
• Administer PRN Medications
• Answer Call Lights
• Assist Primary Nursing staff as requested
• Safety sitter
• Primary Care for a simple/low acuity patient
• Department orientation to each area floated is required
SCHEDULED FLOAT POOL
• RNs in the float pool must be able to work with full competency in at least 3 departments
• Options for departments are a mix of 8 hour and 12 hour options
– Med Surg
– ICU
– ER
– Infusion
– PACU/SDS
– Clinics Float RN---Proficient with at least 3 outpatient clinics
• Scheduled up to their FTE across multiple departments
MAXIMIZING RESOURCES AVAILABLE
• House Supervisor Manager (Also our Quality Manager)
– Nursing Supervisors
– PICC team
– Float Pool RNs
• Centralized Staff Scheduling—all are scheduled in Kronos
– Maximizes awareness of resources available in all clinical areas.
Nursing Bedside Shift Report
Enhancing Patient and Family Engagement to Improve Quality and
SafetyLane Harrington ARNP, MN.
CNO Upson Regional Medical Center
Focal Points for the Session
• Patient and family engagement, regulatory
requirements
• Components of bedside shift report
• Benefits and challenges of bedside shift report
• What does HIPAA say about bedside shift
report?
Patient and Family Engagement
• Regulatory Agencies require/recommend Patients are involved in their care
• Creates an environment where patients, families, clinicians and hospital staff work together as partners to improve the quality and safety of hospital care
• Involves patients and family members as
✓Members of the health care team
✓Advisors working with clinicians and leaders to improve policies and procedures
Patient and Family-Centered Care
• Patient and family engagement is an important part
of providing patient- and family-centered care
• Core concepts of patient- and family-centered care
include:
✓Dignity and respect
✓Information sharing
✓Involvement
✓Collaboration
Why Patient and Family Engagement?
• Research shows patient-centered care approaches
can improve:
✓Patient safety
✓Patient outcomes, including emotional health,
functioning and pain control
✓Patient experience
Why Focus on Bedside Shift Report?
• Transitions in care have potential for medical errors
• Research shows bedside shift report can improve:
✓Patient safety and quality
o Improved communication
oDecrease in hospital-acquired complications (i.e. falls)
✓Patient experiences of care
✓Time management and accountability between nurses
oDecrease in time needed for shift report
oDecrease in overtime
• Critical Elements
• Benefits
• Challenges
What is Bedside Shift Report?
• Nursing staff conducts shift change reports at the
patient’s bedside
• Patient can identify a family member or close friend to
participate
• Report should take about 5 minutes per patient
• Purpose
✓To engage the patient and family in hospital care
✓To share accurate and useful information between
nurses, patients and families
Critical Elements of Bedside Report
• Introduce the nursing staff, patient and family
• Invite the patient and family to participate
• Open medical record or electronic work station in the patient’s room
• Conduct a verbal SBAR report with the patient and family, using words they can understand
• Situation
• Background
• Assessment
• Recommendation
• Conduct a focused assessment of the patient and a safety
assessment of the room
• Review tasks that need to be done
• Identify needs and concerns of the patient and family
Critical Elements of Bedside Report
Benefits of Bedside Report for Patients
• Acknowledges patients as partners
✓Communicates the feeling that the patient and family
are “wanted” as partners in care
✓Enhances the feeling of patient involvement
• Builds trust in the care process
✓Shows the patient how much nurses know and do for
them
✓Shows teamwork among the nursing staff, reassuring
the patient that everyone knows what is going on with
them
Benefits of Bedside Report for Patients
• Encourages patient and family engagement
✓Gives the patient and family an opportunity to ask
questions and correct any inaccuracies in handoff
✓Informs the patient and family members about the
patient’s care throughout the stay and helps with
the transition to home
Benefits of Bedside Report for Nurses
• Better information about the patient’s
condition
• Accountability
• Time management
• Patient safety
Tips for Bedside Shift Report
• Invite patients and family at admission to participate
using bedside shift report brochure
• Use checklist to facilitate bedside shift report
• Thank the nurse going off duty if everything is in good
shape
Potential Challenges
• Unknown visitors or family in the room
• New diagnosis or information patient is not yet aware
of (e.g. waiting for the MD to discuss)
• Patient is asleep
• Patient is noncompliant and you need to share
information with oncoming nurse
• Patient or family has complex question or needs a
lengthy clarification
• Semi-private rooms and HIPAA concerns
Addressing HIPAA Concerns
• Health information can be disclosed for
✓Treatment
✓Health care operations
✓Payment
✓Continuing care
• HIPAA acknowledges incidental disclosures may occur
• Not a HIPAA violation as long as:
✓Take reasonable safeguards to protect privacy
✓Disclose only or use the minimum necessary
information
Addressing HIPAA Concerns
• Question: Is a covered entity required to prevent any
incidental use or disclosure of protected health
information?
• Answer: No. The HIPAA Privacy Rule does not require
that all risk of incidental use or disclosure be
eliminated to satisfy its standards. Rather, the rule
requires only that covered entities implement
reasonable safeguards to limit incidental uses or
disclosures [see 45 CFR 164.530(c)(2)]
Addressing HIPAA Concerns
• Question: Can physicians and nurses engage in
confidential conversations with other providers or with
patients, even if there is a possibility that they could
be overheard?
• Answer: Yes. HIPAA does not prohibit providers from
talking to each other and to their patients. Providers’
primary consideration is the appropriate treatment of
their patients.
Addressing HIPAA Concerns
• Oral communications must often occur freely and
quickly. Covered entities are free to engage in
communications as required for quick, effective and
high-quality health care. For example:
✓Coordination of services at the nurses’ station
✓Discussion of a patient’s condition or treatment
regimen in the patient’s semiprivate room
✓Discussion of a patient’s condition during training
rounds in an academic or training institution
Final Thoughts
• Upson Regional Medical Center is committed to
patient and family engagement—everyone plays a
critical part
• Patients and families won’t engage if they believe that
you don’t want them to—it is too risky for them
• Your job is to make it safe for them to be involved, not
just as patients but as partners in care
Tools for Implementation
Outcomes/Evidence
STRATEGIES FOR EFFECTIVE NURSING
COMPETENCIES
Presented by
Debby A. Renner, PhD, MS, BSN, RN
Competency Selection
• Incident reports
• Sentinel events
• Low volume / high risk procedures
• Polling staff
Competencies & Policies
• Once competencies are selected
• Insure policies are:
• Current
• Relevant
• Referenced
• Easily accessed by staff
Competency & Patient Assignments
• Core staff and travelers
• Must have competencies that mirror each other
• Travelers
Competency Frequency
• Annual
• Quarterly
• Intermittent
• Combination of the above
Competency Validation Method
• Direct Observation
• Demonstration
• Test
• Pediatric Medication Dosages/Administration
• Medication Dosages/Administration
• Combination of the above
Competencies
• Special Considerations
• Pain Management• Opioids
• Low volume OB
• Low volume Pediatrics
• Low volume CVVH
Competency Failure
• Define how competencies are measured
• Firm passing threshold
• Remediation
• Options
• Time line
• Removal from schedule
52
53
If you are interested in a Hospital mock survey or a Swing Bed mock
survey, please contact me.
Carolyn St.Charles [email protected]
Office: 360-584-9868Cell: 206-605-3748