Patient Family Centered Care pays big dividends
Neuro unit slashes LOS, medication errors
Including patients and family members in everything from developing a plan of care to making changes in the hospital's physical appearance has paid off at MCGHealth in Augusta, GA.
The hospital incorporated what it calls Patient Family Centered Care (PFCC) into the planning and day-to-day operations of its new neuroscience unit when it opened in December 2003. The initiative was so successful that the hospital has rolled it out in all units.
MCGHealth is a nonprofit organization affiliated with the Medical College of Georgia that operates the MCG Medical Center, MCGHealth Children's Medical Center, the Georgia Radiation Therapy Center, and related outpatient centers and services.
"Patient Family Centered Care is an approach to health care delivery that emphasizes collaboration between health care providers and patients and families. We work with patients and families from the day that they come into the hospital, engaging them in their care and getting them to the point that they are empowered to take care into their own hands," says Bernard Roberson, MSN, BA, HSC, director of family services development and a former case manager.
After PFCC was instituted, the neuroscience unit experienced a 50% decrease in average length of stay and a 52% reduction in medication errors. The number of complaints by patients and family members on the unit dropped from 17 per year to seven per year.
Patient care from day one
The decrease in length of stay can be attributed to involving the family in the patient's treatment plan and patient care from day one, says Roslyn Marshall, RN, MHSA, BSN, nurse manager for the neuroscience unit.
"When the physical therapists come in, they invite the family to be part of the team. The dietician involves the family in what the diet needs to be at home. We're teaching them how to care for the patient once they go to the next level. This gets the family prepared for the discharge in advance," she says.
Having the pharmacist come in and teach the patients and family members about the medication regimen has reduced the medication errors, Roberson says.
"The patients and families know what medications are prescribed and what the doses and schedules are. They are getting involved in carrying out the treatment plan and speaking out when it isn't being followed," he says.
Under the hospital's PFCC program, family members can be in the patient rooms 24 hours a day — even in the intensive care unit.
This change has expedited discharge planning for patients in the ICU because families can start to learn how to care for the patient at home in the early days of the stay, says Jill Williams, BSN, charge nurse in the neuro intensive care unit and a former case manager on the neuro unit.
"When families can stay in the intensive care unit, they can become involved in patient care. This often serves as a reality check and helps them realize what kind of assistance the patient will require after discharge, facilitating their selection of a facility for post-acute care," she adds.
Members of the hospital's multidisciplinary treatment team, led by the case managers, collaborate with the family to create a plan of care and engage them in the day-to-day treatment of the patient whenever possible.
"Case managers are responsible for coordinating the interdisciplinary team and making sure that everyone knows what is going on with the patient and family and that the patient's and family's wishes are incorporated into the treatment and discharge plan. It's not about giving the patient and family members what they want. It's about creating a partnership and coming to mutual agreement," Roberson says.
Case managers round with the physicians on the unit, then return to the patient rooms and go over the treatment plan with the patients and family to make sure they understand it. They share what the physician says with the nursing staff and therapists as well.
"Our goal is to make sure that everyone tells the patient the same thing and that the patient and family members understand what is going on and are comfortable about asking questions," Marshall says.
Family members and patients have access to the patient's multidisciplinary plan of care, a notebook kept in a wall pocket by the patient's bed.
The entire treatment team documents in the plan, allowing the family to see what treatment is planned for that day, patient goals, and any changes in the patient's condition.
"The family may see that the patient is scheduled for an MRI today or that the physical therapist noted that the patient walked 100 feet today compared with 75 feet yesterday. The book outlines the plan for the patient and their progress during the hospital stay," Roberson says.
After the patient is discharged, the plan goes into the medical record.
When the case manager sees that the patient is scheduled for a particular treatment or procedure, he or she explains to the patient what is going to happen.
"This is all a part of Patient Family Centered Care and keeping them informed. A CT scan is not a pleasant experience but it's not as frightening if the patient is prepared for what is going to happen," Marshall says.
The hospital's neuroscience intensive care unit is equipped with a sofa that pulls out into a bed and two recliners, allowing up to three family members to be with the patient at all times. The room has a full-size private bathroom with a shower.
This gives the family a chance to get involved in patient care by helping the nursing staff turn the patients and working with the physical therapists and occupational therapists on exercises, Williams says.
"We always say that discharge planning starts at admission but it never happened with patients in the ICU. Now, the family is here and we can start talking about what will happen after discharge," she says.
Before the PFCC initiative, families weren't involved in the patients' treatment plans until they were discharged from the ICU and often didn't understand the severity of the patient's condition.
Having the patients in the room for extended periods of time throughout the ICU stay helps with discharge planning, Williams points out.
"When the family is at the bedside for just a few minutes at a time, they may think they can take the patient home even if they are on a ventilator or have feeding tubes. When the family sleeps over, the nurses wake them up every two hours to turn the patient or suction him. They find out how much care the patient needs and can decide whether they will be able to provide that care at home," she says.
Seeing everything that the patient needs helps the families become more receptive to transferring the patient to a long-term acute care hospital, a nursing home, or a rehab facility, Williams points out.
"When I was a case manager talking to the family while the patient was in the ICU, they often weren't receptive to the idea that the patient couldn't be discharged to home. Now, they're at the bedside the whole time and can see that the patient isn't getting any better and isn't going to be able to care for themselves. It makes discharge planning a lot easier," Williams says.
One family was able to care for their loved one at home after spending the weekend on the unit and learning to give the patient all the care he needed.
"The family felt confident in providing the care and we felt comfortable with the discharge to home," Williams added.
Before the neuroscience unit opened, everyone on the staff, including physicians, environmental services, therapy, case managers, social workers, and the facilities staff attended educational sessions that emphasized including patients and family in the care.
Physicians are among the biggest supporters of the philosophy.
"The physicians went through the education process with the rest of the staff. We listened to their concerns and talked them through it. Now they say that it really benefits them because having patients and family members who are educated and informed makes their job easier," Marshall adds.
The process has had a positive impact on patient and family satisfaction, staff retention and satisfaction, quality and outcomes, Roberson says.
"Physicians, nurses, case managers, and other health professionals are reconnecting with their real purpose of taking care of people. When the staff have a common vision to share the responsibility of care, it lessens the burdens, reduces risk, enhances teamwork, enhances safety, and has a positive impact on patient care," Roberson says.
Including patients and family members in everything from developing a plan of care to making changes in the hospital's physical appearance has paid off at MCGHealth in Augusta, GA.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content