You'll need this data on patient QI involvement
Include patients, families on committees
The national focus on patient-centered care isn't just about teaching patients to become more engaged in self-management of their care—it also means putting patients on committees and advisory boards to participate in the process of developing quality programs.
"Hospitals are involving patients in a variety of ways in quality and safety efforts," says Kathryn K. Leonhardt, MD, MPH, patient safety officer at Aurora Health Care in Milwaukee, WI.
However, this is a big paradigm shift. "Traditionally in health care, we felt that we were the experts in creating programs because we have the training," says Leonhardt. "But how can you create a system for patients without patients at the table? How do you create something to meet their needs if we don't know what their needs are?"
Including patients in quality improvement and patient safety efforts is a new process for health care, says Leonhardt. "Though it seems intuitive that patients should be included because they have the experiential knowledge, the health care system is just now learning how best to incorporate the 'patient perspective,'" she says.
The processes by which patients can participate in quality and safety programs are being developed now by various health systems around the world. These include advisory councils, membership on work teams, surveys and focus groups, and participation in event review committees. "However, both patients and health care providers need to be trained and educated prior to implementing these processes, to be sure they are comfortable and effective for all participants," says Leonhardt.
Outcomes data should be collected to demonstrate the impact of patient involvement, stresses Erik Martin, RN, MSN, clinical director of the pediatric intensive care unit at Cincinnati (OH) Children's Hospital.
"Data are awesome things because they provide objective information that cannot be debated," says Martin. "It proves that hard work and ongoing efforts pay off."
The data you collect should answer these questions, says Martin: How did parent/patient involvement improve our patients' care, quality of life, or outcomes? How did it shorten their length of stay? How did it decrease the amount of medication errors or serious safety events that occurred?
"This is something we are currently working on," says Martin. "We'd like to hardwire the system in all three critical care areas, obtain this data, and eventually roll this initiative out for all the inpatient and outpatient units."
Patient input was used to develop a quality initiative involving a parent of a chronic seizure patient. The parent raised a safety concern when the medical team wanted to do a septic workup on her son, including a spinal tap, which she thought was unnecessary. "The mother was concerned about causing undue painful procedures and exposing her son to a potential infection when it was his baseline to spike a fever after a seizure," says Martin.
Through the "Partnering with Parents" initiative, the mother was able to convey her concerns and prevent the septic workup. By the next morning, the patient had returned to baseline and was ready to be transferred out of the pediatric intensive care unit.
Demonstrating the association between patient involvement and patient safety outcomes can be shown through a variety of metrics. "During one project at Aurora HealthCare, we provided tools and education to help patients become more engaged in their own medication management by maintaining their own medication lists," says Leonhardt.
By increasing patient engagement, the accuracy of medication lists in the clinic charts increased by 17%, she reports. To measure the rate of accuracy of medication lists, the patient's medication list was compared to the clinic's, to identify any discrepancies.
"This type of measurement could be done in other settings, both inpatient or outpatient, to add to the evidence-based support for patient involvement in patient safety efforts," says Leonhardt.
At Cincinnati Children's, patients and families are involved in quality improvement and safety projects in many ways. "One of the first ways is to recognize the patient as the expert, or the parents as the expert in their child's care," says Martin. "Soliciting their input and utilizing it when developing a plan is vital to the success of any quality improvement or safety project."
Here are some examples:
- Family-centered rounds: Families are invited to join the physicians, nurses, and respiratory therapist in discussing their child's condition and plan of care. The parent's input is welcomed and valued.
- Family relations department: If families feel their needs and concerns aren't being met, they are encouraged to contact this department so their voices can be heard. "Additionally, family relations is a neutral party who can facilitate communications for the common purpose of the patient," says Martin.
- "Partnering with Parents": This initiative began in September 2007 in the hospital's neonatal intensive care unit and has since been implemented in the hospital's three critical care areas. It is an extension of a collaborative that began on the medical-surgical floors to empower parents to call the Medical Response Team if they become concerned about their child's safety.
"The initiative engages parents in our organization's safety culture. It encourages parents to stop care if a safety concern arises," says Martin.
The staff member who is present when the concern arises contacts the "content expert," such as the pharmacist, physician, or respiratory therapist, to come to the bedside. "Care is resumed only if all parties are satisfied with the resolution to the concern," says Martin.
To make the most of patient involvement in QI initiatives, do the following:
- Have clearly defined roles for patients.
One pitfall is failing to have defined roles and processes for how patients will be involved in the QI process. Some patients may be concerned that their opinion won't be valued and respected because they aren't familiar with medical terminology, while staff may be worried about revealing problem areas to patients. "Make sure that everyone understands that this is a chance to work collaboratively and proactively on quality and safety initiatives. These are not intended to be complaint sessions, nor a peer review process," says Leonhardt.
- Collect the right data.
To measure the impact of the "Partnering with Parents" initiative, parent satisfaction surveys are used, which ask whether nurses were caring and compassionate, whether nurses listened to your opinion, and whether physicians answered questions thoroughly.
When a parent raises a concern, Martin follows up within 48 hours and uses a tracking sheet, which collects data in SBAR (situation, background, assessment, recommendation) format.
"My data collection is simple and mostly qualitative, but it helps to identify whether there are opportunities to improve our process," says Martin. "I inquire about how the process went, how satisfied the parent is with the outcome, and if they have suggestions for improvement."
- Teach patients the benefits of adhering to guidelines and the ramifications of straying from guidelines.
When patients remind health care providers to practice infection control measures, family members call for assistance when a patient's condition changes, and patient-friendly medication lists are provided at the time of hospital discharge. All of these measures help an organization to comply with regulatory goals, says Leonhardt.
For example, to prevent ventilator-acquired pneumonia, respiratory therapists or nurses at Cincinnati Children's involve parents in tasks such as mouth care or keeping the head of the bed elevated. Data on the hospital's process improvement work are posted all around the unit. An outcomes board clearly lists how many days it has been since the last central venous catheter infection, unplanned extubation or ventilator-acquired pneumonia. "We are very transparent with our data and speak openly to parents about it," says Martin.
[For more information, contact:
Kathryn K. Leonhardt, MD, MPH, Patient Safety Officer, Aurora Health Care, 12500 West Bluemound Road, Suite 301, Elm Grove, WI 53122. Phone: (262) 787-2748. Fax: (262) 787-2788. E-mail: [email protected].
Erik Martin, RN, MSN, Clinical Manager, Pediatric Intensive Care Unit, Cincinnati Children's Hospital, Cincinnati, OH 45229. Phone: (513) 803-0683. E-mail: [email protected].
Researchers from the Agency for Healthcare Research and Quality (AHRQ) have developed a guide for hospital leaders on how to get patients and families to partner with health care providers on community-based patient safety advisory councils. Developing a Community-Based Patient Safety Advisory Council can be downloaded free of charge on the AHRQ web site (http://www.ahrq.gov/). Click on "Quality & Patient Safety," "Medical Errors & Patient Safety," "Tools & Resources," and under "Implementation & Transformation," click on the publication title.]
The national focus on patient-centered care isn't just about teaching patients to become more engaged in self-management of their careit also means putting patients on committees and advisory boards to participate in the process of developing quality programs.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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