Download PDF - Hospital Management Asia

August 29, 2014
Radisson Blu Hotel
Cebu City, Philippines
Worldwide Hospital
Management Thinking
& Experience
Improving Care Through EPEEP Nurse
Rounding in a Singapore Tertiary Hospital
(National University Hospital)
Research
Presented by Teng Siew Tin and Pang Shu Kuan
August 2014
Clinical Care
Education
1 | 1.1 Topic goes here | Project number | 14.12.08
Copyright © 2008 National University Health System
National University Hospital (Singapore)
The National University Hospital (NUH):
•
Established in 1985 and it serves as a tertiary hospital, clinical training centre
and research centre for the medical and dental faculties of the National
University of Singapore (NUS).
•
Wide range of medical, surgical and dental specialties including Cardiology,
Gastroenterology and Hepatology, Obstetrics and Gynaecology, Oncology,
Ophthalmology, Paediatrics and Orthopaedic Surgery and Hand and
Reconstructive Microsurgery.
•
1,160-bed tertiary hospital serving more than 670,000 outpatients and 49,000
inpatients.
Background
3 | 1.1 Topic goes here | Project number | 14.12.08
Copyright © 2008 National University Health System
What
is
EPEEP?
Intro at the first contact. Good morning/afternoon.
Mr X. My name is Y. I am the nurse taking care of
you today.
Explain/Observe: Explain task. General
observation of patient.
Pain/Comfort: Assess patient’s pain level/comfort
level.
Position: Assess the patient’s position and
reposition if required.
Elimination: Offer elimination assistance if
required.
Environment:
• Ensure common items within reach, call bell,
drinking water and cup, etc, bed environment is
clutter free.
• Ensure the bed is at lowest, wheels locked and
side rails are secured.
• Ensure there is adequate lighting esp during
night time.
Plan of return: Ask if patient needs anything else
that the nurse can assist and inform patient of the
next planned activity e.g. next medication serving/
meal/parameter taking, etc.
Reinforce the use of the call bell when needed.
Callbell Reasons (Pre-TCAB)
30
- AM
n&
= PM
207shift
- 1/7:
76 calls
Callbells
- 19/8:
65 calls
Period
=
- 7/10: 66 calls
25
25
22
2011
20
20
01/07/2011
Jul
19/08/2011
Aug
Sep
07/10/2011
19
18
15
13
10
9
8
8
7
7
7
5
5
5
5
5
5
5
4
3
0
3
3
0
0
Elimination
assistance
Others
IV problem,
pump alarm
Food & drink
need
Shower
Request for fan
Repositioning,
mobility
assistance
Pain medication
Objectives
7 | 1.1 Topic goes here | Project number | 14.12.08
Copyright © 2008 National University Health System
Direct Patient Contact Time
(General Wards, Overview, Target 60%)
Pre TCAB
Average ‘Direct Patient Contact
Time’ index 51% for 2013
(Target 60%)
(RN, AM Shift, Weekdays)
.n = 16 wards and 46 staff
Post TCAB
Methodology
(Applying of lean tools)
9 | 1.1 Topic goes here | Project number | 14.12.08
Copyright © 2008 National University Health System
Visual Management (Visual Clock)
Voice of the Customer
Plan, Do, Study, Act (PDSA)
Project Spread
1
2
3
4
5
6
7
8
9
10
Area
Jun-13
Pilot Ward 5A
Pilot Ward 6A
Pilot Ward 54
Pilot Ward 43
Medical cluster
Surgical Cluster
Orthopaedic Cluster
Oncology Cluster
Cardiac Cluster
Psychology Med
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Results
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Copyright © 2008 National University Health System
Correlation Test
As observed in the scatterplots, there is
a correlation between:
• ‘No of call bell per patients’ and
‘EPEEP practice compliance’
• ‘No of call bell per patients’
decreases as the ‘EPEEP practice
compliance’ .
Scatterplot of No Call Bells per pt3 vs Epeep practice compliance (Ward 5A)
No Call Bells per pt3
7
6
5
Data source:
Number of patient – Trendcare
Number of Call bells - Bioscientific
4
3
50
60
70
80
Epeep practice compliance
90
•
•
•
Spearmen’s rho indicated the presence of
strong negative correlation between call
bell and EPEEP.
Correlation Coefficient = -.536
Sig (2-tailed) = .001
Control Chart (Ward 5A)
Callbells Per Patient by Day (Pre-Jun'13 & Post-May'14)
Pre-Jun/Jul'13
# Callbells per patient per day
8
Apr
Mar
May
1
7
UCL=6.386
6
2
2
5
_
U=4.005
2
2
2
2
4
3
2
1
LCL=1.624
1
un
1J
13
20
J
14
un
13
20
J
26
un
13
20
1
Ma
4
01
2
r
13
0
r2
a
M
14
25
4
01
2
r
Ma
7
Ap
4
01
2
r
19
Ap
4
01
2
r
1M
ay
14
20
M
13
ay
14
20
M
27
ay
14
20
Date
With proactive structured 2 hourly EPEEP rounding, the number of callbells
(disruptions) per patient per day decreases from 4.665 (June 2013 to 4.005 (May
2014).
Average # Callbells per
patient per day
Average # of Callbells/distruptions saved per
patient per month (28 days)
- 0.37
10.36
Sustenance Strategy
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Copyright © 2008 National University Health System
Nursing TCAB Sustenance Strategies
Level
3
Level
2
Level
1
Leaders
Rounding
Nursing
Quality
Council
(NQC)
Patient
Contact
Time
Tracking
Nursing
Quality
Walkabout
TCAB
Network
Meeting
Unit
Rep
Meeting
Nsg
Quality
Steering
Committee
TCAB
Adoption
Audit
Nursing
Supervisio
n Round
Teamwork
& Comm
Survey
Ward
Staff
forum
Engaging Everyone
Nursing
Standard
s Team
Cluster
TCAB
Review
Leadership Walkabout
Thank you
for your attention
20 | 1.1 Topic goes here | Project number | 14.12.08
Copyright © 2008 National University Health System

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