Nursing Unit Environment of Care (EOC) Optimization What is EOC? Opportunity Approach > Make rapid, meaningful, grass roots‐enabled improvements to our work environment > Core team leads the overall effort > Steering/ SWAT team helps us implement quickly > Deepen relationships among nursing and support services to foster collaborative problem solving > Nurse champions lead optimization in their units Objective Scope > Create an environment of care with shared ownership of patient needs > Highest and best use of space, sort and straighten > Enhancements to supply management * Develop realistic, mutually agreed upon goals that are measurable * Ensure that the patient experience is the focus of all services * Help all staff, nursing and support services, find a sense of meaning and purpose in their work through patient‐focused goals > Make changes sustainable Guiding Principles Timeline > Implement visible solutions quickly to generate excitement > Jun to Nov 2010: Adult acute—Parnassus, Mt. Zion > Create grass‐roots momentum for change > Nov to Dec 2010: Adult ICU—Parnassus, Mt. Zion > Look for opportunities to reduce variation among units > Jan to Feb 2011: Children’s Hospital > Support Services processes & relationships > Patient environment improvements > Break down barriers with dedicated leadership team > Build long term relationships and a structure to sustain improvements 1.18.11 CN III/IV Meeting Nursing Unit Environment of Care (EOC) Optimization List of Projects In Process Accomplished! * Unit by unit optimization: SWAT walk through, punch list, relationship building * 10 to 15 improvements each for: 8S, 8L, 9L, 10CVT, 11L, 11AHU, 12L, 12M, 13L, 14L, 14M, 5E/W, 5N, 4E, 9/13 ICU, 8/11 NICU, 10ICC, 4ICU, 6L, 7L, 15L/WB, 6PICU, 6PCRC, 7E, 7N, 15ICN * Launched online tool to M/L, CH, and MZ * 15+ supply cart reconfigurations and hot tickets * Standardized RT cart configuration * Supplies photographs * Beds and equipment photographs * Return bin process * Hospitality bed turnover checklist * PSA support in the ICUs * L837, L1037, L1137 dirty to clean utility conversion * Tub room shower removal and floor retiling * Mt Zion tub, hopper, and sink removal * Erected temporary walls in L908, L1108 * 7L swap use and locations: med room and clean supply * Secured charting and family consultation rooms for 14M/14L * Over door isolation caddies * Emergency response/disaster kits deployment * Risk Management‐‐belongings case * Pharmacy rings deployment: M/L and MZ acute units * PYXIS reconfiguration on several units * Designed “PFS late tray” pilot * Tray announcements * Launched AONE survey for champions * Put forth approach for determining # of common area APEX workstations * Bar Coding‐‐device trial and selection * Link to APEX orders team: procedure supply order sets * EOC champions attended 11/2 APEX town hall * HUSC/AA champions identify Materiels, Hospitality and Phlebotomy * CE ordering process education for AAs * Toured Kaiser Innovation Center learn their strategies * Toured MB mock ups to identify environmental improvements * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Opportunities * Optimize environments in ED, OR, ACC Implement 3‐day hospitality kits * BMS/ CPP—optimize its use Deploy two standardized clean supply locations on Long * Mission Bay operations optimization and planning Communication/escalation sheets for MS and Hospitality * Challenges with communication Continued Recycling & Med Share deployment * APEX adoption among nursing staff Physician supplies ship to location on 14M * Implement high impact Bright Ideas Hygia reprocessing * Bin cheat sheet‐who, what, schedule, contact Respiratory precaution carts * Chemo roll out Oxygen set up kit * Standardize BP cuffs Rapid response box * SCD pumps in room Trach caddy * Other kits Remaining orders: e.g. blanket warmers * New Product introduction Rings guidelines * Recall communication E shift PSA pilot in the ICUs * MREs Preventative maintenance process in the ICUs * NPO and tube feeds process improvement Specimen refrigerator * Pillows opportunities Patient room EOC upgrades * Gloves opportunities Outside patient room precaution sign booklet * Forms Epic common area workstations recommendations * Remaining ring deployments Supply/computer cart selection * Expand 10CVT phlebotomy process improvement to house Dirty utility remodel to accommodate many bins * CE battery replacement process 12L Pyxis reconfiguration to look like 10CVT * COW, WOW sweep‐‐removal and/or fix process 15ICN Remove large scrub sink * SLAs 12 GCRC casework and remodel * Sleep room strategy 13ICU Replace sinks with handles to get hot water 6E, 7E Remove brown intercom phone system in Peds ICU units 7E Remove toilets in the rooms 9L, 11L Partitioned wall furniture‐‐final 7L Regrout common area bathroom floors 7L Move 2nd refrigerator from clean supply to pantry Adult M/L: 2nd refrigerators and any med room casework 9L Nursing station‐‐insert in the middle 14L Remove wall in 14L med room 15ICN Create ECMO room 15ICN Redo of main desk‐‐nurses are ripping their clothes on it 15L Remove sink in instrument room to expand counter space 15M Remove hopper and sink to convert usage to lactation supply closet 6E improvements to family kitchen area 7E Reconfigure desk so HUSC doesn't have back to entrance 7N Remove sink near front of unit to expand counter space 7N Remove large sink in the pantry CH: 2nd refrigerators and any med room casework 1.18.11 CN III/IV Meeting Nursing Unit Environment of Care (EOC) Optimization What is next? An Example: Communication Provide a single, executable strategy for communicating more effectively and efficiency among nursing and with support services. Ideas generated by staff: 1> Implement email as the standard form of communication 2> Generate communication template and schedule 3> Create a new role: “nursing communication lead” 4> Coordinate communication strategy with impacted groups (new products, nursing standards, nursing education, support services, etc.) 5> Signage is for alerting (vs. informing); remove non‐approved signs 1.18.11 CN III/IV Meeting Nursing Unit Environment of Care (EOC) Optimization Improved environment ‐‐> Engaged nurses & support staff ‐‐> Satisfied patients! 1.18.11 CN III/IV Meeting