Accelerated
Releasing Time to Care
National Forum
Production Programmes
May 2013
Background
• ADHB commenced Releasing Time to Care is 2009 with 33 Wards now
underway
• ADHB investigated alternative delivery options for RTC
• An accelerated approach was chosen with a pilot ward commencing in
July 2012
• Support resource was allocated to work with the team to deliver on a
module a month until completion
Foundation
Modules
Knowing How We are Doing
Well Organised Ward
Patient Status at a Glance
Nursing Procedures
7-9 Months
Nursing Procedures
Nursing Procedures
Ward Rounds
Admissions and Planned D/C
Medicines
Patient Hygiene
Patient Observations
Meals
Shift Handover
Process Modules
Accelerated Programme Approach
Ongoing
Module Implementation – Monthly timeline
Preparation
•Agree team and
confirm roster
•Collect Data
Week 1
Launch
•Patient Interviews
•Staff Interviews
•Process follows
•Learn from other
Wards
•Review data
•Generate excitement
Week 2 & 3
Develop
•Develop Process
Flowchart
•Develop SOPs
Week 4
Implement
Follow Up
•Staff Education
•New equipment
•Go Live with process
improvements
•Facilities
improvements
•Develop Templates
•Audits
•Go-see
•Engage other
stakeholders
•Celebrate success
•Identify
opportunities
•Order new
equipment
•Define new process
•Plan facilities
improvements
•Agree
implementation
timeframe and
communications plan
Key Principles
• Steal with pride - capitalise on the work done and
improvements made by other wards
• Manage scope – focus on specific areas of improvement
• Communication, Communication, Communication – use the
Daily Ward Meetings as a key tool to ensure everyone knows
what is happening, why and when
• Quick fire – keep energy, focus and motivation high by
maintaining momentum
• Share the load – utilise as many of the ward team as possible to
implement change
• Build for the future – develop resources to be utilised by other
wards
Results - Overall
7 Process Modules
delivered
Direct Care Time
= 54%
(38% Improvement)
Patient Satisfaction
= 91 %
3 Foundation
Modules extended
Staff Satisfaction
= 84 %
Reduction in
Pressure Injuries
= 0 in 6 months
Reduction in
Length of Stay
>0.8 days
Sustained
Smoking Cessation
>95%
Sustained
Acute Patient Flow
>95%
“It really has increased the
amount of time we can spend
with the patients”
– Staff Member
Knowing How We are Doing
•Revisited the Ward Vision with input from
the Multidisciplinary team
•Implemented Daily Ward Meetings
•Maintained communications boards and
safety crosses
“The atmosphere on the ward has
changed. You can feel it as you walk
in, things are calm and organised.”
- Staff Member
Well Organised Ward
•4 bedded Rooms
•Equipment Room
•Staff Base
•Whanau Room
•Education Hub
•Ward Meeting
Room
•Sluice Room
“I can find things! Everything
has its place.”
– Staff member
Patient Status at a Glance
•Electronic Whiteboards
updated with required flags
•New wide screens to improve
usability
•Patient Bedcards implemented
•Staff Status at a Glance Board
•Rapid Rounds maintained
Shift Handover
•ISOBAR Bedside Handover
•Patient involvement
•Improved information
transfer
•Safety checks
•Significant impact on direct
care time
“When the nurses change
shifts they introduce who they
are and that they’re our nurse”
- Patient
Meals
•Improved focus on patient
preparation
•Implementation of a meal
preparation bell
•Nurses assisting patients to
complete meal cards – ensuring
sufficient food is ordered and
less meal call backs are required
•Improved use of assist flags for
those patients needing any
assistance at meal times
•Improved timing of meal delivery
Patient Observations
•Improved observation trolley set
up to reduce waste looking for
additional equipment
•Relocation of observation
equipment to point of use (i.e.
within 4-bedded rooms and
outside single bedded rooms)
•Refreshed patient observation
standards including education
“The ward seems calm and
everyone knows what they
are doing.”
- Patient
Patient Hygiene
•Hygiene packs
•Where am I posters for Commode and
Wash Bowl Trolley
•Agreed standards on patient hygiene
requirements
“The staff are fantastic! I would give
them 100%. They work so hard and
every single one of them took time for a
chat and you were never rushed.”
- Patient
Medicines
•New layout and refurbishment of the medication room
•Improved access to controlled drugs cabinet
•Reduce stock levels
•Improved education for patients
Admissions and Planned Discharges
•New patient welcome pack including
–Ward information Booklet
–Ward and hospital maps
–What to expect information
–Transition lounge brochure
–Hospital Resources
•Staff Admission checklist
•Agreement that discharge summaries are
written 24 hours before discharge to allow
for review by the consultant and better
discussion with the patient
Ward Rounds
•Agreed sequence and flow
•Portable laptop to be used during Ward Rounds
•Patient nurse to attend Ward Rounds
•Ward Rounds information sheet for patients in the Welcome Pack
including space to capture questions for the Medical Team
•Improved signage and awareness around which teams are
rounding and when
•Consultant to sit down during Ward Rounds to enable better
engagement with the patient and their support person(s)
•Junior doctor to read back plan to ensure clarity and correctness
Conclusion
•Ward 72 has benefited from the combined impact of the
Accelerated Releasing Time to Care programme, Rapid Rounds
and daily ward meetings
•The ward is now better organised with clearly defined processes.
•The improvements have resulted in a calmer work environment
that provides a better patient experience
•The fast pace of implementation along with the significant team
involvement has resulted in a continuous stream of improvements
on the ward keeping team motivation and engagement high
“Getting better every day!
Great place to work!”
- Staff member
Questions
Do you have any questions?
For future questions please contact
Abbi Harwood-Tobin (abbih@adhb.govt.nz or 021 584 021)
Marie Mata (mmata@adhb.govt.nz or 021 0825 7224)
Sarah Wilson (sarahwil@adhb.govt.nz 021 397 553)
“It means nurses can
identify REAL problems…
and fix them!”
- Staff Member