Modified Modular Nursing
10 West Care Delivery Model
By
Ellen Babilon, ADN, RN, CMSRN
and
Lisa Evert BSN, RN
Modified Modular Nursing
A method of making patient assignments
based on geographical location with
consideration given to the acuity level of
each module assignment.
Implemented September 28, 2012 day shift!
Why go to Modified Modular
nursing?
•
•
•
•
Increase in patient safety
Increase in patient satisfaction
More continuity of care
Addresses all components of our HCAHPS
scores! ie nurse responsiveness, call bell
answered, pain managed, less noise, etc
• Less area to travel
• Less people to have to wait to give and
receive report
• Assignments address acuity
Why go to Modified Modular
nursing?
Increases staff accountability
Modified Modular nursing demonstrates a
model of excellence in which the “it’s not my
patient!” mentality is no longer tolerated.
Why go to Modified Modular
nursing?
The numbers don’t lie………
During the original pilot of Modified Modular
nursing beginning November 2011, fall rates
on 10 West dropped from approximately 6
falls per 1000 patient days to <1 fall per 1000
patients days only to have them rise again to
>4 falls per 1000 patient days after the pilot
ended.
Why go to Modified Modular
nursing?
Number of Falls per Month
August 2011 - July 2012
7
6
5
4
3
Number of Falls
2
1
0
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Why go to Modified Modular
nursing?
• The institutional goal is 3 falls or less per 1000
patient days.
• Modified Modular nursing is one component
in an overall fall prevention initiative on 10
West.
• Modified Modular nursing allows you to be
closest to your patients enabling quick
response to chair and bed alarms.
Why go to Modified Modular
nursing?
• Purposeful hourly rounding is an MUSC
standard. Modified modular nursing keeps
you close to your patients, making
rounding easier.
10 West Fall Prevention Initiatives
• Education of patients and their families
• Staff accountability, signing attestations stating the
understanding of the FIRM Ground Program
• Modified Modular Nursing
• Signage strategically placed in patients rooms
reminding our confused patients to call for
assistance
MODIFIED MODULAR NURSING
ASSIGNMENTS - RN
6 RNs
Charge Nurse takes one
low intensity patient on
Module 6C
Module 6A
54, 55,56, 58
Module 6B
52, 53, 59, 60
Module 6C
64, 65, 66, 67,
73
Module 6D
68, 70, 71, 72
Module 6E
76, 77, 78, 79
MODIFIED MODULAR NURSING
ASSIGNMENTS - RN
5 RNS
Charge Nurse takes
one low intensity
patient on Module 5C
Module 5A
53, 54, 55, 56, 58
Module 5B
52, 59, 60, 64, 65
Module 5C
66, 67, 76, 77, 78, 79
Module 5D
68, 70, 71, 72, 73
MODIFIED MODULAR NURSING
ASSIGNMENTS - RN
4 RNs
Charge Nurse
64, 65, 66
Module 4A
53, 54, 55, 56, 58, 59
Module 4B
52, 60, 76, 77, 78, 79
Module 4C
67, 68, 70, 71, 72, 73
MODIFIED MODULAR NURSING
ASSIGNMENTS - PCT
3 PCTs
Module 3A
52, 53, 54, 55,
56, 58, 59
Module 3B
64, 65, 66, 76,
77, 78, 79
Module 3C
60, 67, 68, 70,
71, 72, 73
MODIFIED MODULAR NURSING
ASSIGNMENTS - PCT
2 PCTs
Module 2A
52 - 66
Module 2B
67 - 79
Buddy System……
Implement the buddy system between RNs
and PCTs. The module with the highest acuity
will be ‘buddied’ with the module with the
lowest acuity. RN and PCT will directly call
their ‘buddy’ for help.
Buddy System…
• RNs and PCTs will cover their ‘buddy’ for breaks and
lunch.
• Buddy assignment will be written on the white board
across from the nurses station.
• All breaks recorded on white board with one 30 minute
lunch break allowed. Breaks are to be taken away from
the nurses station to cut down on traffic and noise.
Assigning Acuity to Each Module
MODIFIED MODULAR NURSING
ASSIGNMENTS
RECOMMENDATIONS
 The expectation is for the RN and PCT to be continually
positioned at their ‘Anchor Station’ during their shift.
This will improve visibility to patients and families and
improve call bell response time. Stations will be
assigned according to team assignment. The charge
nurse’s anchor station will be the nurses station. On
night shift, Module B’s anchor station will also be the
nurses station to assist with answering phones and call
bells.
10 West Anchor Stations
Lessons Learned
•
Resistance from the staff when this Care Delivery Model first presented by
Shared Governance, not a lot of buy-in.
•
Major staff concern included equity of assignments.
•
Staff able to voice concerns via an anonymous survey after this model was in
place for 5 months.
•
Although not as popular with the staff as envisioned, 82% of staff agreed,
based on this survey, that this care delivery model affords greater access to
nursing staff by patient, families and other disciplines and 59% agree that it
provides for greater efficiency.
•
50% of staff surveyed also felt the MMN was instrumental in reducing falls.
Lessons Learned
• Based on survey results, a dialogue was initiated between leaders
and staff members soliciting suggestions for improving this Care
Delivery Model.
• Per staff suggestions, small changes were made in how future
assignments were made, i.e. swapping empty rooms with
occupied rooms in adjacent modules, coaching staff members in
lateral delegation, etc.
• A change in culture was necessary that focused on patient
centered care and required staff being comfortable with lateral
delegation (buddy system)
• New survey administered 17 months after the implementation of
MMN.
And the culture changed……
• 94% of staff surveyed stated that Modified Modular
Nursing provides greater safety for their patients as
opposed to 47 % on the original survey.
• 100% stated that they enjoyed practicing MMN as
opposed to 29%.
• 69% stated that they were comfortable in delegating to
their buddy as opposed to 41%.
• 69% stated that delegating to their buddies helped to
provide equality in work assignments as opposed to 23%.
HCAHPS
Although it in theory it would seem that
certain components of our HCAHPS scores
would improve, this proved not to be the
case.
Where Are We Now?!?!?
• In the 3 months prior to implementation of
Modified Modular Nursing, fall rates on 10
West were approximately 2.1 falls per 1000
patient days.
• In the 3 months following the
implementation of Modified Modular
Nursing, fall rates have decreased to 1 fall
per 1000 patient days.
Where Are We Now?!?!?
Number of Falls per Month
Jan 2012 thru Jan 2013
7
6
5
4
Number of Falls
3
2
1
0
Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12
Jul-12
Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13
17 Months Later……
Since June of 2013, 10 West fall rates have
remained low at 1.22 falls per 1000 patient
days
17 Months Later……
Number of Falls per Month
June 2013 thru Feb 2014
3.5
3
2.5
2
Number of Falls
1.5
1
0.5
0
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Conclusions
IMPROVED:
• Decrease in patient falls
• Greater availability of staff to patients, families, and other
interdisciplinary team members
• Greater ease in purposeful hourly rounding which is an MUSC
standard.
• Less noise and traffic at the nurses station
• 100% compliance with blood glucose rechecks
MUSC Nurses Professional Practice
Model
Questions or comments???
Copies of presentation can be emailed to
interested parties.
babilone@musc.edu