Creating Champions: A Team Leader Approach to Quality Care

1
Creating Champions A Team Leader Approach to
Quality Care

• James F. Gitzinger, LNHA
• Administrator, Pine Meadows Health Care
• Joni Gosser, RN, LNHA, EMBA
• Director of Operations, Louden and Company

2
Where We Were 2003

• In 2002 our company spent approximately 4700 per
  month on incontinence care products
• Our Problem No resident-centered approach
  concerning incontinence care

3
Prior to 2003 History of Skin and Incontinence
Issues

• Facility Quality Measure/Indicator Report
  (quarter ending 7/02 and quarter ending 4/03)
• Our facility flagged at 100 for pressure ulcers
  with more than 26 of residents with skin issues

4
Nursing

• Average for direct nursing care Per Patient Days
  (PPD) in 2003 was 3.75
• The ratio of nursing assistants to residents was
  110
• No consistent staffing patterns
• High turnover
• Standard treatment for skin issues
• Lack of interest in in-services

5
Our efforts to change the problem

• Pressure reduction mattresses
• Therapy department
• Turning schedule protocol
• Hired a full time Treatment Nurse

6
Our Person-Centered Care Solution

• Focus on nursing assistant responsibilities
• Commitment to change
• Loyalty to one vendor
• Staff education programs for nursing assistants
• Learning Circles

7
Person-Centered Care (PCC)

• Back to the Basics
• IOC Foundation for Leadership
• Involvement
• Ownership
• Commitment
• PCC
• Caregivers
• Families
• Residents

8
Employee-Centered Programs

• Incontinence Care Practice (ICP) Team
• All shifts represented
• Specialized training of the incontinence product
  line
• Tools to identify problems
• Solutions for those problems
• Supply storage

9
PCC Approach Fit Right Program

• Resized residents for incontinence products
• Assessed resident needs
• Educated residents on new products
• Gave residents choices

10
Family Night

• Family Council meeting
• Open invitation to all families and residents
• Medical supply representative

11
Our Big Step ICPs to Team Leaders

• No direct care assignment
• No additional full-time employees (FTEs)
• Support nursing assistants in caregiver
  activities
• Team Leader Job Descriptions
• Team Leader Retention Efforts

12
Vendor educational program

• Compass Program
• New Skin Care Protocol

13

• Where We Are Today

14
The facility aggressively addressed skin care
challenges and in the quarter ending 1/01/07 the
Facility Quality Indicator observed percent is at
7.6, which exceeds the targeted goal set by the
Team Leaders and the Nursing Managers at the
facility.
15

• Facility Progress
• High-risk residents with pressure ulcers (per the
  Quality Indicator Report) placed the facility at
  the 100 state percentile (quarter ending March
  2003)
• High-risk residents with pressure ulcers (per the
  Quality Indicator Report) placed the facility at
  the 78 state percentile (quarter ending March
  2005)
• High-risk residents with pressure ulcers (per the
  Quality Indicator Report) placed the facility at
  the 26 state percentile (quarter ending March
  2006)
• Where We Are Today
• High-risk residents with pressure ulcers (per the
  Quality Indicator Report) placed the facility at
  the 20 state percentile with 7.6 skin issues
  for facility observed percentage on the Quality
  Indicator report (quarter ending January 2007)

16
The Big Picture .

• No increase in nursing direct care PPD from start
  of program in 2003 until present time
• Appropriate sizing and individualization of
  products
• Shift in types of incontinence supplies used
  while experiencing no significant increase in
  incontinence budget
• Team leaders for continuity (no additional FTEs)
  
• Equal success for the programhappy residents,
  families, and staff
• Local, state, and national recognition for
  program. The Kentucky AAHSA organization awarded
  this program the innovation of the year in 2006.

17
Quality Indicator Reports for Skin Care
18
State Survey Results
19
Direct Caregiver PPDs

• The direct caregiver average PPD for the year
  2006 was 3.75
• The team leaders are still counted in this direct
  care PPD

20

• The Cost of Success .

21
Cost Per Patient Day for Incontinence Products
22
Monthly Cost for Incontinence Products
23
March 2004 order / May 2006 order
24
PERSON CENTERED CARE WORKS!!!
Pine Meadows Team Leaders 2006