Nursing Unit  Environment of Care (EOC) Optimization What is EOC? Opportunity

Nursing Unit Environment of Care (EOC) Optimization
What is EOC?
> 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
> Create an environment of care with shared ownership of patient
> 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
> 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
* 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