Project Timeframe: October, 2013 – ongoing
Problem: Most individuals have a regular routine of when they attend to the activities of daily living, such as taking a shower or bath, brushing their teeth, combing their hair, etc. A hospital stay disrupts that personal rhythm. Without attention to these activities an individual begins to feel less capable, and less able to meet the challenges of recovery.
Our patients let us know this is important to them! In standard patient satisfaction surveys approximately 20% of those responding told us that nurses had neglected to address completion of ADLs. Chart audits, case reviews and patient interviews confirmed our patient’s perception. Clearly, we had room for improvement.
Goal: To identify ADLs as a nursing priority.
Interventions: In October, 2013, we put together a multidisciplinary Task Force including the VP of Patient Care Services, The Executive Director of Quality and Care Management, The Patient Experience Coordinator, a unit Nurse Manager, two lead nurses on our largest med-surg unit and an IT Specialist to strategize how we could best accomplish our goals and document our efforts.
The team developed the following plan:
- To re-educate nursing staff on the importance of ADLs to a patient’s perception of self and overall sense of well being
- To document attention to ADLs on a flow sheet within our electronic medical record
- Each morning prior to Interdisciplinary Care Coordination Rounds the Patient Experience Coordinator reviews the medical record of each patient for documentation of several key Core Measures and completion of patient ADLs. This information is shared in Rounds with the Nursing Team Leader for follow-up with individual nurses.
- If the Patient Experience Coordinator notes a repeated failure to complete patient ADLs he meets individually with the patient’s nurse to reinforce the importance of their completion and to problem solve any barriers the nurse has encountered in completing them
- Questions regarding completion of ADLs have been incorporated into our post-discharge call template used by the Patient Experience Coordinator.
Measures: Measuring three months after beginning this program we found that only 3% of patient responding to standard surveys told us that nurses had neglected to address completion of ADLs to the patient’s satisfaction.
Next Steps: Achieving success with this project has been heartening. To reinforce continued compliance we continue to incorporate information regarding completion of ADLs as part of daily ICC Rounds.
Michele Rowland, RN, MSN, LICSW
Executive Director, Quality, Utilization and Care Management
Brattleboro Memorial Hospital
17 Belmont Avenue, Brattleboro, VT 05301