thequalitypost
Greetings from Cat, Saj, Ari and Jenica
Welcome to the 115th edition of The Quality Post! In this issue, we feature Tips and Tricks to help us achieve our FY21 True North Metrics; provide updates on the inpatient mobility initiative; recognize our high performers in identifying patients to discharge by noon; and share our True North Metric performance for FY21.
inthisissue
Tips and Tricks for DHM True North Metrics
HBR Tip: Regain a Sense of Control
Improving Inpatient Mobility Update
Recognizing our TCHO High Performers
FY21 DHM True North Metric Performance
Tips and Tricks for Our DHM True North Metrics
You may be wondering what you can do to help us achieve our DHM True North Metrics this year. Below are a few tips and tricks that you can use the next time you're on clinical service. If you have any feedback, please let Cat, Saj, Ari, or Jenica know!
LEP Communication
- Use a professional interpreter EVERY time you speak with a limited English proficiency (LEP) patient and have your team do the same.
- When using a video mediated interpreter, show your ID badge and patient MRN sticker to the interpreter.
- If you think the APeX language section is wrong, email Lev.Malevanchik@ucsf.edu.
EtOH Documentation and Treatment of AUD
- Screen and document your patient's alcohol use by clicking on the EtOH icon in the Social Determinants of Health wheel located at the bottom of the patient banner.
- Avoid free texting this information in your notes to help all providers easily identify and treat patients with alcohol use disorder (AUD).
- Use the "IP Alcohol Use Disorder Orderset" for patients with AUD. The order set provides clinical guidance to help you choose the most appropriate pharmacotherapy for your patient(s).
Patients Treated with Courtesy and Respect
- Introduce yourself at the start of every encounter, acknowledging the difficulty in distinguishing among different healthcare workers in masks.
- Use your enlarged Photo Badge or Sticker from our Portrait Project so that patients have the opportunity to ‘see you’. Use your face cards as well.
- Speak slowly, avoid jargon, and intentionally pause to check for understanding using the teach-back method. Try to articulate, enunciate, and increase volume to overcome the barriers created by the mask.
- Express empathy through verbal statements such as acknowledging, validating, and using PEARLS statements.
ACP Documentation
- View all prior ACP notes using the ACP navigator.
- Every patient admitted to the hospital >=75 yrs of age or with an advanced medical illness needs to have an ACP conversation. To document this conversation:
- Use note type "ACP" if writing a separate note
- Use the smart phrase ".ACP" within any note
Regain a Sense of Control (When Everything Feels Out of Control)
Between the health risks of coronavirus, economic stressors, social distancing, and mandatory work-from-home arrangements, so much of our lives feel out of our control right now. Research shows that anything you can do to restore your sense of autonomy -- even in small ways -- will help you be more resilient. Here are a few tips.
First, if you're working remotely, set up a comfortable and personal workspace. You might define a clear boundary between "work" and "home" by telling yourself: When I'm in this room or wearing these headphones, I'm "at work." Also, identify and embrace the perks of working at home. For example, if you no longer have a long commute, you can choose how you'll spend the time -- whether it's getting an extra hour of sleep, being with your family, or even delving into a new hobby. Just try to resist the temptation to spend the time working. You can also reclaim control over your body and mind by prioritizing self-care. Investing time and attention in your own well-being is crucial during stressful times.
While the pandemic's closure and restrictions may dictate many aspects of your life right now, how you customize your environment, spend your time, and treat yourself is up to you.
This tip is adapted from “Restore Your Sense of Control Despite the Pandemic,” by Eric M. Anicich et al.
Improving Inpatient Mobility
The Safe Mobilization Committee, co-chaired by Ari Hoffman, brings fall prevention, safe patient handling, and mobility work together under one structure. A major goal of the group has been to overhaul the way we assess and document mobility at UCSF, allowing us to "speak one language" when we refer to mobility. This has come to fruition in the form of AMPAC 6-clicks, a validated tool for assessing a patient's level of independence with physical function. This automates an activity goal for patients, and our nursing colleagues will record the patient's highest level of mobility actually achieved using the UCSF Mobility score. This new workflow will eliminate other measures of mobility and activity from nursing flowsheets, simplify activity orders, and create a data infrastructure that allows for enhanced tracking of inpatient mobility and a platform for improvement. As providers, please remember the following:
- Know your patient's activity goal and encourage them to achieve it - You can add the "Last Activity Goal (AMPAC)" column to your patient list in APeX.
- Monitor the trend of AMPAC scores (add to your patient list or look in the comp flowsheet) for functional decline
- Consider PT/OT for AMPAC <17 or downward trend
Congrats to our The Chosen One High Performers!
Thank you to the following individuals for identifying two or more patients for a possible discharge before noon the next day (aka The Chosen One or TCHO) with your case manager! Discharging 20% of our patients before noon helps to level load throughput in our hospital and decrease patient boarding hours in the ED. Major props to Kirsten Kangelaris, Ifedayo Kuye, Marwa Shoeb, Jonathan Duong, Sujatha Sankaran, Farhan Lalani, Adria Bacardi, Armond Esmaili, Adrienne Green, Sarah Summerville, and Shradha Kulkarni.
