CUSP: Patient and Family Engagement

CUSP: Patient and Family Engagement


As you know, one of our strategic goals is to actively engage patients and their families in their care in a more meaningful way. But despite all of our efforts, we’re just not quite where we want to be. So, I want to introduce you to Theresa, one of our former patients who has agreed to join our CUSP team to help us think of better ways to engage patients and their families. Theresa, thank you so much for being here. Thank you. I’m excited to be here. Would you be willing to share your story with the team so they can have a better sense of your interest and your perspective? Sure. I think I may have actually met some of you before. Some of your faces seem familiar. When I was younger, I was hospitalized several times before my kidney transplant. I had to have a lot of tests and procedures while I was sick, and I also had to be on dialysis for a while. But I’m thrilled to say I have not had to stay overnight in the hospital for more than three years since my transplant. I had a lot of great doctors and nurses taking care of me, and I have a lot of respect for what you all do. But, to be honest, there were a few things that could have been better during my hospital stays. I think a lot of patients might have experiences like I did. So, I’m ready to be a part of the CUSP team to make care better for patients in this hospital. Well, we’re all glad you’re here, Theresa. It sounds like we may be able learn from your experiences to improve how we care for our patients. Again, I have a lot of good things to say about my care. The nurses were very kind, hard working and they really took good care of me. I was in the hospital once over my birthday and the nurses got together and they brought me a little cake and sang “Happy Birthday” to me at my bedside. I know it might sound silly, but that kind of personal touch was really important to me. That is important. I think it’s important to understand that it’s humbling to be in the hospital, like when you’re walking down the hall wearing one of those silly gowns that don’t fit. I really didn’t want people to see me like that. Well, other patients have told me the same thing. And, Tanya, when I was really sick I had to use a bed pan. And you lose some dignity when you lose control over your body. It’s the simple things that you do in your day-to-day life that you don’t have any control over when we’re in the hospital. Like, eating when you’re hungry or being able to get up and go to the bathroom. I understand there’s things we can’t control, like having to take certain medications or undergoing treatments, but I think patients can have some input and be involved in our own plan of care. I’ve never really thought about it that way before. I think there are a lot of little things that can be done to make a hospital stay better for patients and their families. We’ve been working with the nurses to look at our admissions process. Maybe we can include developing a discharge plan at the time of admission since this would be the best time to start the conversation with patients and their families. I think that’s a great idea. As a matter of fact, I have a friend who is staying at another hospital, and she told me how they developed her daily plan of care right there at her bedside. Yeah, we’d like to hear more about that. Well, she asked her husband to visit during the morning hours when the health care team was doing rounds, so they could both be there and give input. Then the whole team – the healthcare team, my friend and her husband – wrote out the plan for the day. It really brings back a sense of control when you know what to expect for the day. For instance, how many procedures you’re going to have during a given day or an update if there’s going to be a delay in a procedure. Just little things like that help make you feel more involved in your care. Yeah. That’s really important and it’s something we should consider since we’re trying to involve patients and families more actively in the daily plan of care and discharge. It could go a long way toward helping families feel more confident in contributing to their case and continuing their care after the patient is discharged. I agree. Involving patients and their families can help the patients meet their goals during their stay and help them feel more comfortable when they are discharged. It’s a priority to get them out of bed early and often during their stay with the goal of them taking frequent daily walks. We know this helps in recovery and can also prevent serious complications. Yes, you’re right. And I think we haven’t been meeting our goals because we haven’t been working closely enough with our patients and our families. Well, I have some ideas about how to help with that. You know those white boards in the patients’ rooms that have the names of the nurse and doctors? Well, they also posters with the IDEAL procedure spelled out: Include, Discuss, Educate, Assess and Listen. I also like that approach for getting patients involved in discharge planning. If we can educate patients and their families about the importance of daily walking and how that can help with their recovery process, then they’ll be the ones to push and help us meet our goals and timelines. Alright. Ms. Adams, we’ve got you all set. Your nurse will be in shortly. You doing okay? Yeah, honey, I’m alright, thank you. Hi, Ms. Adams. How are you feeling this morning? I’m glad the surgery is over. I’m pretty sore. I know you are, Ms. Adams. Can you rate your pain for me please? You know that scale where one means it hurts just a little bit and ten is the worst pain you’ve ever felt? What’s your pain right now? Oh, I’d say it’s at least a seven or an eight. Well, the doctor has ordered some pain medicine to help you. We are going to give this to you now so that it’s working when we get you out of bed a little bit later. It’s really important to get you moving so that you don’t develop any blot clots or trouble with your breathing. I don’t want that to happen. I agree. And while you’re here with us for the next couple of days, we want to make sure that you and your family feel comfortable with our daily routine so that you can continue to work on it on your own once you’re discharged. That’s why we have the word IDEAL written out on the board here. It stands for: Include, Discuss, Educate, Assess and Listen. It really helps us to work together to begin preparing for your discharge. Discharge? Already? I’m not ready to take her home. She’s in a lot of pain, and I’m not a nurse. I understand, but talking about this now and throughout your hospital stay will help to ensure that when Ms. Adams is ready for discharge, you both feel comfortable with what you need to do to continue to help her heal and get better. Okay, well, getting her stronger is my goal too. So, we’re a team? Yep. Let’s begin working on this today. Now, as you said, Mr. Adams, your wife is in a fair amount of pain. One of the things that we can do is to get her up and walking after her pain medication has taken effect. Wait, I don’t know if I’m really ready to do that today. I don’t think you understand how sore I am. Well, this pain medicine is pretty strong, and it usually works really well for most patients. We’ll make sure your pain is under control before we get you out of bed. I would appreciate that. And, you know, they’ve been giving me a lot of fluids in this IV, so I go to the bathroom pretty often. I want to make sure I can go to the bathroom before we walk in the hallway. Absolutely. Can we actually plan when we’ll do this? I need to go into the office for an hour or two, but I want to be here to help. ‘Cause I think you’re right. That will make me feel much better at home when it’s just the two of us. Sure. Let’s write out a timeline for today. Honey, the kids are coming to visit around 2 o’clock so you don’t want to be walking then. That’s the kind of thing that you would need to know, right? That’s exactly what I mean. You were due to be given some medications at 11 o’clock. We can give you your pain medicine at noon, right after lunch. It should be helping by 1 o’clock, so you could take your walk then. How does that sound? That works for me. I can be back by 1 o’clock. Great, that works out perfectly. It does. After I walk, I can rest and then watch my favorite You got it. You’re doing great. Keep going. Good job. Here, let me help you get your slippers off. You did a great job on that walk. You sure did, Ms. Adams. How are you feeling? Well, I’m kind of glad it’s over. It will get easier, won’t it? It will, hon. It will. That’s what we’re working towards. So if you both look at the board here, it’s spelled out. Mr. Adams, I’m really glad that you’re able to be here when we’re walking with your wife because I think it’s going to give you a better sense of what to expect once you’re home and how her recovery is progressing. It certainly will. Now, we gave her the pain medication an hour before she walked so that she would feel comfortable. Then, as you saw, when we got her out of bed we had her sit on the edge of the bed to make sure she wasn’t dizzy from the medications. Then we had her to stand for a minute to make sure she was okay before she started walking. That’s going to be important to continue once you’re at home. Uh-huh. And we also talked about how it’s important for Ms. Adams to get all of her medications on time at home. She’s on a blood thinner to prevent blood clots, and walking also keeps her blood circulating, and will prevent clotting as well. Yeah. I really liked that little calendar you showed me that has all the times charted out. But, you know, I’m not sure either one of us is clear on the dose of each medicine. He’s right about that. I’m really glad you told me this, this is exactly the kind of information I need to know. I’ll go over the doses now, and we’ll review them again when Ms. Adams is discharged. Plus, I have some printed materials to give you when you go home as well. Thanks, that’ll be really helpful. Welcome, everyone! We’ve got new data from our staff and patient satisfaction surveys, and I’m excited to share the results with you. Overall, our satisfaction scores have increased over the past quarter. We’ve seen a slow but steady increase each month and that’s something worth celebrating. That’s excellent news, David. I agree. Let’s celebrate, but I also want to take a look at those areas where we still need some improvement. It looks like we’ve increased satisfaction with patients who are English speaking. We have. But our numbers haven’t moved much for our non-English speaking families. I agree. Did we get our interpreters involved in the project to get patients out of bed and walking early after surgery? We didn’t. We do need to improve the process for our non-English speaking patients. We’ve had an interpreter working with us on this, but they haven’t been available 24 hours a day so we’re missing some patients. Okay. You’re right, Dr. Milstead. It looks like we even have room for improvement for people who do speak English. We use so many abbreviations, acronyms, and medical terms and jargon that it may be difficult for patients and their families to understand. You’re right; I find myself doing that and not even realizing it. I can remember my first couple of hospitalizations. I felt like the doctors and nurses were speaking a different language half the time! But, you’re right, though. When doctors and nurses talk about medications, explain test results, give information about a patient’s problem using plain language, without jargon, that they can understand, it’s just so helpful. It really helps the patient start to take ownership of their care. I really want to compliment the team. I like how you have included IDEAL posters in each of the patient’s rooms. Now the patients and families not only know who’s on the team for that day, they know the plan. It’s really helpful to have a sense of what to expect each day. Thanks, Theresa. I agree. Patients have told me how much they really appreciate having a plan they can count on. Yeah, I was talking to Alicia after the last CUSP meeting, and she was telling me how grateful a patient’s family was for being involved in the making of the plan for the day, is that right Alicia? Yes, that’s true. And we planned around the patient’s family visits, meal times and favorite TV programs. [laughter] You said the patient’s family was thrilled, and I’m sure the patient appreciated the effort to lessen her pain as much as possible. She knew that walking after surgery was important, but she appreciated the effort of the team to make it as comfortable for her as possible. That’s a good point. We should be doing that regularly. We should. I remember the last time I was in the hospital the physical therapist did a very nice job working with the nurses to coordinate a schedule for my exercise and walking. And they included my preferences. It was great. But, at the same stay, a couple of doctors used jargon that I just couldn’t understand, and I’m not stupid, but I’m not a doctor and I don’t try to be. Nothing personal, Dr. Milstead. Oh no, of course not! But I still think there’s opportunity for more doctors to use words that patients and their families can easily understand. You’re right. Theresa, would you consider coming to a division meeting with me to talk with my surgical colleagues? Sure. Great. Well, it’s clear to me that involving patients and families in the daily plan of care and discharge planning is really important. Focusing on the words and terms that we use when we explain things to patients is also an important priority. The surveys tell us they’re much more satisfied when we do these things. Theresa, I really appreciate your willingness to be on this CUSP team and to help us to better understand how to get patients and families more involved. Thanks, Alan. I’m grateful for the opportunity to share my experiences and thoughts with you. It’s great to be a part of a team that’s helping to make a hospital stay more pleasant for the next patient. I agree, and I believe we need this in all units across our entire hospital. I’ve been wondering if you’d be willing to help us create a committee or a council of patients and patient advocates so that we can also hear from them. Sure. I’d be open to that. Good. I know there are other hospitals that have created patient advisory councils to help support initiatives across the entire hospital to improve patient and family engagement. To do that right and to create the best council possible, we could really use your help. I’d love to participate. I’m sure we can find some great people who’d be more than willing to help other patients and families.

One thought on “CUSP: Patient and Family Engagement

  • A great video. I came across it in preparation for a talk I';m giving to nurses on how to involve patients in their own care.

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