PAIRED Implementation Guidance - Susan M. Bowles, DNP, RNC-NIC, PAIRED Nurse Consultant - USF Health
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PAIRED Implementation Guidance Susan M. Bowles, DNP, RNC-NIC, PAIRED Nurse Consultant
ENGAGE KEY STAKEHOLDERS
FROM THE START
Keys to MULTIDISCIPLINARY PLANNING
Building a AND IMPLEMENTATION
Successful
Initiative C- SUITE SUPPORT
CONSISTENT COMMITMENT BY
ALL TEAM MEMBERS
2
Components of Successful Participation Create a QI culture—a team environment emphasizing quality and patient safety Hold regular QI team meetings to follow and make progress Share important information, progress and successes with everyone around Be creative and flexible!
WHO SHOULD BE ON THE TEAM • Neonatologists • Nursing Staff • Director/Manager • Quality Improvement • IT • Social Work • Therapists/ RT, OT,PT, • Parents • Others
Create a Culture Ready for Change
• Must be a multidisciplinary effort
• Teams must meet regularly
• Ability to provide a safe
environment for:
• Listening
• Questioning
• Persuading
• Respecting
• Helping
• Sharing
• Participating
• Use the Toolkit!
5
• Meet bi-weekly/ monthly to
start then may be less
frequent later
• Include all departments
impacted by your work
Team • Have an agenda and take
minutes.
Meetings • Review data, 30-60-90 Day
Plan, PDSA cycles, and
potential community
partners
• Discuss insights from
webinars/coaching
• Share progress and challenges
with administration – follow
communication plan
Quick
Start
Checklist
Key
Driver
Diagram
30-60-
PDSA
90 Day
Cycle
Plan
7
Quick Start Checklist
1. Recruit QI team – lead, physician lead, nurse lead, QI/data
lead, administrative champion
2. Review, complete and return PAIRED Data Use Agreement
3. Attend PAIRED Kick-off Meeting
4. Complete the PAIRED Team Readiness Survey and identify
team goals
5. Write down questions or concerns
8Quick
Start
Checklist
Key
Driver
Diagram
30-60-
PDSA
90 Day
Cycle
Plan
Tools to Use
9Date: 10/9/2020
PAIRED—Family-Centered Care
AIM PRIMARY DRIVERS SECONDARY DRIVERS PBPs
Educate family caregiver(s) to become active
• Encourage family caregiver(s) participation in
participants in the care of their infant from admission
Participation to discharge
early skin-to-skin care
• Include of families in daily rounds/creation of
PRIMARY Participation of family in care daily care plans/handoffs
• Provide early and continuing lactation support to
By 6/2023, each Provide family caregiver(s) with appropriate and promote breastfeeding
NICU will achieve a increasing direct care opportunities. • Revisit and revise policies that limit caregiver
20% increase from interaction with infant
baseline in the
percentage of
infants who • Create a culturally sensitive environment
receive skin-to- supportive of skin-to-skin care (reclining chairs,
skin care from at Acknowledge that each infant and family member is an access to food and water, privacy)
least one family Dignity and Respect individual. Incorporate family knowledge, values, • Identify infant and family caregiver(s) by
caregiver within 3 beliefs and cultural backgrounds into the planning and appropriate names in all interactions
days of clinical Identification of each infant and delivery of care. • Celebrate milestones and transitions
eligibility as
defined by family member as an individual
• Consult families, revisit and revise policies that
individual unit
limit family caregiver interaction with infant
protocols.
(protocols regarding skin-to-skin care, holding,
Establish a culturally sensitive environment in which visitation, signage, etc.)
SUPPLEMENTAL
families feel respected and that fosters anticipatory • Improve antenatal counseling
By 6/2023, family and effective communication with and trust from
caregiver surveys Collaboration family caregiver(s).
• Adopt technologies to improve communication
with family caregiver(s) who cannot be at
will demonstrate a
bedside
20% improvement Respectful and effective
from baseline in Encourage collaboration with families, caregivers and • Recruit, create and sustain a family advisory
the perception of communication and partnership unit leaders in the development, implementation, and council/partnership team
the culture of with families evaluation of policies and procedures; in educational • Engage families in the development of effective
family-centered programs; and in protocols for family participation in patient safety and quality initiatives
care in each NICU care. • Develop uniform approach to scheduling and
as averaged staffing complex care conferences with families
across all 4
domains. • Initiate family caregiver and staff competency
Provide family caregiver(s) with complete, accurate training on skin-to-skin care
Information Sharing and unbiased information and graduated education • Initiate medical education early and throughout
throughout the NICU stay to allow effective NICU stay
Education about medical care participation in care, to optimize decision-making, and • Utilize verbal, written, and graphic methods of
and clinical processes to enable caregivers to become competent primary teaching to support family understanding and
caregivers for their infant(s). health literacyQuick
Start
Checklist
Key
Driver
Diagram
30-60-
PDSA
90 Day
Cycle
Plan
1130-60-90
Day Plan
12Foundations
Strengths We have a strong physician champion and good
administrative support
Barriers Some of our providers and staff are very resistant to
change
13Review multidisciplinary
team members and fill
any gaps
Three Things to
Accomplish in
the Next Schedule team
meetings for 6 months
30 Days
Review and revise unit
policies to allow for
early Skin to Skin Care.
14Quick
Start
Checklist
Key
Driver
Diagram
30-60-
PDSA
90 Day
Cycle
Plan
15What is a PDSA cycle?
• Useful tool for developing & documenting tests of
change to for improvement
• AKA PDCA, Deming Cycle, Shewart Cycle
P– Plan a test
D– Do a test
S– Study & learn
from test results
A– Act on results
Dr. Balakrishnan will delve into PDSAs during
her presentation! 16Learn whether change will
result in improvement
Reasons to Predict the amount of
improvement possible
test
changes Evaluate the proposed
change work in a practice
environment
Minimize resistance at
implementationPotential Implementation Barriers & Strategies to
Overcome
Potential Barrier Drivers Strategies to Overcome
• Time limitations • Make sure meetings are organized and
succinct to decrease the impact on time
• Use efforts of staff members-consider
use of nurse clinical ladder to support
project
• Standardize meeting time for ease of
scheduling; consider web-based
meetings for those off site
• Use regularly scheduled department
meetings to highlight project and results-
be succinct
18Potential Implementation Barriers & Strategies to
Overcome
Potential Barrier Drivers Strategies to Overcome
• Resource limitations • Connect with other hospitals or QI
leaders for potential solutions; or
sharing resources through collaborative
work
19As the Project Continues…
• Celebrate successes along the
way
• Display data by keeping it
current AND interesting
• Make it stick
Routinization
• Plan for sustainability
2021 21
Assess Review Attend Plan
Assess your team Review Attend Plan for
to assure all PAIRED Data PAIRED
critical resources Collection launch –
departments Webinar bulletin
Friday, boards;
included
staff
March 26, meetings;
2021, 12-1 event
PM ET invitations
March-April
22April
Official launch in your hospital!
Educate providers and facility leadership on
Launch importance of facility-wide standards
Engage staff and clinicians
Present your hospital’s PAIRED participation
Begin Begin submitting prospective data
23PAIRED Initiative Resources
Project-wide in-
Educational Monthly and
Technical person
sessions, videos, Quarterly QI
Assistance collaboration
and resources Data Reports
meetings
from FPQC staff,
state Clinical Custom, Personalized
Advisors, and
National Experts Monthly e- webcam, phone, or on-site
mail Bulletins Consultations & Grand
Rounds Education
Monthly
Collaboration
Calls with
Online Tool Box
hospitals Algorithms, Sample protocols, education tools, Slide
state-wide sets, etc.
24http://www.fpqc.org/PAIRED
PAIRED
Initiative
Website
Click here to visit the TOOL BOX
25PAIRED
Initiative
Tool Box
http://www.fpqc.org/PAIRED/toolbox
26NOW IT’S YOUR TURN!
QUESTIONS?
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