Engaging Patients And Families In Infection Prevention
Engaging Patients and Families inInfection Prevention1
PresenterSue Collier, MSN, RN, FABCClinical Content Development LeadAmerican Hospital Association (AHA)/Health Research & Educational Trust (HRET)Contributions byKyle Popovich, MD, MSRush University Medical CenterKaren Jones, RN, MPH, CICSt. John Hospital and Medical Center2
Learning Objective Describe the essential components of patient andfamily engagement Apply patient and family engagement principles inyour hospital’s infection prevention efforts3
Evolving Focus on the PatientCare that is Safe Timely Efficient Effective Equitable Patient Centered(Balik B, IHI White Papers, 2011; Institute of Medicine, National Academy Press, 2001; Kohn LT, National AcademyPress, 2000; Read the Law: The Affordable Care Act, HHS.gov, 2015; The Hospital Value-Based Purchasing (HVBP)program, CMS, 2016; Patient-Centered Outcomes Research Institute, Website; Patient and Family EngagementResources, CMS, 2016.)4
Patient-Family Centered Care “Providing care that is respectful of, andresponsive to, individual patientpreferences, needs, and values; andensuring that patient values guide allclinical decisions.” “Patient- and family-centered care is anapproach to the planning, delivery, andevaluation of healthcare that is grounded inmutually beneficial partnerships amonghealthcare providers, patients, and families.It redefines the relationships in healthcare.”(Institute of Medicine, National Academy Press, 2001; FAQ, Institute for Patient- and Family-Centered Care, 2010)5
Four Core Concepts ofPatient- and Family-Centered Care Dignity and Respect: listen and honor choices Information Sharing: communicate accurate, unbiasedand timely knowledge with patients and families Participation: encourage shared decision making inplanning, delivery and evaluation of healthcareservices and programs Collaboration: partner in all aspects of care at all levels(FAQ, Institute for Patient- and Family-Centered Care, 2010; Carman KL, Health Affairs, 2013)6
CMS Person and Family EngagementDefinition Individuals and families are partners in defining, designingand assessing the care practices and systems Services provided should be respectful of and responsive toindividual patient preferences, needs, and values Individual values guide all clinical decisions and drivesgenuine transformation in attitudes, behavior, andpractice(Hatlie MJ and Consumers Advancing Patient Safety, Patient and Family Engagement in PfP HEN 2.0, 2015)7
National Survey on Patient and FamilyEngagement Practices Conducted from 2013 to 2014 Over 1,400 hospitals surveyed Questions divided into three categories– Organizational practices– Bedside practices– Access to information and shared decision-making(Herrin J, BMJ Qual Saf, 2016)8
Patient and Family Engagement“Best Practices” Menu Bedside shift reports with patient and family engagement Family presence Interdisciplinary rounds with active patient involvement Patient communication boards and care plans Patient stories shared in meetings and sometimes by the patients Safety rounds with patient advisors Shared decision-making tools and teach backs Education materials developed with patients Patient and family advisor roles and councils Advisors on boards and improvement teams(Herrin J, BMJ Qual Saf, 2016)9
National Survey on PFE Practices:Findings Most common barrier to PFE adoption was competing organizationalpriorities Few hospitals had fully implemented a majority of the recommendedpatient engagement strategies(Herrin J, BMJ Qual Saf, 2016)10
Patient and Family EngagementThemes Building mutually beneficial partnerships Communicating and sharing information honestly and clearly Offering understanding and empathy to foster effectiverelationships Respecting the patients knowledge about their needs andpreferences Supporting mutually agreed upon goals Involving patients and families in planning, delivery andevaluation of care11
Another Pair of Eyes “Engaging patients and family members as active partners willidentify safety problems that might otherwise go undetected ” “Good clinicians are constantly on the alert for signs of deteriorationin their patients and for problems and failings in the healthcaresystem. Patients and families can, and should, do the same .” “Educate and train all personnel to be effective partners”(Doyle C, BMJ Open, 2013; Safety Is Personal: Partnering with Patients and Families for the Safest Care,National Patient Safety Foundation, 2014)12
Practices and Policies:Safe Care Campaign Founded by patient and familyadvocates with personalexperiences with healthcareassociated infections, HAIs Includes access to resources forpatients and families Includes information concerninghow patients can be involved inpreventing various infections(Safe Care Campaign, 2007; Nahum V, Armando Nahum, 2012)13
AHRQ’s Guide toPatient and Family EngagementStrategies to Help Hospitals Get StartedStrategy 1: Working WithPatient and Family AdvisorsHow to identify, recruit, train and work withpatient and family advisorsStrategy 2: Communicating toImprove QualityIdeas on how to communicate with patients,families and clinicians during a hospital stayStrategy 3: Nurse Bedside Shift Ways to ensure a safe handoff of care amongReportstaff, patients and family membersStrategy 4: Ideal DischargeStrategies to engage patients and familymembers in the transition from hospital tohome(Guide to Patient and Family Engagement in Hospital Quality and Safety, AHRQ, 2013)14
A Roadmap for Patient and FamilyEngagement in HealthCare(Carman KL, American Institutes for Research (AIR), 2014)15
Case ExampleA hospital with persistently elevated catheter-associated urinary tractinfection (CAUTI) rates would like to implement the followinginterventions:– Establish a dedicated clinical quality advisor, or unit champion,to lead daily catheter rounds– Retrain all staff in catheter insertion and maintenance and basicinfection prevention practices– Expand the use of urinary catheter alternativesHow might you engage patients andfamilies in these interventions?16
Case Example:Including Patient EngagementInfection Prevention Action Step toReduce CAUTI RatesHow to Include Patient and FamilyEngagementEstablish a dedicated clinical qualityadvisor, or unit champion, to lead dailycatheter rounds Ask patient advisor to review roundingand audit forms Include patient advisor in debriefsRetrain all staff in catheter insertion andmaintenance and basic infectionprevention practices Include patient stories in educationsessions Educate patients and family membersabout cathetersExpand the use of urinary catheteralternatives Invite patients to review urinarycatheter alternatives17
Patient and Family Engagement inHand Hygiene Share hand hygiene videos with patientsand families Ask patients and families to demonstrateproper technique Provide family members and visitors accessto handwashing stations and hand hygienesupplies Ask patients to speak up if they observestaff not following safe practices(Hand Hygiene Saves Lives, CDC, 2010)18
Patient and Family Engagement inPersonal Protective Equipment (PPE) Upon admission provide education topatients and family members aboutwhy PPE is being usedCDC MRSA FAQ Demonstrate how to don and doff PPE Explain what the hospital is doing toprevent the spread of infections Answer questions using clear andstraightforward explanations(Munoz-Price LS, Infect Control Hosp Epidemiol, 2015; FAQ About MRSA, CDC; Pandemic Planning andPatient– and Family-Centered Care, IPFCC, 2010)19
Patient and Family Engagement inAntibiotic Stewardship Educate patients about the risks and why antibioticstewardship is important Educate patients about what the hospital is doing to monitorantibiotics and implement good stewardship practices Educate patients and families about appropriate use ofantibiotics Include patient advocates on the antibiotic stewardship team Share data on efforts to reduce inappropriate antibiotic use andsolicit patient perspectives on how to include patients in theefforts(Get Smart Programs & Observances, CDC, 2014; Get Smart: Know When Antibiotics Work, CDC, 2015)20
Patient and Family Engagement in Training,Audits and Feedback Ask patients and family members to serve asfaculty in training programs and share theirstories Use trained patient advisors to conductsafety audits Encourage patients to speak up!(Guide to Patient and Family Engagement in Hospital Quality and Safety, AHRQ, 2013)21
Barriers to Patient EngagementTimeCulture Focusedon PatientResponsibilityOverarching Culture Change “How do Imake this partof my everydaywork?” “How can weincludepatients?”(Luxford K, Int J Qual Health Care, 2011)22 “Who can Iwork with?”
Overcoming Barriers to PatientEngagement in Infection Prevention Identify barriers unique to your culture Talk with staff to discover opportunities, barriers andchallenges Encourage senior leaders to make patient partnerships apriority Designate a patient and family engagement champion Develop action plans and focus on small tests of change(Advancing the practice of patient- and family-centered care in hospitals. How to get started, IPFCC, 2015;Profiles of Change, IPFCC, 2015)23
Key Take-Aways Patients and family members are essential partners ininfection prevention Infection prevention education should include patients andfamilies The patient’s perspective should be integrated intoinfection prevention efforts Expanding patient engagement practices requires culturechange There are many resources to help organizations improve inpatient engagement24
References Advancing the Practice of Patient- and Family-Centered Care in Hospitals. How to Get Started.Institute for Patient- and Family-Centered Care (IPFCC). 2015. Available athttp://www.ipfcc.org/pdf/getting started.pdf. Balik B, Conway J, Zipperer L, et al. Achieving an exceptional patient and family experience ofinpatient hospital care. IHI Innovation Series White Paper. Institute for Healthcare Improvement.2011. Carman KL, Dardess P, Maurer M, et al. Patient and family engagement: a framework forunderstanding the elements and developing interventions and policies. Health Affairs. 2013;32(2):223-31. Carman KL, Dardess P, Maurer ME, et al. A Roadmap for Patient and Family Engagement inHealthcare Practice and Research. (Prepared by the American Institutes for Research under a grantfrom the Gordon and Betty Moore Foundation, Dominick Frosch, Project Officer and Fellow; SusanBaade, Program Officer.) Gordon and Betty Moore Foundation. September 2014.www.patientfamilyengagement.org. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patientexperiences and clinical safety and effectiveness. BMJ Open. 2013; 3(1): e001570. FAQs About MRSA. Centers for Disease Control and Prevention. Available at:http://www.cdc.gov/mrsa/pdf/SHEA-mrsa tagged.pdf. Get Smart: Know When Antibiotics Work. Centers for Disease Control and Prevention website.25
References (continued) Frequently asked questions. Institute for Patient- and Family-Centered Care website.http://www.ipfcc.org/faq.html. Updated December29, 2010. Accessed August 15, 2016. Get Smart Programs & Observances. Centers for Disease Control and Prevention website.http://www.cdc.gov/getsmart/. Updated September 18, 2014. Accessed August 12, 2016. Guide to Patient and Family Engagement in Hospital Quality and Safety. Agency for HealthcareResearch and Quality hospital/engagingfamilies/index.html. UpdatedJune 2013. Accessed August 15, 2016. Hand Hygiene Saves Lives [Video]. Centers for Disease Control and Prevention; August 4, 2010.Available at: d-hygiene-saves-lives.html. Hatlie MJ, Consumers Advancing Patient Safety. Lecture presented: Patient and FamilyEngagement in PfP HEN 2.0; November 20, 2015. Accessed 5-deck-pfe-v6.pdf Herrin J, Harris K, Kenward K, et al. Patient and family engagement: a survey of US hospitalpractices. BMJ Qual Saf. 2016; 25(3):182-9.26
References (continued) The Hospital Value-Based Purchasing (HVBP) program. Centers for Medicare & MedicaidServices website. HVBP/Hospital-Value-Based-Purchasing.html AccessedAugust 12, 2016. Institute of Medicine and Committee on Quality of Health Care in America. Crossing the QualityChasm: A New Health System for the 21st Century. National Academy Press. 2001. Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. NationalAcademy Press. 2000. Luxford K, Safran DG, Delbanco T. Promoting patient-centered care: a qualitative study offacilitators and barriers in healthcare organizations with a reputation for improving the patientexperience. Int J Qual Health Care. 2011; 23(5): 510-5. Munoz-Price LS, Banach DB, Bearman G, et al. Isolation precautions for visitors. Infect ControlHosp Epidemiol. 2015; 36(7):747-58. Nahum V. How to be safe while receiving medical care. Armando Nahum; 2012. National Patient Safety Foundation’s Lucian Leape Institute. Safety Is Personal: Partnering withPatients and Families for the Safest Care. National Patient Safety Foundation. 2014.27
References (continued) Pandemic planning and patient– and family-centered care. Institute for Patient- and FamilyCentered Care. 2010. Available athttp://www.ipfcc.org/tools/Pandemic Planning and PFCC.pdf Patient-Centered Outcomes Research Institute. Website. http://www.pcori.org/ 2011.Accessed August 12, 2016. Patient and Family Engagement. Resources. Centers for Medicare & Medicaid Services website.https://partnershipforpatients.cms.gov/p4p -and-family-engagement.html Accessed August 12,2016. Profiles of Change. Institute for Patient- and Family-Centered Care website.http://www.ipfcc.org/profiles/index.html. Updated October 8, 2015. Accessed August 15,2016. Read the Law: The Affordable Care Act, section by section. HHS.gov Health Care w/read-the-law/ Published Updated August 28,2015. Accessed August 15, 2016. Safe Care Campaign website http://www.safecarecampaign.org/index.html. Published 2007.Accessed August 15, 2016.28
Speaker Notes29
Speaker Notes: Slide 1Hello and welcome to this module titled “Engaging Patients andFamilies in Infection Prevention.” This module is designed to helpyou understand the elements of patient and family engagementand highlight key strategies you can use to involve patients andfamilies in your organization’s infection prevention efforts.30
Speaker Notes: Slide 2This module was developed by national infection preventionefforts devoted to improving patient safety and infectionprevention efforts.31
Speaker Notes: Slide 3First, this module will describe the essential components ofpatient and family engagement including resources that you canuse for implementation in your organization. Next we willaddress how you can apply the principles of patient and familyengagement when developing, implementing and evaluatingyour hospital’s infection prevention efforts.32
Speaker Notes: Slide 4In an article published by Balik in 2011, we learned that the termpatient-centered care was referenced in the literature as early asthe 1950’s. Later, in 2000 and 2001, the Institute of Medicine,now known as the National Academy of Medicine, published twosentinel reports titled “To Err is Human” and “Crossing theQuality Chasm,” which introduced patient-centeredness as oneof the six key aims of quality improvement. Since 2010, we haveseen unprecedented attention to the role of the patient inhealthcare, especially in the Affordable Care Act and the Centersfor Medicare and Medicaid Service’s value based purchasingprogram.33
Speaker Notes: Slide 4 ContinuedSimilarly, the Patient Centered Outcomes Research Institute(PCORI) was developed to ensure meaningful engagement ofpatients in research. The Partnership for Patients initiative,sometimes known as the hospital engagement network, or HEN,is a public-private partnership focused on the goals of decreasinghealthcare-associated conditions such as infections, andreducing hospital readmissions. Throughout the Partnership forPatients initiative, patients and families have been recognized asessential partners in making care safer.34
Speaker Notes: Slide 5In the 2001 “Crossing the Quality Chasm” report, the Institute ofMedicine (IOM) defined patient-centered care as“providing care that is respectful of and responsive toindividual patient preferences, needs, and values and ensuringthat patient values guide all clinical decisions.”35
Speaker Notes: Slide 5 ContinuedWhile the Institute for Patient and Family Centered Caredefinition states that “Patient- and family-centered care is anapproach to the planning, delivery, and evaluation of healthcarethat is grounded in mutually beneficial partnerships amonghealthcare providers, patients and families. It redefines therelationships in healthcare.” And a mutually beneficialpartnership is grounded in the belief that all partners have valueand can offer unique and needed perspectives that contribute toachieving shared goals.36
Speaker Notes: Slide 6 ContinuedThe Institute of Patient and Family Centered Care went on toexpand on their definition by offering four core concepts that arekey to creating a culture in which patients and family membersare considered true partners on the care team.37
Speaker Notes: Slide 6 ContinuedThese concepts include: Demonstrating dignity and respect by listening to and honoringthe choices that individuals make about their personal health. Sharing information in a way that is unbiased and timely, sothat patients and families understand and can use theinformation to make personal decisions. Encouraging participation such that shared decision making ispart of the planning, implementation and evaluation ofhealthcare services, and finally, Collaborating as partners in all aspects of care, at all levels ofcare delivery.38
Speaker Notes: Slide 6 ContinuedFurthermore, in 2013 Carmen and others published a frameworkfor understanding the various components of patient and familyengagement. This framework suggests that patient engagementcan and should occur at various levels across a healthcare system– from direct care, to the service line or hospital level, to thecommunity and policy levels, and across the continuum of care.39
Speaker Notes: Slide 7Finally, the Centers for Medicare and Medicaid (CMS) in a recentwebinar for the Hospital Engagement Network contractors,offered the following definition for person and familyengagement: “Individuals and families are partners in defining,designing, and assessing the care practices and systems thatserve them to assure services provided are respectful of andresponsive to individual patient preferences, needs, and values.This collaborative engagement allows individual values to guideall clinical decisions and drives genuine transformation inattitudes, behavior, and practice.”40
Speaker Notes: Slide 7 ContinuedNote the term person in lieu of patient and the emphasis placedon collaboration and transformation in attitudes and behaviors,or culture.41
Speaker Notes: Slide 8Now that we have a shared mental model concerning patientand family engagement, let’s turn our attention to research onhow well hospitals are doing in demonstrating these key themesor characteristics. During 2013 and 2014, the Health Research &Educational Trust in collaboration with the Gordon and BettyMoore Foundation, conducted a national survey of hospitalsregarding their patient and family engagement pr
system. Patients and families can, and should, do the same .” “Educate and train all personnel to be effective partners” 12 (Doyle C, BMJ Open, 2013; Safety Is Personal: Partnering with Patients and Families for the Safest
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