Integrating the Process

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19 Οκτ 2013 (πριν από 3 χρόνια και 9 μήνες)

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Integrating the Process


Discover

the role of the nurse in healthcare design and
determine how nurses can be leaders.



Learn

about evidence based design and list areas of design
that have been proven to improve patient outcomes
.



Learn

current design and technology trends and relate
those scenarios to their current work environment
.



Identify

nurse leadership initiatives to align the
architecture and technology
to support processes and work
flow.


Learning Objectives




Vanderbilt
Nursing


School


1984






1984


Open Wards


Semi Private Rooms


Centralized Nursing


8 hours shifts


Rolling Medicine
Carts







Today


Private Rooms


Decentralized
Nursing


12 hours shifts


Bar Code Medication


Patient Entertainment


Family Area




Support and optimize
the delivery of care
models through
architecture and
technology


Nurses have unique
perspectives

-
Patient Safety

-
Family/Care giver needs

-
Physician Interactions

-
Infection Control

-
Working with Teams

-
Work flow and processes

-
Medication Safety



-
HIPAA Compliance

-
Communication

-
Organizational Culture

-
Organizational Initiatives

-
Care model/Patient care
philosophy

-
Critical thinking skills

-
Outcomes oriented


Interdisciplinary leadership


Communication &
relationship building


Knowledge of the healthcare
environment


Business skills


Professionalism


Transformational leadership


Stichler, JF (2007). Nurse Executive Leadership Competencies for Health Facility Design.
JONA, 37
(3), 109
-
112.



Nurse Executive

-
Validating that the design
supports the strategic vision,
mission, values and culture
of the organization

-
Stay involved


Chief Nursing Officer

-
Ensuring that the design
supports the professional
practice model

-
Insure project continuity


Director

-
Articulating how the design
will affect costs, market
share, satisfaction levels

-
Design principles metrics

-
Change management

-
Policies and procedures

-
Training


Manager

-
Determining how the
design affects staffing and
patient flow

-
Giving staff time to
participate

-
Create enthusiasm

-
Team Builder

-
Staffing


Staff Nurse


Giving input to the
architect team


Soliciting creative ideas


“Being present”


Team Supporter


Nurse Project Manager


Coordinating the
interdisciplinary process of
design, giving a voice to all
providers and patients



Nurse Project Director


Managing millions or
billions of dollars; keeping
the project on time and
within budget


Big picture/managing details


Nurse Consultant


Internal to the organization or
external in the architects office


Integrating the voice of nursing
patient care and design


Who’s on the project team?


Nurse
Architect/Designer


Interfacing the design
world with health care


Nurse Researcher


Nurse Technology
Expert on w
ork flow
analysis







Evidence based design
is the intentional
attempt to base design
and construction
decisions on “evidence”
or “research” to
improve outcomes for
patients and staff.

Schiphol Airport in Amsterdam












Alzheimer Bus Stop

The
Benrath

Senior Center
-

Düsseldorf,
Germany


First

Evidence based

Design

Practitioner

.

It may seem a strange

principle to enunciate as the

very first requirement in a

Hospital that it should do the

sick no harm.

Florence Nightingale, 1859


Group of researchers
from Texas
A&M

and
GeorgiaTech

combed
through several thousand
scientific articles.



More than 600 research
studies were found that
establish a link between
hospital design and
improved outcomes for
patients and staff.



The studies were
assessed on their rigor,
quality of research
design, sample sizes and
degree of control.


Patient
confidentiality



Noise



Nature



Daylight



Positive distraction



Social support



Improved
communication



Medication errors



Patient falls


Infection control



Ergonomic design



Improved layout
for reduced steps



Consistency in
design


Healthcare Work Environment


(Architectural/Engineering Perspective)





Square Footage Requirements


Building Codes and Regulations


Space Planning


Adjacencies


Infrastructure







Used by permission: Roger K. Lewis,
FAIA
, Architect & Planner Columnist,
"Shaping the City," The Washington Post, Professor Emeritus, University of
Maryland School of Architecture, Planning and Preservation


Healthcare Setting


Work Processes


Workforce Demographics


Culture and Geographic Location


Information Technology



You have to understand how a nurse works in a room in order to
design it well





Design Process



Programming


Schematic Design


Design Development


Contract Documents


Construction



Nursing Process



Assessment


Planning


Intervention


Evaluation



Operational Model


Care Delivery Philosophy


Patient Population


Specialty, Geriatrics, etc.


Teaching
vs

Non
-
Teaching


Staffing


Unit Secretary


Team


Physician Specialty




HKS Architects


Processes


Supplies


Medications


Other Services


Communication


Workflow & Devices


Documentation




Charting Alcoves


Computerized Charting


Meaningful Use


Nurse Servers


Bar
-
coding


RFID


OR Integration


Nurse Call


DAS


Telemetry


Network Hardware


Physiomonitoring


Security


Emergency Power


Widely accepted as most beneficial.



Implemented in almost all hospitals.



Semi
-
private rooms generally occur only
for:


Elderly patients who feel less


confused with roommate.


Veterans who appreciate


camaraderie of roommate.


Behavioral/Psychiatric settings


Small hospitals with too few resources.


Single
-
Handed Rooms


Pros:


Concept is accepted by many organizations.


Standardization of all patients approached from same
side is convenient and helps in responding to codes
in room.


Some hospitals incorporated angled corner walls to
increase view from hallway.

Cons:


Limited evidence of being safer


difficult to judge
because every patient is different.


Challenge to observe 2 patients at once from
communication station outside rooms.


Extra cost for not having back to back toilets (no
hard numbers for difference).


Pushback from nurses that they can’t adapt to
mirror
-
imaged rooms.

Single
-
handed rooms

Mirror
-
imaged rooms



Very convenient and saves time.


TJC had issue with contamination from patient to patient


everything
in room must be taken out when terminally cleaned.


Now TJC accepts if minimum number of towels, linens, and supplies
are put in cabinet. Need to make sure it is stocked appropriately and
without unnecessary materials.

Issues:


Who stocks cabinet.


Building codes can require the door in
the corridor to have a closer, which
makes server hard to keep open.


Location can be inconvenient and hard to
access from corridor and inside patient
room.


Need to displace personal effects to use
bedside table for treatment.



Reduces medication errors by ensuring correct
medicine and dosage.


Better than barcode medication administration
because it is not interrupted by leaving to get
medicine once scanned.


Provides charge, capture, and inventory
management.


Operational issue: who stocks machine and how
often.


Infrastructure of steel supports above ceiling being built in.


More institutions want lifts in every room. Now only a percentage


of rooms get lifts


typically in bariatric rooms.


H
-
type gantry lift (moves in 4 directions) is preferred over the


single rail lift, which has less flexibility.


Some hospitals have lifts into bathrooms.


Some hospitals utilize lift teams.

Issues
:


Because lifts are not in every
room, nurses often don’t know
how to use them.


Need education included in lift
purchase.


Many lifts don’t have the
necessary lift ability of 1000
pounds.



Need more bariatric rooms to allow for increase in
heavier patients.


Issue of hygiene


make bariatric rooms with wet
rooms with drains, hoses, and a hazmat
containment pool.


Problem with bathroom


need greater


distance from wall for bariatric patients,


but that exceeds


the code for ADA
.


One console controls TV, lighting, draperies,
music, and call system for nurse.


Wireless keyboards for internet, communication,
controls, and meal selection.


Equipment
: Keeps track of all
equipment in hospital


helps locate
and maintain inventory.


Patients
: Especially helpful in ER


reduces need for security and helps
monitor vulnerable and dangerous
patients.


Staff
: Very beneficial for ER and
Specialty Services staff. Mostly used
with Nurse Calls
.

Robots


Take dietary orders with filter for
patient’s specific dietary needs and
deliver meal trays.


Remote doctor robot has doctor’s
face on screen and 2
-
way
communication from remote
location. Allows for clinicians to be
involved without having to be
present.






Simplifies the many components of the


operating room into one easy
-
to
-
use interface.


Helps nurses and surgeons make decisions with centralized
control of medical devices and information.


Attracts better surgeons and more patients,
improves patient outcome and experience,
and increases efficiency.



Helps ensure compliance
and increases frequency
of staff washing hands


Improves patient safety
by reducing spread of
infections

Technology ahead of practice transformation


Smart Beds


Alerts staff to changes in patient’s
status and movement.


Can help reduce emergency reaction
time.


Some issue with data overload due to
info coming from Smart Beds and
monitors.


Integration


Wireless Phones


IV Pumps


Telemetry Systems


Admitting Systems


Bed Exit Systems


Smoke Detectors


Staff Location, Infant


Security & Asset
Tracking


Ventilators, Pulse Ox,
AB Monitors, etc


Communications
Planning and
Documentation

Design
Considerations


Philosophy


Budget


Devices


Flexibility

HKS Architects

HKS Architects



Improves staff to staff communication, patient
to nurse communication, efficiency, and


patient satisfaction.


Reduces reaction time and overall


noise by eliminating paging.


Can also act as a recording device,


nurse call system, and a device alarm.


Healthcare applications
specifically designed for
iPhone

being adopted and
more being developed.


Improves workflow process,
reaction time, and efficiency.


Technology is widely accepted
and easy to use.



Physicians Rounds


Physicians use their
iPads

for
EHR, POE, Personalized Team Census (
signout
), E
-
Ticket (billing), web
-
based paging, and their
hospital emergency department (ED) dashboard.



Education, distraction and preparation
-

Child life
specialists use it to help patients manage stress
during their stay. They use the
iPad

to show patients
how physicians prepare for surgery; to play games
with patients; and to educate them about their
procedures or conditions.



X
-
ray images, EKG results and other patient
monitoring programs
-

Used in inpatient and out
patient settings by home health, hospice care
workers, nurses, dietitians and pharmacists.



Staff documentation


Entering the patients
information on a screen that doesn’t require turning
your back to the patient.



Speech therapy


Speech therapist uses
iPad
/
iPhone

app Proloquo2Go with stroke victims and autistic
patients to enable patients to speak through the
devices to their care team.

Mobile Health



Wireless


DAS


Smart Phones


Tablets


Emergency Power


Telehealth



Challenges Foreseen


The first rule of any technology used in a
business is that automation applied to an
efficient operation will magnify the efficiency.
The second is that automation applied to an
inefficient operation will magnify the
inefficiency.”







Bill
Gates


Increases efficiency


Reduces administrative work


Improves safety for patients and staff


Improves workflow processes


Better reaction times


Improves patient experience


Convenience


Many are easy to use


Improves communication and decision
making



Difficult to change culture of routine and “old
ways,” especially among older staff


Learning curve for some technology


Requires training


Data overload


Until staff are sure of devices, need backup


dual info


If not widely integrated, less likely to use or
remember how to use


Not all advances have proven benefits


Evidence Based Design is improving the
healthcare environment


A Nursing Advocate needs to be at the table


Technology is ahead of practice
transformation


Designing for technology must become
evidence based to improve healthcare
delivery and determine best practices

Aligning:




Corporate Vision

Clinical Vision

Architecture Vision

IT Vision




NIHD

Founding

Board of Directors


Nurses Planning Session


Nursing Institute for Healthcare Design ( NIHD)


www.nursingihd.com


Center for Health Design (CHD)


www.healthdesign.org


Joint Commission Resources


www.jcrinc.com


Institute for Healthcare Improvement



www.ihi.org


Agency for Healthcare Research and Quality (
AHRQ
)


www.ahrq.org


Robert Wood Johnson Foundation (RWJF)


www.rwjf.org







Health Environments Research & Design
Journal (HERD)


Facility Care


Healthcare Design


Journal of Nursing Administration
-

Healthcare
Design Feature


Critical Care Nursing Quarterly


Design Issue


Healthcare Design’13


November 16
-
19, 2013


Orlando, Florida


Nursing Institute for Healthcare Design



ASHE
PDC

2014


March 16
-
19, 2014


Orlando, Florida



Debbie

Gregory

RN,

BSN

Senior

Clinical

Consultant

SSR

Technology

Group

Smith,

Seckman,

Reid,

Inc
.

615
-
714
-
6794

dgregory@ssr
-
inc
.
com


The

Nursing

Institute

for

Healthcare

Design

www
.
nursingihd
.
com