Patient Centered Care Model Antepartum Unit – 9 Prentice

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Patient Centered Care ModelAntepartum Unit 9
Prentice

• Training Guide

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Patient Centered Care ModelAntepartum Unit 9
Prentice
Why is this important? Mission and Vision The
Antepartum Patient Centered Care Model provides a
healing environment centered around trust,
compassion, and the incorporation of patients
individual needs. The goal is to ensure healthy
outcomes for mothers and infants. The Model
provides nurses with critical thinking skills and
creates a culture of seamless communication among
members of the health care team.

• What are we trying to accomplish? Goals
• Increase communication of the multidisciplinary
  team in achieving a collaborative plan of care
• Increase the patients involvement in goal
  setting with the multidisciplinary team
• Include the patient in shift to shift RN handoffs
• Ensure timely and accurate interpretation of non
  stress tests
• Ensure serial and structured nursing observation
  of patients

• What is our responsibility? Expectations
• Each team member is accountable for his/her role
  and assigned responsibility
• Nurses and physicians will collaborate daily with
  the patient/family and the multidisciplinary team
  to develop an individualized plan of care and
  adapt it as necessary
• A team approach will be used to achieve
  individualized care goals for each patient
• Patient satisfaction will increase through
  consistent patient involvement in establishing
  goals
• Staff satisfaction will increase through
  coordination of care and enhanced communication
  within the health care team
• Patient care staff will have a goal of hourly
  rounds on assigned patients

Adoption of this model requires a shift in
culture towards more critical thinking,
flexibility to adapt to individual patient needs,
and communication with all members of the care
team.
Everyone is Responsible
For Every Patient
Everyday
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Patient Centered Care ModelAntepartum Unit 9
Prentice
What is involved? Components of the Model
Interdisciplinary Rounds help to facilitate
execution of the Antepartum Patient Centered Care
Model
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Patient Centered Care ModelAntepartum Unit 9
Prentice
How does this impact me? A Day in the Life of
an Antepartum Nurse
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Patient Centered Care ModelAntepartum Unit 9
Prentice
Revised NST Review and Communication Process
NST order placed by MD
NST performed by primary RN
NST reviewed by primary RN
NST reviewed by charge RN
NST placed in bin for Attending sign-off by
following day
Y
Reactive NST?
N

• Expectations
• All NSTs will be reviewed by the primary RN and
  charge RN
• If charge RN is unavailable for review, staff
  educator or other senior RN can provide secondary
  review
• Primary RN and charge RN reviews must be
  documented in QS
• Reactive NSTs (defined below) will be placed in
  bin for MD review by the following day
• If MD disagrees with reactive definition of
  NST, feedback will be given to the RN team during
  interdisciplinary rounds
• If NST result shows anything other than
  reactive, NST must be reviewed by a physician
  immediately
• MD review of all non-reactive NSTs will follow a
  defined escalation process based on MD
  availability to review NST result within 1 hour
• The Unit Attending is the final source for
  escalation and must review NST within allowable
  timeframe
• If NST performed on 9S, MD can pull up strip
  electronically and use paper strip as back-up
• If NST performed on 9N, RN will provide paper
  strip for review
• All plan of care changes based on review of
  non-reactive NST must be communicated back to RN
  by MD
• All NST sign-off and final results will be
  completed by MD in PowerChart

High-risk OB resident notified
Pager 5-5334 (or web page)
Y
N
3rd or 4th year LD resident notified
Pager 5-2975 (or web page)Phone 2-2030 (R3) /
2-2031 (R4)
NST results reviewed/ signed-off within 1 hour
plan of care updated
Y
N
ONLY Mon-Fri, 8am 5pm See MFM call schedule
to webpage
Antepartum Attending notified
Y
MD communicates sign-off / plan of care changes
to RN
N
Y
LD Unit Attending notified
Phone 2-2032Pager 5-6458 (or web page)
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Patient Centered Care ModelAntepartum Unit 9
Prentice
Frequently Asked Questions
Q How is this different from how I have been
caring for my patients? A The components of this
model are not new concepts. Many of them are
interventions that simply stopped happening over
the course of time. In this new Patient Centered
Care Model, you are still responsible for the
care of patients who are assigned to you
(complete assessments, administer medications,
carry out orders or procedures, record vitals,
etc.), but you will also have the support and
insight of your peers to help you care for your
patients. Q What are the benefits of adopting
this new model of care? A The Patient Centered
Care Model will allow for a more structured use
of your time and will decrease interruptions in
your daily work schedule. Studies show that
hourly rounding delivers quality clinical
outcomes, decreases the number of call lights,
and takes much less of a nurses time when faced
with higher acuity patients. Whiteboard
documentation and in-room shift report allow for
nurses to communicate the plan of care not only
to their peers, but also the patient and her
family. This direct contact with patients
engages them in their care and helps to improve
patient satisfaction. Safety huddles allow for
each member of the care team to know who the high
risk patients are, and provide a forum for
education and support. You have already seen the
tremendous benefit of improved nurse-physician
communication and collaboration during
Interdisciplinary Rounds. This model will only
enhance the changes we have seen in our
practice.Q Is this new model really going to
work? A Yes. The concepts and components of the
model have been proven at many other institutions
like NMH, and the model has been customized
specifically for this Antepartum unit. You are
an essential part of the model and your ability
to adapt and be flexible to change will help to
make this a success. Additionally, this model
shouldnt be viewed as something you are being
told to do it should be something you want to do
and that you believe is the right thing to do for
the patient. This is a work in progress. It may
not be perfect the first time around, but with
your input and ideas, we can continue to make it
better and easier. Q Am I going to have enough
time during my shift to accomplish everything? A
The model was designed with you in mind. It is a
structured approach to your daily activities and
job function, and therefore should make it easier
for you to work effectively during your shift.
That being said, you are part of a care team that
works together if for some reason you feel
overwhelmed, do not hesitate to pull in your CC,
Staff Educator, or fellow Staff Nurse to help you
with patient rounds or other patient care
activities. Q Does in-room shift report violate
a patients right to privacy? A Face-to-face
handoff communication (or report) is a National
Patient Safety Goal set by The Joint Commission.
It is important to conduct yourself
professionally and respect a patients right to
confidentiality. All of our patients have
private rooms on the Antepartum unit, so the
conversation during in-room shift report will not
be heard by anyone other than the patient and the
nurses caring for her. If there is a visitor or
family member in the patients room, it is always
appropriate to ask the patient whether or not
they want the other person in the room during
shift report.