Program increases patient, family involvement

Patient safety initiative honors NPSG

Increased patient involvement in their own care is encouraged by The Joint Commission and other organizations as one of the keys to improving patient safety. In fact, "encouraging patients' active involvement in their own care" is one of the National Patient Safety Goals.

In recognition of the importance of such an approach, Community Health Network in Indianapolis has launched a new patient safety initiative, Call FIRST (Family-Initiated Rapid Screening Team), in all five of its hospitals.

As part of the program, patients and their family members are encouraged to make a phone call when there is a change in the patient's condition and they feel their concerns are not being addressed. A designated internal phone line has been established for the program at each facility.

When the number is called, a nursing supervisor or consult nurse will provide help within 15 minutes at the bedside to evaluate and stabilize the situation. The program is intended only for serious concerns in the change of a patient's condition. If there is confusion about the condition or treatment plan, Call FIRST also can assess the situation.

According to Community Health officials, the program is based on the "Condition H" program started by the University of Pittsburgh Medical Center in 2005.

A culture of safety

Informaing patients about Call FIRST program "One of the reasons we started the program was because we are changing our culture to a safety culture," explains Eleanore Wilson, RN, MA, BSN, vice president of nursing at Community Hospital North. "We want to be sure our patients are safe."

The Community Health version of the program was developed by its senior leaders and safety trainers, she says, and it was launched in September.

To help prepare staff for the program, discussions were held during regular staff meetings, and "team days" were held where staff education was provided. During these half-day sessions, Wilson discussed the purpose of the program, and how it would increase patient safety.

As for the patients and their families, there are several vehicles of communication. For example, there is written information provided at admission and Call FIRST signs have been posted in the patient areas to make patients and families aware of the initiative. The sign says: "Please ask us — we want your involvement." (For more details, see box.) "It also explains that we are dedicated to creating an exceptional experience, and that we want the patients and families to be our partners in care," says Wilson.

"When a patient is admitted, we give them a brochure that talks about the program," adds Wilson. "When the nurse admits them, she also explains the program to the patient and lets them know it is available."

The patient and family are told that if the patient does not feel they are being heard he or she should call the number, and that staff want to be sure a manager responds within 15 minutes. In the brochure itself the question, "When is Call FIRST appropriate?" is posed, and then answered as follows: "If there is a change in condition and you feel your concerns are not being addressed."

Early data positive

Since the program is so new, there are not yet much data available. However, Wilson says, the feedback from patients, families, and staff has been positive. "One of the hospitals received a call from a patient who was being discharged and did not feel they were ready to leave the hospital," she shares. "The manager went over the case and explained that it was time for the patient to go. In addition, she said if the patient felt she needed any additional help, such as home care, that it would be provided." In short, says Wilson, "All her questions were answered."

There are a number of situations in which the program can prove beneficial, says Wilson. "For example, there could be a case of a woman who has been with her husband for 20 years and knows he is not acting normal," she says. "The family members might recognize something that we don't."

Because of this added level of communication, she adds, "we feel family involvement will increase patient safety."

[For more information, contact:

Eleanore Wilson, RN, MA, BSN, Vice President of Nursing, Community Hospital North, 7150 Clearvista Drive, Indianapolis, IN 46256. Phone: (317) 621-6262.]