Finding a Solution:
The team consolidated these above causes into four main key drivers.
Product must be available within SHC Central Supply and Home Agencies formulary with HME.
This first key driver proved to be critical because our team discovered that we didn’t carry the product. We then had to connect with supply chain to figure out how to get the product in stock regularly.
Multidisciplinary engagement with product change (including APP’s, Nursing, Physicians, Speech and Respiratory Therapy).
We recognized that making a change like this takes a village. There are many different stakeholders in this process, so including all of them in developing a process and making the product change would be critical. Our team created educational materials with the help of these stakeholders, including a One Point Lesson (OPL).
HME training for ENT service staff, patients, and families.
As mentioned in the multidisciplinary engagement key driver, our team had to develop educational materials. The training on these materials was also critical. The training had to be something that was easily accessible, regularly updated and reviewed with the appropriate parties.
A second part of this training would be how patients and families are educated in the use of the device. We realized one big gap was that there wasn’t any patient-facing training on this topic. While we further develop this material and create an order set, we decided to verbally train patients and families. We have been in contact with the team at ATOS to work with them in the development of educational materials for patients and their families.
In developing the use of HME’s and documenting the process, we recognized that we would need to do several PDSA cycles for implementation. Once we received the product and figured patients required further secretion management, we revised our education to include the needs of these patients.
Post discharge planning with CM, Home Health and Skilled Nursing.
One final big bucket was the post discharge planning process with Case Management. We also had to include these stakeholders to ensure that they could educate frequently used home health agencies on the use and ordering of HME devices. Case Management was represented on our team, so we had them utilize our initial OPL to develop their own material. This encouraged them to have conversations about trach care earlier in their process.
The outlook:
As our team began training people and developing our processes, the utilization of HMEs started to get people excited! It was satisfying to see other units get engaged and want to utilize the product as well. Based on the positive response and the good clinical outcomes, we plan to expand further to other units. We will also need to continue to work with Supply Chain to create ready supply in the hospital.
Reflection:
Our team stumbled a few times throughout our project. The first sticking point was including all the key stakeholders in the change. When it comes to change, people have strong feelings. We found it critical to make sure all stakeholders felt comfortable. Respiratory Therapy and Speech found out about our planned change after discussing with Nursing and Physician teams. Initially Respiratory and Speech had reservations, but after showing them the product and educating them they understood the benefits and were eager to utilize it.
One other learning point was understanding the external processes that our team would impact or be impacted by. For example, navigating how to get HMEs in stock was something we had never done before. We discovered that getting product in house takes time and wish we had started sooner.
Team Members (shown here): Carol Bertelsen, Maribeth Cambridge, Christa Groen, Ann Kearney, Kristi Norris, Staci Peavler, Idris Samad
Team Sponsors: Dr. Damrose and Dr. Sharon Hampton
Extended References
