After reading this article, you will be able to:
- Discuss the differences between family-centered and family-focused care
- Identify strategies for putting a family-activated rapid response system in place
- Recall the tactics of the Condition H family-activated rapid response team
Editor's note: The following is an excerpt from the HCPro book Rapid Response Teams: Proven Strategies for Successful Implementation, Second Edition, by Della M. Lin. To find out more, visit www.hcmarketplace.com.
Hospitals are rolling out family-activated rapid response teams (RRT) in conjunction with the growing emphasis on involving patients and their families in care delivery.
"If people are able to call 911 from their homes, why is this control taken away from them when hospitalized?" says the RRT team at the University of Pittsburgh Medical Center (UPMC) Shadyside when asked why a hospital might consider implementing a family-activated RRT.
One of the team's greatest impetuses to start a family-activated RRT came from the story of Josie King, an 18-month-old girl who died at Johns Hopkins in 2001 as a result of a series of medical errors. Josie's story is available as part of UPMC Shadyside's Bedside Education System, which educates patients about the hospital's family-activated RRT, dubbed "Condition H." Sorrel King, Josie's mother, continues to be a major force in advancing family-activated RRTs throughout the country. Read more about the Condition H program.
The core of a family-activated RRT
The concept of a family-activated RRT aligns with patient- and family-centered care. Jack Davis, president and CEO of the Calgary (Canada) Health Region, reminds us that "Our provision of care is not the same as the experience of illness ... both perspectives need to be considered."
The Institute for Family-Centered Care lists four core values that are critical toward this aim:
Dignity and respect
These core values explain why hospitals should implement a family-activated RRT. Read more about patient- and family-centered care.
Setting up a family-activated RRT also expands a different arm of a rapid response system. Opening the channels for calls that trigger timely intervention will contribute to the strength of the system.
Additionally, The Joint Commission's National Patient Safety Goal #13 includes the following two implementation requirements that address an organization's need to establish methods for patient and family involvement:
Requirement #13A calls on facilities to define and communicate ways for patients and their families to report concerns about safety, as well as encourage them to do so
Requirement #16A, Implementation Expectation A3, says hospitals should empower staff members, patients, and families to request additional assistance when they are concerned about a patient's condition
A family-activated RRT that integrates into patient care processes is one way to meet these goals.
Get a rapid start
The message from many hospitals that have put a family-activated RRT in place is don't hesitate.
"Just do it," says Linda Casner, RN, MSN, CNAA, FNP, senior director of patient safety and education at Yampa Valley Medical Center in Steamboat Springs, CO. If you have an active RRT in place, you can put a family-activated arm in place without any new resources. These hospitals should consider the following points:
Involve patients in planning and building the program: Don't miss the opportunity to gain the power and perspective of the patient and family while planning the program. Hospitals throughout the country are inviting patients and their families to partner in hospital committees and patient advisory councils. A family-activated RRT initiative would be a perfect situation for a patient or family member to sit on the task force and provide his or her perspective.
Consider an algorithm: Because patient calls traditionally are forwarded to a patient relations office, those involved in the process must be clear about how these calls should be directed.
Having a clear algorithm and script for the telephone operators is often beneficial. Some hospitals have established a specific phone to ring in the event of a patient- or family-activated RRT call.
Similar to a staff-activated RRT, the response arm—whether it is the operator, the intervention team, or the staff nurse—should remain positive and refrain from punitive-sounding statements such as "Why did you call?"
Consider multiple avenues for educating patients on admission: Posters, flyers, and in-house TV education channels are methods hospitals have used to implement family-activated RRTs.
Direct education should also occur at multiple levels. The admitting nurse may share the information, but it is also beneficial to have someone else (e.g., a volunteer or an education coordinator) sit down with the patient within 24 hours of admission to reinforce the message and create a safe environment so patients and family members will not feel discouraged from activating a call.
Ensure that posters and flyers are clear. Patients are inundated with information upon admission, so make sure this information stands out and is not lost in the clutter. Also, if you have invited a patient to participate in your task force initiative, get his or her input on poster design to maximize the message.
Start with a pilot unit: Implementation that begins on a pilot unit provides a way to address glitches early.
In addition, a story of a family-activated call in the early stages can provide additional motivating power to drive the initiative hospitalwide.
Some hospitals specifically choose more vulnerable units as their pilot unit. Frequently, in such cases, the patient has just transferred onto the unit (either up from a lower level of care or down from a higher, ICU-level of care). In those situations, patients and family members have particularly welcomed the concept of the additional safety net the family-activated call provides.
Educate staff members. Don't assume having a staff-activated RRT already in place means staff require minimal education regarding the rollout of a family-activated RRT.
Logistical questions concerning how a family-activated RRT works need to be covered as well as how to handle any perception of resistance. Staff members may perceive a family-activated call as a personal failure or a criticism of how they are doing their job. Leadership and management must make clear that in evolving optimal rapid response systems, all calls should be welcomed.
Gauge success through follow-up
Just as with traditional RRT calls, family-activated calls require review and follow-up for future learning. This effort should include getting feedback from patients and family members.
At UPMC Shadyside, a questionnaire prompts the patient or family member to respond to the following statements:
I felt I was given clear direction regarding Condition H
I felt comfortable calling a Condition H
When I/my family called a Condition H, I/we felt my/our needs were met
I felt my needs or the needs of my loved one were met after the Condition H call
Read about the high levels of patient, family, and staff satisfaction at UPMC Shadyside after introducing the Condition H program.