I will be making another quick trip home this week (one day home and two days traveling). I am always so excited for the opportunity to go back home. I envision rest and relaxation, but really, it is always another competing prioritization situation, no different than work right now. Should I spend the day cooking/baking, running errands, visiting family/friends, working out with my crossfit team, getting a pedicure, dying my hair, catching up on laundry, decorating for Christmas… the list goes on and on.
I’m excited to report a small win this week (a small win that will hopefully become a big win later). Assessing our quality measures and trying to determine which ones we could impact, led me to the decision to focus on opportunities related to UTI’s, dehydration, and ER visits. Although dehydration is not technically r/t a quality measure, it indirectly impacts UTI’s and often leads to ER visits. We already had a process in place to identify residents that were at risk for dehydration, however, there was a disjointed process for addressing it. We knew which residents were at high risk for dehydration but with the chaos that ensues with constant shift changes and revolving staff, it is easy to lose sight of those who need more fluids. To compound that, the ones at risk for dehydration often have some form of neuro-cognitive deficit or dementia and are unable to communicate fluid needs or even recognize/identify thirst. We know that taste buds also diminish as dementia and Alzheimer’s disease progress. We were serving them water in mugs daily and keeping them filled, however, water loses its appeal to patient’s with dementia (because it isn’t sweet/no flavor). As they decline, they often seek out foods and fluids with sweet flavors. Knowing this, I asked dietary if they could purchase flavor additives for water. So, the dietary department purchased some different flavor additives and we set up a bingo game while we served shots of the different flavors. We served them to everybody so that we could see what was the most popular, but we also paid special attention to the ones that are unable to communicate thirst or request fluids that they prefer. With close attention, we were able to identify their preferences. We then placed stickers on their doorframes to correlate to their preference so that when the CNA’s go around to fill their beverages, they would know to add that flavor to their water. We got creative and decided to vamp up our current beverage cart, as well. We decided that cranberry juice would be beneficial, so it is offered to everyone every morning. In the afternoon, we are offering sodas (we know they’re not the best health choice, but fluids are fluids and any increase of fluid intake is better than nothing). In the evenings we are serving juice and an option for a hot beverage (cocoa or tea). We have decided that we’ll monitor and watch to see what the residents like the best. Due to this collaborative effort, we are already seeing a positive impact. They are consuming more fluids and their urine is less concentrated and lighter in color.
Aside from that, I have now been given the clinical schedule to coordinate. If you have ever attempted to create/manage a facility schedule, then you already know……..nothing else needs to be said. One of the first things that I did was convert to self-scheduling. It was a completely foreign concept to them, and some were very anxious about the idea. But what I know from experience is that when someone selects their own shifts, they are more likely to work them. The first run went terrific and now the staff have come to me requesting a 12 hour shift schedule instead of 8 hour shifts. I have successfully transitioned a facility with this before. It is a huge undertaking, but the benefits are well worth it. With a 12-hour shift schedule, there are only two shift turnovers per day, resulting in fewer opportunities for miscommunications and disruptions that negatively impact continuity and consistency of care. Having more days off relieves stress and improves outlook and attitude for the staff, and the facility has reduced staffing costs. I only have a limited amount of time to achieve this, so our implementation goal is January 1. More on that to come….
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