Thursday, August 7, 2014

International Patient and Family Centred Care Conference #4

Better together – partnering with families

Deborah Dokken and Joanna Kaufman from IPFCC: Joanne is responsible for content on the website and also looks after the PFAC list-serve. Deborah Dokken is a Patient and Family Leader and works on Better Together Campaign.

Help to change the concept of families as visitors to partners in care. The IPFCC has a new campaign and tools that will help in changing this concept.

They showed a slide with a number of signs of visiting hours signs – families feel locked out, that their loved ones have been imprisoned, that they cannot see them to calm they and check tha they are okay. 11% of hospitals in New York state have 7 hours or fewer of visiting hours. And 40% of all hospitals in the US restrict visitors. Even ins hostpials that have open visitation 70% of ICU poslicies restrict family visiting. When people are at their sickest when they are at their most vulnerable they need to see their family and friends.
They put up a quote from Aronson (2013) that I really like: active participation of patients and families is essential to optimal outcomes. The full quote is richer - so here it is:
...the impetus for my decisions lay in a trait of our medical culture. When we call patients and families “good,” or at least spare them the “difficult” label, we are noting and rewarding acquiescence. Too often, this “good” means you agree with me and you don't bother me and you let me be in charge of what happens and when. Such a definition runs counter to what we know about truly good care as a collaborative process. From the history that so often generates the diagnosis to the treatment that is the basis of care or cure, active participation of patients and families is essential to optimal outcomes..

In the Plenary session Leilani spoke powerfully about the impact of tradition and habit and the IPFCC team shared a similar comment:
Much of what takes place in a way of specific policies and practices … across country is baed on tradition rather than science (Market 2008)

There are beliefs and concerns around the need for restrictive practices and these include: infection control, gets in the way of staff doing their job, noise and disruption to other patients, not enough physical space, confidentiality and privacy, cultural differences, security and believing that patients and families want restricted hours.

They gave a couple of examples where the change has made made successfully.
Anne Arundel Medical Centre Indianapolis, Merryland. "Recognizing that family members and loved ones are an important part of a patient's care team, Anne Arundel Medical Center promotes family presence. All rooms are private throughout our hospital facilities." 
The other example was something like East Carolina Heath (although I'm not sure that's right). They're motto os terrific: We’re in this together. We want families and patients to be part of the team.

The presenters stressed taht change doesn’t happen overnight, and it's a bit like taking two steps forward and one step back. It will take time. It is important to take the time to listen to everybody’s concerns – housekeeping, security, nursing and doctors and also administrative staff. This involves significant change and re positioning: it is not about allowing people to visit but rather changing the concept to one that welcomes families and visitors.

It is useful to have a forum where staff can voice their concerns. And it is useful to convene discussion groups with particular groups and have a family share their story with senior leads and describe their experience of being treated as visitors.  And it really helps to have the CEO on board.

Each department needs to identify all the things that are preventing them from being open and welcoming facility and to map what is required to address the concerns that are. They need to be heard.

They showed a video of Anna Roth CEO, Contra Costa Hospital Martinez, California speaking about her experience of introducing open visiting hours. I have paraphrased her here...
“No one is coming to visit our facility, the people who come to be with our patients are part of their lives. We are the visitors, not them.”

They publish how many people are staying overnight so that staff know the impact of the change in policy. Within one month 641 people stayed overnight in 166 bed hospital. ( I need to watch the video again to check hat figure.)

With the short length of stay in hospitals increasingly the norm it means that 362 days of the year patients are somewhere else and not in hospital. We are at home, with our families and friends and yet for the three days we are in hospital our families and friends become visitors in our lives. This simply doesn’t make sense.

The Institute want so change visiting hours in 1000 hospitals across the US and Canada in the next three years and to this end they have developed a toolkit for use. There are five main areas of the toolkit: strategies for changing policies; strategic for educating staff; guides for families and staff; videos; and also media resources.

These resources are available to download at no cost. These are materials to be used and adapted. They are in pdf and can be printed, and logos can be added. This will help people to get started and incorporate the experience of other services that have already started this work and you benefit from the wisdom other others.

In closing they added a few other messages:
  • Patient gets to define who their family is, not the hospital. Hospitals in the past have prohibited visitors and made decision out family. This is important.
  • These are tools to make it a little easier but it is not going to be easy.
  • Do we “allow” families or does your website talk about differentiating visitors from family. Family are partners in care and there is benefit in having them there. Visitors, like neighbours and work colleagues may be visitors and
  • Family presence and not “visitation”
  • Participation not “permission”

“Families are respected as part of the care team – never visitors – in every area of the hospital” Lucian Leape 2009
Question: how can you meet the needs of specific populations? Caucasian members of the Family Advisory Committee are comfortable with restrictions on visitation policy yet Latino members want policy relaxed to allow for more than two people visiting at the time. How do you deal with this? Work with the Family Advisory Council to work through this issue to develop a policy that

Question: How long does it take? It takes about a year to make it happen and establish the process to make sure that everyone is heard. Identifying the goal, identify the issues and concerns and plan for the next step. There are 12 profiles on the IPFCC website that talks about the processes these organisations undertook to revise their policies.
Vanderbilt trauma unit, lots of gang activity workplace violence committee help in training the nurses in how to deal with this. If family is being disruptive and they cannot be I the therapeutic environment and lend themselves to the healing environment then they cannot be here and will be asked to leave.


Darlene Cox
@darlenecox

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