New techniques: How Labrador-Grenfell Health is trying to improve patient care

Labrador-Grenfell Health isn't reinventing the wheel, just changing the way nurses do their rounds — and a few other things.

The health authority has been implementing methods from a comprehensive nursing-care model from the Ottawa Hospital, which focuses on patient, family and nursing organization and addresses problems such as nursing burnout, and was adopted by the Newfoundland and Labrador government in 2009.

Each of Newfoundland and Labrador's four regional health authorities have been introducing methods from the model. Some of the practices implemented by Labrador-Grenfell Health involve pre-operative calls, bedside shift reports, intentional patient rounding, communication boards and post-discharge calls.

Pre-operative calls

A pre-operative call is contact with a patient before they come in for an operation.

"The whole purpose for implementing our calls was to decrease no-shows in our surgical area, improve client preparation engagement, improve appointment access, decrease tardiness," Corenia Price, the nurse specialist responsible for carrying out the initiative, told CBC News.

"Our patients are coming more prepared. They have their medication bottles with them, they're leaving their valuables at home, they're more familiar with where to go and how to get there, and they have that opportunity to speak to a nurse in advance."

Bedside shift report

Bedside shift reports are for nurses changing shifts. Where in some hospitals this takes place at the nurses' station, the Ottawa method is for outgoing nurses to give their reports bedside with each patient.

"Our bedside shift-change report makes a larger connection with our patient each time that we introduce a new interaction like this," said Megan Harris-Edwards, a nurse at Labrador Health Centre in Happy Valley-Goose Bay.

"it's all about the patient being involved with their care and being knowledgeable about their care that they're receiving,"

This type of shift-change report might not be best in every case, said Harris-Edwards, such as when a patient might not be able to understand it due to a language barrier.

"Or, if they aren't informed about their health, then we could face issues in divulging too much information — not in a negative way but in a 'this is the plan of care right now' [way]," Harris-Edwards said.

"We need to be mindful about the information that we do share to make sure that family wishes are being respected and the patient's wishes are being respected, because this is a public area and doing the shift-change report at the bedside could put us at risk for breaking privacy and confidentiality of the patient."

For Corina Porter, Labrador-Grenfell Health's regional director of interprofessional practice, the bedside shift report is all about involving the patient in their own care.

"We're trying to get them to move away more so from 'the doctor says this,' 'the doctor says that.' It's more about the patient client being an advocate in their care," Porter said, adding it gives patients and their families the opportunity to ask questions and be more informed about their care.

"It's a form of communication that's patient-family-centred."

Intentional patient rounding

The Ottawa Hospital model gives more structure to nurses' daily rounds, by having nurses make their roudns at set times with set questions.

"We want to make sure that the patient is comfortable, the patient has all their belongings next to them, if they need the washroom," said Labrador Health Centre nurse Dianne Whalen, who has 23 years' experience..

"We would ask them if there was anything we could help them with or anything that needs prompting right now. Pain is a big one and also washroom services seems to be the most popular," she said.

Managers call that checklist the four P's: potty, possessions, positioning and pain.

"Nurses have always rounded with a purpose, so it now has a guide, a reason for actually rounding," said Wanda Slade, regional director of acute care and Labrador West Health Centre's senior director of operations.

A nurse for 25 years, Slade said she has always done hourly rounding but now they're ensuring they check on all the patient's needs.

"It would prevent the patient from ringing just when you get down the hall for something they really could have taken care of while they were at the bedside," she said.

"Our patients love it because they have that confidence that their nurse is going to be back every hour, they're going to get checked on," she said.

Communication boards

In short: dry-erase white boards that include crucial patient info, updated every morning with the patient's name, room number, discharge date, nurse on duty, and a section for comments for the patient or the doctor.

"We encourage family also, for if they step out, that they can write a note there to the nurse or the doctor," said Whalen.

Wanda Slade, the regional director of acute care, says communication boards came into practice in line with the intentional patient rounding.

"It's a two-way communication board. If I'm in and your nurse is not there today then you can certainly leave me a message," said Slade. "If there's other things that you want us to look at, then we can certainly communicate through our patient communication board."

Post-discharge call

Post-discharge calls are made after a patient has left the hospital to see how they're doing.

Deanne Welsh, a community health nurse at the Labrador Health Centre in Happy Valley-Goose Bay, said patients are sometimes unsure about followup care they might need and will sometimes miss appointments with family doctors, or procedures like having bloodwork done.

"When we do this call whatever followup the patient is listed for, it's listed right on their discharge plan, so we're able to discuss that with them and give them the process ahead of time to sort of save any headache that they might have," she said.

Antionette Cabot, Labrador-Grenfell Health's regional director of public health, primary health and emergency services, said the post-discharge calls are a chance to address patients' concerns or negative experiences, but also an opportunity to celebrate what they're doing well.

"One of the questions that we ask in the post discharge call is, 'Was there an employee that made your stay more enjoyable?'" said Cabot. "This gives the patient opportunity to identify a person on our staff that helped with their stay and if that staff member is identified a couple times then we reward and acknowledge that staff member."

When a nurse is positively mentioned twice by patients, they receive a thank-you card from their manager. Six positive mentions earns a thank-you card from Labrador-Grenfell Health's CEO.

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