AvaSys Soars When Senior Leaders are on Board
Over the years, I have observed a direct correlation between the level of success an AvaSys TeleSitter program achieves within an institution and the degree of leadership support for the program.
It is not a surprise that this correlation exists. Research has shown that involved leaders promote adoption of clinical quality improvement initiatives (see BJ Weiner, writing in Health Services Research in 1997). In a 2009 white paper setting forth new leadership standards, Paul M. Schyve, MD, senior vice president of the Joint Commission, wrote: “It is the leaders who can strategically plan for the provision of services, acquire and allocate resources, and set priorities for improved performance. And it is the leaders who establish the organization’s culture through their words, expectations for action, and behavior— a culture that values high-quality, safe patient care, responsible use of resources, community service, and ethical behavior.”
AvaSure’s clinical services team provides resources and best practices that lead to swift and significant outcomes in patient safety, but ultimately, continued success remains in the hands of people within the hospital who are willing to be change agents. Among many important program objectives, there are three must-have roles that stand out.
An executive leadership sponsor is the C-suite champion (usually CNO/CFO/CIO or the like) who sets expectations for execution of video monitoring. Those expectations include elements such as when go-live must occur, when data collection should start, and who should plan and manage the program from an operational perspective. This sponsor must also establish a guideline that all monitor units be in use at all times. One of our biggest lessons learned from 184 deployments is if this expectation is not set by leadership and set very early on, the frontline staff easily forget about the option of video monitoring and do as they have always done, such as use in-room sitters. The standard should clearly state that if all sitter replacement needs are filled by AvaSys and there are monitoring units not in use, monitoring should be initiated on additional patients who meet high fall risk criteria and/or other inclusion criteria.
Finally, the C-suite champion should ask for and receive metrics monthly on AvaSys use (hours per unit, number of patients monitored by unit, number of verbal interventions) and outcomes (fall rates, sitter costs, etc.). This is especially important in the first six months, when tweaks to the program are most needed as the hospital adapts to this new capability.
Meanwhile, a program owner/director (typically a director of nursing/safety or the like) is responsible for ensuring that expectations set by executive leadership are achieved. He or she needs to have authority over frontline users to make changes and direct expectations if needed. Nurses may tend to take the path of least resistance and continue to use/request sitters. In order for this program to work, it needs to be executed correctly. It is a culture change and requires a lot of attention in the beginning to make it a habit.
The program owner is responsible for providing metrics to the executive sponsor. Working with the executive sponsor and the AvaSure team, the owner creates data collection methods that can be reviewed and presented once a month (at least for the first 6 months to a year).
The owner is also responsible for ensuring policy and procedures are followed by frontline staff, including inclusion/exclusion criteria, trial protocol, failure protocol and triaging. This level of oversight is a model that should be adopted by all organizations with AvaSys. Each shift should have someone assigned to this role.
The program owner should designate an IT lead to provide feet on the ground support if troubleshooting is needed. Facility IT will work with AvaSure directly in the event the AvaSys support team needs access to a setting change or a minor fix. Also, IT may be needed to help troubleshoot hospital network related issues.
Last, but far from least, the operations manager is needed to ensure AvaSys program goals are met on the frontlines daily and operations are kept consistent throughout each shift. It is easy for complacency to set in and other tasks to intrude, but with patients at risk, someone must assure all monitor units are in use all the time.
This essential role involves triaging patients; managing a wait list; and tracking hours of monitoring, number of interventions and alarms, the reasons for monitoring and admission/discharge times. It is easy for staff to request AvaSys for use on a patient who would have needed a 1:1 sitter. However, there are many other inclusion criteria aside from that. Nurses must go beyond sitter replacement and use AvaSys for all types of patient needs.
Other tasks for the operations manager include:
- Analyzing metrics monthly as it relates to 1:1 sitter hours and fall rates to ensure AvaSys program goals are being met. Providing reports to executive team.
- Addressing AvaSys in daily bed and clinical unit huddles, just as 1:1 sitter use is addressed. This will help to increase awareness of program as well as ensure that monitoring units are assigned appropriately and non-used monitoring units can be dispersed.
- Developing continuing education as it relates to AvaSys as well as ongoing monitor tech training to keep the program current.
- Collecting and publicizing “good catches” – clinical staff or monitor staff stories about keeping patients safe using AvaSys. Good catch stories are always helpful when posted in break rooms or included in newsletters. They build staff confidence and continued awareness of the AvaSys program.
- Holding monthly AvaSys meetings with monitor staff and key clinical staff. AvaSys needs care and maintenance just like other programs. Monthly or quarterly meetings with key staff are essential to keep up with changes, new processes, awareness and continuing education.
There are many other elements to successful adoption of AvaSys, but having the right people lead this effort is a baseline on which to build.