t i k l o o T s u l p KE
The N
Toolkit
Tools, Tools, Tools! In the following pages you will find a collection of posters, guides, flyers, and other tools that were called out in the Playbook to help you successfully implement NKEplus. These tools will help you plan, educate, reinforce behaviors with staff, and sustain NKEplus for years to come. You will find the tools in digital form at the end of this book. Many of them are ready to print right away, while others are templates meant to be customized to the unit before being printed and are marked as such.
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Tools by stage Having the right tools when you need them can make all the difference. in the following pages, you will find all the tools called out in the Playbook as well as a few more. For simplicity, tools are grouped by the stage in which they may first be useful, but many of the tools will come in handy more than once as you implement NkEplus on your unit. Feel free to use any tool wherever and whenever you need it. They are here for you!
PREPARE • U1: Unit Self-Assessment Tool
KICKOFF • K1: Roll-out Schedule poster
• P1: Role Coordination Worksheet
• K2: NkEplus Think tank poster
• P2: Pi Planning form
• K3: NkEplus Goals poster
• P3: Project Snapshot worksheet
• K4: NkEplus overview poster
• P4: Workflow cards
• K5: interview guide (cards) • K6: Walk-through guide (cards)
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PLANNING
NKEplus Essentials
TRYING THINGS OUT
ROLL OUT
EVALUATE AND SUSTAIN
• T1: “Things we’re trying” sheets
• R1: NkEplus Badge Cards
• S1: NkEplus Tracker Tool
• T2: “Trying new things” tags
• R2: imagine your day worksheet
• S2: Charge RN checklist
• T3: Question Card
• R3: Cards of various uses.
• S3: NkEplus float tool
• T4: Preparing Hot Towels Card
• R4: Pop-up Video library
• S4: Bedside Tidbit cards
• T5: UA Message Pad
• R5: Tips for HiPAA compliance
• S5: Call-light dashboard
• T6: UA Call Triage Protocol
• R6: Manager sign-up calendar
• S6: Create your own dashboard
• T7: UA Checklist
• R7: “We made it ours” tags
• S7: Further sustainability tips
• T8: Final Hourly Round Times flyer
• R8: Patient-RN Appreciation clips
• T9: Question of the Day
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U1 SELF-ASSESSMENT TOOL
Prepare Note: “Prepare” is not a stage in the Playbook, but this tool is so useful, we couldn’t stand to leave it out! Use it to make sure a unit is ready to start rolling out NKEplus.
HOW TO USE IT Use this self-assessment tool to see how ready the unit is to introduce NkEplus.
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Kickoff Tools • K1: Roll-out Schedule poster • K2: NKEplus Think tank poster • K3: NKEplus Goals poster • K4: NKEplus Overview poster • K5: Interview guide (cards) • K6: Walk-through guide (cards)
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K1 ROLL-OUT SCHEDULE POSTER
K2 NKEPLUS THINK-TANK POSTER
HOW TO USE IT
HOW TO USE IT Put up a big poster to communicate project schedule. Use this to help set expectations with staff regarding timing and roles.
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Use this fun poster to build excitement about NkEplus and convey that the unit is “making it theirs�. Put the poster up on a conference room door or somewhere that marks a designated space where the champions team can explore and immerse themselves in NkEplus, make decisions, hold diagnostic workshops, and create additional posters to put up on the unit.
K3 NKEplus GOALS POSTER
K4 NKEplus OVERVIEW POSTER
Template
NKEplus
6 Essential Parts
Nurse Role Supporting
*
Staff Roles
1. Last Hourl y Round
5. Pre-shift Assignmen ts
HOW TO USE IT Use this poster to communicate the goals of NkEplus. Point to it during training, post it up on the walls, keep it around for reference throughout the soft-start process. Having everyone understand the overarching goals of NkEplus will keep the unit striving for the same outcomes while allowing individuals to be flexible in their approach.
In-Room Nur se-Patient Nurse invites Engageme patient to part nt icipate in exc hange of info rma
*
tion.
*
2. In-Room SBAR
3. In-Room Safety Check
4. Careboar d with Shift Goals & Teachback
* 6. Unit Supp
or t
During En d of shift During han dof f
* CUSTOM FITS: Customize these part
s of NKEplus
HOW TO USE IT
based on the
unit’s unique need
s and dynamics
.
Use this poster to share a summary of NkEplus with the unit. Post it up in one or more obvious places where staff can see it an get familiar with it. Staff bathrooms, staff conference rooms, nurse stations, computer carts, and hallways are all good places for this information.
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K5 INTERVIEW GUIDE
K6 WALK-THROUGH GUIDE
HOW TO USE IT HOW TO USE IT Use these cards as guides for interviewing patients and peers about shift changes to discover and understand the issues and concerns first-hand.
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Use these cards as guides for what to look for while performing a walk-through of the unit. The prompts are meant to help the observer see first-hand and better understand the issues on the unit around shift-change.
Planning Tools • P1: Role Coordination Worksheet • P2: PI Planning form • P3: Project Snapshot worksheet • P4: Workflow cards
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P1 ROLE COORDINATION WORKSHEET
P2 PI PLANNING FORM
Template
HOW TO USE IT Use this sheet to help staff coordinate roles on the unit during shift change. Using initial input from nurses, make a sheet that shows who might do what at different times during the shift change. letting the unit decide how to coordinate roles helps them feel ownership of the process and gets them thinking critically about how to get things done in a way that works for everyone.
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HOW TO USE IT Use this form to help think about and set specific goals around how NkEplus will positively impact the unit.
P3 PROJECT SNAPSHOT WORKSHEETS
P4 WORKFLOW CARDS
Template
HOW TO USE IT Provide this tool to nurses to help them think through problems and ideas they want to try out and communicate them clearly to each other. This sheet can also be used for future projects that involve getting nurses involved in making changes they want to see on the unit.
HOW TO USE THEM Capture and communicate what staff will be trying (NkEplus processes & behaviors) using these half-sheets. Tack them to computer carts or hand them out directly to provide staff with the specifics they need.
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“Trying Things Out” Tools • T1: “Things we’re trying” sheets
NKEplus Essentials
• T2: “Trying new Things” tags • T3: Question Card • T4: Preparing Hot Towels Card • T5: UA Message Pad • T6: UA Call Triage Protocol • T7: UA Checklist • T8: Final Hourly Round Times flyer • T9: Question of the Day
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T1 “THINGS WE’RE TRYING” SHEETS
T2 “TRYING NEW THINGS” TAGS
HOW TO USE THEM Fill out these half-sheets and post them on the unit, or hand them out to staff directly. This sheet is a good place to write down specifically what you want people to try. The written instructions can easily be communicated between shifts. You can never have enough communication materials when it comes to trying new ideas. Staff will be able to provide better feedback about their experience when they are clear about what they are being asked to try.
HOW TO USE THEM Post these cultural reminder tags up on the unit during the “customize and try” phase to indicate ideas the unit is trying out and needs feedback on.
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NKEplus Essentials T3 QUESTION CARD
Quest
ions/N
CAPT
otes
URE Q
UEST
IONS A hos FOR Y OUR pit RN/D be ha al can be a OCTO rd to re confu R sing p memb lace. er wh Often at you Use th it want e spac to ask can you h e belo ! av w to w HOW TO USE IT remem e (or anyth ri te d ing ow b questi er). Check else you w n questio ns ons yo o a u mig ut the bac nt to k h of this For patients who have a lot of questions during shiftt report, not ha ca ve tho ught a rd for bout. nurses can give them this card to write things down and
remember for later. This allows the nurse to stay on track getting the rest of reports and follow up on patient questions when he or she returns during assessments.
Sample introduction: “I have to take report on my other patients right now, but I definitely want to know about any questions or concerns you have. I’m going to give you this card to down any questions you might have for me. I’ll be back within an hour to assess you. And that’s the perfect time for us to talk about any questions you might have.”
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Quest
ions/N
CAPT
otes
URE Q
UEST
IONS A hos FOR Y OUR pit RN/D be ha al can be a OCTO rd to re confu R sing p memb lace. er wh Often at you Use th it want e spac to ask can you h e belo ! av w to w remem e (or anyth ri te dow ing b questi er). Check else you w n questio ns ons yo o a u mig ut the bac nt to k ht not have th of this card fo ought about. r
NKEplus Essentials T4 PREPARING HOT TOWELS CARD
NKEplus Essentials T5 UA MESSAGE PAD
HOW TO USE IT
HOW TO USE IT Tack this to the hot towel cart when first starting NkEplus. instructions like this may seem unnecessary, but they can go a long way to helping make the transition as easy as possible in the early stages of a new process.
Use these brightly colored, self-stick message pads to ensure nurses get messages passed to them about family, patient, and other clinician needs during shift change. Stick them to computer carts where nurses won’t miss them. Pads pictured here are available at most office supply stores.
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NKEplus Essentials T6 UA CALL TRIAGE PROTOCOL
NKEplus Essentials T7 UA CHECKLIST
Template
HOW TO USE IT
HOW TO USE IT Provide this to the Unit Assistant to help establish a consistent way to triage calls from different parties (family members, doctors, patients, etc.).
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Post this checklist near unit assistants/clerks workstations to provide clear instructions for what they can do to support nurses during shift change. The goal is for any unit assistant, including floats, to be able to see it and understand it easily. Bright colors will help it stand out and maintain a fun feel.
T8 FINAL HOURLY ROUND TIMES FLYER
T9 QUESTION OF THE DAY BOARD
Template
HOW TO USE IT
HOW TO USE IT
Use this tool to encourage staff to complete their final hourly round within the last hour of their shift by calling out a specific time for staff to start final rounds.
Make your own board and solicit feedback from the staff. The key is to create a public forum that gets people’s attention with a way for them to answer privately. Some tips: • Post board on staff-room door to get people’s attention.
other good reminders include: sending automatic text messages to nurse Spectralink phones, calling all nurses directly (UA), manager rounding, dimming lights or turning lights back on. Make up your own!
• Hand out strips of paper at huddles. • Display answers in a fun format.
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Roll-Out Tools • R1: NKEplus Badge Cards • R2: Imagine your day worksheet • R3: Cards of various uses. • R4: Pop-up Video Library • R5: Tips for HIPAA compliance • R6: Manager sign-up calendar • R7: “We made it ours” tags • R8: Patient-RN Appreciation clips
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R1 NKEplus BADGE CARDS
R2 IMAGINE YOUR DAY WORKSHEET
Template
HOW TO USE THEM
HOW TO USE IT
Provide these cards to nurses and PCTs to attach to their badges as a reminder of the process. This will serve as a reference they can always have on hand.
Use this worksheet to help staff think about the general schedule of their day now and any adjustments they might make adjustments to make NkEplus work for them.
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R3 CARDS OF VARIOUS USES
Template
HOW TO USE THEM Use this card template to make fun cards that can be used in multiple settings. Here are two occasions where cards can be useful: 1) Story Capture during training The training kickoff meeting should involve a lot of listening and sharing. Help nurses build excitement around NkEplus by sharing stories that highlight the issues that NkEplus is trying to address. Capture these stories on cards so they can be easily shared across shifts.
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2) Quiz Cards Make meetings fun with quizzes. Ask questions to get staff thinking more deeply about the process. The goal is to get them thinking about why you are doing this and asking themselves, “How well do i know this?” Throw in questions that are obvious, don’t matter, or don’t have a right answer to keep it from feeling like a test. Provide candy or small prizes to winners.
R4 POP-UP VIDEO LIBRARY
R5 TIPS FOR HIPAA COMPLIANCE
HOW TO USE IT Use any one of this series of tips and tricks videos to demonstrate nursing best practices during shift change to staff. Videos are taken from real nurses with real patients in a live setting. Topics include: engaging patients during shift change, showing as a way of telling, dealing w/ doctors and family members during shift-change, etc.
HOW TO USE IT Use this document to help nurses understand and practice protecting patient privacy while involving them in shift change in cases where others are in the room during the bedside handoff.
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R6 MANAGER SIGN-UP CALENDAR
R7 “WE MADE IT OURS” TAGS
HOW TO USE THEM HOW TO USE IT Use this sign-up calendar to help managers commit to seeing NkEplus in action during implementation.
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Use these tags on handouts and giveaways during the Golive to remind nurses that NkEplus is a process designed by them and customized for them.
R8 PATIENT-RN APPRECIATION CLIPS
HOW TO USE THEM Hand out these cards and clips to patients on the floor to get them engaged in the process of going live with NkEplus. Hold a contest to see which nurse can get the most clips for involving their patients in the bedside handoff.
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Evaluate and Sustain Tools • S1: NKEplus Tracker Tool • S2: Charge RN checklist • S3: NKEplus float tool • S4: Bedside Tidbit cards • S5: Call-light dashboard • S6: Create your own NKEplus dashboard • S7: Further sustainability tips
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S1 NKEPLUS TRACKER
Data collection tool
Period worksheet
Dashboard (Tables and charts)
HOW TO USE IT The NkEplus tracker consists of three tools. The details for how to use each of these tools are outlined on the following pages. --->
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S1 NKEplus TRACKER: Data Collection Tool Use the data collection tool during period observations to see how NkEplus is going. it is meant to be printed and photocopied so it can be filled out by hand. X O X
FREQUENCY: To get a sufficient read on how NkEplus is going, you will need to collect 30 data points per month -– ideally in the same week per month. one data point equals one shift change on one patient.
O
Use three codes to collect the data properly: • X = the task was completed • o = the task was not completed • N/A = not applicable...the task could not be completed.
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X
X
X
O
if you have 2 shifts, collect 15 med passes from AM and 15 from PM. if you have 3 shifts, collect 10 from morning, 10 from afternoon, and 10 from the night. HOW TO USE IT: The observer tracks the number of interruptions using hash marks and use an X or o to mark which steps of NkEplus have been completed.
X O O
N/A X
X
X
3
X N/A X
X
3
O N/A
1
in the example above, for Data Point #1, the oncoming nurse was not introduced to the patient so an “o” was placed into the box since this step should have been performed.
S1 NKEplus TRACKER: Period worksheet
After the 30 data points are collected they need to be entered into the correct Period worksheet (see Excel file). The correct Period is the next Period that is blank. For example, if Period 2 is filled out, and Period 3 is empty, then the period to enter the data is Period 3. To enter the data, use an “x” to indicate the process step was completed, “o“ (not a zero!!) if it was not, and blank if the nurse was unable to complete it. This should be direct data entry from the Data Collection Tool to the Period worksheet.
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S1 NKEplus TRACKER: Dashboard (Tables and charts)
The Table and Charts worksheet is your guide to understanding the state of NkEplus on the unit. lucky for you, this worksheet automatically tabulates and creates the charts based on your data entry in the period worksheet. Therefore, the Table and Charts worksheet is only for viewing and printing, so no data should be entered here.
PART 1: DASHBOARD TABLE
in this example, see the unit moving from
The first section is the “Green light” table. Based on the data, the table will calculate a result and automatically turn it red, yellow or green.
showing improvement!
red to yellow/green, meaning that they are
GREEN indicates success- the task was completed ≥90% of the time or time in the room is between 3 and 5 minutes. YELLOW indicates that more work needs to be done -– the task was completed between 80% and 90% of the time, or time in the room is between 1 and 3 or between 5 and 7 minutes.
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RED indicates that a “more heroic” intervention may be needed. The task was completed < 80% of the time or time in the room is less than 1 or greater than 7 minutes.
S1 NKEplus TRACKER: Dashboard (Tables and charts)
PART 2: CHARTS The second section of the Table and Charts worksheet is composed of four charts to make it easier to visualize the state of NkEplus. Remember that all data points in the future are zero, thus the charts â&#x20AC;&#x153;plungeâ&#x20AC;? to zero after the last entered data point.
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S2 CHARGE RN CHECKLIST
S3 NKEplus FLOAT TOOL
HOW TO USE IT HOW TO USE IT Have Charge RNs and managers use or modify this checklist of daily activities that includes top things each person can do to support NkEplus. The goal is to help them build supporting the unit into their daily workflow.
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Having float RNs that don't know how to participate in NkEplus can be disruptive to the process. For a good implementation, use this tool to walk your float RN through what NkEplus is about and help them understand that at the bare minimum they are expected to participate as a member of the frontline staff in your unit.
S4 BEDSIDE TIDBIT CARDS
S5 CALL-LIGHT DASHBOARD NKEplu
s... GO
OD NE
WS!
Call lights
during shift change
HOW TO USE THEM Use these cartoons to convey the “whys” of bedside reporting in a refreshing and fun way. Post them up on the unit, hand them out to nurses, place them around in conspicuous places, etc. This is especially useful as reminders as you’re trying to sustain NkEplus.
Average # of calls before NKEplus :
12 11 10 9 8 7 6 5 4 3 2 1 0 -
AM PM EVE Sunday
Other rea
sons to
Celebr
ate...
AM PM EVE Monda y
AM PM EVE Tuesday
AM PM EVE Wednesda y
AM PM EVE Thursday
AM PM EVE Friday
AM PM EVE Saturday
HOW TO USE IT Having trouble with your final hourly round and call lights during shift change?
Use them a few at a time and make them last. Pick one that’s relevant to what you’re working on.
Put this up on the unit to give a live readout of “how we’re doing” on NkEplus during your roll out.
You can also use them as a fun way to get staff to share stories that are related to these topics.
Track call lights to show how well your final hourly round is impacting call lights during shift change.
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S6 CREATE YOUR OWN NKEplus DASHBOARD
HOW TO USE IT When sustaining NkEplus, pick a few focus areas that you want to put in front of your staff as reminders of what the unit is working on. Here’s a fun way to show the data you’ve collected: • Go to a fundraiser thermometer generator on the internet. This one is good: http://www.entropyfarm.org/software/ thermo/ • Create a thermometer chart using data you have pulled from NkEplus Tracker that you want to show your unit. Pick and choose the area you want your unit to focus on. • Enter the number from your NkEplus Tracker data as “current” and use 100 as “goal”. • Click on “Save Graphic” and save it to your computer. it will save as JPG. Paste it into Powerpoint or Word, and make a poster out of it. • label your thermometer so that it’s clear, along with messages you want to convey to the staff.
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S7 FURTHER SUSTAINABILITY TIPS
Make sl
Tips an d tricks
ippage
• Reac t at
uncom
fortable
first sig : Don’t let ns to m slippag ake it cle e beco ful not ar that me the to be to feedbac returning norm. o nega k wher to old wa tive, bu e it is ne t ys in no • Rem at the sa eded. ove old t desirab me tim structu le. e don’t sh ral supp y away orts as from giv sociate Keep up ing d with the atte the old way. ntion: Do n’t let th • Keep e atten on mea tion sli su p away ring an a priority , keep d feedin . it on pe g back: improv Set up a syste ople’s m Measu ement m that inds. remen effort, t comm • Reco never re assures auto unicate gnize an m ally let s that so d celeb it settle atic re-measu • Set th methin rat into sim re e main e bar ev g is taining ple main . Make it a co en highe improve perform nt tenanc r, try to even mo ance. e mode. inuous improv re. • Re-tr e even ain, re-ed more. e.g. Create ucate, • Educ frie re -ca ndl y compet mpaign ate new ition bet staff. Qu ween uni NKEplus ts to ickly ed Float To ucate fl ol. • Cont oat RN inue to s or staff create unfamilia unit. the posit r with NK ive em Eplus us otional • Use th ing the story of e excit what NK ement • Cont Eplus ha of impr inue to ovemen s brough listen to t to keep t to the being he staff, lea up the dership, attentio Keep me ard. e.g. Share n. an d cham ssages fre stories in pions to sh with huddles humor. or post the ensure m up on that th the wall. eir storie Try to sha Structu s are re stories re it: Bu every oth er week ild the or so. improv ement • Standa into the rdize: Inc fabric of orporat daily wo • Establi e the ne rk and sh on-go w way system ing traini into po s • Create licies an ng. new ro d proced les and ures. • Make respon someo sibilities ne acco that su previou untable pport th s levels to see e new . that th • Have proces e new s. bite-size proces bu s • Make t consist does no proces ent task t degrad ses cle unit. s ever yd e back ar and to ay to su transpa pport NK rent. e.g Eplus. . Outline the
Sustain ability
• Be ca re
Engage
HOW TO USE THEM
succes
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or t: The
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Use these tips to help guide you as you sustain NkEplus on different units. Many of these tips are can be applied to sustaining other initiatives as well. al orga
nization
manag
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Glossary of Terms ANM- Assistant Nurse Manager Careboard- A patient-caregiver communication board that lives in each patient room. CNO- Chief Nursing Officer COO- Chief Operation Officer EVS- Environmental Services IA- Improvement Advisor NKE- Nurse Knowledge Exchange PCT- Patient Care Technician (same as CNA, nurse aide, nursing assistant, etc) PI- Project Improvement PM- Project Manager RN- Any certified nurse SCL- Santa Clara Kaiser Permanente Hospital SAC-Sacramento Kaiser Permanente Hospital UBT/DBT- Unit Based Team/Department Based Team UA- Unit Assistant (same as unit clerk) 122 Glossary
Congratulations & Good luck!