Culture Change in Nursing Homes
Culture change in nursing homes refers to the new and revolutionary patient care practices developing in modern long term care. The overarching goal is to transform these facilities from institutions into real homes and communities.
This change is guided by a shift in focus aimed at enhancing the respect and care given to elderly patients. Culture change stresses the importance of patient choice, dignity, autonomy, and purposeful living. One of the goals of this movement is to expand patient care beyond just physical boundaries; the patient’s mental and emotional well-being also becomes a priority. By attending to every aspect of a patient’s needs while maintaining high respect for the patient, more trust is established between patient and caregiver and the patient will be more satisfied with the care that he or she is receiving.
Healthcare facilities and nursing homes that are involved in this culture change will notice that small changes can lead to big results. For example, changing certain aspects about the language used in the workplace will create a community atmosphere where patients and workers are known as “friends.” Referring to patients as “friends” or “neighbors” and nursing homes as “communities” or “life centers” is a subtle way to deinstitutionalize the atmosphere.
Personalized Care is the Most Important
Creating “neighborhoods” within the nursing home, consistently staffed by the same caregivers, helps enhance the relational aspect of the culture change. Personalized one-on-one care is an important part of nursing home culture change. By having the same caregivers care for the same group of patients, the patients become more familiar and friendly with the workers, and healthy relationships are encouraged.
Also, many times nursing homes that are creating these neighborhoods will allow the staff of each area to maintain high levels of self-management, which increases job satisfaction.
Patient choice plays an important role in nursing home culture change. Certain choice options, such as allowing patients to choose what to eat for dinner, what activities to participate in, or when they would like to go to bed can go a long way toward improving the patients’ perceived quality of life. Also, more nursing homes are making efforts to provide each resident with a private room, as this allows the patient to feel more independent.
New Technology Assists in Nursing Home Culture Change
New remote patient monitoring technology, such as Dalcon Alert!, helps nursing homes “deinstitutionalize” and create a homelike environment by eliminating loud alarms and the need to use the overhead pager. The system also greatly improves staff communication and the quality of care.
The culture change in long term care movement is gaining momentum, mostly because of the benefits that it brings to both residents and employees. Nursing homes that adopt the principles of culture change often see improvements throughout the entire organization, such as reduced operational costs, increased staff retention rates, higher occupancy rates, and increases in overall competitive position.
Decentralized Nursing Stations: A Change for the Better
As hospitals move further into the 21st century, decentralized nursing stations are becoming the standard for enhancing the quality and efficiency of nursing care.
In the past, when medical information was stored on paper, centralized nursing stations were necessary to keep all medical data stored in an easy to access place. However, with the advent of new digital information storage and communication technology, centralized nursing stations have become an increasing burden on the quality of patient care.
The Value of Decentralization
The primary benefit of a well-managed system of decentralized nursing stations is the positive impact the system has on patient care. Having multiple nursing stations located throughout a floor instead of one centrally located station puts nurses in closer proximity to the patients. A result of close nurse-patient proximity is improved nurse response time and room observations.
Also, the close nurse to patient proximity helps hospitals with decentralized nurse stations better prevent never events due to patient falls.
Decentralized nursing stations also save nurses thousands of steps each day traveling back and forth from patient rooms to the central station. Less travel fatigue leads to enhanced quality of care. Also, hospitals with successfully implemented decentralized systems experience lower staff turnover due to improved work satisfaction.
When planning the decentralization process, it is important that nurses retain an area where they can gather and collaborate. Nurses, like many workers, enjoy camaraderie and need to have particular areas allocated for their gathering. Effective nursing requires teamwork, and the social aspect of the job must be respected. Thus, a central nursing workroom is an important part of any decentralized system.
Hospitals looking to incorporate decentralized nursing stations should be prepared to expand their supply inventories since there will be more stations. However, the added cost of expansion will be offset by decreased nursing staff turnover and more efficient workspace.
Importance of Nurse Communication
Communication is a key issue when developing a successful decentralization plan. Because the stations are spread out, effective nurse communications become a more important factor in determining quality of patient care. Communications technology to solve this problem is currently available. Dalcon has multiple communication solutions, including Dalcon Alert!, that can effectively bridge this nurse communication gap by placing wireless phones in the hands of caregiving staff.
Dalcon Alert! is a Remote Patient Monitoring system that places fully functional wireless phones in the hands of caregiving staff. When a patient monitoring device triggers an alert connected to Dalcon Alert!, the system sends a text message to caregivers’ wireless phones so they can respond to the patient immediately. Alerts are simultaneously sent to the PC displays of all nursing stations. The alert is tracked in real time so that caregivers at each station can observe which alerts have been canceled and which have not.
Preventing Pressure Ulcers (Bed Sores) Never Events with Technology
In October 2008, the Center for Medicare & Medicaid Services (CMS) began requiring hospitals that receive federal funding from Medicare and Medicaid to begin disclosing “never events.” CMS has stated that they will no longer reimburse hospitals for any costs associated with never events, and hospitals are prohibited from passing costs onto the patient.
What are Never Events?
Never events are a series of medical errors that are defined by CMS as, “clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility.” Included in the CMS financial year 2009 list of never events that will be denied federal reimbursement are the following medical errors:
List of Never Events covered under the FY 2009 provision
- Object left in patient during surgery
- Air embolism
- Blood incompatibility
- Catheter-associated urinary tract infection
- Pressure ulcers
- Vascular-catheter-associated infection
- Surgical site infection (specifically mediastinitis after coronary artery bypass graft surgery)
- Hospital-acquired injury due to external causes (fractures, dislocations, intracranial injury, crushing injury, burns, and other unspecified effects)
How Dalcon Alert! Helps Prevent Pressure Ulcers (Bed Sores)
Obviously, never events can be quite costly for hospitals. Yet some occur much more frequently than others. Preventing bed sores can be difficult, but new technology is available to help hospitals prevent bed sores. Dalcon Alert! is a system that contains 3 distinct sections that help nurses treat and prevent pressure ulcers.
- Remote Patient Monitoring
- Alert Management Software
- Pressure Ulcer Management System
Dalcon Alert! Remote Patient Monitoring
Remote Patient Monitoring is achieved by integrating with existing patient monitoring devices in the hospital. Dalcon Alert! automatically forwards all device alerts—via a text message—to wireless phones carried by the nursing staff.
Although Dalcon Alert! contains the technology for nurses to remotely monitor patients via wireless phones, the pressure ulcer management system does not require their use or purchase. If desired, hospitals can implement Dalcon Alert!’s Alert Management software & Pressure Ulcer Management System as a stand alone system, and use it as a tool to create and manage bed turn alerts using current hospital policy.
Dalcon Alert! Alert Management Software
Dalcon Alert!’s Alert Management application helps caregivers actively manage the many patient monitoring alerts that are created in the hospital. The Alert Management software is similar to a web application, but it can only be accessed from the browsers of computers on the hospital network.
The function of the Alert Management software is to display, in real time, all active alerts that are being managed by the Dalcon Alert! system. Combined with Dalcon Alert!’s pressure ulcer management system, Dalcon Alert!’s Alert Management software makes sure no pressure ulcer treatment is overlooked by staff.
Dalcon Alert! Pressure Ulcer Management System
Dalcon Alert!’s pressure ulcer management system is a unique solution. When this feature is turned on, the system automatically creates a “bed turn” alert that reoccurs after a set period of time (dictated by the hospital). This “bed turn” alert is treated the same as any other alert that Dalcon Alert! manages; relevant caregivers receive the alert on their wireless phone, and the alert is reported on the system’s alert management software. Thus, caregivers are continually reminded to attend to and turn at risk patients. Because Dalcon Alert! helps nurses pro-actively prevent pressure ulcer negligence, the occurrence of dangerous pressure ulcers in at risk patients is significantly reduced.
Creating a Homelike Environment in Nursing Homes with New technology
In June 2009, the Centers for Medicare & Medicaid Services (CMS) issued new revolutionary guidelines for long term care facilities (nursing homes) that receive federal funds. These guidelines called upon nursing homes to create a “Homelike Environment” for residents; creating a call to action to deinstitutionalize these facilities by making changes such as:
• Removing overhead paging and piped in music.
• Removing institutionalized signage and labeling (such as closet and bathroom labels).
• Removing medicine carts and large centralized nursing stations.
• Discontinuing long term use of patient monitoring systems that use audible alarms.
• Eliminating mass-purchased furniture displayed throughout the building.
Dalcon’s unique patient care communications solution, Dalcon Alert!, is designed to help nursing homes make several of these changes. As a result, facilities using the Dalcon Alert! system will meet numerous new CMS Homelike Environment guidelines, and their quality of patient care will drastically increase.
Dalcon Alert! provides a communications platform that eliminates the need for:
- Overhead Paging
- Audible patient monitoring alarms
- A large centralized nursing station
How Does Dalcon Alert! Eliminate Audible Alarms?
Dalcon Alert! is a patient care communications system that has several features. The system provides Remote Patient Monitoring and Alarm Management by integrating with patient monitoring devices including but not limited to:
• bed exit pads
• bed fall pads
• IV-Pumps
• Patient Nurse Calls
When an alert is created by any integrated device, Dalcon Alert! routes that alert to a remote nursing station where it can be actively managed on a PC monitor using Dalcon Alert!’s alert management software. Dalcon Alert! also sends that alert to select staff carrying fully functional wireless phones via text message, so they are immediately made aware of that alert regardless of their location—and without the use of audible alarms.
How Does Dalcon Alert! Reduce the need for Overhead Paging and a Large Centralized Nursing Station?
Equipping vital staff with wireless phones is a central piece of the Dalcon Alert! system. These phones allow staff to receive important alerts regardless of their location. Caregivers can be reached remotely by phone, vastly eliminating the need for overhead paging.
A key component of the successful implementation of a decentralized nursing station system is staff communication. Dalcon Alert! provides staff with an effective decentralized communications platform, built around fully functional wireless phones. Also, Dalcon Alert!’s alert management software is accessed via a browser, and there is no limit to how many computers can be logged on to it at once. Thus, each decentralized nursing station can be actively managing alerts at any given time.
New CMS Guidelines: Homelike Environment for Nursing Homes
The Center for Medicare & Medicaid Services (CMS) creates guidelines for long term care facilities (nursing homes) that receive federal funding via Medicaid and Medicare. Licensed state surveyors perform annual checkups on nursing homes to make sure that these facilities are meeting the expectations of CMS—if not, those facilities are ineligible for CMS reimbursement.
In June 2009, CMS updated their guidelines for long term care facilities (nursing homes) in several ways. Out of the many changes made, the new “Homelike Environment” guideline is one of the most revolutionary.
Section §483.15(h) Homelike Environment
The actual CMS guideline reads, “The facility must provide a safe, clean, comfortable and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.” CMS interpretation of this guideline suggests that, “A ‘homelike environment’ is one that de-emphasizes the institutional character of the setting, to the extent possible, and allows the resident to use those personal belongings that support a homelike environment.” What this means for nursing homes across the nation, is that sweeping changes will have to be made gradually to transform and deinstitutionalize these facilities.
Some of the more drastic “homelike environment” changes include:
• Removing overhead paging and piped in music.
• Removing institutionalized signage and labeling (such as closet and bathroom labels).
• Removing medicine carts and centralized nursing stations.
• Discontinuing long term use of patient monitoring systems that use audible alarms.
• Eliminating mass-purchased furniture displayed throughout the building.
Homelike Environment Compliance Expectations
Obviously, many of these CMS homelike environment suggestions represent sweeping changes for many nursing homes throughout the nation. CMS has stated that these guidelines have been effective since June 12, 2009; but in their own words they don’t expect most nursing homes to be able to meet them immediately. However, they are expecting nursing homes to actively pursue the new guidelines—or face the consequences:
“Many facilities cannot immediately make these types of changes, but it should be a goal for all facilities that have not yet made these types of changes to work toward them. A nursing facility is not considered non-compliant if it still has some of these institutional features, but the facility is expected to do all it can within fiscal constraints to provide an environment that enhances quality of life for residents, in accordance with resident preferences.”
Meeting Homelike Environment Expectations
New technologies exist, such as Dalcon’s patient care communications system Dalcon Alert!, that help nursing homes meet numerous “Homelike Environment” expectations. However, CMS has also stated that physical changes alone won’t fit the bill of a “Homelike Environment.” They are expecting serious culture change by nursing home staff; including a shift towards person centered care, and quality staff-to-resident relationship building.
