The Patient and Family-Centered Care Program at Jefferson is integral to fostering a healthcare environment that goes beyond traditional models, recognizing the importance of involving patients and their families as essential partners in the care process. This approach leads to improved patient satisfaction, better health outcomes, and a more compassionate and responsive healthcare system.In October 2022, Baptist Senior Family decided to close its Mt. Lebanon campus, a facility with 125 years of service and a five-star rating, displacing approximately 90 residents and the staff. During the transition, many of its dedicated staff members from all departments transferred to a sister location, Providence Point. Mixing two unique cultures is never an easy task; however, these individuals did so with grace and dignity and came together to provide optimal outcomes to our residents with a focus on use of clinical data.

The Patients at Risk (PAR) meeting was formed as a way for the new interdisciplinary team to engage in meaningful discussions and formalize residents’ individual plans of care, considering their emotional, social, and spiritual needs. Healthcare truly takes a team to deliver the best experiences to residents. This often begins before a resident steps foot through the facility’s doors. This team, being relatively new to one another and to the facility, strived for the best outcomes for the residents and worked together to identify resident risk and swift intervention to promote positive outcomes.

The team met weekly and proactively identified residents at risk using analytical data derived from clinical software, such The kick-off meeting was held in June 2023 and the team determined to focus on falls with major injuries, associated in-house acquired infections, and antipsychotic medications. as review of residents triggering on the quality measure reports, infections, falls, grievances, weights, therapy concerns, and medical record documentation.   

The kick-off meeting was held in June 2023 and the team determined to focus on falls with major injuries, associated in-house acquired infections, and antipsychotic medications.

• Reviewing first quarter data, the team
  
• conducted training on falls and fall prevention
• identified residents at risk for falls via assessment and event reports
• updated care plan with specific, resident-centered interventions in mind
• implemented telehealth (Third Eye Health) with physician access 24/7, leading to a 92% treat-in-place rate 
• formation of a monthly infection control meeting with the interdisciplinary team and medical director
• Provided in-services by the infection preventionist on handwashing and urinary tract infection (UTI) prevention, including Foley catheter care, peri-care, incontinence care, increasing fluid intake, Enhanced Barrier Precautions
• Increased access to eye washing stations in community soiled utility rooms
• Held a monthly Antipsychotic Stewardship Meeting that included the pharmacy consultant, psychiatric nurse practitioner, social service, medical director, and nursing administration, to monitor generic dispersion ratio, behaviors, 14-day stop dates, and to avoid PRN (“as necessary”) use​

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