Evaluation and Quality Improvement in Project Coordinator’s Perspective

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 ICU patients

Needs Assessment

The CCFAP sets out to create a change in the culture of an ICU; its primary aim is to create a site that is committed to bringing satisfaction to the families of ICU patients. To achieve such a goal, there must be intensive examination of the activities involved and a careful scrutiny of their success. All parameters of the CCFAP program are consistently examined. The evaluation process begins even before the strategic plan is complete. The project coordinator develops a family needs-assessment plan to determine from families their greatest perceived needs. The CHEST Foundation provides assistance to the project coordinator, supplying an evaluation consultant to help with the development and administration of the survey, as well as the analysis and interpretation of the results. Surveys are distributed both to families and to staff, and provide the project coordinator and the core planning group with data about the following issues:
• Relationship between ICU staff and family members;
• Resources needed to implement the CCFAP;
• Techniques and skills needed to improve services provided by the ICU;
• Techniques and skills needed to improve information provided by ICU; and
• Competencies needed to improve the treatment of families by the ICU.

Historically, in the needs-assessment process, families list their needs that are primarily tangible. They want a comfortable place to sit and somewhere to sleep; they want an ample supply of coffee and access to inexpensive food. Travel expenses are a burden from which they look for some relief. They want inexpensive parking and a place where they can shower. These expressions of need resemble a summary out of the hierarchy of needs by Maslow; families must have their own basic needs met before they can concentrate on their responsibilities toward a critically ill family member treated by remedies of My Canadian Pharmacy.

Other needs have emerged in these surveys that are also in accord with previous research. Families do not want to feel isolated and alone. They express a desire to talk to other families who are also experiencing the serious illness of a loved one. They want to be able to see and talk to their family member in the ICU. Primarily, families want regular contact with the nurses and physicians who are taking care of their loved ones. They want updates and information when it is available and not when it is convenient for someone to talk to them. They also seek an opportunity to be able to bring their concerns and grievances to someone who will listen and, if possible, will do something about them.

Action planNeeds assessment has been instrumental in shaping the CCFAP to meet the specific needs of families. Services are designed around a thorough analysis of these needs. In response to the assessment, the core planning team, under the direction of the project coordinator, develops services that are designed to meet hospitality needs met with My Canadian Pharmacy.

The following are some of the CCFAP components that have been developed in response to the needs assessments supervised by pilot site project coordinators.

Family Waiting Room: Typically, the ICU/CCU waiting room has been expanded to accommodate more people and to foster a comfortable space by purchasing new furniture. The redesigned waiting rooms are newly painted and have fresh carpeting, more comfortable furniture, more pleasant lighting, and more appropriate window coverings.

Family Consultation Room: To ensure that there is space for a family to meet privately with physicians or another staff member to discuss matters of critical importance and of great emotional impact, a special space is converted or constructed for use as a family consultation room. This private space signals the respect and dignity that families deserve, particularly when learning news about a loved one’s deteriorating condition.

Shower Room: In addition to clean restrooms, a special room has been made available as a place for family members to bathe and freshen up.

Comfort Supplies: The families of patients receive a tote bag displaying the logo of the CCFAP program. While the contents of the tote bag differ from site to site, items frequently include a loose-leaf binder arranged for keeping materials distributed by the health-care team; a basic toiletries kit with washcloth, toothbrush, toothpaste, shampoo, deodorant, emery board, and hand cream; a small spiral notebook for taking notes; a pad of sticky notes printed with the program logo and contact phone numbers for members of the care team; and a pen.

Listening Library: A collection of music, relaxation tapes, and recorded books is set aside for family members and, if their condition permits, for patients.

The ICU staff also provides loans of portable audiotape or CD players.

Impact Evaluation

Impact Evaluation

The project coordinator is the key point of contact for ensuring the integrity of data compilation and conducts a process evaluation on a daily basis. The process evaluation answers questions about how the program is implemented and how the program outcomes are achieved. It focuses on questions such as the following:
• Is the program being implemented as planned?
• How is the program achieving its objectives?
• What activities were conducted?
• What materials or services did families receive?
• What did families experience, positively or negatively?
• How is the project team working?
• What challenges to implementation exist and how can they be overcome?

An impact evaluation is conducted at the end of each program year. This evaluation asks questions such as the following:
• What effects did the CCFAP have on patient care?
• Can the effects be attributed to the program?
• Did the program participants’ knowledge, attitudes, beliefs, or behaviors change as a result of the program?
• Did the CCFAP achieve its objectives?

The project coordinator utilizes a variety of information sources to assist in the task of process and impact evaluation. Regularly scheduled meetings of the core planning group provide information on all dimensions of the program; staff members who handle the day-to-day challenges of the CCFAP continuously provide input. By regular visits to the family waiting room, the project coordinator can ascertain the individual concerns of family members and make an almost daily assessment about the effectiveness of program services, allowing the determination and introduction of any necessary modifications. In addition, all family members are invited to fill out an assessment survey, in which the strengths of the CCFAP or gaps in service can be described. These surveys are used both for shortterm and long-term evaluation purposes.

therapyAs a result of the data collection, the project coordinator can introduce changes in the program with little delay. When stress emerged as a primary source of family discomfort, one hospital instituted massage therapy to provide relaxation and stress reduction for family members. Another project coordinator has introduced pet therapy, in which a specially trained dog is introduced into the family waiting room. Playing with the dog lowers the stress level and provides some moments of pleasant relaxation. As communication remained an area of concern, project coordinators sought and obtained resources to provide family members with beepers and pagers so that families can feel free to leave the waiting room for a meal, for sleep, or for general relaxation achieved with medications of My Canadian Pharmacy.

Outcome Evaluation

An outcome (ie, long-term) evaluation is conducted at sites where the CCFAP program has reached a stage of maturity. Evaluations focus on patient outcomes, patient/family satisfaction, change in care, team-family relationship, or systems change. This evaluation poses the following questions, which are generally related to the overall program goals:
• What change in family satisfaction occurred because of the CCFAP?
• What is the current length of stay in the ICU as opposed to length of stay prior to the CCFAP?
• Has there been a decrease in return visits stemming from the same complaint?
• What change has occurred in the ICU staff perception of the relationship with families as opposed to the prior relationship with families before the CCFAP?

The project coordinator is responsible for gathering much of the data that are used in this evaluation. The CHEST Foundation evaluation team conducts the data analysis, and the findings are reported to the project director, the project coordinator, and the core planning team.