RWRD Receives APWA Award
by Lorraine Simon

The Pima County Regional Wastewater Reclamation Department (PCRWRD) Federal Bureau of Prisons (FBOP) Gravity Sewer project has been selected as the American Public Works Association (APWA) 2007 Project of the Year. The FBOP project was in the environment category, with a project cost of $2 million but less than $10 million. The project was completed 30 days ahead of schedule and $550,000 below budget.

The FBOP Gravity Sewer Project was a Capital Improvement Program project that was completed in August 2007 with a total project cost of $7.3 million. This project was a gravity system designed to carry flows from the Federal Penitentiary site at Wilmot Road to the Federal Corrections Institute (FCI) on North Wilmot Road. The flow from the Federal Penitentiary, FCI, and Arizona State Prison were merged into one FBOP gravity sewer line. The merged FBOP gravity sewer line crosses under I-10, and discharges into the Southeast Interceptor.

The award was presented on August 5 at the APWA Arizona Chapter 2008 Statewide Conference awards dinner held at the JW Marriott Starr Pass Resort.

APWA presented the award to the PCRWRD; the contractor, KE&G Construction, Inc.; and the consulting engineer firm, Westland Resources, Inc. The project team members were: Jaime Rivera, PCRWRD Project Manager; Chris Albright, KE&G Project Manager; and Thom Martinez, Westland Resources Principal.

The award reflects the department's commitment to fiscal responsibility, by promoting an environment where construction projects are completed within budget on schedule.

The American Public Works Association is an international educational and professional association of public agencies, private sector companies, and individuals dedicated to providing high quality public works goods and services. APWA has 64 chapters throughout North America with 29,000 members.

Rethinking Restraints—A Success Story

Posada Del Sol Health Care Center is a 156-bed, dually-certified skilled nursing home and outpatient facility owned by Pima County and managed by Pima Health System. From the third quarter 2005 (Q3) to the second quarter of 2007 (Q2), Posada Del Sol achieved an improvement in the Physical Restraints Quality Measure, going from 26.5 percent of our patients restrained in Q3 2005 to 0.00 percent in Q2 2007. The below run chart illustrates the quarterly trending of Posada Del Sol’s data.

The journey toward physical restraint elimination

Posada Del Sol provides specialty care, such as ventilator and respiratory care, traumatic brain injury care, behavioral health care, neurological care, wound care, and total parenteral nutrition care—primarily to the Arizona Long-Term Care System (ALTCS) population.

Prior to joining Health Services Advisory Group’s (HSAG’s) Nursing Home Collaborative Work Group, Posada Del Sol evaluated their January through September 2005 Physical Restraint Quality Measure data and determined there were opportunities for improvement. The facility began a root cause analysis (RCA) into their restraint management processes-of-care as part of their Continuous Quality Improvement (CQI) program. Based on the RCA, it was determined that a subset of residents were being identified and coded on the Minimum Data Set (MDS) 2.0 as using physical restraints, when in actuality the residents were using the devices to improve their highest practicable physical, mental, and psychosocial well-being. These devices act to promote, maintenance and/or enhancement of the residents’ quality of life.
In addition, these devices did not restrict the physical movement of the residents nor access to the resident’s own body, based on the individual conditions of the resident. Some of the devices being coded as physical restraints were Geri chairs and trunk and limb support devices.

In September 2005, the RCA findings were presented to Posada Del Sol’s Senior Management Team and Medical Director. Multiple discussions took place regarding regulatory interpretations of restraints, enablers, and restraints as enablers—which created a radical change in thinking for the clinical team. The facility then contacted the Arizona Department of Health Services (ADHS) to ensure that they were interpreting the regulations correctly. ADHS confirmed that the interpretations were appropriate and accurate.

Next, Posada Del Sol revised its existing restraint guidelines policies and procedures and enlisted the assistance of HSAG staff members to further evaluate the progress toward physical restraint reduction. Posada Del Sol’s participation in HSAG’s Nursing Home Collaborative Work Group proved extremely important to the change process and provided a venue to network with and learn from other facilities. Here, Posada Del Sol learned best practices for restraint management and reduction, including effective restraint alternatives.

Posada Del Sol also conducted frequent restraint management meetings to discuss each resident using a device and decide whether the device was limiting or restricting physical movement or access to the resident’s own body. During the meetings, the Resident Assessment Instrument (RAI) User’s Manual was used to ensure accurate interpretation of the MDS restraint questions.

In addition, house-wide education and re-education lead by CQI team members and nursing clinical coordinators included “just-in-time” bedside education for all direct-care staff regarding restraint and enabler definitions, interpretations, and restraint alternatives. The direct-care staff has embraced this approach and are currently responsible for assessing and evaluating each resident’s needs related to implementing appropriate enablers and/or restraints. Posada Del Sol’s senior management and Medical Director attribute much of the facility’s success in restraint reduction—and ultimately restraint elimination—to its direct-care staff members.

Results

Posada Del Sol started its restraint reduction journey with a restraint rate of 26.5 percent in Q3 2005. By Q4 2005, the rate reduced to 24.3 percent. In Q1 2006, the rate made a dramatic drop to 5.2 percent. In Q2 2006, the facility was restraint free! As of Q2 2007, the facility remains restraint free.

The topic of restraint reduction continues to be a journey toward improvement and excellence at Posada Del Sol. The success and lessons learned during this process demonstrates to all staff members, residents, family members, and visitors what one small but mighty not-for-profit, county-owned facility is capable of accomplishing!
To learn more about Posada Del Sol’s restraint reduction journey, please feel free to contact Lee Westfall, RN, MS, Quality Director, at 520.733.8809 or at lee.westfall@pima.org.

Adopt-a-Roadway Volunteer Road Clean-up Program in its 16th Year

The Adopt-a-Roadway Program is in its sixteenth year of operation with a strong base of volunteers numbering approximately 300 groups or individuals. Each volunteer group is asked to clean its assigned segment of road twice each year for two years. The program saves the county cleaning costs of about $200.00 per mile.

The family of Alan E. Mc Peek is the most recent group to join. In 2007 Alan Mc Peek, age 20, was killed by “friendly fire” in Iraq. His mother, along with family and friends, will perform their first clean-up on Saturday, August 29.

Longtime members of the program include the Naval Junior ROTC at Sahuarita High School, DECA program at Sabino High School, Student Council at Sabino, the Drama Club at Marana High School, the Future Business Leaders of America at Mountain View High School and the Junior ROTC at Flowing Wells High School. One or two Saturdays per school year students turn out in numbers from 25 to 50 to clean at least one mile and sometimes two miles of roadway.

We have the staff of Miraval Spa and Resort north of the community of Catalina, several groups in the community of Picture Rocks, many groups on Arivaca Road, families from Vail and churches and civic clubs from all over. Another recent addition to the program is the Roy Long Foothills staff, who wanted to undertake a community project. Some of the most dedicated people are those folks who like to take care of the litter in their neighborhoods while taking a walk each day and their efforts are appreciated too.

The Pima County Department of Transportation continues to enthusiastically support the endeavors of this program and thank all who have volunteered their time and energy to enhance the beauty of our roadways.

 

 

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