INTERACT 101 October 6, 2014
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1 INTERACT 101 October 6, 2014 Loretta Kaes, BSN, RN-B-C, C-AL, LNHA, CALA, Health Care Association of New Jersey Janet Knoth, BS, RN, CHPN, CPHQ, Healthcare Quality Strategies, Inc.
2 Objectives/Overview 2
3 Why Now? The Centers for Medicare and Medicaid Services (CMS) Triple Aim Improving care Improving health Making care affordable Affordable Care Act Establish Quality Assurance and Performance Improvement (QAPI) program Increased focus on managing chronic conditions Increased emphasis on post-acute care 3
4 Ready or Not 4
5 The Reason We re All Here Hospital admissions and readmissions are: Costly All too common Mostly preventable Nursing home residents may experience many complications from hospital visits 5
6 The Reason We re All Here Hospital admissions and readmissions are: Costly All too common Mostly preventable Nursing home residents may experience many complications from hospital visits Every hospitalization chips away at quality of life. 6
7 Complications of Hospitalizations Distress/delirium Decreased appetite/weight loss Immobility/pressure ulcers Loss of muscle tone Falls/injuries Incontinence/catheters Healthcare-associated infections Poly-pharmacy, adverse drug events 7
8 Shared Accountability 8
9 What is INTERACT? Interventions to Reduce Acute Care Transfers A quality improvement program that focuses on the management of acute changes in resident condition Clinical and educational tools and strategies for use in everyday practice in long term care facilities 9
10 Benefits of using INTERACT Everyday with all staff members Early identification of resident changes Empowers staff to expedite evaluations Key communication between staff members Complete report to covering physicians Act on resident decline before an emergency Transfer to hospital with all pertinent details 10
11 INTERACT Quality Improvement Program 11
12 INTERACT Tools in Every Day Care The INTERACT Quality Improvement Program is for nursing home staff use at all stages of patient care every day! 12
13 13 Quality Improvement Tools
14 Hospitalization Rate Tracking Tool 14
15 Tracking Tools 15
16 Root Cause Analysis Use INTERACT to teach RCA Incorporate into everyday staff tasks Consistent program provides Employee confidence Empowerment to improve care Teamwork Validate the improvement Share the success 16
17 Review of Acute Care Transfers Each unplanned transfer is reviewed by the team involved in the transfer Look for gaps Were tools used? Look for similarities Same doctor Same shift Where is education needed? 17
18 INTERACT Quality Improvement Tool continued 18
19 INTERACT Quality Improvement Tool continued 19
20 20 INTERACT Quality Improvement Tool continued
21 21 INTERACT Quality Improvement Tool continued
22 INTERACT Quality Improvement Tool The referenced slide on Section 5 is not available. 22
23 Communication Tools 23
24 Stop and Watch Early Warning Tool Designated for use by CNAs Dietary Housekeeping Therapies Families Education for nursing Complete feedback loop Validate successes 24
25 Situation, Background, Assessment, Request (SBAR) Nursing communication tool Physicians Nurses Who else? Reports change in condition Provides consistent and complete report every time Builds physician trust Supports nursing home staff Informs hospital transfer 25
26 Nursing Home Capabilities List What services do you provide? How quickly can you get new medications? Blood results? What therapies do you provide? Do your covering clinicians, emergency room liaisons, and staff members know? 26
27 Decision Support Tools 27
28 Change in Condition File Cards and Care Paths Decision support tools Best practice protocol for signs and symptoms Consistent nursing practice Recognition Evaluation Management Reporting Criteria for notifying clinicians and staff 28
29 Care Paths Available for 9 conditions Signs and symptoms Best practices Criteria Algorithm for next steps Notifications Orders Monitoring condition 29
30 Advance Care Planning Tools 30
31 Communication Guide End of life planning Continue to have the conversation Empower staff Honor resident wishes/ family aware Early education on care choices Supportive care/active listening Palliative or hospice care 31
32 Patient and Family Education Three topics Feeding tubes CPR Going to the hospital Problem Treatment Your choice Risks and benefits Making the decision 32
33 Study Results: Achieving Success with INTERACT and Advance Care Planning Combination of quality improvement and palliative care makes a significant difference in complex elder care One long-term care facility s readmission rate was 19% but one year after implementing the INTERACT program, the rate dropped to 6% Systematically addressing code status, advance directives, and goals of care has further decreased readmission rates Source: Hmpadmin. "Two Studies Examine the Triumphs and Struggles of INTERACT for Quality Improvement." Annals of Long-Term Care: Clinical Care and Aging 22.6 (2014): Web. 31 July < 33
34 Business Case Better outcomes make your facility more attractive as a preferred provider in integrated care models (such as ACOs and HMOs) Quality data is more valuable now than ever Use analytics to pinpoint and illustrate your competitive advantage 34
35 Engage Your Hospitals 35
36 Here s the Plan Leadership buy-in Select champions Pilot first then spread Provide education and implementation time Share success stories Mrs. S didn t have to go to the hospital Validate teamwork in resident care Create an action plan from lessons learned 36
37 Thank you! Loretta Kaes BSN, RN-B-C, C-AL, LNHA, CALA Health Care Association of New Jersey Director, Quality Improvement & Clinical Services Janet Knoth BS, RN, CHPN, CPHQ Healthcare Quality Strategies, Inc. Quality Improvement Specialist 37
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