Leading and Sustaining Systemic Change Collaborative (LSSCC) 2

Transcription

1 Leading and Sustaining Systemic Change Collaborative (LSSCC) 2 Creating a Culture of Safety Kick-Off Event ID: Event Started: 4/13/2017 1:48:58 PM ET Welcome and Introduction Good afternoon and welcome to Leading Systemic Collaborative Change II, Creating a Culture of Safety. We want to say thank you for taking the time to join us and we appreciate all you do to achieve quality and achieve better outcomes in health for our nursing home residents. My name is Beth Hercher, and I serve as a Quality Advisor out of Qsource at Tennessee. I will be serving as a facilitator for today's session. Before we get started I want to turn the presentation over to Karen Ragland. She will be sharing with you some instructions on how to use the chat feature in our webinar. Chat Functioning and Polls Good afternoon and thank you Beth. Before we begin I want to run through some housekeeping items, all phone lines have been muted for the presentation, but we do encourage your participation in the chat feature. This is either located on the right side or the top of your screen. Several of us will be there monitoring chat to respond to your questions and feedback that you would like to share. Will everyone take a second to chat in their favorite flavor of ice cream? It's always good to know something special about our audience. You can also use the Q&A function to direct questions privately to a certain individual so feel free to use that if you are so inclined. Also, today we will ask that you please interact with our speakers by answering three different polling questions. After you make this selection, make sure you hit the submit button so we can capture your response. We will have a polling question come up shortly. Back to you Beth. Agenda Great, thank you Karen. What we hope you will take away from today is that we want to introduce to you the atom Alliance Nursing Home team. We will be providing you an overview of our phase one, which is the Collaborative I for Leading and Sustaining Systemic Change. Then you will hear exciting new topics as we move forward and transition into the Collaborative 2, which is Creating a Culture of Safety. Then we will wrap things up with giving you an overview of the new long-term care regulations around infection control and antibiotic stewardship. Quality Innovation Network atom Alliance Many of you that are on the webinar today have probably heard this, but, we may have some new team members and we want to share with you. The beginning of the contract cycle with CMS,

2 the QIO program went through some restructuring and typically you would know us by your single organization within your state or one organization across each state across the nation. This particular contract cycle, CMS has restructured and the slide that you are seeing represents the four Quality Innovation Networks. CMS asked regions to consolidate and work together across state lines and you are looking at a graphic of those 14 Quality Innovation Networks across the region and atom alliance is five states. We are a five state, multi state network, Indiana, Kentucky, Tennessee, Mississippi, and Alabama. This is the atom Alliance partnership. Poll Question 1 I think I am going to pause right here and we do have a polling question. Karen if you want to go ahead and pull that polling question and then I will introduce the atom Alliance team as we get these questions captured. Thanks, you should see a polling box pop up on the screen and for the first question today we would love to know how many people are in the room today viewing this presentation. Are you alone, or you have a couple, or even up to 10. Do not forget to hit the submit button after you select your response and thanks for participating in the polling. Back to you Beth. I think the polling question may not be the correct one Karen, it looks like we have the to a QAPI plan polling question. Okay we need to pull up the slide six question. My apologies, why we are getting this polling question pulled up, many of you know these beautiful faces that you see here on this screen. There is the polling question and you can go ahead and select your answer and do not forget to click the submit button to submit your answer. atom Alliance Nursing Home Team These are your point of contacts throughout your state. We have Beth Greene, and in Indiana we have Kara Dawson, Marcia Landon, and Teresa Sargent. Here in Tennessee, we have myself, Beth Hercher, Julie Clark, and Sarah Potter. In Kentucky, we have Scott Gibson, Brandi Claggett. In Mississippi, we have Mae McDaniel. I am sure that many of you have talked with these people and you know who to contact, but we want you to be sure if you have not made your point of contact in your state, to get a hold of them. We will have their contact information at the end of the presentation. Poll Question 1 Results It looks like we are getting our polling question in and some of you are just by yourself. A lot of you have 2 to 5 and we are excited that you are with us and thank you for participating.

3 Collaborative Phase 1 At this point, I will turn the presentation over to Julie Clark. Julie is a colleague here on the Nursing Home team here in Tennessee. Julie is going to share with you a review of our first Collaborative, Phase 1, for the Collaborative. Julie, I will turn it over to you. Thanks Beth. I first must call out Lee Elliott in chat, I don't know if you watched the ice cream flavors. But Lee said Tabasco and I'm going to have to try that if it's a real thing. What we are looking at today, we are going to do the first part of this and it is kind of a review of what we did during the first phase of the Leading and Sustaining Systemic Change Collaborative. We did start the first phase in April of 2015 and it wrapped up in September of last year. Many great improvements were accomplished across the Alliance and we will talk a bit about that as well. The next slide that you are looking at here gives you an indication of how many nursing homes were participating with us between April and September. Participants and Goals We had 940 nursing homes in the first collaborative, across the five states, that were participating with us. We appreciate that in the number has gone up for the Collaborative 2, so you will see that in a moment. Next slide. This is how we laid out the structure of the webinars and learning events and action periods that we had. The 940 nursing homes that were part of the first collaborative participated in these quarterly webinars that are covering QAPI methodology and long-term care modules and the eight steps of change. During the action period where you see the plan, do, study, act, nursing homes were asked to work with state quality nursing home advisors and you saw the photo of our faces a moment ago. During those action periods, you were working on reducing antipsychotic medication use, off label use and the composite scores they were working on improving, and much more to improve the care for the residents. We did have a purpose statement and we did share this during each of our learning sessions, our purpose was to have Leading and Sustaining Systemic Change Collaborative to equip nursing home leaders to charter lead and develop self-directed, high functioning teams to drive and sustain systemic change improvement using QAPI methodology. These were the goals for the first part of the Collaborative and we have some new goals that Sarah will share with you in a little bit for the Collaborative part 2, but during the Collaborative part one, these were the goals that we focused in on. They were hand in hand with the National Nursing Home Quality Collaborative goals and included things like improving the composite score nationally and especially within our five states. We saw a lot of great movements with the composite score and hopefully that will continue. We worked on reducing antipsychotic drug use in dementia residents. We have seen great improvements in that area as well. Then of course, the ultimate goal is to increase resident satisfaction and quality of life and improve the systems in your facility so that the care you provide the residents is that much better.

4 This little graphic was shared during all of the webinars, as well, and it really focuses in on the fact that in order to drive and sustain the change in the facility, you do need leadership buy-in. They need to be that strength and lead the team into the change. You need both high functioning teams to be working on improvement efforts and the QAPI methodology. We got into each step and all of these things are working together. The QAPI methodology will help your facilities with driving and sustaining the change that you want. That is kind of what we did during the first collaborative and these next couple of slides I will show you some of the improvements that we have made. Impacts You all have been doing so great. Looking at this back in April 2015 to June 2015, that quarter there, we had 100 nursing homes. This is looking over the 940 that were participating in the first collaborative. When that started out, only 100 of those 940 had reached the 6.0 goal for their composite score. You can see as the quarters have moved on up, until that last spot, there where it was April of 2015 to September 2016, that measure is showing you overall. 310 of those nursing homes across the five states have met 6.0 point or lower on their composite score. If you do not know what the composite score is you need to get with your Quality Improvement Advisor in your state and reach out. Say, I would like some help with this and I am not understanding it or maybe you need to know a little more about what it is. We are here to help you and we want to get you into those numbers and hopefully get more nursing homes to that 6.0 mark. There are three opportunities for improvement did seem to hit all five of our states going across the atom Alliance. These three opportunities are with the incontinence, the low-risk bowel and bladder, and the loss of bowel and bladder control. The antipsychotic medication use, with dementia patients, and ADL decline. This is the top three across our atom Alliance. These are the three quality measures in the composite report that seem to be the highest drivers or need the most improvement. Poll Question 2 I will stop for a second here and with this thought in your mind, we will have another poll here. We will ask you which area you feel is the greatest improvement area in your facility based on the incontinence, antipsychotic medication and ADL decline. Please select which one you feel your facility needs the most improvement in. Then do not forget to hit the submit button down on the bottom. You are just judging on your facility which one you think you need to work on the most, the incontinence, the antipsychotic medication or ADL decline. While you guys are taking that, we will move on and go to the next slide and I will come back to the result of this when they come up. Martha s Patient Story Introduction of Guest Speaker The next thing that we will have here is our guest speaker. Her name is Martha Blankenship and it is my pleasure to introduce you to her. She is a member of the atom Alliance Council that is

5 compiled of Medicare beneficiaries. We meet with them on a regular, monthly, and we have multiple beneficiaries from different states. Martha has agreed to share some of her stories about her aunt and how the nursing home that she was living in worked with Martha to improve her aunt's care by utilizing communication and teamwork. Martha, I will turn the floor over to you so that you can share your wonderful story with us. Martha s Aunt Gladys Thanks so much. I want to introduce everyone to my Aunt Gladys that is what we are going to call her Aunt Gladys. Aunt Gladys was born and raised in England. It is World War II and she is working in London. She was a very attractive and striking young lady with impeccable manners. She is petite and stands about 5 foot 2 inches. She had naturally curly red hair. Her makeup was tastefully done and she was trim in the suits that flattered her body, with small pumps and that was the fashion in the day. She was never without her dark lipstick or her manicured nails, with matching nail polish. She had a gentleness about her, as well as a strength that comes from living in wartime. Now, she met my mother's brother, who we call uncle Harvey. He was a lanky, tall, quiet man from the hills of Kentucky. He was in the Air Force, stationed in England, and they married there. She became a war bride. She knew how to handle the frequent air raid, the lights out required, and the dark shades on the windows. She lived in London until she had a child and the bombing got severe. My uncle sent her and their toddler son on a ship to cross the ocean, where they came to live with my grandmother and my mother, who was a teenager at the time, on a small farm in Kentucky. There was a period of adjustment to say the least. Through it all, she held onto her habits from England. A soft-boiled egg, toast and hot tea for breakfast. Tea and cookies every afternoon, between 3 PM and 4 PM. This teatime would hold her over until her dinner time at 8 PM. My grandmother's family, they were country folks through and through, got up at dawn and did their chores, ate a big breakfast. At noon they had their dinner, supper at 5 PM and bedtime was about 8 PM. It was an adjustment between the two cultures. After the war ended, my uncle decided to make the military his career. He took Aunt Gladys, and now two sons, as they traveled the world to beautiful islands from the places that they lived. I have a thin china tea service with dessert plates that I got from postwar Germany that they gave to me. Gladys after Retirement After retirement, they brought back all their beautiful belongings and furnished their home, about 10 miles from Uncle Harvey's Charlotte home here in Kentucky. She was a wonderful hostess and visits to her house always included teatime. She even learned to make ice tea though she thought we Americans have ruined tea. You see, she said that we heated it up only to cool it down. Tea should always be hot if it is done right, according to my Aunt Gladys. At the age of

6 80, my Aunt Gladys was a widow. One of her sons had been killed and the other one was busy as a professor of dentistry, in a large city, several hours from here. He made me Aunt Gladys is medical power of attorney. He was a hands-off son. I met with a nice nursing home that he had placed her in. They would call me any time there was a problem. I visited her weekly, so she had long forgotten who I was or most of her family. Dementia and Culture She became very fearful at night, especially with noises, the bed alarms and the fire alarms. She would get out of bed and go to the bathroom, turn out the lights, shutting the door and sit on the floor refusing to come out until it was over. The nursing home was the restraint free facility, but they did give her medication to calm her down because she got up so often and was so shaky and off-balance. They used to get chair alarms and bed alarms and there were nights that I would sit with her in the dark in the bathroom. She finally fell and broke her wrist, along with several ribs, and I am assured that she by herself made the risk of falls in that facility very high. They finally put her mattress on the floor and yet she would continue to crawl across the floor to the bathroom. Finally, I was asked to come to a patient/family interdisciplinary meeting. During that meeting, I found out that nighttime was not her only time of distress. At about 3 PM to 4 PM every afternoon, she started demanding tea and biscuits. At supper around 5 PM, they would bring her a glass of tall iced tea and some canned biscuit, which she would taste, spit out at the aids, and then throw her supper tray to the floor. They gave her more medication. The medication just made her a zombie and then she started refusing to eat. I told them at this meeting about her past, and the wartime that she lived in, and how she thought the bathroom was her air raid shelter. The lights had to be left off and she did not want the bombers to see where she was hiding. I also explained that she was used to teatime at 3 to 4 PM with hot tea, no sugar, and a touch of cream, along with shortbread cookies, which the British called biscuits. She had been asking for a torch to have in her hand and that was a flashlight and I got her one. Whenever she asked for a frock she was asking for dress. When she asked for a crisp she was asking for potato chips. Solutions Implemented The staff at the nursing home were wonderful and they implemented these requests along with others as they came up. This caused a calmer, quieter and more cooperative patient. I made arrangements for her to go to the beauty shop there in the nursing home once a week for her hair washing and fixing and I made sure she had her nails done. Did she know what was really going on and what we were trying to do? No, she did not. Her dementia was too advanced, but she would grab a hold of the things that she could remember. The safe places of the air raid shelter and the ritual of her teatime. Medications were lowered and some more stopped completely. You see, it bothered me seeing such an elegant and refined lady so confused and agitated and un-kept. After working with the staff and them working with me, I finally saw an

7 elderly lady living her final days in a much gentler way and that did my heart good. I want to say thank you for listening to my story about Aunt Gladys and the importance of communicating with family and letting the residents have part of their life in their home, while they are there at your facilities. Discussion Thank you, Martha. We really do appreciate you sharing the story. I cannot imagine. This is Julie again. My career was in the nursing home, but to have a resident asked for a torch would've been a new one for me. It is interesting to see how so much can be lost in translation with the residents and brushed off to their diagnosis and then possibly moved on to medication, which is not what Aunt Gladys needed. You did a wonderful job and thank you for taking great care of her as well as sharing your story with us today. It was great hearing your story. We all know the stories in our facility of different people that have been residents in the facility and we have had these a-ha moments where you figure out what they are needing. The key to Martha s story is the fact that the great communication happened. Great communication, with great leadership, and they had good teamwork going on in that facility. They were working to figure out what the problem was and they used the QAPI methodology, I am sure, when they were working on this. They are striving to make it a personcentered care environment for Aunt Gladys. Again, just bringing this back up, that in order to drive and have leadership and high functioning teams, it will be key. Responding to Chat Questions I will take just a second to pause and ask if there any questions in the chat that we need to address before we move on? While I am waiting on that I think that is Louisiana that you are talking about. Do I have to leave? Any other questions in chat? I do not see any questions Julie. Okay, guys please feel free to type any questions in the comments and stories that you may have had that were kind of like Martha's that is just welling up and you know after you've heard her story. Please feel free to put your comments in chat and we would like you to stay engaged. We use this information when we are building these events. That is it for Collaborative Part I, in my section, and we will move into what to expect from Collaborative 2.

8 Collaborative Phase 2 The Difference Between Phase 1 and Phase 2 I will turn the floor over to the amazing Sarah Potter. She is in Nashville and is also a QI advisor in Tennessee. Sarah, I will turn it over to you. Thank you for the wonderful introduction. My name is Sarah Potter and we talked about the first phase of the collaborative. I will talk to a little bit about what is coming up in the second phase. Next slide. Julie showed you the numbers of the first phase of the collaborative and as you can see looking at this picture, we have several more nursing homes working with us now and we are up to 1,190 total across the Alliance. On the right side, you can see it broken down by each state how many facilities are participating with us. Our Collaborative is staged in two, 18-month phases. We talked about how Collaborative One was complete and now we are moving into the second part of the Collaborative. It will go from April 2017 through September This graphic provides a visual for the timeline and virtual learning sessions are followed by action periods. During those action periods, the QIN-QIO faculty will work with their team to apply knowledge during the learning session and this will drive improvement. Some of the goals of this Collaborative are to continue to improve the national nursing home composite quality measures score and to continue to reduce antipsychotic drug use in dementia residents, as well as, continue to increase resident satisfaction and quality of life. With the ultimate goal being improving systems to improve care. Here is a little bit of the purpose statement for the second part of the collaborative. There are new features as well and we will train participating nursing homes in common communication methodology. We will also foster the adoption of antibiotic stewardship processes and CDI management and prevention. I will hand it back over to Julie who will introduce the next guest speaker. Thanks Sarah. Bill s Patient Story Introduction of Guest Speaker The next guest speaker is Bill Gossard. He is also a member of the atom Alliance Counsel. I want to put a plug, that if you know of anyone that is a Medicare beneficiary that would like to join the Council, you can reach out to me, Julie Clark and I will get you with that group.

9 Bill is coming with us today to share a story that is a lot around communication and I think you are picking up on this idea that communication will be a big deal. Bill is going to share about a story that his wife and he experienced with her health and how communication with healthcare providers has improved her outcome that she was dealing with. Bill has also helped us quite a bit in the atom Alliance with other tasks and he will share how he has done that. It is my pleasure Bill, to turn the floor over to you. The Story of Bill s Wife Thank you, good afternoon, and I appreciate the opportunity to tell my wife's medication story. If it helps one person avoid a similar experience, it is well worth it. In retrospect, it does show the importance of communications among all parties involved in patient care. My name is Bill Gossard and I am joining in from Tipton, Indiana. My wife passed away a couple of years ago after several years of declining health. Mainly heart and lung issues and she had close long-term relationships with her family doctor, her cardiologist, and her lung specialist. In later years, she began to see a neurologist and one experience that she had was with her medications. Adverse Drug Events We kept a detailed list of her prescriptions and over time, particularly after beginning to see the neurologist, the medications being prescribed to her grew to 18. After a while, one evening, her body just seemed to shut down and she became disoriented and lost control of her bladder and bowels, and had tremors and sweats, and passed out. After a couple of days in the hospital, a family doctor and the specialist reviewed the medications, and the list was pared back to five. It was not long before she felt much better, clearer, and had much more energy. Despite the medication creep, the doctors did focus on the issues and made the appropriate adjustments. Because of the number of medications that she took, we kept a detailed prescription checklist with a compartmentalized organized compartment pillbox. She took them from morning to bedtime. The checklist listed the drug, the dosage, the frequency, the reason and the drug she was allergic to. Looking back on it, I should've added that there be a 6-month review to the checklist. We organized the list by the doctor s name. Maybe we should've simply listed the drugs because we took the list to every doctor s appointment and maybe they only focused on the drugs under

10 their name and not the others. Maybe the family primary physician should've scrutinized the list more closely. Looking back, we should've taken a see-through plastic container with all of the prescription bottles. That would've opened some eyes. We did use a single pharmacy and because of frequent visits we knew this stuff well. They were extremely helpful and probed for reactions at the appropriate time. All they could do was alert us. While in the hospital, she would wear a bar-coded wristband that was checked by the drug partners, to prevent errors, and we never had any issues. It just seems that the best protection is to take responsibility for your own medication and know what, why, and how to take these prescriptions and be alert to the regimen. Each person is an individual and we could have different effects from the same drug. We need to ask questions or have an advocate on our side. In retrospect, I think the potential adverse drug effects could have been foreseen when the neurologist began prescribing medication. The drugs were potent and had exaggerated effects that really changed things. That changed the experience with prescription drugs and they are a major component of our healthcare. They deserve keen focus and analysis and clearly communicated. I would like to take a moment to complement and commend the atom Alliance with educating beneficiaries and the quality initiatives. Medication Index Solution Amanda Ryan, the clinical pharmacy specialist, constructed a medication major regimen complexity index. It effectively scores the medicine regimen and when the score exceeds a particular level, red flags go up to signify the regimen should be examined. This will be perfect to include in a patient's portal. My doctor s practice recently made the patient portal available online and this allows the patient to review exams, list the prescriptions and allows communications with the doctor and nurse. It would be difficult to miss the red flag on these medicines. My other suggestion is to continue to develop the medication complexity index concept. This can be made as robotic as possible to measure chemical inter reactions of medicines to reduce the influence of human judgment. The pharmaceutical manufacturers, the pharmacy and the medical professionals should work together and become more sophisticated. I know that atom Alliance is working closely with physicians and pharmacists across the fivestate region to have monitoring tools such as the medication index and Doctor Ryan has been working closer with the Patient Advisory Council to develop a simplified version of this index.

11 atom s Patient Advisory Council The Council is made up of 15 volunteer members, three from each state, with varying backgrounds and healthcare experiences. The main purpose is to provide feedback to clinicians about care and clinical interventions. The medication index tool will help encourage patients to talk with clinicians about these issues with the goal of improving medication safety. Communication among the providers and caregivers is vital. I enjoy working with the atom Alliance staff because they are open, receptive and forward thinking and the impact the community. They make a difference. Thanks for the opportunity to join the webinar and keep up the good work. Discussion Thank you, Bill. That was great sharing and we sure appreciate you taking the time to share that important message with all of our nursing home teams today. As you can tell from what he was saying, not only is atom Alliance awesome, but also this communication is so important. He had to do the communication with the providers and they will discuss the medication. Making sure that the communication doors are open is extremely important and we will talk about this in Collaborative 2 and how to build strong communication skills. Keep that in mind while you are working with us over the next 18 months. We sure appreciate this. The slide that is popping up, it is coming back to us again, it is just again reminding you that leadership needs to be driving any kind of change or communication efforts. With these high functioning teams and the QAPI methodology. Again, we want to make this extremely apparent. Phase 2 Activities New regulations Regulations are a fun thing to learn about and we have some new ones here that we thought we would bring to your attention. We thought we would see if you have any questions and if we can help steer you in the right way. Remember that chat is there for you with questions and we will have someone read these off. There are a few new regulations and one of them is around QAPI. Hopefully, you know about these, but we want to make sure that you know why we sure this in the webinar that you understand what is out there and how to be prepared. The QAPI Reg started to be implemented November 28 of last year and that was the phase 1 section. It was asking that facilities update policies, procedures, training needs and staff knowledge. Getting the QAPI ready in your facility. The one in red, the Phase 2, that needs to be completed in your facility is by November 28 of this year, 2017, is that your facility needs to have a quality assurance and performance improvement plan, or a QAPI plan, written up in the facility to have ready if a surveyor asked for it when they come into your survey. The other one is infection control and antibiotic stewardship principles and practices.

12 Poll Question 3 I will stop again for just a second and we will put up another poll. Now that I have brought these two phases up, atom Alliance is curious, as to how ready you are for Part 2 being that it is coming up this year November 28. If we get the next polling question. It will ask you how prepared you are. We are somewhat prepared, we are prepared, or we are not prepared. Remember to hit the submit down below after you choose your answer. Phase 3 The third phase will be due November 28 of 2019 and that is a brief description to provide proof that the facility has performed at least one performance improvement project following the elements of the new and revised regulations. You will be required to do a performance improvement project. We are certainly here to help you figure out how to put this in place and we have many recorded webinars that we could refer you to or you can talk to your quality assurance person at your state level, for whatever state you are in. Poll Question 3 Results We have some answers, somewhat repaired seems to be the majority of the votes and coming in second, we are prepared. I love those guys. And then the not prepared. We will make a point to continue to help you out with getting ready and one of the things that we will do is provide you with this QAPI How to Guide with the plan and it will be located and they will put this in chat on the dedicated webpage. It is a How to Guide and it will walk you through the steps of what you need to have put in place in writing for the QAPI plan by November of this year. This How to Guide is a ready posted out there on our dedicated webpage so someone can put that back into the chat so they will know where to find that. Again, as a reminder the plan needs to be lined up because the plan may or may not be for November. That is it for the QAPI part. I will turn it back over to Sarah Potter and she will talk a little bit about some of the other regulations that are coming out. Sarah? Thank you, Julie. Phase 2 Work Ahead As you saw in Part 2 you saw the wording about antibiotic stewardship and infection prevention.

13 The changes include updating the facilities infection prevention and control program and to implement an antibiotic stewardship program. This needs to include antibiotic use protocols and a system to monitor antibiotic use. During the collaborative, we will discuss and teach you the core elements of these programs. The core elements of the infection prevention program and antibiotic stewardship which have been set for us by the CDC. Hopefully, that will also help you in preparation for having all of these things in place by the end of this year, in November. That is all I have on that and I will give it back on Beth to talk about the next steps. Next Steps Action Period Great, thanks so much Sarah and Julie. You guys provided our audience with a good overview of what we have been working on and what we will continue to work on with our goals. You just heard Sarah talk about these new topics around infection prevention and this is how we are transitioning into the culture of safety that we have seen for Collaborative 2. After the webinar kickoff, you will officially be in what we refer to as an action period. Action Period 1 The month of May, June and July will be action period one. We want you to continue to work on your composite score. You can reach your quality advisor in your state and if you are not familiar with these reports that we send out to you, they will be happy to review that with you. PIP Preparation We have a great video on our dedicated webpage. I will demo that for you in just a moment. But this video is how a Tennessee nursing home did a performance improvement project around the composite score. It is a brief video that you and your team could view. Then you can reach out to your Quality Advisor and take a look at the composite score and, as Julie said, with the new regulation around QAPI coming in phase three, you will have to show proof that you have done a performance improvement project. This is a great way to dip your toes in and really perfect the performance improvement project that you may begin to work on. Continue Antipsychotics Reduction Continue to do the fabulous job that you are all doing around antipsychotic medication reduction. This is a national goal for us for a while and great work has been going on with this and we just say thank you for that.

14 QAPI Plan Julie talked about the QAPI written plan. That is of course in the new regulation and you will have to have this drafted and have it in place. This guide is a great way for you to start your draft. Train the Trainer Then we have an exciting train the trainer series around communication, we heard a lot about effective communication and teamwork. I will demo that for you in just a moment. There are two modules from the train the trainer series that we really encourage you to view in between now and when we meet again in August. It is the clinical overview for C. difficile and Sarah had to review a little bit of this a sneak peek of what you will hear in August. Please review this. And then Julie talked a lot, and we heard Bill and Martha share about the importance of this communication and working as a team to effectively communicate together. TeamSTEPPS TeamSTEPPS is a module and a great resource for you. These modules provide continuing education credits and I will show you how to do that or where to go locate them and then you can follow these instructions to get your CEs. This is what we are asking you to do during this action period time and Karen, if you can pass me the control, I will share my desktop and show them where these modules are. Questions and Answers While Beth is setting this up, I did see that there was one person that would like to know where the tool is that Bill spoke about. Amanda Ryan, I know that you are on but you are muted. If you can go into the chat and share how to do this I can't see how to do this. Any other questions you may have and then we can answer before we get off the call. Thank you, Julie. Demonstration of Resources What I have pulled up is on the atom Alliance website, but it is a dedicated page and you can only get there through a specific URL, and that is on your PowerPoint and you have also seen that in chat. Are you showing your screen because I do not see this yet? Are you on the website? I am. There we go.

15 Hopefully, everyone can see my screen. When you login, you will be on the home page of the dedicated webpage, this is what it looks like. It gives you some of the goals that you have heard and these are hyperlinks. You can click on these links for team stats and the National Nursing Home Change Package. That is something that we did not really mention, but it is full of great ideas for performance improvement projects. What I really want to show you is how to get to, and let me scroll down, as you scroll down the page, this is the menu, and you can see what we offered for Collaborative 1. If you are not participating, you can go look at these archived materials and there's lots of great resources around the QAPI implementation steps. In the Collaborative 2 materials, this is where the kickoff presentation, materials can be located. Then the written guide that you can download from here. The train the trainer series, it is located on the page, and you simply click on go here and it takes you to all of the modules. There is just a couple that we want you to take the time to review between now and August. The communications module and then Sarah has spoken about part one of the clinical overview for C. diff. As you can see, there are sixth modules with great information and we will cover them as we go through the next 18 months together. Closing That was an overview of how to get to these resources on the dedicated webpage and now I am going to try and go back to our PowerPoint. I opened the wrong thing. We will go back to the PowerPoint and close us out. We have any questions in chat? I do not think we do. I am not locating my PowerPoint. I am so sorry. I figured I would do this. Feel free to pass the ball back to me and I can advance the slides for us. I think I will. I knew I would get in trouble when I started trying to advance my slides. It's not as easy as it sounds. I think I've actually just got myself out of this altogether. I am so sorry. We only had a couple more slides to review and they were just how to connect to us on social media and you can do this through Facebook, through twitter. I have to log back in, because I have myself completely out. You do that and I will talk. Getting This Presentation I know I see a lot of people and I can jump in and talk but I do see a lot of people asking about the PowerPoint and yes, you can get this and thank you guys for putting the link into chat. You need to go to the dedicated webpage that Beth was demoing for you and you will see the kickoff event for today. There will be a PowerPoint there. Feel free to print this and share with everyone. The other nice thing about these events as they are all recorded and Karen, this is in like a week I think. It should be posted on to that dedicated webpage. We try to send out an that lets you

16 know that it has been uploaded. Just in case you did not get that , just check back at that webpage the Beth was showing and in that same area where the PowerPoint is, the link to the recorded version of today will be put there as well. If you have staff that you would like to hear what was shared today or other nursing homes at your sister facilities or anything like that, please feel free to let them know about the recorded link. You will not get back to that webinar. I am having all kinds of trouble. Karen, can I do this from this tool? If you have a panel up where it shows your name as the presenter and the chat and everything else, you can try and pass that ball from your name to my name. This is what I was trying to do and I just cannot get it to load. I do not even see her opened at the bottom. Can you grab this? Or does it not let you? WebEx, can you please pass the ball to me, Karen Ragland. I apologize, I hope there are several out there in the audience that are is challenged as I am with technology. Save the Date and Contacts The last thing we want you to know is to save the date for August 10 th. That is the upcoming learning session for August 10 th and Sarah explained to you that we will touch on antibiotic stewardship and principles and practices around CDI. Mark your calendar for that and visit the dedicated webpage that we just showed you how to get to and find the resources. Social media is another way to click and connect. We are on Twitter, Facebook, Pinterest, and LinkedIn and feel free to use these if you choose. These are the contacts for you and your Quality Advisor in your particular state. We asked that if you do not know them you get in touch with them and I think this is going to conclude. We say thank you for your patience and I appreciate you being patient with me as I reconnect. Do we have any questions in chat? There are no questions in chat, but many people are looking for how to download the slides. Those slides are available on the webpage that we have listed in chat. Here is the URL and you can type this in your browser and if you want to copy this from chat and save it into a Word document for later, you can paste this into your browser. It will take you to this dedicated webpage and that is where we were when I browsed through to show you the different resources and where they were located. This is where everything is uploaded and made available for you. With that, I think we are going to say goodbye until August. We want to say thank you to Bill and Martha, as well. We appreciate their time in the great stories. Everyone have a great day. Have a good day.