IGHL s Aspiration Prevention, Precautions and Monitoring Policy and Procedure. October, 2015

Transcription

1 IGHL s Aspiration Prevention, Precautions and Monitoring Policy and Procedure October, 2015

2 Today s goals include: Understanding why this process was developed Understanding how this process works

3 Why was this process developed? Our FIRST priority is consumer safety We re responsible for addressing consumer needs NYS OPWDD noted consumer deaths or illnesses were related to aspiration/aspiration pneumonia events We noticed that we could do a better job coordinating our aspiration prevention, precautions and monitoring efforts

4 How does the process work? We use the relevant treatment team approach to address aspiration needs 2. We require the team to address certain situations/events that tend to lead to aspiration concerns 3. We created a special IGHL Aspiration Monitoring Summary Form in PDF for the team to use to insure continuity of care 4. We provide some standard definitions for everyone to use 5. We use our existing program planning documentation process to capture our efforts

5 1. We use the relevant treatment team approach to address aspiration needs Program planning and monitoring is done by the treatment team members with the greatest expertise Typically, those team members include (but are not limited to and in no particular order) the: The consumer/family/representative MD/PA Direct support staff Registered Nurse Speech/Language Pathologist Nutritionist Applied Behavioral Specialist QIDP Treatment team leader/msc

6 2. We require the team to address certain situations/events that tend to lead to aspiration concerns We noticed that certain events should gain our immediate attention regarding aspiration precautions: A new consumers admission A related professionally qualified aspiration precaution planning assessment that indicates the need for aspiration precautions The ordering of and subsequent implementation of a mechanically manipulated consistency and/or modified fluid diet order

7 We noticed that certain events should gain our immediate attention regarding aspiration precautions (cont.): The ordering of and subsequent implementation of an NPO diet The implementation of an eating intervention; such as but not limited to pacing, food volume, alternating liquids and solids etc. A choking incident as defined by Part 624/625 Incident Review regulations A hospitalization for any reason Any other reason deemed appropriate by the treatment team, but no less than every six months

8 3. We created a special IGHL Aspiration Monitoring Summary Form in PDF for the team to use to insure continuity of care The IGHL Aspiration Monitoring Summary Form, prepared by treatment teams and in all records by 11/15/2015, captures all of the relevant aspiration-related information about a consumer to insure CONTINUITY OF CARE, such as: Whether or not a consumer has current aspiration precaution needs MODIFIED FOOD/LIQUID DIET orders EATING PRECAUTIONS/INTERVENTIONS HEAD-OF-BED/ELEVATION PRECAUTIONS Any OTHER reason The team uses the form to document their current work (or old business ), any recent developments (or new business ) and their Recommendations to address the current situation

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10 4. We provide some standard definitions for everyone to use, such as: Aspiration is the act of inhaling something other than air into the lungs. Aspiration precautions, being proactive interventions designed to reduce the probability of aspiration pneumonia The relevant treatment team A related professionally qualified aspiration precaution planning assessment what?!?... Coughing expelling air through an unblocked airway Choking trying to expel air through a blocked airway

11 5. We use our existing program planning documentation process to capture our efforts The CFA/ISP (and related documents) process Old CFA/ISPs (as of 11/14/2015) and other related documents need to be amended to accommodate this new, more coordinated team effort All under the heading of Aspiration Planning New CFA/ISPs (as of 11/15/2015) and other related documents need to have a new Aspiration Planning section to accommodate this new, more coordinated team effort All under the heading of Aspiration Planning What to do with outside CFA and ISP-writing agencies

12 Other related documents means: The consumers Individualized Program Plan or Habilitation Plan and/or Plan of Protective Oversight that provide specific instructions for staff to implement an intervention In-service training material that relates to aspiration prevention, precautions and monitoring; either ingeneral or consumer-specific training Any other appropriate device you want to use to help staff understand and remember a specific consumers needs

13 Questions?

14 Questions and Answers Regarding the IGHL Aspiration Prevention, Precautions and Monitoring Policy and Procedure Q. Why do we have to do this? A. At IGHL, we already do a great many things for those consumers that have aspiration prevention needs, but we haven t had a process that insures that all of those interventions are coordinated with each other. This procedure is intended to address that issue. Q. It looks like the policy expects us to evaluate every consumer A. Well, no; that sounds a bit too clinical. It might be better to look at it like we need to immediately consider every consumer, and document the types of needs and interventions that we are already aware of; basically establishing a new starting point. But, as we consider everyone, we need to be on the look-out for any need that we might not have considered before and make sure we address it now.

15 Q. So, everybody has to have one of the new IGHL Aspiration Monitoring Summary Form done? A. Yes, as done by the consumers treatment team, by no later than November 15, Q. But not everybody has aspiration precaution needs A. That s true, mostly. While aspiration precautions usually involve medically frail and/or older consumers, anybody could develop the need for these precautions. And while most such precautions are long-term, many times they re only needed for a few months. Our process requires, at the very least, that we consider each person s needs every six months. If there are no needs presented, we merely check the There is no need for aspiration precautions or other preventative services at this time box on the Summary form, make sure that the central planning document reflects this and move on.

16 Q. What about consumers that receive only Community Habilitation and/or Family Support Services? They really don t have a traditional treatment team. A. That s true, but they may have aspiration precaution needs that must be addressed. So basically, for these consumers the policy and procedure requires everything but the treatment team oriented Summary form aspect. Q. Will the Summary form be in the new PDF format? A. Yes, this will make it very easy to update. Q. Where in the CFA/ISP is all of this aspiration precaution information supposed to go? A. Right now, aspiration information can be found in a lot of different places in the consumer record, which has been a big problem. Now, we will be dedicating a new domain or category in the CFA/ISP just for Aspiration Planning information from every discipline.

17 Q. Why do we have to have all of this information written into both the CFA/ISP and the Summary form? A. All consumer services MUST be documented within the CFA/ISP for billing purposes, but they re really not very practical documents to use day-to-day. The Summary form acts as an active, practical extension of the CFA/ISP that captures all of our treatment teams aspiration prevention efforts on one form. The Summary form is also a much more flexible document that can be updated every time the team meets, even if it s every day, and provides insurance that each discipline will know what the other disciplines are doing. Q. What happens if IGHL staff don t write the CFA/ISP s? A. We ll be asking the other agency staff to include a new Aspiration Planning section into the documents they write. If they choose not to, we ll be giving them an addendum (that we would have done for one of our own CFA/ISP s) to include in their document.

18 Q. So why do we have to implement this process if someone chokes or returns from the hospital or some assessment changes? A. These types of situations were found to be when our treatment team process needed the most significant improvement. Too many times choking incidents would occur without a significant response, even a short-term one, by the treatment team. And, it was found that many times consumers would return from the hospital with a new aspiration precaution ordered and/or have a new in-house assessment done and the treatment team didn t integrate those things into the program plan. Those matters had to be addressed. Q. Sometimes I m not sure whether someone is coughing or choking A. Well, for most of our consumers, there s a very simple way to tell the difference Coughing is something we do all the time; pushing some air out of our lungs in order to clear some irritating material from our respiratory passages. Most importantly, we are still able to breathe (and talk) at the time of a cough. Choking on the other hand, is the inability to breathe (or talk) because the trachea is blocked, constricted, or swollen shut.

19 Choking calls for some rather drastic interventions, such as the use of abdominal thrusts at the time, perhaps the modification of food and fluid items, trips to the emergency room, Incident Reports, Aspiration Team meetings, highly supervised meals and such. Coughing is usually just followed up by someone saying excuse me. The best way to know if someone is choking or just coughing, is to simply ask them to say hello (or to make some other vocal sound) If you re coughing, talk away But if you re choking, you can t say so if someone can get air into and out of their lungs, can say hello or make some kind of sound, it s most likely that they re just coughing if on the other hand they can t say hello or make some kind of vocal sound, immediate action, such as the use of abdominal thrusts, should occur. it s very important that you know the difference.

20 Q. So, can you give me the short version of all of this? A. Sure. By 11/15/2015, we need to: - summarize, most often by having a treatment team meeting, any existing aspiration precaution interventions and recommendations on the Summary form, or indicate on the Summary form that no interventions are needed and - document the aspiration interventions within the new Aspiration Planning domain of the CFA/ISP (or on an addendum until the new CFA/ISP is written) Then - we implement (or continue to implement) the services Then - we update the Summary form every time something happens or changes (but at least every six months), keeping the last two Summary forms in the main record and, - continue to update the CFA/ISP each time it s written.

21 Q. We re an agency day hab program and one of our consumers lives in a residential program. If they get a new diet order from a recent hospitalization, how are we supposed to know the diet order changed? A. Like always, the residence, be it a certified residence or even if the consumer lives at home, is responsible for letting you know, as soon as possible, that the order changed and what the changes involve; how else would you know? Q. Who writes these new Summary forms? A. Like always, agency residences are responsible to document the teams recommendations on the Summary form for both programs; the day program is part of the treatment team. If the consumer lives at a non-agency residence or lives at home, the day hab program does the writing. Either way, you need to implement the new order the very next time the consumer eats at your program. Q. This seems to be a lot of extra work to do. Is all of this really necessary? A. It might seem like a lot, but we already do most of these things already. The problem was we needed to do a better job coordinating our treatment team process and we needed to be more consistent when the consumers experienced certain types of situations and risks that call for immediate attention.

22 Having the team meetings and capturing all of that information on the Summary form is the best way to coordinate the treatment team process. And, by requiring this procedure to be implemented any time these different kinds of events and potential risks occur, we are insuring a common response to important circumstances. If you have any other questions, please contact any Quality Assurance staff!

23 THE END