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1 Thank You for Joining! Learning Series 2: Improving Dementia Care New England Nursing Home Quality Care Collaborative Webinar Will Begin Shortly. Call-In Number: (888) Access Code: /10/2016 1

2 Learning Series 2: Improving Dementia Care New England-Nursing Home Quality Care Collaborative (NE-NHQCC) - Webinar #2 Melissa Miranda, Nursing Home Regional Lead mmiranda@healthcentricadvisors.org Margie McLaughlin, MA, Consultant Director of Education for Healthcentric Advisors and Senior Director of Quality Improvement at the American Health Care Association mmclaughlin@healthcentricadvisors.org Lynn McNicoll, MD, FRCPC, AGSF, Healthcentric Advisors, Associate Professor of Medicine, Alpert Medical School of Brown University lmcnicoll@lifespan.org February 11, :00 am 12:00 pm This material was prepared by the New England Quality Innovation Network-Quality Improvement Organization (NE QIN-QIO), the Medicare Quality Improvement Organization for New England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy CMSQIN_C2_ _0392

3 New England Nursing Home Collaborative How we can support you Technical Support (QAPI) Organized Affinity Groups (Learning & Sharing) LTC Stakeholder Collaboration Virtual Educational Webinars/Materials/SME Quarterly Data Reports to Track Progress 2/10/2016 3

4 Reminder: QIN-QIO Data Reports (Qtr ) Distributed to you by Mid-February! Readmissions Facility Readmission Report Standard Analytic Report (SAR) Long-Stay and Short-Stay Quality Measures 2/10/2016 4

5 Polling Question Have you visited the Nursing Home section of the New England QIN-QIO website? Yes No 5

6 Visit our website at: 6

7 View & Download our Educational Modules at: /#edu 7

8 Polling Question As we prepare for upcoming educational opportunities, which TWO (2) of the following are of greatest interest to your nursing home? Incontinence Pain Depression Help w/ ADL Weight Loss Staffing Stability/Turnover 8

9 Thank you for your Feedback! Your suggestions will help shape future educational opportunities: Webinars Conference Calls Educational Materials 9

10 Today s Objectives: Participants will be able to Recognize the implications of your staffing infrastructure on care to your residents Identify key concepts of keeping and growing your staff Apply quality improvement strategies based on peer sharing 03/24/15 10

11 Learning Series 2: Module 3 Staff Stability PART 1: A PRE-CONDITION TO QUALITY! Margie McLaughlin, MA, Consultant Director of Education for Healthcentric Advisors and Senior Director of Quality Improvement at the American Health Care Association 11

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13 Staff Stability: Why this is Critical? Turnover has a significant effect on quality 13

14 Quality (higher value = lower quality) Staff Turnover Vs. Quality 140 Turnover Targets Based on Quality Figure 1: Hypothesized Quality-Turnover Relationship % 50% Staff Stability is a Precondition of quality! Turnover (percent) 14

15 Polling Question Do you know your rate of Turnover? Turnover Rate Less than 25% Between 25% - 50% Between 51% and 75% 52% 80% Between 76% and 100% Greater than 100% 68% % 15

16 Increased Turnover = Decreased Quality Contractures Physical restraints Catheter use Pressure ulcers Psychoactive drugs Quality of care deficiencies Turnover Quality Castle, et al

17 Increased Turnover = Decreased Quality CNA s report the task neglected when short staffed: Range of Motion Hydration Feeding Bathing Castle, et al

18 Turnover Adds Up 18

19 Staff Stability: Why this is Critical? How much?? Centers frequently review turnover data but infrequently realize how much money is associated with that figure. Example: A nursing home choosing between operating at the 25 th percentile versus the 75 th percentile of turnover, i.e. between 38% and 78%, would experience a cost saving of $668,

20 Dementia Care & Staff Stability What high performing, low drug use centers know:

21 The Workplace Practices of High performing Dementia Care Centers Philosophy of Care focused on well being Staff who are fluent in Alzheimer s Consistent Assignment Ongoing investment in education, training, GROWTH! 21

22 HATCh Philosophy of Care Critical Elements 1. Zone thinking: Well being as the primary goal 2. All behaviors are communication 3. Team approach: Whatever it takes! 4. Alternative approaches are drugs. They are the last resort. Everything else is the primary way of being 22

23 1. Finding & Holding The Zone The Zone! Comfort Crisis! The Zone Comfort Safety/Security Well being Therapeutic Environment 23

24 2. All Behaviors are Communication 24

25 3. Team Approach: Whatever it takes 25

26 4. Create a world where Alternative approaches are drugs Black Box Warning Issued in 2005 Warning: Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. [Name of Antipsychotic] is not approved for the treatment of patients with dementia-related psychosis. 26

27 Staff Stability A NURSING HOME PROVIDER PERSPECTIVE Lynn McNicoll, MD, Consultant Physician Faculty for Healthcentric Advisors and Associate Professor of Medicine at Alpert Medical School of Brown University 2/10/

28 Provider Vulnerability Physicians, PA s, and NP s are reliant on the information from nurses and allied health providers Providers are usually not in the Nursing Home during a medical crisis or during significant clinical changes Nurses are our eyes and ears Decisions are made with information provided 28

29 Troubling Encounters for Providers Covering nurses: I m just here for the day Recurring patterns with the same nurse: I don t know why but when I am on, everything goes wrong Not being part of the solution: I don t know what s wrong with her, you tell me, you re the doctor 29

30 Proper Modes of Communication Be prepared to answer questions (labs, vitals, history, exam) Use proper judgement for urgent versus non-urgent calls Call immediately for head injury Avoid calling at 2 am to report iron tablet not given the day before Use SBAR Use INTERACT Tools 30

31 What Providers Value? Nurses who know the resident well and can distinguish between normal variations in behavior versus abnormal changes that need to be addressed especially important for residents with dementia Nurses who take ownership of process no turfing 31

32 What can providers do? Answer pages right away Be respectful, say hello, know their names Be patient and listen, don t interrupt If information not readily available, ask them to gather information and you will call back Encourage RN to provide their input (re: diagnosis, treatment options) Be thankful 32

33 Why is this important? Well-known impact that improved RN-provider communication has on patient safety and reducing medical errors Nurse satisfaction is directly proportional to the respect they receive from providers Stress levels can be greatly reduced with better communication among health care professionals NH are struggling to maintain provider coverage but that doesn t mean they should accept rude behavior from providers Improved RN satisfaction leads to better staff retention and engagement 33

34 Thank you I Am Old But I Am Happy Photo by Wim Denjis, photocommunity.com 34

35 This is how we do it!! PRESENTED BY: HEATHER BEAUCHEMIN, RN DIRECTOR OF NURSES 35

36 Elmwood Team 36

37 From A Galaxy Far Far Away. Developed QAPI Team Partnered with QIN-QIO - Healthcentric Advisors Regularly Scheduled Meetings Boy did we have our trials and tribulations 37

38 Back to the drawing board Established a clear agenda Focused conversations Everyone had time to speak 38

39 Right here.. right now (CAMP) Comprehensive Activities for the Memory Impaired Program 39

40 Spiritual Coordinator Psych team Environmental Staff training 40

41 But what about staff? 41

42 Created a sense of community 42

43 Making an Impact 43

44 03/05/15 44

45 Next Steps 1. Complete the QAPI Self Assessment 2. Complete one Plan-Do-Study-Act (PDSA) Cycle A Change You re Implementing 3. Access learning modules on QAPI and other topics to re-educate your staff 4. Call your QIO to learn about affinity groups, talk through QAPI plans, and/or share your experience with others! 5. Let us know if you are interested in getting ahead of the nation on Cdiff Reporting! 6. Next Regional Webinar April 14, /10/

46 Contact your Nursing Home Quality Improvement State Lead Connecticut Florence Johnson: Maine Melissa Miranda: Massachusetts Sarah Dereniuk: New Hampshire Pamela Heckman: Rhode Island Nelia Silva Odom: Vermont Gail Harbour: 03/05/15 46