Sharing advanced INTERACT Success! Developed by the following workgroup members: Irene Fleshner Pam Zanes William Thompson Laura Tubbs Judith Taubenheim Presentations by: Matt Tobalsky, LNHA Misti Valentino, MHA Pamela Zanes, Ed.M., RN, BSN Lenore Williams, RN Making a Difference: Advanced INTERACT use Crest View Senior Communities Matt Tobalsky, LNHA Care Center Administrator 1
Briefly describe your setting We are a 122-bed Skilled Nursing Facility with a 20-bed TCU and a secure memory care unit located in Columbia Heights, MN. Crest View Lutheran Home is a part of a larger continuum of care campus that includes both assisted living and senior housing with services As a result of using INTERACT we were able to.... Reduce the number of re-admission within 30-days 18% in Q1 of 2012 to 9.9% in Q1 2014 2
Other notable gains include: Better Communication with Providers SBAR Charting Quicker Response to Change of Condition STOP AND WATCH The INTERACT tool that helped us to accomplish our success was: SBAR Charting STOP AND WATCH Form Quality Tool after hospital transfer 3
How we did it Education SBAR STOP AND WATCH Creating Buy-In Understanding the role everyone plays in avoiding readmissions INTERACT Contest Barriers we had to overcome Problem Creating Staff Buy-In Education on the problem Solution Showing the positive results that come from following the process Showing Success Stories Helping staff understand the role they play in the process 4
Sustaining the gains... Formatted all Progress Notes in our EHR to only be in the SBAR format Make STOP AND WATCH Forms a part of the uniform Integrating the training into our orientation and annual inservices Share our success We are happy to share our success with others: Name: Matt Tobalsky, LNHA Phone: 763-782-1620 Email: mtobalsky@crestviewcares.org 5
Making a Difference: Advanced INTERACT use Mi Casa Nursing Center Misti Valentino, MHA Senior Executive Director Briefly describe your setting Mi Casa Nursing Center is a well established 180 bed skilled nursing facility in the Mesa community with an excellent reputation and above average customer satisfaction scores. We provide the Mesa community with quality post acute care, rehabilitation and long term care. Some of the services we offer are skilled nursing care, inpatient and outpatient rehabilitation therapy, in-house full time physician, IV therapy, tube feeding, peritoneal dialysis, TPN care, oxygen therapies, wound care management, bariatric services, and respite services. For rehabilitation we offer three therapy disciplines physical, occupational and speech therapies. 6
As a result of using INTERACT we were able to.... We began implementing INTERACT in our facility in February of 2013. During that month we had had over 17 transfers to the hospital with a 30-day re-admission rate for post-acute/chronic LTC of 20.7%, which also happened to be our highest rate for the year. As we continued to implement the INTERACT Program we continued to see a decline in our re-admission rate. Once the entire program had been implemented we had an alltime low of a 6.5% re-admission rate. Other notable gains include: Physician support of the INTERACT Initiative. Physicians also helping us to hold each other accountable, by asking our nurses for the SBAR when our nurses call them, etc. Also, Physicians encouraging our nurses to use their nursing judgment and providing education as needed. Residents happy about not having to go to the hospital to be treated, being able to stay in the facility and receive the same treatment Empowered nurses, practicing with a higher level of clinical expertise 7
Other notable gains include: A facility that is more prepared and capable to provide the care that our patients need Improved critical thinking skills of all of our staff, improved nurses assessment, associates are asking more questions and are gaining more knowledge Avoiding, those avoidable transfers!! Improved care, improved access to services, improved community relationships The INTERACT tool that helped us to accomplish our success was: The INTERACT tool that helped us to accomplish our success was: All of them!!! Stop and Watch has been successful in identifying issues with patients early on. SBAR and the Clinical Pathways have improved our evaluation and communication and have empowered the nurses to practice with a higher level of expertise. 8
The INTERACT tool that helped us to accomplish our success was: The Advance Care Planning Tools have allowed for us to be more prepared and capable of knowing what to look for when it comes to Advanced Care Planning. The QI Tools have allowed us to look closer at our processes and improve / provide education where needed. Also, we have found ways to utilize resources that we never even knew we had! The medication reconciliation has helped us identify trends in the hospital orders when a patient comes from the hospital to the facility and has allowed us to work closer with our hospital for a smoother transition upon admission. How we did it Education to the Management Team on INTERACT and to prepare them for the implementation over the next several months Determine which areas of the facility to implement first Determine Champions and a Team and set aside 1 hour every week for each of these members Educate Team of Champions on INTERACT- What, Why and How? Each team member had their own binder of Interact tools to refer to. 9
How we did it continued Choose what Tools to implement. As a team we implemented in this order Advancing Excellence Hospitalization Rate Tracking Tool- Transfer Forms Stop & Watch How we did it continued Nursing Home Capabilities SBAR Form and Progress Note, Change in Condition File Cards, Care Paths Transfer Document Checklist QI Tools Advance Care Planning Tracking Form and Tools 10
How we did it continued Medication Reconciliation Worksheet After each tool was implemented we kept following back up with our champions to hear what was working and what was not working and then re-educating. It was a process. We also reviewed cases on a weekly basis. We continued monitoring our progress, tracking and trending and then rolled out each process to the entire facility, when it was successful in one area At the same time, we implemented community TCC Meetings where we did Case Reviews on re-admissions Barriers we had to overcome Problem Initially no buy-in from the team Forms too cumbersome for our nurses Team was telling the ED and DON that Interact was implemented but in reality it was not Solution Champions and weekly meetings. Sharing re-admission data Follow-up and Tracking/Trending Data 11
Sustaining the gains... To sustain our success with INTERACT we: have had to continue holding monthly meetings with our Champions. We review our progress and determine any action as needed. We continue to monitor compliance for usage of the INTERACT tools and follow-up and provide education as necessary. We also, continue to monitor our readmission data and share the data with our entire facility and it takes all of us to make a difference. It is an ongoing process, one that we continue to monitor and improve upon on a daily basis. We are happy to share our success with others: Name: Misti Valentino, MHA Phone: 480-981-0687 Email: misti_valentino@lcca.com 12
Making a Difference: Advanced INTERACT use Kindred Healthcare Pamela Zanes, Ed.M., RN, BSN Lenore Williams, RN Briefly describe your setting Kindred Transitional Care and Rehabilitation is a SNF. The facility has a Transitional Care Unit (Medicare) and a Long Term Care Unit. It is budgeted for 146. The facility is located in an urban setting, has multiple hospital systems referring, takes a high acuity, and has a high Medicare, managed care patient population. 13
As a result of using INTERACT we were able to.... Focus on patients with Heart Failure Reduce avoidable re-hospitalizations Improve patient/caregiver engagement Improve MD/NP and facility collaboration Other notable gains include: Improved discharge planning Increased staff confidence and morale Improved IDT collaboration Improved patient/caregiver trust Better relationships with referring hospital 14
The INTERACT tools that helped us to accomplish our success were: Stop and Watch Care Paths SBAR Acute change in condition file cards Acute Care Transfer tool Transfer checklist and follow up Hospital log (based on INTERACT) How we did it Support of Management All staff in-serviced on INTERACT HF Champions / INTERACT Champions Immediate identification of HF patients Staff visual aides Staff engagement MD/NP engagement Patient/caregiver engagement Advanced Care Planning HF patient assessment 15
Barriers we had to overcome Problem Time to educate Labor Solution Modified HF Program Staff was educated in shorter time increments for INTERACT and HF Sustaining the gains... Champions in place Management support Positive results Staff input Celebrate success 16
We are happy to share our success with others: Name: Pamela M Zanes Phone: 317.439.0249 Email: pamela.zanes@kindred.com Name: Lenore Williams Phone: 317.353.1290 Email: lenore.williams@kindred.com AHCA Quality Initiative Goals 17
AHCA Quality Initiative Goals Safely reduce 30-day hospital readmissions by 15% by 2015 Reduce clinical staff turnover by 15% by 2015 Increase customer satisfaction to 90% by 2015 Safely reduce the off-label use of antipsychotics by 15% by the end of 2013 QualityInitiative.ahcancal.org Quality Initiative Recognition Program Recognize skilled nursing members which demonstrate attainment of Quality Initiative goals Tiered approach the more goals achieved, the more recognition received All members recognized to be honored at 2015 AHCA/NCAL Quality Symposium in Austin, TX Achieve all 4 goals: Special recognition at Quality Symposium Featured in Provider Magazine Featured in a national AHCA/NCAL press release 18
Quality Initiative Recognition Program How to Participate: Submit 2013 nursing staff turnover through AHCA s Staffing Survey: www.ahcancal.org/research_data/staffing If not already done, submit 2011 staffing data as a baseline Submit 2013 customer satisfaction results through AHCA s online survey Readmission and antipsychotic data will be looked up for members DEADLINE TO SUBMIT: MAY 1, 2014 http://qualityinitiative.ahcancal.org www.ahcancal.org ahcancal ahcancal 19