An Innovative Approach to Identifying and Communicating Change of Condition Introduction to INTERACT II Presenters Cathy Lipton, Senior Medical Director, Evercare, cathy_lipton@uhc.com Pam O Rourke, VP Resource Management, Ethica Health & Retirement, POrourke@ethicahealth.org Donna Hendricksen, VP of Clinical Services, Sava Senior Care & Consulting, DBHendricksen@SavaSC.com Deb Kriner, President, Kriner& Associates, debbie@dkriner.com 1
Overview of Interact II Tools Debra Kriner RN History of SBAR SBAR (Situation Background Assessment Recommendation) was initially developed by US Navy as a communication tool Nuclear Submarines Retired US naval officer Doug Bonacumadapted to use in healthcare while working at Kaiser Permanente Healthcare in 2002 Standardized tool that allows a simple but effective way to communicate between nurses and physicians Provides important information, removes unnecessary narrative Allows physician to make a decision based on facts 2
Communication Tools Initial version developed by Dr. Ouslanderand Mary Perloe GNP: Early Warning Tool (Stop and Watch) SBAR and Progress Note Resident Transfer Form Transfer Checklist Advance Care Planning Stop and Watch Used by frontline staff Helps to identify changes Reduce hospitalization Quick and simple Used shift to shift Good tool for identifying restorative needs as well as changes requiring medical intervention Can circle more than one change on form 3
SBAR Utilized with each phone call Completed prior to calling physician Helps to gather needed medical information in one place Assists physician to make better decision regarding resident Resident Transfer Form Helps ensure safe handoff to hospital Filled out with each transfer Provides the ER physician a better picture as to what is occurring with resident Provides capabilities of nursing home for return Decrease admission to hospital 4
Acute Care Transfer Good tool for making sure all needed information is contained in transfer envelope May not complete if emergency, can send information later Quality Improvement Tool 5
Quality Improvement Tool Used post discharge of resident to hospital Helps to identify areas for improvement Management of resident within nursing facility Identifies educational needs of nursing staff Also reinforces positive response to change in condition Care Path Maps Used to guide nursing staff in assessment and management of symptoms Educational tool Useful in identifying when to notify physician and completion of SBAR Kept at nurses station 6
Advance Care Planning Helps guide nursing/social service staff to have conversations regarding end of life care, advance directives or palliative care Helps to make sure residents receive the level of care they desire Decreases panic readmissions by family/residents Provides reminder quarterly to review and ensure wishes remain unchanged Acute Care Transfer Log 7
Acute Care Transfer Log Useful in tracking transfers and admissions to hospital Helps to monitor necessary as well as unnecessary admissions Can expand on information individualized Nurse on duty Physician Implementation of INTERACT II Georgia Initiative Pam O Rourke 8
INTERACT II Joseph G. Ouslander, M.D.(Project Director) Gerri Lamb, Ph.D., R.N., F.A.A.N.(Project Co-director) Laurie Herndon, G.N.P. (Senior Project Coordinator) Ruth Tappen, Ed.D., F.A.A.N. (Project Collaborator) Alice Bonner,Ph.D., R.N.(Project Collaborator) Mary Perloe RN, MS, GNP-BC(Project Collaborator) www.interact2.net 9
Interested Parties INTERACT II and the Health Care Community Climate January 20, 2012 INTERACT training at the GHCA Convention GHCA 2012 Spring Council Meeting Sessions INTERACT II Support Conference Calls- Office Hours Participating in Community Healthcare Connection meetings This material was prepared by Alliant GMCF, the Medicare Quality Improvement Organization for Georgia, 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. Publication No. 10SOW-GA-ICPC-12-45 10
Building Support Presentation to GMDA 2012 Winter Meeting MD to MD Dr. Cathy Lipton Focus on impact to quality care MD ability to make informed decision Implementation of INTERACT II Incorporating Into Daily Practice 11
Implementation Steps Local Expert INTERACT II Evidence Base All Tools Compare to current tools and processes Adapt as needed Tele-health Fall Management Program Leadership Support Focus on Quality of Care Develop Implementation Plan Moving INTERACT II into Daily Practice Streamlined Education Easy Access to Resources Focused SNF Implementation Team Support for SNF Team Measure for Success Process Measures Outcome Measures 12
Streamlined Education Session 1 Overview, Tracking Transfers, Avoidability, QA Review Tool Session 2 Early Warning Tool Session 3 SBAR Communication Tool and Progress Note Session 4 Decision Support Tools Session 5 Information Transfer Session 6 Advance Care Planning Tools Session 7 Overcoming Barriers and Achieving Sustainability Streamlined Education-Clear Goals INTERACT stands for Interventions to Reduce Acute Care Transfers Goal- To improve the care and quality of resident care To decrease avoidable hospital re-admissions To assist in more rapid transfer of residents who need hospital care 13
Streamlined Education- Outcomes of Success Reducing Avoidable hospital readmissions Improving communications with EDs/Hospitals Improving communications with Physicians/PCPs Improving communications with Residents/Family members Improving Resident Care Improving Nursing Clinical Practice INTERACT II Tools The different INTERACT tools are meant to be used together in your daily work in your Center. 14
Easy Access to Resources On-line Access INTERACT Tools Company Tools Educational Resources Order Form Training Handouts Implementation Team INTERACT II Implementation Team INTERACT Champion DON Administrator Others as elected INTERACT II Support Team Regional Nurse Corporate INTERACT Champion GMCF Quality Advisors 15
Planning Your Participation Put dates on your calendar Review Intranet INTERACT page Meet as a team to discuss participation Let referring ACH know you are actively reducing hospital re-admissions Complete Assignments after each Training Session Voice of Experience DON, Champion Implemented INTERACT II Shared Expectations What to do What not to do How to overcome barriers 16
Let s Get Started- Tracking Transfers Identifying situations that commonly result in transfers of residents to the hospital Determine which situations you can potentially manage effectively and safely in your Center without transfer Improve quality of care for your residents The different INTERACT tools are meant to be used together in your daily work in the Center. The Quality Improvement Review Tool is meant to identify opportunities to improve management of changes In condition. 17
Measures for Success Outcome Measures Readmission Rates ED visits/1000 pt days Process Measures Participation in Training Implementation of Tools/Process Completion of Assignments Program Sustainability Donna Hendricksen 18
Key Factors for Success Implementation plan Initial training approach Ongoing orientation Rehospitalization trends and disease management Ongoing program validation for sustainability Implementation Plan Data analysis, if available Strategic roll-out by skilled unit, facility or region Webinar versus in person Share the bigger picture Focus on clinical care as the driver Define your owner Make it personal by allowing time for each facility s leaders to discuss their unique challenges and how the program would benefit their residents, families and staff 19
Orientation & Training High rates of staff turnover in nursing homes is not a recent phenomenon. As far back as the mid 1970s studies have documented average turnover rates for registered nurses (RNs), licensed vocational nurses (LVNs) and certified nurses aides (CNAs) ranging between 55% and 75%. Rates have remained high throughout the decades, often exceeding 100% for CNAs, the most common type of care giver in nursing homes. - The costs of turnover in nursing homes Dana B. Mukamel, Ph.D., Professor and Senior Fellow, William D. Spector, Ph.D., Senior Social Scientist, Phona Limcangco, Ph.D., Ying Wang, M.S., Zhanlian Feg, Ph.D., Assistant Professor, and Vincent Mor, Ph.D., Professor & Chair (2010) Orientation & Training General orientation for all staff is appropriate Focused and ongoing training for certified nursing assistants and licensed nurses is crucial to success Identify unit/team champions Establish a learning environment Quality Improvement Tools and performance improvement Skills labs 20
Disease Management Rehospitalization trends Quality Improvement Tools and Tracking log Comprehensive assessment It is all about early identification and timely intervention. Disease management tools Posters and badge cards with symptoms or signs Care paths Ongoing Validation Method to track training Medical director and physician partnership Referral source education Effective use of tools in the facility availability and demonstration of use QAPI 21
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