Improving Patient Safety in Long-Term Care Facilities: Communicating Change in a Resident s Condition Supplemental Material to Accompany the Webinar The first two Webinars in the series Improving Patient Safety in Long-Term Care Facilities: Introduction to the Webinar Series, and Improving Patient Safety in Long-Term Care Facilities: Detecting Change in a Resident s Condition are available on demand for CE and have no registration fee. The courses can be accessed at: http://ce.ahrq.gov/nurses/ The Instructor Guide can be found at: http://www.ahrq.gov/professionals/systems/long-termcare/resources/facilities/ptsafety/ltcinstructor.html. A PDF version of the Instructor Guide can be downloaded and printed by clicking on the download button at the top of the page. The Instructor Guide comprises all three modules, including suggested slides, pretests, and posttests to gauge the student's knowledge level before and after training. Separate Student Workbooks are available for each module. Ordering Information Printed copies of the Instructor Guide and student modules can be ordered separately or as a set from the AHRQ Publications Clearinghouse. To request copies of the printed materials, send an e-mail to the AHRQ Publications Clearinghouse at AHRQPubs@ahrq.hhs.gov or call 1-800-358-9295. Be sure to specify the AHRQ Publication number when ordering. Instructor Materials The 96-page Instructor Guide can be ordered separately or as a complete set that includes one copy of the Instructor Guide and one copy each of the Student Workbooks for Modules 1, 2, and 3. Single copies are free; charges may apply for additional quantities and for shipping to addresses outside the United States. There are no copyright issues with this material. You may print additional copies from the Web site if you want to avoid the charges associated with ordering multiple copies. Instructor Guide, 96 pp. (AHRQ publication no. 12-0001-1) (describes how to use the materials in the Student Workbooks as a teaching session, including suggested slides, pretests, and posttests to gauge the student's knowledge level before and after training). Instructor Set (AHRQ Publication no. 12-0001) (includes one instructor guide and one copy each of the three Student Workbooks). 1
Student Materials Separate Student Workbooks are available for each module. The workbooks can also be ordered separately or as a Student Workbook set. Copies of the Student Workbooks are also included in the Instructor Set. There is no charge for single copies; charges may apply for additional quantities and for shipping to addresses outside the United States. Module 1. Detecting Change in a Resident's Condition: Student Workbook, 20 pp (AHRQ Publication No. 12-0001-2). Available to download at: http://www.ahrq.gov/professionals/systems/long-termcare/resources/facilities/ptsafety/ltcmodule1.html Module 2. Communicating Change in a Resident's Condition: Student Workbook, 19 pp (AHRQ Publication No. 12-0001-3). Available to download at: http://www.ahrq.gov/professionals/systems/long-termcare/resources/facilities/ptsafety/ltcmodule2.html Module 3. Falls Prevention and Management: Student Workbook, 19 pp (AHRQ Publication No. 12-0001-4). Available to download at: http://www.ahrq.gov/professionals/systems/long-termcare/resources/facilities/ptsafety/ltcmodule3.html Student Workbook Set (includes one copy each of the Student Workbooks for the three-module set) (AHRQ Publication No. 12-0001-5). 2
Improving Patient Safety in Long- Term Care Facilities: Communicating Change in a Resident s Condition Marian Edmiston, DEd, MSN, RN-BC Recorded Version AHRQ http://ce.ahrq.gov/nurses/ National Gerontological Nursing Association http://www.ngna.org/ National Association of Directors of Nursing Administration in Long-Term Care https://www.nadona.org/ 2 1
Disclosures This Webinar has been funded and developed by the Agency for Healthcare Research and Quality (AHRQ); there has been no outside commercial support. Presenter(s)/staff have no conflicts of interest or relevant financial relationships to disclose. 3 Requirements for Successful Completion, CE Be present for the entire Webinar. Complete an online evaluation. Pass the posttest with a grade of 80% or higher. Complete and submit the evaluation/ posttest within 30 days of the Webinar. 4 2
Designation Statements The following Continuing Education (CE) credits will be available to participants of the live Webinar. The American Association of Nurse Practitioners (AANP) designates this education activity for a maximum of 1 contact hour. The Arizona Nurses Association (AzNA) designates this education activity for a maximum of 1 contact hour. The Commission for Case Manager Certification (CCMC) designates this continuing education activity for a maximum of 1 clock hour. 5 Accreditation Statements This program was planned in accordance with American Association of Nurse Practitioners (AANP) CE Standards and Policies and AANP Commercial Support Standards. This program has been approved by the Commission for Case Manager Certification to provide CE credit to Certified Case Managers (CCMs). This continuing nursing education activity was approved by AzNA, an accredited approver by the American Nurses Credentialing Center (ANCC) Commission on Accreditation. Accreditation refers to recognition of continuing nursing education only and does not imply AANP, AzNA, or ANCC Commission on Accreditation approval or endorsement of any commercial products discussed or displayed in conjunction with this educational activity. 6 3
Introduction Priscilla Novak, MPH Health Communications Specialist AHRQ 7 Agency for Healthcare Research and Quality (AHRQ) 8 4
Scope of Webinar Module 2: Communicating Change in a Resident's s Condition How to communicate changes How to overcome barriers 9 Improving Patient Safety in Long- Term Care Facilities: Module 2: Communicating Change in a Resident s Condition Marian Edmiston, DEd, MSN, RN-BC 5
Learning Purpose The goal of this Webinar is to provide nurse administrators and nurse educators guidance on training using the materials covered in AHRQ s Improving Patient Safety in Long-Term Care Facilities Instructor Guide. 11 Webinar Objectives At the end of this presentation, participants will be able to: 1. Utilize effective engagement strategies to present an audience-appropriate training program for nursing assistants, licensed nurses, and other staff. 2. Utilize the AHRQ Patient Care training resources to train staff in how to communicate changes in a resident s condition. 3. Present relevant case studies as examples of how best to communicate change in a resident s condition. 12 6
Module 2: Communicating Change in a Resident s Condition Available Teaching Materials Online Materials Instructor Guide Student Workbook Additional Materials Today Student slide deck 13 Introduction Effective communication is an essential step in improving patient safety improving patient safety 14 7
What Staff Need to Know Why communicating changes in a resident's condition is an important safety issue. Key principles of effective communication. Barriers to effective communication. What should be communicated about changes in a resident s condition. How should information be communicated. Early Warning Tool SBAR CUS 15 A Safe Environment Effectively communicating change in a resident s condition is critical to patient safety. 16 8
Case Study #1 17 Ms. Malone 18 9
Creating a Safe Environment Reporting changes helps keep resident s safe. Learning and experience are what make safety possible. Openly reporting anything that might affect a resident s well-being is essential for a safe environment. Change in a resident s condition should be reported openly whenever it happens. 19 Key Principles of Effective Communication Teamwork Open reporting Reporting unwanted events Giving and receiving information 20 10
Teamwork Report change across the care team care team. Work together to identify what the change may mean. Take action as a team. 21 Open Reporting Put procedures in place that allow and encourage staff to report resident change openly, whenever it happens. 22 11
Reporting Unwanted Events Staff need to: Learn to communicate promptly and openly when something happens that might affect a resident s wellbeing. Move beyond blaming anyone to being able to openly share experiences. Show they care by speaking up. 23 Giving and Receiving Information Staff must: Express information in a way that t will be understood by others. Hear information as it is being reported. Make effective use both of verbal and nonverbal communication skills. 24 12
Barriers to Communication Gender Age/generation Language Culture Status Interpersonal issues System barriers 25 Case Study #2 26 13
Case Study #2 Mrs. Brown 27 Case #2 Min-Wa and Susan 28 14
Case Study #2 Observations 29 What Should Be Communicated? Physical changes Walking Urination/bowel patterns Skin quality Level of weakness Falls Vital signs Nonphysical changes Demeanor Appetite Sleep Confusion Agitation Pain Relevant external factors 30 15
How Should Information Be Communicated? Reporting and communication tools: Early Warning Tool SBAR CUS 31 Stop and Watch Early Warning Tool 32 16
SBAR Tool SBAR: http://interact2.net/docs/interact%20version%203.0%20tools/communication%20tools/ Communication%20Within%20the%20Nursing%20Home/INTERACT%20SBAR%20Form% 20v8%20Jan%2014%202013.pdf 33 Case Study #3 34 17
Case Study #3 Mr. Harris 35 Case #3 Observations, Day 4 36 18
Case Study #4 37 Case Study #4 Change-of-Shift Meeting (Min-Wa) 38 19
The CUS Tool I am Concerned about my resident ss condition. I am Uncomfortable with my resident s condition. I believe the Safety of the resident is at risk. 39 Principles in Action CUS: Min-Wa to RN Team Leader I'm Im concerned about Mr. Harris. I m uncomfortable that his temperature is up and that he has developed diarrhea. I believe that he might be developing an infection that should be treated. 40 20
Case Study #5 41 Case Study #5: Mrs. Carver February 2012 March 2014 42 21
Case Study #5: Mrs. Carver April 1, 2014 43 Case Study #5: Mrs. Carver April 2, 2014 44 22
Group Discussion How can this case study help your staff understand the importance of observing and communicating change? How does this case study emphasize that change can be communicated from many different sources? At what point in this case did a change from baseline signal an important t change? What tools can help staff members overcome their barriers to communication? 45 Key Points Communicate changes promptly. Reports of change can come from many sources. Every team member is responsible for reporting changes. Everyone faces barriers to communication. Tools to break down barriers. 46 23
Questions? 47 Remember! This is the third of a four-part series of Webinars. Final Webinar in the series: Falls Prevention and Management Wednesday, August 13, 2014 / 1:00 PM 2:00 PM (ET) Technical assistance call on July 30, 2014, 1:00 PM 2:00 PM (ET). Toll-Free: 1-866-901-6455 Access Code: 172-123-792 48 24
Wrap-Up To obtain credit: Complete an online evaluation. Pass the posttest with a grade of 80% or higher. Complete and submit the evaluation/posttest within 30 days of the Webinar. 49 Wrap-Up cont. Request for volunteers for follow-up If you have any questions or problems, please contact us at: educationservices@hayesinc.com Phone: 267-498-7926 50 25
Improving Patient Safety in Long-Term Care Facilities: Communicating Change in a Resident s Condition Live Webinar: 1. Q: Please define the acronyms presented. Questions & Answers A: The tools and acronyms presented during the live Webinar included the following: STOP AND WATCH: Seems different than usual Talks or communicates less Overall needs more help Pain new or worsening; participates less in activities Ate less No bowel movement in 3 days; or diarrhea Drank less Weight loss Agitated or nervous more than usual Tired, weak, confused, or drowsy Change in skin color or condition Help with walking, transferring, or toileting more than usual SBAR: Situational Background Assessment Request CUS: I am Concerned about my resident's condition. I am Uncomfortable with my resident's condition. I believe the Safety of the resident is at risk. 2. Q: I am wondering how many of the nurses on this webinar are aware of AMDA's Know-it-All- Before-you-Call data collection tools. These are a very easy way for front-line staff to not only observe a new change of condition, but learn how and what to observe and report. It is a great tool for reducing avoidable transitions. A: The Know-it-All-Before-you-Call tools are from the Society for Post-Acute and Long-Term Care Medicine (AMDA) and can be found at: http://www.amda.com/tools/kia.cfm#know. There appears to be a cost for ordering the tools. 1
Improving Patient Safety in Long-Term Care Facilities: Communicating Change in a Resident s Condition Live Webinar: 3. A comment from one of the participants referred to AHRQ s TeamSTEPPS tools. TeamSTEPPS is a teamwork system designed for healthcare professionals that is: A powerful solution to improving patient safety within your organization. An evidence-based teamwork system to improve communication and teamwork skills among health care professionals. A source for ready-to-use materials and a training curriculum to successfully integrate teamwork principles into all areas of your healthcare system. Scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles. Developed by Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality. TeamSTEPPS provides higher quality, safer patient care by: Producing highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients. Increasing team awareness and clarifying team roles and responsibilities. Resolving conflicts and improving information sharing. Eliminating barriers to quality and safety. TeamSTEPPS has a three-phased process aimed at creating and sustaining a culture of safety with: A pretraining assessment for site readiness. Training for onsite trainers and healthcare staff. Implementation and sustainment. The TeamSTEPPS curriculum is an easy-to-use comprehensive multimedia kit that contains: Fundamentals modules in text and presentation format. A pocket guide that corresponds with the essentials version of the course. Video vignettes to illustrate key concepts. Workshop materials, including a supporting CD and DVD, on change management, coaching, and implementation. Team STEPPS can be accessed at: http://teamstepps.ahrq.gov/. 2