Presentation on theme: "INTERACT Boot Camp Communication Tools"— Presentation transcript:
1 INTERACT Boot Camp Communication Tools August 2013
2 Welcome BackIntroduce yourselves and share what you learned from reviewing your readmission data.
3 NC ACE: INTERACT BOOT CAMP Year long commitment to work on perfecting your Performance Improvement ProjectBoot CampCommunication ToolsDecision Support ToolsAdvanced Care PlanningYou are HereBuilding your QI ProgramNov.Jan.PDSA,Monitor Data,SpreadMonitorData,Outcomes CongressApril
4 Rolling outcommunicationtoolsINTERACT as QI programINTERACT Championis part of theQAPI CommitteeFocus on data,PDSA cycles
5 Where are you in the INTERACT implementation process? Polling QuestionWhere are you in the INTERACT implementation process?Have not started yetCreated plan to implement INTERACT with leadershipStarted using INTERACT implementation checklistReviewed last 3 months of readmissionsCompleting QI summary monthlyUsing Hospitalization Rate Tracking Tool
6 Open DiscussionShare success, challenges, barriers, or solutions you have encountered in the last 3 months of your INTERACT work.
9 Tips for Hardwiring your Data Look at your processand outcome measuresHave Admissions enter the resident info dailyReview every morning during standupRun monthly reports and share with leadership and staffDiscuss readmissionsFindings from QI Review ToolShare monthly findings from Summary Tool
10 Polling QuestionWhat is the most common driver of readmission based on your QI Summary?Delay in identifying change in conditionLack of evaluation before calling physicianPhysician insistence on transferResident family expectationsCommunication problems between nurses, or between nurses and primary care cliniciansServices needed are not availableDelay in advanced care planningOther
11 Actions for Next 3 Months Ongoing monitoring of dataPrioritize areas for improvementDevelop your SMART goalAssess your plan of action and make adjustments
12 Staff Education/Communication Share your data at staff meeting:Post your timeline on bulletin boards.Have staff share “Bright Ideas” on implementation.Discuss rollout at staff meeting.Select key staff to be champions.Begin on one unit and spread.
13 INTERACT Program Components Putting the Tools to Work in Everyday PracticeCommunication ToolsDecision Support ToolsAdvanced Care Planning ToolsQI Tools
14 What This Session Will Cover Review use of STOP and WATCH and SBARImplementation strategiesCommon barriers and lessons learnedProblem solving for success14
16 Polling QuestionWho has been trained and is now completing the STOP and WATCH tool on a regular basis in your facility?CNAs and nursesAll non-nursing staff with direct resident contactFamily and close friends with regular direct contact1 and 2All of the above
17 STOP and WATCH Seems different Talks or communicates less Communication ToolsSTOP and WATCHSeems differentNot their usual self? Change in personality or behavior?Talks or communicates lessQuieter? Drowsier? Confused? Change in speech?Overall needs more helpNeeds more assistance? Changes in gait, transfer or balance?Participated in activities lessWithdrawn? Decline in ADLs? Change in normal routine?Pain level increased17
18 AND Ate less than usual (Not because of dislike of food) No bowel movement in 3 days or diarrheaDrank less than usual18
19 WATCH Weight gain or loss Agitated or nervous Tired, weak, confused, or drowsyChange in skin color or conditionHelp with walking, transferring, or toileting more than usual19
20 Part of Daily Routine Keep the pocket card with you at all times. Make it a part of your normal routine.Complete the Stop and Watch form during your shiftbefore you leave.Give the Stop and Watch form to the nurse taking careof resident.20
21 Implementation Where will forms be located? Which nurse will direct care staff give the tool to?How will the nurse receiving the tool respond back tothe person giving it?4. How will the nurse document resident follow-up andactions taken?Where will the forms go after follow-up is complete?Does it need to be electronic?21
22 Common Barriers to Communicating Early Changes in Residents Unit nurses are busygiving medications,taking physicianorders, and admittingnew residentsCNAs are very busygiving direct careStop and Watchcan helpclose the gap!22
23 Common BarriersWhy can’t I just tell the nurse? I don’t want to write it.Too many forms and too much paper.Not sure where to keep them.Not all units are consistent.Staff are not always compliant.Need other languages.Hard to get all nurses on board.
24 Ways to Monitor and Improve Use Clinical champion and/or DONMonitorWho completes tool?Who the tool is reported to?Action taken by the nurseDocumentationFinal outcomeComputerized summary or paper flowDaily, weekly, monthly
25 Suggestions from the Field Print on carbon paper.Keep forms handy, near linen room and time clock.Duplicate copy goes to DON who follows up with nurse.Fine tune it to facility needs.Make CNAs more aware.Incorporate into EHR.Emphasize benefit of written proof that CNA reported change.
26 Suggestions from the Field Monthly drawing for person using most S&WBulletin board to recognize CNAs who use itNurses need to encourage CNAs to use toolAutomatically goes to nurses’ electronic dashboard.Embed in new employee orientation and all in-services.Monthly meeting with CNAs.
27 Use QAPI to Get Started Planning for PDSA Select one unit. Make 25 copies of Stop and Watch for use.Laminate a copy for each CNA on the unit so that it fits easily into pocket.Make blank copies and put within easy access for all direct care staff.Ask lead CNAs and key nurses to teach all direct care staff and nurses working on the unit how to use the tool.Your facility’s project champion is responsible for coordinating INTERACT implementation. She or he may ask you to complete specific activities.Suggested activities include:Select one unit.Make 25 copies of the Stop and Watch tool. See the INTERACT website to print a copy. Go to Click on INTERACT Tools, Click on “Early Warning Tool”Laminate a copy for each CNA on the unit so that it fits easily into a pocket and can be used for easy reference.Make blank copies and put within easy access for all direct care staff.Ask lead CNAs and key nurses to teach all frontline staff and nurses working on the unit how to use the tool.Try using the Stop and Watch for a week. Track its use as suggested. Meet with staff to discuss how it was used, what barriers arose, and ways to improve. How many times a shift was the tool used? How did the nurses respond? Try again for another week and continue to identify areas of success as well as those that need improvement.27
28 STOP and WATCH PDSA D – Implement on unit S – Data to collect: Number of times tool is usedFlow of tool use and responsesStaff input about barriers and what is workingA – Huddle with staffWhat needs to be modified?If no modification, then spread to other shifts and then facility wide
29 Polling QuestionWhat type of training has been most helpful in training nurses to use SBAR in your facility?In-person group training1:1 trainingOnline trainingUnit-based trainingAll of the aboveOther
30 Polling QuestionWhat percentage of nurses complete the SBAR successfully in your facility?10% or less25%50%75%100%
31 Assessment/Appearance Request Communication ToolsSBAR ToolSituationBackgroundAssessment/AppearanceRequest
32 SBAR: More than one purpose Communication toolContact MD/NPChange of shift reportMorning meeting/huddle/change of status meetingDocumentation toolProgress noteTransfer note to send to EDEducational toolJust in time and scheduled in-service
33 Barriers It is too long. Not all MDs like it. If you suggest an intervention and it is not done, facility is liable.Overwhelming for nurses without good clinical assessment skills.Time and frustrationNurses are not trained for this.
34 Suggestions from the Field Education, education, education (nurses and physicians)Adapt it to facility needs.Fax it to MD who may fax it back or use telephone order.Review in weekly nurse meetings.Changed “request” to “response.”Instruct MDs and NPs to ask nurse to complete SBAR.Ask MDs and NPs to show gratitude for improved communication due to SBAR.
35 Suggestions from the Field Tie use to prevention of hospital transfer and reward staff for successful prevention of transfer.Supervisor reviews SBAR and goes over it with nurse.Incorporate into EHR.Use SBAR in interdisciplinary team resident reviews as the “nurses note.”Use SBAR as first step in QI Review Tool.
36 Use QAPI to Get Started PDSA P – Nurse input, current process, eliminate duplication, train staff, involve MDand NP, design accountability, adjust or modify based on inputD –Begin with smaller group or unit, reinforce in daily huddle, continue to trainas needed, use in team meeting reviewS – Data to collect:Number of times tool is usedNumber of times hospital transfer avertedNurse and physician inputA – What is working? What needs tobe modified? If no modification,then spread to other shifts or units.
37 Medication Reconciliation Receive Admission Med from FL2Nurse completes reviewFax Med List to MDFax list to pharmacyNurse completes MARMD approves listMeds delivered by pharmacyNurse checks medsPlace in med cartMakes adjustmentsClarify ordersClarify ordersVerify any discrepancies
38 Where do most of your medication errors occur? Polling QuestionWhere do most of your medication errors occur?Upon admission with FL2MD clarificationTranscriptionPharmacy reviewPharmacy fillAdministrationAdverse reaction
39 How to Roll Out INTERACT QI Program QAPI Leadership TeamINTERACTMed RecTool Implementation
40 Communication with Hospital What have you accomplished in last 3 months?Shared Nursing Home Capability ListMet with hospital and discussed readmissionShared potential goals you could work onParticipating in coalition with other LTC and hospital
41 Call to Action Next 3 months Work on hardwiring Stop and Watch and SBARMonitor process and modify as neededReview medication errors with nursing and pharmacyContinue communication with hospital
42 Thank you!This material was prepared by The Carolinas Center for Medical Excellence (CCME), the Medicare Quality Improvement Organization for North and South Carolina, 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. 10SOW-BI-C