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INTERACT Curriculum “Stop and Watch”

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Presentation on theme: "INTERACT Curriculum “Stop and Watch”"— Presentation transcript:

1 INTERACT Curriculum “Stop and Watch”
Session 3 EARLY WARNING TOOL “Stop and Watch” Jo A. Taylor, RN, MPH Care Improvement Specialist The Carolinas Center for Medical Excellence Welcome to the third educational session on the INTERACT program. This is the 3rd of 12 sessions. Next slide The development and evaluation of the INTERACT quality improvement program and Curriculum are supported by grants from the Retirement Research Foundation and The Commonwealth Fund 1

2 INTERACT Curriculum Before You Begin
Session 3 Before You Begin Download and print the Early Warning Tool, “Stop and Watch” from the INTERACT II website Go to Click on INTERACT Tools Click on “Early Warning Tool” Note to instructor: Before you begin, please download and provide copies of the Early Warning Tool, “Stop and Watch,” to all participants. This is easily done from the INTERACT website, Click on INTERACT tools, then click on Early Warning Tool and print. Next slide 2

3 INTERACT Curriculum Session 3
If you are participating in a teleconference proceed to the next slide for instructions If you are reviewing this session as a self-learning activity: Proceed to slide # 4 Click the speaker at the bottom of each slide to listen to the audio If you do not have audio, click on “View” on the toolbar, and select “Normal” to view the text below each slide – if necessary select “Zoom” to make all of the slide and text visible. There are no notes for this slide Next slide

4 Early Warning Tool: “Stop and Watch”
Teleconference Instructions Call in Number Conference Code # To un-mute your line to ask questions: Press # 6 After asking your question (s) re-mute your line: Press * 6 There are no notes for this slide Next slide If the leader is not on the call when you call in, please wait

5 Early Warning Tool: “Stop and Watch”
This session is for: Project champion and co-champion DON Key RNs Key LPNs Lead CNAs Early Warning Tool “Stop and Watch” The audience for this third session should include the project champion and co-champion and a selection of key staff who have direct contact with the resident on a daily basis. This includes lead CNAs and key RNs and LPNs who work on the unit and supervise direct care workers. It also includes those nurses who are responsible for communicating resident changes to physicians, nurse practitioners and physician assistants. Next slide

6 Early Warning Tool: “Stop and Watch”
Jo Taylor RN, MPH is a care improvement specialist at the Carolinas Center for Medical Excellence, the quality improvement organization for North and South Carolina. She has 20 years experience developing and implementing quality improvement programs for frontline, management and administrative staff in long term care. Her areas of research include pain management, falls management, restraint reduction, behavior management and improving CNA retention. I am Jo Taylor. I am a nurse who has worked the past 20 years to improve the quality of long term care through partnerships with over 350 nursing homes across the country during formal research projects as well as regional and national programs. In this capacity I have developed and delivered over 1000 inservices to nursing home staff in the area sof falls management, improving pain management, restraint elimination and the management of behaviors related to dementia. I have also helped develop a program to empower frontline staff and reduce CNA turnover. I am aware of the critical role frontline staff have in improving the care of residents and preventing unnecessary hospitalizations. I am proud to say that as a teenager, I first began my career as a nursing assistant. Next slide

7 Early Warning Tool: “Stop and Watch”
The INTERACT Interdisciplinary Team Joe Ouslander, MD Florida Atlantic University Laurie Herndon, GNP Mass Senior Care Foundation Gerri Lamb, PhD, RN, FAAN Arizona State University Ruth Tappen, EdD, RN, FAAN Florida Atlantic University Sanya Diaz, MD Florida Atlantic University John Schnelle, PhD Vanderbilt University Sandra Simmons, PhD Vanderbilt University Annie Rahman, MSW Miami University Jo Taylor, RN, MPH The Carolinas Center for Medical Excellence Alice Bonner, PhD, GNP Center for Medicare and Medicaid Services The INTERACT program team, listed on this slide, is interdisciplinary, and includes advanced practice nurses, physicians, an individual with a social work background, and psychologists. This team has worked together on many educational projects related to INTERACT and other topics in long-term care over the past several years. You will get to interact with several members of the team during the course of this curriculum. Your facility is one of several from many different states that is participating in the evaluation of this curriculum, and our team thanks you for joining us in this project. Next slide In collaboration with participating nursing homes

8 Early Warning Tool: “Stop and Watch”
Pre-Session #3 Quiz Please complete the Pre-Session Quiz If you take the Quiz in a paper and pencil format, please make sure your facility champion or co-champion gets a copy If you are reviewing this session on-line, you can take the on-line Quiz, or take the Quiz using a hard copy obtained from your facility champion or co-champion, and return it to them Before moving forward with the rest of the session, we want you to complete a pre-session quiz. This should take no longer than 3-5 minutes. Written documentation of completion of the pre-session and post-session quizzes will be required for those applying for CEUs. The project champion or co-champion is responsible for providing our team with the documentation so that we can process the CEUs, so make sure they receive a hard copy of your quizzes. Next slide

9 Early Warning Tool: “Stop and Watch”
Objectives Describe the purpose of the Early Warning Tool, “Stop and Watch” Identify who uses the tool to improve resident care List the primary changes in resident condition the tool helps frontline staff to identify and report to the nurse In this third session we will describe the purpose of the Early Warning Tool, “Stop and Watch.” We will identify who should use the tool on a daily basis. We will review the primary changes in the resident’s condition which the tool helps direct care workers to identify and report to the nurse. Next slide 9

10 Purpose of “Stop and Watch”
Early Warning Tool: “Stop and Watch” Purpose of “Stop and Watch” To guide frontline staff through a brief review of early changes in the resident’s condition To improve communication between frontline staff and the nurse in charge The purpose of the Early Warning tool is to guide frontline staff through a list of those early changes in the resident’s condition which should be reported. In addition, this tool will help to improve communication between frontline staff and the nurse in charge. Next slide 10

11 Early Warning Tool: “Stop and Watch” Purpose of “Stop and Watch”
To improve the quality of care for residents To prevent unnecessary transfers to hospital The final positive outcome of using the “Stop and Watch” tool is to improve the quality of care for your residents while preventing unnecessary transfers to the hospital. When frontline staff communicate early changes in a resident’s condition and the proper steps are taken to treat the resident in the nursing home, visits to the Emergency Department and hospital admissions can sometimes be prevented. This means the resident doesn’t experience the trauma of leaving the facility and being exposed to all of the risks associated with a hospitalization. We all know what it is like to get a resident back from the hospital in worse shape than when they left because of a fall or side effects from medications or restraint use! Next slide 11

12 Stop and Watch helps frontline staff identify important changes in the resident’s condition
Who is frontline staff? CNA’s and other nursing staff, therapists, dietary staff, housekeeping staff, activities staff and any staff member with direct resident contact It is important to be clear about who uses the “Stop and Watch” tool, It is designed for daily use by the CNA, therapist, dietary staff, housekeeping staff, activities staff and any staff member who has direct contact with the resident on a regular basis. Most often this tool will be used by the CNA but others may use it as well. Next slide 12

13 What early changes in condition should be reported?
Early Warning Tool: “Stop and Watch” What early changes in condition should be reported? Changes in mental status – sleepy, confused, agitated, anxious Changes in physical status – problems with walking, transferring Changes in function – problems with ADL’s Changes in behavior – wandering, combative, yelling, verbal or physical aggression Changes in pain level What to report are changes in the resident’s condition including: Changes in mental status, for example increased sleepiness, confusion, agitation, or anxiety. Remember that increasing confusion can be a sign of a new acute condition such as infection or worsening of a chronic condition such as chronic lung disease or heart failure. Changes in physical status such as problems with walking or transferring Changes in function which include any new or different problems with the resident’s activities of daily living such as their ability to participate in AM or PM care as well as their participation at mealtime Changes in behavior such as new or different patterns of wandering, combativeness, yelling, and verbal or physical aggression Changes in pain level such as a new occurrence of pain when there was previously none or a significant increase in pain level from the usual Next slide 13

14 the resident’s condition
Stop and Watch is the primary method for CNAs to alert the LPN/RN of changes in the resident’s condition AND for the nurse to hear what the CNA has to say. Here is how the “Stop and Watch” Tool fits into the overall INTERACT Program. It is the primary (and most important!) link between the resident and taking action. As you can see on this diagram, without effective communication using the “Stop and Watch” tool, nothing else can happen. It is the critical link in the chain of action to prevent unnecessary hospitalizations. Next slide

15 Early Warning Tool: “Stop and Watch”
In Summary Important changes to report are: Actions or behaviors that are not part of the resident’s normal routine A change from the resident’s baseline To summarize, the CNA and other frontline staff should report actions or behaviors that are not part of the resident’s normal routine and are a move away from the resident’s baseline behavior. Of course there is a balance. We don’t want to report every little thing, but on the other hand we don’t want to miss important changes. It takes practice to know what to report. The most important part is knowing the resident’s baseline, their normal activity level and usual mental status. We must know the resident very well before we can determine what is a change. Observe closely. You may need to ask others who have more knowledge of the resident. Of course, if the change is an improvement for the better such as decreased pain, we would report these desirable changes to the nurse but not use the “Stop and Watch” Tool. “Stop and Watch” is designed to alert staff to those changes which signal a new condition or worsening of an existing one. Next slide 15

16 Early Warning Tool: “Stop and Watch”
Your Eyes Are the Best Frontline staff: Know the resident best See changes in condition first Should identify important changes in the resident’s condition during their normal care routine Must be empowered to communicate what they know and see Observing for change should be done throughout the day during your normal routine of providing care. This means observing when you first see your resident, during AM or PM care, at meals, during toileting, at activities, during naps or bedtime - all through the shift. Most frontline staff already make these kinds of observations and many report them regularly. Sometimes a break in the chain comes when the CNA has something to report but no one to listen to them. Depending upon the culture of your nursing home, communication can be tough not only between staff on the same shift but between different shifts as well. So frontline staff need to have the skills to observe and correctly identify early changes in the resident’s condition and be empowered to communicate these changes to the nurse. The “Stop and Watch” tool helps you do this. Next slide 16

17 “Stop and Watch” is a great way to communicate changes
Early Warning Tool: “Stop and Watch” “Stop and Watch” is a great way to communicate changes It helps … You know what kinds of changes to report The nurse understand what you have to say is important and when to take action The “Stop and Watch” Tool helps you know what kinds of changes are important to report and because it is a written document, it helps the nurse understand that what you have to say is important and when action is needed. Next slide 17

18 When to Use “Stop and Watch”
Early Warning Tool: “Stop and Watch” When to Use “Stop and Watch” During or at the end of every shift Make it a part of your normal routine Waiting to report a change in your resident’s condition may have serious results! Use the “Stop and Watch” tool as part of your normal routine and complete it during your shift when you have changes to report. Don’t wait to report a change in your resident’s condition until the next day. It may be too late and the resident may have gotten much sicker as a result of your waiting. Remember, the “Stop and Watch” tool helps you to give better care. Next slide 18

19 Early Warning Tool: “Stop and Watch”
Unit nurses are busy giving medications and taking physician orders CNA’s are busy giving direct care “Stop and Watch” reporting can help close the gap! We know that often unit nurses are very busy passing medications several times a shift and taking physician orders and giving treatments and so on. It is also true that CNAs who care for large numbers of residents are very busy and sometimes do not take the time to communicate changes because they can barely get basic care done before they go home. The “Stop and Watch” Tool is a way to fix that broken pattern of communication. It helps CNAs report what should be reported and it helps nurses know how and when to listen. Next slide 19

20 Instructions for “Stop and Watch”
Early Warning Tool: “Stop and Watch” Instructions for “Stop and Watch” If you have identified an important change while caring for a resident today, please circle the change and discuss it with the charge nurse before the end of your shift. More than one change may be marked on the same form Name of Resident ____________________ Let’s review the actual tool itself. If you have identified an important change while caring for a resident today, please circle the change and discuss it with the charge nurse before the end of your shift. More than one change may be marked on the same form. Remember, you do not need more than one form per resident. Just mark more than one change on the same form. First write, Name of Resident ____________________ Next slide 20

21 STOP Seems different than usual Talks or communicates less than usual
Not their usual self? Change in personality or behavior? Talks or communicates less than usual Quieter? Drowsier? Confused? Altered speech? Overall needs more help than usual Needs more assistance? Changes in gait, transfer or balance? Participated in activities less than usual Withdrawn? Decline in ADL’s? Change in normal routine? These are the changes you might circle for your resident. Seems different than usual Not their usual self? Change in personality or behavior? Talks or communicates less than usual Quieter? Drowsier? Confused? Altered speech? Overall needs more help than usual Needs more assistance? Changes in gait, transfer or balance? Participated in activities less than usual Withdrawn? Decline in ADL’s? Change in normal routine? Next slide 21

22 AND Ate less than usual N Drank less than usual
(Not because of dislike of food) N Drank less than usual The next word AND stand for the following resident changes: Ate less than usual (Not because of dislike of food) N Drank less than usual Next slide 22

23 WATCH Weight change Agitated or nervous more than usual
Tired, weak, confused or drowsy Change in skin color or condition Help with walking, transferring, toileting more than usual The third word, WATCH, includes the following resident changes: Weight change Agitated or nervous more than usual Tired, weak, confused or drowsy Change in skin color or condition Help with walking, transferring, toileting more than usual Next slide 23

24 Instructions: “Stop and Watch”
Early Warning Tool: “Stop and Watch” Instructions: “Stop and Watch” Staff ____________________________ Reported to ______________________ Date __/__/__ Time ____________ After circling the change or changes which you have observed in your resident, write your name, the nurse’s name you reported to, the date, and time. Next slide 24

25 Early Warning Tool: “Stop and Watch”
Please wait while the video is showing There is no audio for this slide If you have a computer that is capable of playing video, please click as indicated to view the video clip that illustrates these points Scenario for the video 1. Not using the “Stop and Watch Tool” A CNA notices one of her residents becoming more confused throughout the day. She knows this is not a normal pattern for this resident. She reports this to the LPN during a busy med pass. The nurse says she doesn’t have time and to just keep watching the resident. She has a “don’t bother me” attitude. She says that she will get to it when she can. She forgets because there is a new admission and the CNA does not follow up and leaves for the day without reporting it again. The next morning at report the CNA hears from another that the resident was taken to the Emergency Department of the local hospital because of worsening confusion related to delirium secondary to a urinary tract infection. Using the “Stop and Watch” Tool The CNA notices her resident becoming more confused throughout the day which is not a normal pattern for this resident. She completes the “Stop and Watch” Tool circling the following two symptoms: Seems different than usual Tired, weak, confused or drowsy The CNA hands the completed form to the nurse after her mid-day med pass. The LPN looks at it, says thank you, reassures the CNA that she will follow-up, and then gives it to the RN supervisor when she goes into the station to do her charting and complete the paperwork for the new admission. The RN supervisor checks the resident’s chart and MAR and then goes in to see the resident to complete an assessment and determine the proper course of action. Next slide 25

26 How to Implement “Stop and Watch” in Your Nursing Home
Early Warning Tool: “Stop and Watch” How to Implement “Stop and Watch” in Your Nursing Home Keep the pocket card with you at all times Complete the “Stop and Watch” form during or at the end of the shift before you leave Give the “Stop and Watch” form to the nurse taking care of your resident There are just three basic rules when using the “Stop and Watch” tool. First, your facility may make the “Stop and Watch” Tool into a pocket card which you can keep with you at all times. The idea is that you should have at least one copy with you in a pocket for easy reference. Other blank copies of the “Stop and Watch” tool can be kept at the station or any place where they are easy to find and complete. Second, complete the form at the time you notice a change in the resident’s condition, that is, during or at the end of your shift. Remember, do not wait. Third, give the form to the nurse taking care of your resident. Next slide 26

27 INTERACT Implementation Assignment
Your facility’s project champion is responsible for coordinating INTERACT implementation. She or he may ask you to complete specific activities before the next teleconference or before you review the next session on-line. Suggested implementation activities before the next session: 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 a pocket and can be used for easy reference. Ask lead CNAs and key nurses to teach all frontline 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 before the next teleconference or before you review the next session on-line. The Interact implementation assignment for this session includes the following activities: Select one unit. You may want to select the unit that has the most staff at this training session. 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. Ask lead CNAs and key nurses to teach all frontline staff and nurses working on the unit how to use the tool. Next slide 27

28 INTERACT Implementation Assignment
Use the tool for one week Note how many times it was used and consequences of use Note ease of use and any breaks in communication Hold a second teaching session with unit staff to review results Plan for spread to other units when barriers have been resolved Use the tool for one week. Note how many times it was used and consequences of use. Note ease of use and any breaks in communication. Pay careful attention to the communication between the charge nurse and frontline staff. Answer these questions: Are the CNAs over or under utilizing the tool? Are the nurses listening and reporting the changes? Are the nurses taking time for a comprehensive assessment? Hold a second teaching session with unit staff to review the results and problem solve about any barriers. Plan for spreading use of the tool to other units when barriers have been resolved. Next slide 28

29 Early Warning Tool: “Stop and Watch”
For teleconference participants: Questions, Suggestions, Comments? Un-mute the line: Press # 6 Please re-mute your line after talking: Press * 6 Questions and suggestions on Session 3 can also be directed to Dr. Ouslander by at: Please insert in the Subject Line: “Question about the INTERACT Curriculum” For teleconference participants, follow the instructions on this slide to ask questions. For all participants, you can address questions about this session directly to Dr. Ouslander at the address shown. Please put “Questions about the INTERACT Curriculum” in the Subject Line. Next slide

30 Early Warning Tool: “Stop and Watch”
The Next Session The topic and participants are listed below For teleconference participants, check the date and time for the next session Session 4: SBAR Champion DON Key RNs and LPNs Medical Director Key MDs, NPs/PAs The topic of Session Four is SBAR. Participants for this session include the champion; co-champion; director of nursing; medical director; key physicians, nurse practitioners, and physician assistants; and key RNs and LPNs. Next slide

31 Early Warning Tool: “Stop and Watch”
Post-Session #3 Quiz and Evaluation Please complete the Post-Session Quiz and Evaluation If you take the Quiz and complete the Evaluation in a paper and pencil format, please make sure your facility champion or co-champion gets a copy If you are reviewing this session on-line, you can take the on-line Quiz and complete the evaluation on-line Before leaving the room after the teleconference, or logging off the website, please take the Post Session Quiz and complete the Evaluation. If you are doing this by paper and pencil, hand them to the project champion or co-champion. Thank you very much for your participation in INTERACT.


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