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EARLY WARNING TOOL “Stop and Watch” Jo A. Taylor, RN, MPH Care Improvement Specialist The Carolinas Center for Medical Excellence INTERACT Curriculum.

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Presentation on theme: "EARLY WARNING TOOL “Stop and Watch” Jo A. Taylor, RN, MPH Care Improvement Specialist The Carolinas Center for Medical Excellence INTERACT Curriculum."— Presentation transcript:

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2 EARLY WARNING TOOL “Stop and Watch” Jo A. Taylor, RN, MPH Care Improvement Specialist The Carolinas Center for Medical Excellence INTERACT Curriculum Session 3 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

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” INTERACT Curriculum Session 3

4  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. INTERACT Curriculum Session 3

5 Teleconference Instructions If the leader is not on the call when you call in, please wait Early Warning Tool: “Stop and Watch” 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

6 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”

7 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.

8 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 In collaboration with participating nursing homes Early Warning Tool: “Stop and Watch”

9 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 Pre-Session #3 Quiz Early Warning Tool: “Stop and Watch”

10 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 Early Warning Tool: “Stop and Watch”

11 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 Early Warning Tool: “Stop and Watch”

12  To improve the quality of care for residents  To prevent unnecessary transfers to hospital Purpose of “Stop and Watch” Early Warning Tool: “Stop and Watch”

13  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

14 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 Early Warning Tool: “Stop and Watch”

15 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.

16 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 Early Warning Tool: “Stop and Watch”

17 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 Early Warning Tool: “Stop and Watch”

18 “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 Early Warning Tool: “Stop and Watch”

19 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! Early Warning Tool: “Stop and Watch”

20 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! Early Warning Tool: “Stop and Watch”

21 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 ____________________ Early Warning Tool: “Stop and Watch”

22 STOP S eems different than usual  Not their usual self? Change in personality or behavior? T alks or communicates less than usual  Quieter? Drowsier? Confused? Altered speech? O verall needs more help than usual  Needs more assistance? Changes in gait, transfer or balance? P articipated in activities less than usual  Withdrawn? Decline in ADL’s? Change in normal routine?

23 AND A te less than usual (Not because of dislike of food) N D rank less than usual

24 WATCH W eight change A gitated or nervous more than usual T ired, weak, confused or drowsy C hange in skin color or condition H elp with walking, transferring, toileting more than usual

25 Instructions: “Stop and Watch” Staff ____________________________ Reported to ______________________ Date __/__/__ Time ____________ Early Warning Tool: “Stop and Watch”

26 Please wait while the video is showing

27 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 Early Warning Tool: “Stop and Watch”

28  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. INTERACT Implementation Assignment

29  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 INTERACT Implementation Assignment

30  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: Questions, Suggestions, Comments? Early Warning Tool: “Stop and Watch”

31 Session 4: SBAR The Next Session  The topic and participants are listed below  For teleconference participants, check the date and time for the next session Early Warning Tool: “Stop and Watch”  Champion  DON  Key RNs and LPNs  Medical Director  Key MDs, NPs/PAs

32 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 Post-Session #3 Quiz and Evaluation Early Warning Tool: “Stop and Watch”


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