1. Pioneer Network’s National Learning Collaborative on Using MDS 3.0 as the Engine for High Quality Individualized Care Lynda Crandall Executive Director Pioneer Network lynda.crandall@pioneernetwork.net Engaging Staff in Individualizing Care Your Systems Create Your Outcomes

2. Four Foundational Relational Practices: Consistent Assignment Huddles Involving CNAs in care planning QI huddles closest to the resident Are conduits for…… Clinical Applications: Promoting mobility, reducing falls and alarms A good welcome: the first 24 hours Reducing off-label use of anti-psychotic medications Because they enable staff to bring individualized approaches to clinical situations…… Operationalizing Individualized Care: Individualized mornings Flexible dining services Individualized night time routines Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation Incubator Care Practices

3. Pioneer Network/B& F Consulting 9 Conveners 49 Incubator Homes Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation Incubator Process

4. What it is: Consistent assignment means residents have the same CNAs and nurses caring for them every day whenever these staff are working Why it is important: Consistent assignments transform caregiving from "tasks" to relationship-based care Consistent assignments are the foundation for high quality individualized care and good teamwork Consistent assignments provide stability – for residents and for staff Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation Consistent Assignment

5. Consistent Assignment Adoption RatingLowMidHigh Beginning of Collaborative (% of homes)10%45% End of Collaborative (% of homes)0%11%89% Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation Greater % of staff/residents affected by consistent assignment (including more roles) Handling call-offs and logistics More of a focus on relationships Capturing CNAs knowledge of residents Communication between consistently assigned CNAs Use of CNA knowledge in quality improvement Collaborative Consistent Assignment Adoption Improvements

6. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation What it is: information exchange and problem solving in structured, efficient and routine manner Why it is important: Information sharing is key to continuity Care-partnering is not a one person job It is empowering Huddles

7. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation Huddle Tips If you don’t have them yet, consider starting with huddles to prepare for new residents and hear about their first 24 hours Make sure to provide coverage for short time while huddles are occurring Keep them short Guide staff on what to share Use Just in time teaching to problem solve It’s a skill – the more you do it the better you get Mentor staff on how to keep huddles moving and constructive

8. What it is: Involving CNAs in care planning means having them as true members of the care team, able to provide timely, actionable information about residents that can have profound effects on the care provided Why it is important: Up-to-date information about residents Knowledge of likes and their dislikes and resident customary routines Details of residents' day-to-day life and activities Relationships and trust Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation CNAs in Care Planning

9. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation Leadership support – “cheerleading” to keep the process going Understanding logistics (e.g., meetings schedule, coverage, communication, location) Mentoring on communication Clinical team buy-in Following up on CNA input/observations Use of care plan as a dynamic document CNA Involvement in Care Planning RatingLowMidHigh Beginning of Collaborative (% of homes)50%39%11% End of Collaborative (% of homes)22%38%40% Collaborative CNAs in Care Planning Adoption

10. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation The Care Conference Team met with both day and evening shifts The Team role played a care conference to give the CNAs an idea of what is discussed in care conferences Questions/thoughts were shared among the CNAs and the rest of the team This training is offered to CNAs twice a year Start with Staff Training

11. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation The social worker and the medical records specialist coordinate the order of care conferences each week Care conferences are offered in the morning to those families that are able to attend. Other care conferences are offered in the later afternoon to accommodate the schedules of family members who are working Scheduling

12. Schedule of care conferences is placed in breakroom each week; Also includes list of suggested topics for CNA to discuss at care conference Care conference schedule is also noted on the CNA daily assignment sheet Each CNA works with their hall partner to communicate what time they will be away at the care conference Care Conferences for this week: Thursday, January 31 st : 10:00am Mrs. A 10:20am Mrs. B 3:30pm Mr. C If you are the caregiver for any of these residents, please meet us in #41 Friendship Room at the designated time. In the last 3 months, have you noticed: Activities of daily living—any change in the person’s ability to participate in care? Mood & Cognition—does the resident seem content? Agitated? More or less confused? Dining—change in appetite? Change in the amount of assistance needed for dining Communicating the schedule to the CNAs each week

13. What it is: Inclusion of CNA in prevention and improvement efforts. QI closest to the resident means moving meetings traditionally held in the conference room out to where residents live in order to involve the staff who know residents best, and whenever possible, the residents themselves, in finding workable solutions Why it is important: Up-to-date information about residents Knowledge of likes and their dislikes and resident customary routines Details of residents' day-to-day life and activities Relationships and trust Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation QI Closest to the Resident

14. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation Mary is 85 year old woman in the middle to later stages of dementia. How could consistent assignment help Mary? Consistent Assignment

15. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation What might happen WITHOUT consistent assignment to help Mary? Consistent Assignment

16. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation How did consistently assigned CNAs communicating help Mary? Consistent Assignment + Huddles

17. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation Mary: Environment with High-Engagement Shift Change Huddles

18. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation Mary: Environment without High-Engagement Shift Change Huddles

19. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation How does involving CNAs in care planning help Mary? CNAs Involved in Care Planning

20. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation What might happen WITHOUT CNAs involved in care planning for Mary? CNAs Involved in Care Planning

21. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation Building your Internal Communication Network

22. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation Improvements in: Quality of life - “happy residents, happy staff” Teamwork and staff participation Communication and relationships Problem solving Five-Star ratings Reductions in: Restraints/alarms Antipsychotics Falls Incidents Outcomes

23. Material developed by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS 3.0 as the Engine for High Quality Individualized Care funded by the Retirement Research Foundation http://www.pioneernetwork.net /Providers/StarterToolkit Free Starter Toolkit