increase opportunities for person-centered care …2015/03/15 · 3/26/2015 1 susan lagrange rn,...

3/26/2015

1

Susan LaGrange RN, BSN, NHA

Director of Education

Pathway Health

Ray Miller MSOSH, GP

Dir. of Risk &Safety Solutions

Direct Supply

Increase Opportunities for Person-Centered Care Planning and Decision Making --

Building and Sustaining Person Centered Care Building and Sustaining Person Centered Care

The HATChTM Model

Holistic Approach to Transformational Change

Helping Your STAFF Build and Sustain

Quality of Life and Quality of Care

For Your Residents --

Empower them to LEAD and

MAKE THE DIFFERENCE

On 9 Dec 2014 Kara Butler of Healthcentric Advisors granted

Direct Supply permission to use the HATChTM

Model.

Ray Miller

Direct Supply

Educator,

Story Teller

& Grandpa

3/26/2015

2

Important

Things That

You

Do For Your

Residents*

1. Help

2. TIME

3. LOVE

4. Safety

5. COOK

6. SMILE

7. Dignity

8. TEACH

9. Support

10. LISTEN

11. Respect

12. Advocate

13. Heal them

14. PURPOSE

15. Greet them

16. Daily needs

17. Conversation

18. Be a FRIEND

19. Rub their back

20. COMFORT THEM

21. Provide SPECIAL Events

22. Make them feel IMPORTANT

73 Staff Members of

Willowcrest Care Center

3821 South Chicago Av.

South Milwaukee, WI 53172

55 Staff Members of

BRIA Health Svcs.

1101 E State St

Geneva, IL 60134-2438

You:

Staff Member

Care Giver

Leader

Friend

5

100 Staff Members of

Woodbury / Tealwood.

7012 Lake Road

Woodbury, MN 55125

Today’s Agenda

1. Introductions: Me + You + Things That You Do For Your Residents

2. HATChTM: The Six Domains + The Key Responsibilities

3. Culture + Clinical Practices + Contractures + A Smile

4. Workplace Practices + Leadership + Empowerment

5. Community + Family + Technology

6. Outside, Inside, Bedside, Person

6

Copyright 2015-2016 Direct Supply, Inc. All rights reserved

R

3. Environment

Clinical

Practice

1-Body

2-Mind

3-Spirit

4-Emotions

Key

Responsibilities Copyright 2015-2016 Direct Supply, Inc. All rights reserved

7

3/26/2015

3

R

3. Environment

Work Place

Practices

1-Do

2-Hire

3-Train

4-Mentor

5-Retain

Environment

1-Five Senses

2-Safety

3-Comfort

4-Cleanliness

5-Compassion Key


8

R

3. Environment

Leadership

1-Vision

2-Team

3-Culture*

4-Finance

5-Processes

6-Education

7-Development

8-Human Rsrcs.

9-Physical Plant

CULTURE

1-Trust

2-Quality

3-Patience

4-Sanctuary

5-Friendship

6-Fulfilment

7-Engagement

8-Compassion

Key

Responsibilities

S.A.

Esteem

Love & Belonging

Safety & Security

Physiological

Copyright 2015-2016 Direct Supply, Inc. All rights reserved 9

R

3. Environment

Community

and Family

1-HOME

2-Society

3-Connection

4-Engagement (RSF)

5-

6-

Key


10

3/26/2015

4

R

3. Environment

Compliance

1-Knowledege

2-Awareness

3-Experience

4-Preparation

5-Consistency Key


11

R

3. Environment

Holistic

Approach to

Transformational

ChangeTM

The HATChTM

Model


Work Place

Practice

1-Do

2-Hire

3-Train

4-Mentor

5-Retain

Environment

1-Five Senses

2-Safety

3-Comfort

4-Cleanliness

5-Compassion

Leadership

1-Vision

2-Team

3-Culture*

4-Finance

5-Processes

6-Education

7-Development

8-Human Rsrcs.

9-Physical Plant

CULTURE

1-Trust

2-Quality

3-Patience

4-Sanctuary

5-Friendship

6-Fulfilment

7-Engagement

8-Compassion

Community

and Family

1-HOME

2-Society

3-Connection

4-Engagment

5-

6-

Compliance

1-Knowledege

2-Awareness

3-Experience

4-Preparation

5-Consistency

Let’s take a

look at a few

examples

Clinical

Practice

1-Body

2-Mind

3-Spirit

4-Emotions

Which matters

the most?


3/26/2015

5

Today’s Agenda







14


Culture

CULTURE

1-Trust

2-Quality

3-Patience

4-Sanctuary

5-Friendship

6-Fulfilment

7-Engagement

8-Compassion

Clinical

Practice

1-Body

2-Mind

3-Spirit

4-Emotions +

Contractures

+

The HATChTM Model

HOLISTIC Approach to Transformational Change

Macro R Micro =

+



3/26/2015

6

USED WITH PERMISSION: by Karen L Bonn, President, Restorative Medical, Inc.; 270-422-5454; 800-793-5544; www.restorativemedical.com . Copyrighted

Orthopedic = Rehab (quick + surgery + painful therapy)

IF splints: rigid + static (hold a body part in a certain plane

to facilitate healing and function)

Restorative = disease process, CNS injury, neurological

“No pain – no gain” Restorative patients do not have

adhesions BUT they do OR will have neurological tone

Cerebral Palsy … Parkinson’s disease … Stroke … Traumatic brain injury

… Whiplash (Torticollis/Wry neck) … MS … Spinal cord injury … Spina

bifida … end-stage Alzheimer’s

These orthotic devices must have a bioengineered

“FLEX” i.e. mild resistance

Prolonged low load passive stretch that over time,

gradually re-lengthens tissue.

Orthopedic vs. Restorative Contractures (= LRM)



Prolonged low load passive

stretch over time (6 weeks)

15-20 minutes on the Golgi

Tendon Organs will allow the

Resident to reach a “Muscle

Inhibition” (Relaxation)

So how does it work? Fishing Pole Analogy copyrighted by RMI


Golgi Tendon Organ

Proprioceptive sensory

receptor organ.

They are located at the insertion of skeletal muscle

fibers into the tendons of skeletal muscle.


3/26/2015

7

+


=

MY “STORY”

These are NOT really “stories”.

These are residents that in a very real way,

got at least a portion of their lives back.

Their “culture” was improved

– therapeutically, clinically.


24 Copyright 2015-2016 Direct Supply, Inc. All rights reserved

Ms. Barbara – family wanted to keep her at home


3/26/2015

8


Ms. Barbara


Initial fitting

15 minutes after fitting

25 min. after fitting

She woke up, opened her eyes and smiled

Skin Tissue

(wound)

USED WITH PERMISSION: by Karen L Bonn, President, Restorative Medical, Inc.; 270-422-5454; 800-793-5544; www.restorativemedical.com . Copyrighted 26



By-the-way, how’s your hand?

Prolonged low load passive stretch that over

time, gradually re-lengthens tissue …

3/26/2015

9

28

Ms. Pat had a whiplash injury (developed into Torticollis)

Tone worsens when standing


Less than 30 minutes after fitting:*

She worked through her tone

to reach muscle inhibition


Her neck remained upright

and relaxed and she smiled Copyright 2015-2016 Direct Supply, Inc. All rights reserved

Today’s Agenda







30


3/26/2015

10

Work Place

Practice

1-Do

2-Hire

3-Train

4-Mentor

5-Retain

Work Place Practice --

Consistent Assignment


The Influence of Consistent Assignment on Nursing

Home Deficiency Citations

(SAMPLE: 3,941 facilities / 2007 data)

Results: 68% of NH’s reported using consistent assignment

(“CA”). … only 28% @ 85% (or more).

1. 4 of 5 “CA” models associated with reduced deficiency citations

2. Quality of Life and Care deficiency citations < non-CA users

3. “Few significant findings were found in nursing homes using

lower levels of consistent assignment.”

The Influence of Consistent Assignment on Nursing Home Deficiency Citations; Nicholas G. Castle, PhD* Department of Health Policy

& Management, Graduate School of Public Health, Univ. of Pitts., E-mail: [email protected]; Received March 7, 2011. Accepted May 26,

2011; (http://gerontologist.oxfordjournals.org/content/51/6/750.abstract ) Copyright 2015-2016 Direct Supply, Inc. All rights reserved 33

Benefits of Consistent Assignment:

1. Increased Staff stability

2. Reduced call-offs and turn-over

3. Strengthened Team work and trust

4. [Improved Quality (Life and Care)]

Barriers To Consistent Assignment:

1. Short staffing

2. Best to not let friends work with friends

3. Need to avoid emotional attachments

between resident and staff

4. Everyone should be trained on every unit

and available everywhere

5. Need to protect staff from being “stuck”

with the “hard-to-care-for” residents

Regulatory Support:

1. NO regulatory requirement

2. F240 Interpretive Guidelines:

“The intention of the Q of L

requirements specify the facility’s

responsibilities towards creating

and sustaining an environment

that humanizes and

individualizes each resident.”

3. Under F241 (Dignity), F242 (Self-

Determination and Participation), and

F246 (Accommodation of Needs):

All include the nursing home’s

responsibility to create and

maintain an environment that

supports each resident’s

individuality.

Change Idea Sheet-Consistent Assignment; Quality Partners of Rhode Island, 31 Aug 2007 Copyright 2015-2016 Direct Supply, Inc. All rights reserved

36

http://gerontologist.oxfordjournals.org/content/51/6/750.abstract#corresp-1

mailto:[email protected]

http://gerontologist.oxfordjournals.org/content/51/6/750.abstract



3/26/2015

11

Leadership

FLS Empowerment =

“Making” Them Leaders

Leadership

1-Vision

2-Team

3-Culture*

4-Finance

5-Processes

6-Education

7-Development

8-Human Rsrcs.

9-Physical Plant

CULTURE

1-Trust

2-Quality

3-Patience

4-Sanctuary

5-Friendship

6-Fulfilment

7-Engagement

+

Culture +


Staff Dynamics

Authority vs. Familiarity

http://www.apbs.org/conference/denver/files/A18-Bird.ppt#369,13,Federal Regulations: Potential areas of citations

Degree of Familiarity

CNAs

Therapies

RNs

Administrator

Respect level of

FAMILIARITY

When

Gathering

Information

Level of Authoirty

Administrator

RNs

Therapies

CNAs

Respect level of

AUTHORITY

When

Seeking

Permissions

So how do we build on this? How do we strengthen

“Q of L” and “Q of C” using these facts?


CULTURE

1-Trust

2-Quality

3-Patience

4-Sanctuary

5-Friendship

6-Fulfilment

7-Engagement

8-Compassion

10 Traits of Well

Respected CNAs

1-Patient

2-Flexible

3-Reliable

4-Focused

5-Punctual

6-Enthusiastic

7-Hard-working

8-Work-oriented

9-Compassionate

10-Self-disciplined

by PATTI on JANUARY 25, 2013 in SPOT LIGHT SERIES; http://www.nursingassistants.net/10-traits-of-well-respected-cnas/

“Treat a man as he is, and he will remain as he is. Treat a

man as he could be, and he will become what he should be.”

― Ralph Waldo Emerson

“Treat a CNA as she is, and she will remain as she is. Treat a CNA

as she could be, and she will become what she should be.”

― Ralph and Ray


http://www.nursingassistants.net/10-traits-of-well-respected-cnas/











http://www.goodreads.com/author/show/12080.Ralph_Waldo_Emerson

http://www.goodreads.com/author/show/12080.Ralph_Waldo_Emerson

3/26/2015

12

http://www.nursingassistants.net/; © 1997-2013. All Rights Reserved. Nursing Assistant

Resources On The Web. This material can be used freely for educational purposes.

To do what nobody else will do,

In a way nobody else can do,

In spite of all we go through.

That is to be a nurse's aide.

Anonymous

+ Macro R Micro =


No. 1 Need In LTC

MARCH 17, 2012 -- by PATTI on OCTOBER 3, 2013; http://www.nursingassistants.net/; © 1997-2013. All Rights Reserved. Nursing Assistant Resources

On The Web. This material can be used freely for educational purposes.

CNAs Taught by Those Who Care


1. SHE IS PROACTIVE ... resourceful … initiative … solutions

2. SHE BALANCES HER TIME … “medical needs” vs “non-

medical wants” vs “TLC fix” vs “something else is going on”

3. SHE ALWAYS promotes resident choice, dignity and individuality

4. SHE LISTENS ... knows that a resident doesn’t always

understand … but HELPS with that

5. SHE WORKS WITH THE RESIDENT to overcome conflicts

and misunderstandings

6. SHE KNOWS WHEN TO STEP AWAY

7. SHE HAS A PERSONAL MISSION STATEMENT based on

her morals and values. It helps her to make choices and decisions MARCH 17, 2012 -- by PATTI on OCTOBER 3, 2013; http://www.nursingassistants.net/; © 1997-2013. All Rights Reserved. Nursing Assistant Resources

On The Web. This material can be used freely for educational purposes.

7 Habits Of Highly Effective CNA’s


http://www.nursingassistants.net/




3/26/2015

13

STAFF quotes and pictures


Today’s Agenda







50


Community and Family

Preventing

Social Isolation

Community

and Family

1-HOME

2-Society

3-Connection

4-Engagement (RSF)

5-

6-


3/26/2015

14

Photo: The Guardian


Fighting Isolation With Technology by Linda Barbarotta

July / Aug 2014

… Limited Contact with others … PERCEIVED inadequate contact

… STRONGLY associated with decreased quality of life (decline)

… MAY enhance symptoms (arthritis, heart disease, hypertension and diabetes)

* ASPE Report to Congress: Aging Services Technology Study (June 2012)

http://aspe.hhs.gov/daltcp/reports/2012/astsrptcong.cfm

Community and Family


Community and Family: Technology Can Improve

the Quality of Residents’ Lives*

Technology-based Solutions For Social Isolation

Shirley: "I look at the

calendar before I go to sleep

to see what programs are on

the next day.

“This program has enriched

my life. I have friends I can talk

with every day." Selfhelp Community Services

LeadingAge Magazine July / August 2014: Fighting Isolation With Technology

by Linda Barbarotta; http://www.leadingage.org/Fighting_Isolation_With_Technology_V4N4.aspx

Photo: The Guardian


3/26/2015

15

Insert

Resident

Technology

Adoption

Video

Today’s Agenda







58


Environment

1-Five Senses

2-Safety

3-Comfort

4-Cleanliness

5-Compassion

+ Reducing

Falls

Risk

Using Multi-factorial Assessments

62

3/26/2015

16

Multi-factorial

Assessments

63

Outside Inside Bedside Person

1. Shade

2. Patios

3. Security

4. Vehicles

5. Sidewalks

OUTSIDE

65

Safe At Home

6. Parking lot

7. Way finding

8. Grassy areas

9. Weather-related

10. Seating and benches


Safe At Home

1. Lighting: Adequate, no glare

2. Walking: Areas clear of barriers

3. Equipment: Beds, w/c, footwear, grab bars

4. Furnishings: Design, function, color, height

5. Monitoring Systems: Nurse call, resident monitoring

6. Risks in specific spaces: Gym, dining room, bathrooms

INSIDE


3/26/2015

17

What does your Staff see?*


Falls Prevention:

“5 Feet Around the Bed” BEDSIDE

1. .

What changes have you made in the last 10 yrs.? Copyright 2015-2016 Direct Supply, Inc. All rights reserved

Transforming Care at the Bedside How-to Guide: Reducing Patient Injuries from Falls; Boushon B, Nielsen G, Quigley P, Rutherford P, Taylor J, Shannon D,

Rita S. How-to Guide: Reducing Patient Injuries from Falls. Cambridge, MA: Institute for Healthcare Improvement; 2012. Available at www.IHI.org.

• In-depth, Multifactorial, Interdisciplinary Fall

• Risk Assessment

• COMMUNICATE: those “at risk” for fall and / or injury

• EDUCATE: R/F,/S residents, falls and injury risks

• “INDICATE”: Current status

•Everyone is at RISK

•Of falling (Hx)

•Of related injury (smoking, steroids, alcohol, chemo,) (Osteoporosis, Frx, of bleeding)

• STANDARDIZED:

•Facility-wide & resident-level environment improvements

•Regular rounding (1-2 hrs.) (pain, toileting, positioning)

• CUSTOMIZED: (high risk)

•Medication interventions (side effects)

•Observation (intensity / frequency)

•Environmental adaptations

•Personal devices INTERVENTIONS

Standardized and Customized

(frequency and severity reduction)

FALLS RISK

ASSUMPTION

at time of

admission

ASSESSMENTS

8 hrs., 72 hrs.,

5 days … OR

Clinical Status Changes

COMMUNICATE

EDUCATE

INDICATE

Transforming

Care at the

Bedside

http://www.ihi.org/

3/26/2015

18

FAILURE TO:

1. Reassess risk during patients’ entire facility stay

2. Recognize the limitations of the falls risk screening tools

3. Intervene quickly and link interventions to specific assessed risk factors

LACK OF:

1. Procedure for or time to consistently reassess change in patient condition

2. Standardized or reliable process for comprehensive fall risk assessment

3. Expertise in administering the assessment after positive risk screening

4. Administration of multifactorial and interdisciplinary assessment

5. Identification of patients at increased risk for a fall-related injury

6. Clarity in expectations regarding patient assessment

Transforming Care at the Bedside How-to Guide: Reducing Patient Injuries from Falls; Boushon B, Nielsen G, Quigley P, Rutherford P, Taylor J, Shannon D,

Rita S. How-to Guide: Reducing Patient Injuries from Falls. Cambridge, MA: Institute for Healthcare Improvement; 2012. Available at www.IHI.org.

Typical Failures Of Resident Assessments


Assessments

2. Hendrich II Fall Risk Model—evidence based, but limited in scope of what it

assesses. http://consultgerirn.org/uploads/File/trythis/try_this_8.pdf

3. Tinetti—good tool, often used by therapists.

http://consultgerirn.org/uploads/File/Tinetti_Assessment_Balance.pdf

4. CDC tool—modified from other tools—this doesn’t have a score and is a pretty

decent tool http://www.cdc.gov/HomeandRecreationalSafety/pdf/steadi/fall_risk_checklist.pdf

5. Modified tool from MedPass that a provider put together and MedPass sells. This

is a good example of a non-standardized test that has a hodgepodge of

assessment questions and non-tested scoring in it. http://www.med-

pass.com/media/pdf/HC1040H_sp.pdf


1. Morse: “I’ve seen this one used frequently where facility staff

will select interventions based on a score instead of selecting

based on why the resident is at risk. A score doesn’t tell you

if you have balance problems, or orthostatic hypotension. It’s

just a number.”

Liz Jensen, RN, MSN

Multi-factorial Fall Assessment

1. Focused History

2. Physical Examination

3. Timed Up-and-Go Test

4. Orthostatic Hypotension

5. …

PERSON

AMDA Clinical Practice Guidelines, 2011; AGS Clinical Practice Guidelines, 2010


http://www.ihi.org/

http://consultgerirn.org/uploads/File/trythis/try_this_8.pdf

http://consultgerirn.org/uploads/File/trythis/try_this_8.pdf



http://www.cdc.gov/HomeandRecreationalSafety/pdf/steadi/fall_risk_checklist.pdf

http://www.cdc.gov/HomeandRecreationalSafety/pdf/steadi/fall_risk_checklist.pdf

http://www.med-pass.com/media/pdf/HC1040H_sp.pdf




3/26/2015

19

1. What do you think caused you to fall?

2. What were you doing before the fall?

3. How were you feeling before the fall?

4. … ?

PERSON ASSESSMENT:

Resident Interview


ASSESSMENT:

Clues & Cues

NEW:

1. Pain

2. Cough

3. Color change

4. Posture change

5. Change in routines

6. Off patterns or habits

7. Less visible in the community

8. Hospitalization / physician visit: check for changes in meds

PERSON

WHO and HOW?

Earlier Identification

Earlier Response WHY?

Frontline Staff

+

“Itchy Vigilance”

79

=


Staff Reflections --

Woodbury Senior Living Person


3/26/2015

20

Today’s Agenda – In Review

Do You Have Questions?







82

Did We Hit Them?

Was It of Worth?


Important Things

That You Do

For Your Residents …

BE THAT LEADER –

MAKE THAT DIFFERENCE

THANK YOU

You:

Staff Member,

Care Giver,

Leader,

Friend

Susan LaGrange RN, BSN, NHA

Director of Education

Pathway Health

Ray Miller MSOSH, GP

Dir. of Risk &Safety Solutions

Direct Supply

Increase Opportunities for Person-Centered Care Planning and Decision Making --

Building and Sustaining Person Centered Care

Increase Opportunities for Person-Centered Care Planning and Decision Making

increase opportunities for person-centered care …2015/03/15 · 3/26/2015 1 susan lagrange rn,...

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