module 4 overview of interact clinical practice tools this module is designed for: rns and lpns...
TRANSCRIPT
Module 4
Overview of INTERACT Clinical Practice Tools
This module is designed for:
•RNs and LPNs•Medical directors•Primary care MDs, and NPs/PAs
The development and evaluation of the INTERACT quality improvement program and curriculum have been supported by grants from The Commonwealth Fund and the Retirement Research Foundation.
The INTERACT Interdisciplinary Team
Joseph Ouslander, MD Florida Atlantic UniversityRuth Tappen, EdD, RN, FAAN Florida Atlantic UniversityJill Shutes, GNP Florida Atlantic UniversityNancy Henry, PhD, GNP Florida Atlantic UniversityMaria Rojido, MD Florida Atlantic UniversitySanya Diaz, MD Florida Atlantic UniversityLaurie Herndon, MSN, GNP-BC Mass Senior Care FoundationJo Taylor, RN, MPH The Carolinas Center for Medical ExcellenceGerri Lamb, PhD, RN, FAAN Arizona State UniversityAnnie Rahman, PhD, MSW USC Davis School of GerontologyDan Osterweil, MD California Association of Long Term Care MedicineMary Perloe, GNP Georgia Medical Care FoundationJohn Schnelle, PhD Vanderbilt UniversitySandra Simmons, PhD Vanderbilt UniversityAlice Bonner, PhD, GNP Centers for Medicare and Medicaid Services
In collaboration with participating nursing homes
Overview of INTERACT Clinical Practice Tools
A brief description of the INTERACT Clinical Practice Tools
Incorporating the tools into your typical work flow Using the tools together
What This Module Will Cover
Tracking Hospital Transfers and the Quality Improvement Review ToolOverview of INTERACT Clinical Practice Tools
Communication Tools
Decision Support Tools
Advance Care Planning Tools
Quality Improvement Tools
Overview of the INTERACT Program
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• The different INTERACT tools are meant to be used together in your daily work in the nursing home
Overview of INTERACT Clinical Practice Tools
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Meet Mr. Salvi
• It is Tuesday morning at 7am
• CNA enters room of Mr. Salvi to help him into the bathroom to get washed for breakfast
• Today, he says: “GO AWAY”
• She knows his usual routine and wonders if something may be wrong
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Overview of INTERACT Clinical Practice Tools
A Change In The Routine
• 8 am; still not following usual routine
• He still does not want to get up and looks restless and uncomfortable
• These are somewhat nonspecific changes.
Should the CNA report these changes to the
nurse?7
Overview of INTERACT Clinical Practice Tools
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Stop and Watch is the primary method forCNAs to alert the LPN/RNs of changes in the resident’s conditionand for the nurse to hear what the CNAs have to say.
Overview of INTERACT Clinical Practice Tools
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• What to report• When to use it• Who should use it• How it helps
Overview of INTERACT Clinical Practice Tools
Further Assessment of Mr.
Salvi
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Overview of INTERACT Clinical Practice Tools
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Decision Support Tools:Change in Condition File Cards and Care Paths
Overview of INTERACT Clinical Practice Tools
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The INTERACT Change in Condition File Cards include recommendations
Immediate vs. non-immediate notification for specific:
Vital signs Lab results Symptoms
and signs
Overview of INTERACT Clinical Practice ToolsChange In Condition File Cards
Mr. Salvi
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Overview of INTERACT Clinical Practice Tools
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The INTERACT Care Paths :
Acute Mental Status Change Behavioral Symptoms of Dementia –
New or Worsening Fever Gastrointestinal (GI) Symptoms Shortness of Breath Symptoms of CHF Symptoms and Signs of Dehydration Symptoms of Lower Respiratory Illness Symptoms of UTI
Overview of INTERACT Clinical Practice ToolsCare Paths
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• Improved communication
• Same language• Standard criteria• Efficient and
effective communication
• Improved documentation
Overview of INTERACT Clinical Practice Tools
Mr. SalviThe Complete Picture
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Overview of INTERACT Clinical Practice Tools
The Importance of Advance Care Planning
• How might you discuss the case with Mr. Salvi’s family?
• What would be the goal for your call?• How comfortable are your frontline
staff in having these conversations?
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Overview of INTERACT Clinical Practice Tools
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Overview of INTERACT Clinical Practice Tools
• Use available information
• Determine the wishes of the resident for care
• Front line staff may not be comfortable with these converstations
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Overview of INTERACT Clinical Practice Tools
Advance Care Planning Tools
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Overview of INTERACT Clinical Practice Tools
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Overview of INTERACT Clinical Practice ToolsAdvance Care Planning
ACP is especially important among residents at high risk of dying in the very near future
This tool provides examples of residents who are at such risk
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Overview of INTERACT Clinical Practice ToolsAdvance Care Planning
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Comfort or palliative care, whether or not the resident is enrolled in a hospice program, should include standard orders that address common symptoms, including:
• shortness of breath, dyspnea, and terminal “death rattle”
• pain• anorexia• Anxiety• bowel symptoms
Overview of INTERACT Clinical Practice ToolsAdvance Care Planning
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Coalition for Compassionate Care of California - Resources for both health care providers and for lay people who want to talk about advance care planning, including downloadable forms and factsheets. http://www.coalitionccc.org/advance-health-planning.php
Alzheimer’s Association - Comprehensive recommendations aimed at improving communication and care at end of life. http://www.alz.org/national/documents/brochure_DCPRphase3.pdf
Caring Connections – downloadable educational information and forms (www.caringinfo.org/Home.htm - click on Advance Directives)
Aging with Dignity - offers a document called “Five Wishes,” which makes ACP more user-friendly, valid in 40 states; downloadable for $5 (www.agingwithdignity.org/5wishes.html)
Overview of INTERACT Clinical Practice ToolsAdvance Care Planning
Additional Resources for ACP and End-of-Life Care
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Overview of INTERACT Clinical Practice Tools
The INTERACT Quality Improvement Program is designed to prevent UNNECESSARY ACUTE CARE TRANSFERS, not all transfers.
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Overview of INTERACT Clinical Practice Tools
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Overview of INTERACT Clinical Practice Tools
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Overview of INTERACT Clinical Practice Tools
Key Points From Module 4
• The INTERACT Quality Improvement Program includes a number of clinical tools organized into 4 categories
• These clinical tools are meant to be utilized together to help frontline staff to recognize and respond to an acute change in condition
• Implementation of all of the clinical tools is recommended in order to maximize program effectiveness
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Please complete the Quiz and Evaluation If you do not complete them:
You will not receive continuing education credit
If your facility is tracking who completes specific modules, you will not be counted
Quiz and Evaluation