Joseph G. Ouslander, MD Professor and Associate Dean for Geriatric Programs

1. Joseph G. Ouslander, MD Professor and Associate Dean for Geriatric Programs Charles E. Schmidt College of Medicine Professor (Courtesy), Christine E. Lynn College of Nursing Florida Atlantic University INTERACT Curriculum Final Session Wrap-Up and Strategies for Implementation and Sustainability 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

2. INTERACT Curriculum Final Session • If you are participating in a teleconferenceproceed 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.

3. INTERACT Curriculum Final Session Teleconference Instructions • If the leader is not on the call when you call in, please wait

4. INTERACT Curriculum Final Session Welcome and Introductions • This session is designed for the entire interdisciplinary team, including the: • Project champion and co-champion • DON, key RNs, LPNs, and CNAs • Medical director, primary care MDs, and NPs/PAs • Social workers • Administrators

5. Joseph G. Ouslander, M.D. is Professor and Associate Dean for Geriatric Programs at the Charles E. Schmidt College of Medicine, and Professor at the Christine E. Lynn College of Nursing of Florida Atlantic University in Boca Raton Florida. He is a past-President of the American Geriatrics Society and is the Executive Editor of the society's Journal. He is a co-author of Essentials of Clinical Geriatrics and Medical Care in the Nursing Home, and an editor of Hazzard's Textbook of Geriatric Medicine and Gerontology.  Dr. Ouslander’s work is now focused on improving the quality of care and quality of life for older people, and reducing unnecessary health care expenditures through programs such as INTERACT. INTERACT Curriculum Final Session jousland@fau.edu

6. INTERACT Curriculum Final Session • The INTERACT Interdisciplinary Team • Laurie Herndon, GNP Mass Senior Care Foundation • Gerri Lamb, PhD, RN, FAANArizona 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, GNPCenter for Medicare and Medicaid Services In collaboration with participating nursing homes

7. INTERACT Curriculum Final Session What This Session Will Cover • Review of: • The goals of INTERACT • Why it matters to you and your organization • How the INTERACT tools work together in everyday practice • Strategies for effective implementation and sustainability of the program

8. INTERACT Curriculum Final Session Pre-Session Quiz • There is no Pre-Session Quiz for this session!

9. INTERACT Curriculum Final Session Congratulations and Thanks! • The INTERACT team congratulates and thanks you for your participation in this curriculum • We would greatly appreciate your feedback by completing the Final Evaluation form • For licensed nurses – you will receive CEU’s for your participation

10. INTERACT Curriculum Final Session INTERACT – review of definition and goals • INTERACT or “Interventions to Reduce Acute Care Transfers is a quality improvement program designed to improve the care of nursing home residents

11. INTERACT Curriculum Final Session INTERACT – review of definition and goals • The goal of INTERACT is to improve care quality, not to prevent all hospital transfers • In fact, INTERACT can result in more rapid transfer of residents who need hospital care

12. INTERACT Curriculum Final Session INTERACT – review of definition and goals • INTERACT can result in reduced hospital transfers by helping you to: • Prevent conditions from becoming severe enough to require hospitalization through early identification and evaluation of changes in resident condition • Manage some conditions in the NH without transfer when this is feasible and safe • Improve advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization for some residents

13. INTERACT Curriculum Final Session A Tale of Three Siblings • Sadie • Sara • Sam

14. INTERACT Curriculum Final Session Sadie A 96 year old long-stay NH resident • Hospitalized for UTI and dehydration • Discharged back to the NH after 4 days • Re-hospitalized 7 days later for dehydration and recurrent UTI Avoidable? • INTERACT strategy: • Prevent conditions from becoming severe enough to require hospitalization through early detection and evaluation

15. INTERACT Curriculum Final Session Sara (Sadie’s younger sister) A 92 year old long-stay NH resident • Hospitalized for a lower respiratory infection, but had normal vital signs and oxygen saturation • Developed delirium in the hospital, fell and fractured her hip Avoidable? • INTERACT strategy: • Manage some conditions in the NH without transfer

16. INTERACT Curriculum Final Session Sam (Sara and Sadie’s older brother) A 101 year old long-stay NH resident • Hospitalized for the 4th time in 2 months for aspiration pneumonia related to end-stage Alzheimer’s disease • Transferred to hospice on the day of admission Avoidable? • INTERACT strategy: • Improve advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization

17. INTERACT Curriculum Final Session INTERACT – review of definition and goals • INTERACT includes 3 types of tools for you to use in your daily work in the nursing home: Communication Tools Care Paths http://interact2.net Advance Care Planning Tools

18. The different INTERACT tools are meant to be used together in your daily work in the nursing home http://interact2.net

19. INTERACT Curriculum Final Session Why it matters – to you and your facility (1) • INTERACT will help you and facility: • Improve quality of care for your residents • Benefit from tools to help your team work together more effectively • Take advantage of everyone’s contributions to resident care

20. INTERACT Curriculum Final Session Why it matters – to you and your facility (2) • The current situation, which favors hospital transfers, is going to change • Medicare is planning changes in payment that will reward lower rates of avoidable hospitalizations • Surveyors will be examining how facilities evaluate and manage acute changes in status • You need to be prepared!

21. INTERACT Curriculum Final Session Implementation and Sustainability • Effective implementation of INTERACT is critical to long-term sustainability of the program • The program cannot be effectively implemented or sustained without strong support from facility leadership

22. INTERACT Curriculum Final Session Implementation and Sustainability • General Principles • Make INTERACT a key aspect of your facility’s quality improvement activities • Implementation of the INTERACT program should be consistent with the way you provide care in your facility • Integrate the INTERACT program and tools into your everyday practice • Recognize that organizational change takes time - programs such as INTERACT can take several months to fully implement

23. INTERACT Curriculum Final Session Implementation and Sustainability • Select Your Team • Pearl of Wisdom: • Selection of the Champion and Co-Champion is one of the most important decisions you will make

24. INTERACT Curriculum Final Session Implementation and Sustainability • Find the Gaps • Pearl of Wisdom: • Avoid redundancy - the INTERACT program should fill in gaps in your care processes and not create more work for your staff.

25. INTERACT Curriculum Final Session Implementation and Sustainability • Carefully Plan Your Training

26. INTERACT Curriculum Final Session Implementation and Sustainability • Make the Tools Visible in for Easy Use in Everyday Practice • Pearls of Wisdom: • Remove old forms from nursing units to avoid confusion and to encourage standard use of new tools and forms • Successful INTERACT Champions have found ways to keep the program visible on a daily basis through discussions at stand up meetings, on rounds and other strategies

27. INTERACT Curriculum Final Session Implementation and Sustainability • Once You Are Started Take the Next Steps • Pearls of Wisdom: • Complete Quality Improvement tools as soon after acute care transfers as possible so that details are fresh • If the transfer is determined to be preventable, implement a plan to improve right away • Use the data to improve care processes and to focus educational activities • Contact and meet with your local hospitals leadership and Emergency Room staff to inform and educate them about INTERACT

28. INTERACT Curriculum Final Session Implementation and Sustainability • Continue Tracking Your Data and Looking for Ways to Improve Your Care • Pearls of Wisdom: • Make data tracking part of your everyday routine, as well as your overall quality improvement activities • Ongoing data collection and analysis is key to determining if you have actually improved care for your residents • Set your own benchmarks and work on improving

29. INTERACT Curriculum Final Session Strategies for Effective Implementation and Sustainability • Select Your Team and Champion • Find the Gaps • Carefully Plan Your Training • Make the Tools Useful and Visible in Everyday Practice in the Facility • Once You Are Started Take the Next Steps • Continue Tracking Your Data and Looking for Ways to Improve Your Care

30. INTERACT Curriculum Final Session Overcoming Barriers to Implementation

31. INTERACT Curriculum Final Session Overcoming Barriers to Implementation (1)

32. INTERACT Curriculum Final Session Overcoming Barriers to Implementation (2)

33. INTERACT Curriculum Final Session Overcoming Barriers to Implementation (3)

34. INTERACT Curriculum Final Session Overcoming Barriers to Implementation (4)

35. INTERACT Curriculum Final Session Sustaining the Program • Make INTERACT a permanent part of your quality improvement activities • Be sure that you have ongoing leadership support • Continue to track changes in rates of hospital transfer and how you manage acute changes in condition • Learn from you Quality Improvement Review tools • Visit the INTERACT website for updates and new resources: http://interact2.net • Don’t hesitate to contact us through the website Keep up the good work and Good Luck!

36. INTERACT Curriculum Final Session Final Quiz and Program Evaluation Thank you very much! • Please complete the Post-Session Quiz and Evaluation We really want and need your feedback to continue to improve the program! • 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 online, please take the online Quiz and complete the evaluation online

37. INTERACT Curriculum Final Session 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 1 can also be directed to Dr. Ouslander by email at: jousland@fau.edu Please insert in the Subject Line: “Question about the INTERACT Curriculum”