Engaging Staff in Individualizing Care with Consistent Assignment, Huddles, and Involving CNAs in Care Planning

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

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 Incubator Care Practices 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

3. Incubator Process 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

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 Consistent Assignment 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

5. Collaborative Consistent Assignment Adoption Improvements • 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 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

6. 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 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

7. HuddleTips • 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 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

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 CNAs in Care Planning 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

9. Collaborative CNAs in Care Planning Adoption • 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 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

10. 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 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

11. 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 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

12. Care Conferences for this week: Thursday, January 31st : 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 • 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 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 QI Closest to the Resident 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

14. Mary is 85 year old woman in the middle to later stages of dementia. How could consistent assignment help Mary? Consistent Assignment 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

15. What might happen WITHOUT consistent assignment to help Mary? Consistent Assignment 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

16. How did consistently assigned CNAs communicating help Mary? Consistent Assignment + Huddles 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

17. Mary: Environment with High-Engagement Shift Change Huddles 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

18. Mary: Environment without High-Engagement Shift Change Huddles 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

19. How does involving CNAs in care planning help Mary? CNAs Involved in Care Planning 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

20. What might happen WITHOUT CNAs involved in care planning for Mary? CNAs Involved in Care Planning 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

21. Building your Internal Communication Network 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

22. 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 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

23. Free Starter Toolkit http://www.pioneernetwork.net/Providers/StarterToolkit 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