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Care Practices in Person Directed Care

Care Practices in Person Directed Care. Rebecca Lea Quality Improvement Consultant On each slide in this presentation in the upper Left hand corner there is a Logo with three concentric circles converging in the center.

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Care Practices in Person Directed Care

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  1. Care Practices in Person Directed Care Rebecca Lea Quality Improvement Consultant On each slide in this presentation in the upper Left hand corner there is a Logo with three concentric circles converging in the center. Circle 1 represents Ombudsman, Circle 2 represents SSA Program Manager and Circle 3 represents TMF-QIC. Where Ombudsman and SSA Program Manager meet they share the responsibilities of Staff and Residents. Where SSA Program Manager and TMF-QIC meet they share the responsibilities of Family and Residents. Where TMF-QIC and Ombudsman meet they share the responsibilities of administration and Residences. Also appearing on the left hand side of each slide are the words “Texas Person Directed Care Pilot” and the TMF Health Quality Institute logo, placed. This material was prepared by TMF Health Quality Institute, the Medicare Quality Improvement Organization for Texas, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 8SOW-TX-NHQI-05-25 Slide notes: Give Definition

  2. Person Directed Care Model

  3. Objectives • Define the care practices domain • Analyze current processes • Identify key change ideas and potential measures

  4. The Care Practices domain is where we strive to restore personhood, individuality, and normalcy to all by placing choice and control in the hands of the residents.

  5. Principles • Honor individual choice • Create opportunities for growth • Promote wellness • Integrate Quality of Life/Quality of Care • Embrace Quality Improvement

  6. Model For Improvement

  7. Three questions for QIbecome five in PDC • What are we trying to accomplish? • How will we know if a change is an improvement? • What change can we make that will result in an improvement? • Why? • Why not?

  8. Key Care Practices • Meals • Bathing • Sleeping & Waking • Death & Dying

  9. Current process for meals • Bibs • Institutional dishware • Feeder tables • 7:00am, 12noon, and 5:00pm with a substantial HS snack • Supplements • Staff eat on break, separate from residents

  10. Image Slide

  11. Change ideas for meal service • Restaurant style, buffet, family dining, or drive through • Variety-lifestyle, culture, ethnicity • Dishes with pattern, cloth napkins • Hostess, Wait staff • Newspaper with continental breakfast • Time frame 6:30-8:30am, 11:00am-1:00pm • Snacks available throughout the day throughout the home

  12. Potential ways to measure improvement • Weight gains • Weight loss • Satisfaction • Costs of supplements • Food waste

  13. Image Slide

  14. Routine Night Care • Turn every 2 hours • Start at one end of hall and work down • Turn off lights • Flip person over • Talking among staff, over person • Intercom-overhead paging • 5:00am accuchecks • 12:00pm sleeping pill • Check for impactions • Nighttime baths

  15. Image slide

  16. Sleep Deprivation Causes • Reduced energy • Difficulty concentrating • Diminished mood • Increased risk of accidents

  17. What interrupts your sleep? • Pain • Noise level • Lights • Temperature • Full Moon • Aging bladder

  18. Medical Problems Affecting Sleep • Arthritis • Osteoporosis • Heartburn • Cancer • Parkinson’s Disease • Dementia • Alzheimer’s Disease • Incontinence • Gastro Esophageal Reflux(GER) • Nocturnal Cardiac Ischemia • Chronic Obstructive Pulmonary Disease • Congestive Heart Failure • Peripheral Vascular Disease

  19. What about the bed? • Warm enough? • Cold, plastic feeling? • Is it a bed at all? • PJ’s? • Pillow(s)? • Height?

  20. Steps to better sleep • Bedtime routine • Avoid heavy meals before bed • Conducive environment that is cool, quiet and dark • Avoid caffeinated drinks • Avoid use of alcohol as sleep aid • Avoid smoking • Exercise regularly • Use bed only for sleep • Get out of bed if you can’t fall asleep within 15 minutes • Avoid regular naps

  21. PDC at Night • Assess each individual’s need • Reposition only as needed • Recognize that “position change” does not have to be total “flip” • Check hourly to assess need • Provide assistance gently, quietly with low light • Use super-absorbent briefs • If they are awake and want to get up, provide a warm place and company

  22. Potential Measurements for improvement • Number of residents who sleep through the night • Number of residents who wake of their own • Decrease in agitated behavior • Decrease in anxiety meds • Bowel and bladder incontinence • Skin issues • Weight change, mobility, social engagement; staff-resident relationships; staff workload

  23. Image Slide

  24. Bathing Without A Battle*BYOB *Joanne Rader VHS presentation

  25. Description of a shower room in the nursing home • Cold, Sterile • Tub with lifts, sides that open • Shower chairs on wheels • Gurney with arms like construction crane • Soiled utility carts • Extra wheelchairs • Boxes of supplies

  26. Image Slide

  27. Myths Related to Bathing • It takes lots of water to get people clean. • If caregivers are delaying, deferring, shortening or adapting the bath or shower, they are trying to get out of work. • Families will insist on a shower or tub bath.

  28. Image Slide

  29. More Myths About Bathing… • People always feel better after a bath or shower. • There will be more infections and skin problems. • You have to just go ahead because for most people who resist, there won’t be a good time.

  30. Myths about bathing cont’d… • They just forget about the battle so it doesn’t matter. • Can be seen as possible neglect. • The individualized approach will take more time and we don’t have it.

  31. What does your “perfect” bath look like? • Car wash or spa? • Shower room or torture chamber? • Scheduled appointment or M,W, F on 6-2? • Bed bath, bath, or shower?

  32. Bathing measures • Number of residents screaming, calling out • Number of incident reports r/t bathing, including injuries to staff • Increase in number of baths, showers • Resident satisfaction • Staff satisfaction

  33. Relationships are the heart of PDC…don’t sacrifice the relationship for the task.

  34. Death & Dying • What happens when a resident dies? • Resident (s)? • Staff? • Families?

  35. Image Slide

  36. Change ideas • Celebrate life • Message board • Comfort cart • Memorial service, or special tradition • Belongings placed in gift bags • Hospice education

  37. Image Slide

  38. Measurement possibilities • Number of people who die alone • Expressions of gratitude • Expressions of grief with appropriate closure • Satisfaction surveys • Referrals from previous families • Decreased turnover

  39. The Homework Challenge • Eat a meal • Take a shower • Spend the night • Sense survey

  40. “It is good to have an end to journey toward, but it is the journey that matters in the end.” ---Ursula K. LeGuin

  41. Thank you for what you are doing, you are making a difference.Questions?

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