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

1. Joseph G. Ouslander, MD Professor and Senior Associate Dean for Geriatric Programs Charles E. Schmidt College of Medicine Professor (Courtesy), Christine E. Lynn College of Nursing Florida Atlantic University Professor of Medicine (Voluntary), University of Miami Session 5 INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards 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. Session 5 INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards • 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. Session 5 INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards Teleconference Instructions • If the leader is not on the call when you call in, please wait

4. Session 5 INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards Welcome and Introductions • This session is designed for the entire interdisciplinary team, including the: • Project champion and co-champion • DON • Key RNs and LPNs • Medical Director • Key MDs, NPs/PAs

5. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards • Care Paths • Purpose • How to use them in everyday care • Change in Condition File Cards • Purpose • How to use them in everyday care What This Session Will Cover

6. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards • The INTERACT Care Paths and Change in Condition File Cards are decision support tools • Available for guidance when changes in status or specific symptoms and signs occur

7. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards • These tools help guide decisions about: • Further evaluation of changes in resident condition • When to communicate with the MD/NP/PA • When to consider transfer to the hospital • How to manage some conditions in the facility

8. Who Uses the INTERACT Decision Support Tools? • RN’s • LPN’s • Nurse supervisors • Staff development nurses and nurse educators • Medical providers

9. The Care Paths and Change in Condition File Cards are meant to be used together with other INTERACT tools • The change in condition or new symptom or sign may have been noted using the Stop and Watch Tool • Nurses should consider completing an SBAR Form and Progress Note using guidance from these tools

10. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards • The INTERACT Care Paths and Change in Condition File Cards are based on established clinical guidelines published by several national professional organizations • Most are based on expert opinion as opposed to definitive scientific clinical trials

11. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards • Recommendations in the INTERACT Care Paths and Change in Condition File Cards are not fixed in stone • They are meant to guide decision making, not dictate it • Your clinical team may choose to modify specific recommendations • The systematic, clearly defined approach to symptoms and signs is more important than the specific recommendations

12. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards • The INTERACT Change in Condition File Cards include recommendations • Immediate vs. non-immediate notification for specific: • Vital signs • Lab results • Symptoms and signs

13. INTERACT Change in Condition File Cards • The INTERACT Change in Condition File Cards: • The case of Mrs. S - a classic case that illustrates their purpose

14. Using the Change in Condition File Cards • Staff education in developing critical thinking skills • Nurse educators and managers use Change of Condition File Cards when teaching staff nurses who are assessing a resident’s change in condition • Strategies • 5-minute huddle on the unit • Morning stand-up meeting • Report between shifts

15. INTERACT Change in Condition File Cards

16. INTERACT Change in Condition File Cards

17. INTERACT Change in Condition File Cards

18. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards • The INTERACT Care Paths focus on 6 conditions that are: • Common reasons for hospital transfer • Often manageable in the nursing home • Frequent causes of potentially avoidable and preventable transfers or hospitalizations

19. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards • The INTERACT Care Paths : • Acute mental status change • Fever • Dehydration • Symptoms of CHF • Symptoms of Lower Respiratory Illness • Symptoms of UTI

20. INTERACTCare Paths • All structured the same way • Provide guidance on when to notify the MD/NP/PA consistent with File Cards • Suggest evaluation strategies • Provide recommendations for management and monitoring in the facility

21. Examples of Using the Care Paths • LPN refers to the Acute Mental Status Change Care Path when CNA reports Mr. Smith has increased confusion and agitation • RN refers to the Symptoms of CHF Care Path when LPN reports Ms. Jones has increased SOB and lower extremity edema • Unit supervisor uses the Symptoms of UTI Care Path when completing the SBAR Communication tool before calling the MD or NP about Ms. Brown’s new onset of painful urination and urge incontinence

32. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards Implementation Assignment • Review the Change in Condition File Cards for vital signs and laboratory results, and list any questions or concerns you have • Review two Care Paths for conditions you encounter frequently, and list any questions you have about them • Review two recent acute changes in condition and list how one or more of the Care Paths could have been used

33. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards 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”

34. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards The Next Session • The next teleconference will be held at the same time next week • The topic and participants are listed below

35. INTERACT Decision Support Tools:Care Paths and Change in Condition File Cards Post-Session # 5 Quiz and Evaluation • Please complete the Post-Session Quiz and Evaluation • 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 on-line, you can take the on-line Quiz and complete the evaluation on-line.