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Module 4 Overview of INTERACT Clinical Practice Tools

Module 4 Overview of INTERACT Clinical Practice Tools. This module is designed for: RNs and LPNs Medical directors Primary care MDs, and NPs/PAs.

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Module 4 Overview of INTERACT Clinical Practice Tools

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  1. 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.

  2. Overview of INTERACT Clinical Practice Tools The INTERACT Interdisciplinary Team Joseph Ouslander, MD Florida Atlantic University Ruth Tappen, EdD, RN, FAAN Florida Atlantic University Jill Shutes, GNP Florida Atlantic University Nancy Henry, PhD, GNP Florida Atlantic University Maria Rojido, MD Florida Atlantic University Sanya Diaz, MD Florida Atlantic University Laurie Herndon, MSN, GNP-BC Mass Senior Care Foundation Jo Taylor, RN, MPH The Carolinas Center for Medical Excellence Gerri Lamb, PhD, RN, FAAN Arizona State University Annie Rahman, PhD, MSW USC Davis School of Gerontology Dan Osterweil, MD California Association of Long Term Care Medicine Mary Perloe, GNP Georgia Medical Care Foundation John Schnelle, PhD Vanderbilt University Sandra Simmons, PhD Vanderbilt University Alice Bonner, PhD, GNP Centers for Medicare and Medicaid Services In collaboration with participating nursing homes

  3. Tracking Hospital Transfers and the Quality Improvement Review Tool Overview of INTERACT Clinical Practice Tools What This Module Will Cover • A brief description of the INTERACT Clinical Practice Tools • Incorporating the tools into your typical work flow • Using the tools together

  4. Overview of the INTERACT Program Quality Improvement Tools Communication Tools Decision Support Tools Advance Care Planning Tools

  5. Overview of INTERACT Clinical Practice Tools • The different INTERACT tools are meant to be used together in your daily work in the nursing home 5

  6. Meet Mr. Salvi Overview of INTERACT Clinical Practice Tools • 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 6 6

  7. A Change In The Routine Overview of INTERACT Clinical Practice Tools • 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

  8. Overview of INTERACT Clinical Practice Tools Stop and Watchis the primary method for CNAs to alert the LPN/RNs of changes in the resident’s condition and for the nurse to hear what the CNAs have to say. 8

  9. Overview of INTERACT Clinical Practice Tools • What to report • When to use it • Who should use it • How it helps 9

  10. Further Assessment of Mr. Salvi Overview of INTERACT Clinical Practice Tools 10

  11. Overview of INTERACT Clinical Practice Tools Decision Support Tools:Change in Condition File Cards and Care Paths 11

  12. Overview of INTERACT Clinical Practice Tools 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. Mr. Salvi Overview of INTERACT Clinical Practice Tools 12

  14. Overview of INTERACT Clinical Practice Tools Care Paths • 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

  15. Overview of INTERACT Clinical Practice Tools • Improved communication • Same language • Standard criteria • Efficient and effective communication • Improved documentation 14

  16. Mr. SalviThe Complete Picture Overview of INTERACT Clinical Practice Tools 15

  17. The Importance of Advance Care Planning Overview of INTERACT Clinical Practice Tools • 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? 16

  18. Overview of INTERACT Clinical Practice Tools 17

  19. 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 18

  20. Advance Care Planning Tools Overview of INTERACT Clinical Practice Tools 19

  21. Overview of INTERACT Clinical Practice Tools Advance 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 20

  22. Overview of INTERACT Clinical Practice Tools Advance Care Planning

  23. Overview of INTERACT Clinical Practice Tools Advance Care Planning • 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

  24. Overview of INTERACT Clinical Practice Tools Advance Care PlanningAdditional Resources for ACP and End-of-Life Care • 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)

  25. Overview of INTERACT Clinical Practice Tools The INTERACT Quality Improvement Program is designed to prevent UNNECESSARY ACUTE CARE TRANSFERS, not all transfers. 21

  26. Overview of INTERACT Clinical Practice Tools 22

  27. Overview of INTERACT Clinical Practice Tools 23

  28. Overview of INTERACT Clinical Practice Tools 24

  29. 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 25

  30. 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

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