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 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 INTERACT Curriculum Final Session

 If you are participating in a teleconference proceed 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. INTERACT Curriculum Final Session

Teleconference Instructions Call in Number Conference Code # To un-mute your line to ask questions: Press # 6 After asking your question (s) re-mute your line: Press * 6 If the leader is not on the call when you call in, please wait 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 INTERACT Curriculum Final Session

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

The INTERACT Interdisciplinary Team Laurie Herndon, GNP Mass Senior Care Foundation Gerri Lamb, PhD, RN, FAAN Arizona 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, GNP Center for Medicare and Medicaid Services In collaboration with participating nursing homes INTERACT Curriculum Final Session

 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 What This Session Will Cover INTERACT Curriculum Final Session

 There is no Pre-Session Quiz for this session! Pre-Session Quiz INTERACT Curriculum Final Session

 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 Congratulations and Thanks! 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 INTERACT Curriculum Final Session

 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 INTERACT Curriculum Final Session INTERACT – review of definition and goals

 INTERACT can result in reduced hospital transfers by helping you to: 1.Prevent conditions from becoming severe enough to require hospitalization through early identification and evaluation of changes in resident condition 2.Manage some conditions in the NH without transfer when this is feasible and safe 3.Improve advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization for some residents INTERACT Curriculum Final Session INTERACT – review of definition and goals

 Sadie  Sara  Sam A Tale of Three Siblings INTERACT Curriculum Final Session

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

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

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

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

The different INTERACT tools are meant to be used together in your daily work in the nursing home

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 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! INTERACT Curriculum Final Session

 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 INTERACT Curriculum Final Session Implementation and Sustainability

General Principles 1.Make INTERACT a key aspect of your facility’s quality improvement activities 2.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 3.Recognize that organizational change takes time - programs such as INTERACT can take several months to fully implement INTERACT Curriculum Final Session Implementation and Sustainability

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

2.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. INTERACT Curriculum Final Session Implementation and Sustainability

3.Carefully Plan Your Training INTERACT Curriculum Final Session Implementation and Sustainability Facility Characteristics Start with one unit or one tool at a time and have all of the tools implemented by a set date Implement the whole toolkit all at once throughout the whole facility We are a small facility with no other major initiatives underway. x Our champion does very well teaching one on one. x Our champion is our in-service director and is experienced conducting large in-services. x We usually roll out programs for everyone at the same time. x We are a large facility with several nursing units. x We have a short time line to carry out the training and implement the program x

4.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 INTERACT Curriculum Final Session Implementation and Sustainability

5.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 INTERACT Curriculum Final Session Implementation and Sustainability

6.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 INTERACT Curriculum Final Session Implementation and Sustainability

INTERACT Curriculum Final Session 1.Select Your Team and Champion 2.Find the Gaps 3.Carefully Plan Your Training 4.Make the Tools Useful and Visible in Everyday Practice in the Facility 5.Once You Are Started Take the Next Steps 6.Continue Tracking Your Data and Looking for Ways to Improve Your Care Strategies for Effective Implementation and Sustainability

INTERACT Curriculum Final Session Overcoming Barriers to Implementation

INTERACT Curriculum Final Session Overcoming Barriers to Implementation (1) BarriersStrategies to Overcome “We don’t have a problem with hospital transfers” Regularly track hospital transfers and follow trends; you may have a problem and not know it “We don’t have control over who gets admitted” Using INTERACT tools to improve management of acute changes and communication with physicians and emergency rooms staff will give you more control “The doctors won’t cooperate”The medical director and the primary care providers must buy in to the INTERACT program

INTERACT Curriculum Final Session Overcoming Barriers to Implementation (2) BarriersStrategies to Overcome “Families want residents hospitalized” Families need to be educated about the risks as well as benefits of hospitalization “We could get sued”There is no fail-safe way to prevent law suits – but the INTERACT program provides tools for evidence-based and expert recommended care, and improves communication and documentation

INTERACT Curriculum Final Session Overcoming Barriers to Implementation (3) BarriersStrategies to Overcome “We don’t have the staff or time” Improving the management of acute changes in condition has to be a priority of the facility and its leadership “We have too many other things going on” INTERACT must be one of the major quality improvement initiatives at the facility “We are in our survey window” INTERACT implementation will result in improved care and adherence to multiple F Tags and other requirements

INTERACT Curriculum Final Session Overcoming Barriers to Implementation (4) BarriersStrategies to Overcome “Things don’t go well when the Champion is not here” Appointing a co-champion and embedding INTERACT tools into everyday practice will help overcome staff absences and turnover “We already have similar forms and processes” Use your tools, or use or modify the INTERACT tools based on what your facility already has in place

 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:  Don’t hesitate to contact us through the website INTERACT Curriculum Final Session Sustaining the Program Keep up the good work and Good Luck!

 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 Final Quiz and Program Evaluation INTERACT Curriculum Final Session Thank you very much!

 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 at: Please insert in the Subject Line: “Question about the INTERACT Curriculum” For teleconference participants: Questions, Suggestions, Comments? INTERACT Curriculum Final Session