AHRQ Safety Program for Long-term Care: HAIs/CAUTI Communicating Changes in Resident Condition National Content Series December 2015

Learning Objectives Upon completion of this training participants will be able to: List three keys to identifying a change in resident condition; Describe physical and nonphysical resident changes that should be reported; Describe the characteristics of effective communication; and Identify and apply a TeamSTEPPS communication strategy that can be used to share changes in resident condition. 2

Residents Depend on Everyone to Detect and Communicate Changes in their Condition Nursing assistants Therapists Licensed nurses Activities Social workers Clerks Dietary Maintenance Laundry Housekeeping 3

Know the resident’s: Baseline condition Ability to move around Activity of daily living status Preferences Changes from the resident's normal condition can signal an acute change in condition. 4 Keys to Detecting a Resident Change

Any observations and concerns about changes in the resident's condition. 5 What Should be Reported?

Top 6 Physical Changes to Watch For 1.Walking 2.Urination and bowel patterns 3.Skin 4.Level of weakness 5.Falls risk 6.Vital signs 6

Top 6 Non-Physical Changes to Watch For 1.Demeanor 2.Appetite 3.Sleeping 4.Speech 5.Confusion or agitation 6.Resident complains of pain 7

Effective and clear communication between interdisciplinary team members, including nurses and providers, leads to: Prevention of acute changes of condition (ACOCs) Improved identification and management of ACOCs A safer resident care environment 8 Communication is Critical and TeamSTEPPS Can Help!

Effective Communication Complete Clear Brief Timely 9

SBAR Situation—What is happening with the resident? Background—What is the clinical background? Assessment—What do I think the problem is? Recommendation—What would I recommend?

SBAR – A Clinical Example Situation Mrs. Smith’s daughter is concerned because her mother’s urine appears cloudy in her catheter drainage bag. Background Mrs. Smith has an indwelling catheter due to a diagnosis of neurogenic bladder. Her vital signs are all within her normal parameters. She is displaying her usual level of orientation. She has no pain or discharge around the catheter. Assessment Mrs. Smith has no signs or symptoms of CAUTI. Her fluid intake was reduced a little today from her normal. Recommendation I’d like to continue to encourage fluids for Mrs. Smith and closely monitor her status, including her vital signs, and alert you if there is a change.

SBAR is useful for framing any conversation. Team members know what to expect when communicating with each other. Because a recommendation is made, the receiver of the information is less likely to be left guessing. Standardized communication techniques foster teamwork and resident safety. 12 SBAR Works!

Residents depend on everyone to detect and communicate changes in their condition. Changes from the resident's normal condition can signal an acute change in condition. Effective communication leads to a prevention of ACOCs, improved identification and management of ACOCs, and a safer resident care environment. SBAR is useful for framing any conversation, especially one about a resident or any other situation that requires immediate attention. 13 Summary

Stay Updated with Useful Resources 1.AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project WebsiteAHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website Login information Username: ltcsafety Password: ltcsafety 2.TeamSTEPPS ® for Long-term CareTeamSTEPPS ® for Long-term Care 14 3.NHSN CAUTI Definition Pocket CardsNHSN CAUTI Definition Pocket Cards 4.AHRQ Improving Patient Safety in Long-Term Care FacilitiesAHRQ Improving Patient Safety in Long-Term Care Facilities