1. September 2012 Your hosts: Jody Rothe, MetaStar Stephanie Sobczak, WHA

2.  Thank you to these organizations for sponsoring this webinar series: A special thank you to the Wisconsin Clinical Resource Center for serving as the home base for recorded webinars and materials related to the INTERACT II collaborative

3. JulyOverview & Case Review Tools AugustCommunication Tools SeptemberEarly Warning Tools OctoberChange in Condition Tools NovemberResident Transfer Tools DecemberContinuous Improvement Tools

4.  Share experiences with SBAR  Early Warning Signs  Stop and Watch Tool  Implementing the Stop and Watch Tool  30 day Action Items

5. Results of Feedback Tool Discussion: How did trying or testing SBAR go?  What went well?  What didn’t work well?  Can you share your plans for implementation? Please be sure your phone lines are muted (*6) to keep background noise to a minimum.

6.  Why this is important: 1. Patients conditions can change suddenly, but can also be very subtle. 2. Patients may under report their symptoms or concerns, “They don’t want to be a bother”. 3. Usually assistants are the first to hear about or see changes in a patient’s condition.

7.  Early warning signs that are missed can result in:  Adverse outcomes from delayed treatment  Avoidable transfers  Patient & Family dissatisfaction  Worsening of chronic conditions over time  Unnecessary time spend in a hospital bed  State survey citations (F157)

8. This is an Early Warning Tool to recognize, then report changes in a patients condition. It serves as a reminder to discuss with a charge nurse before the end of a shift. It is known as “STOP AnD WATCH”

9. S – Seems different than usual T – Talks or communicates less than ususal O – Overall needs more help than ususal P – Participated in activities less than usual A – Ate less than ususal (not because of dislike of food served) n D – Drank less than usual

10. W – Weight change A – Agitated or Nervous more than ususal T – Tired, Weak, Confused or Drowsy C – Change in Skin Color or condition H – Help with Walking, Transferring, Toileting more than ususal

12. Name of Resident Circle the changes noted Complete your name, reported to, date and time. Submit the tool to the appropriate person on staff.

13. 1. Start small 2. Find staff volunteers willing to try the tool. 3. Be willing to “tweak” the tool, or the process for using the tool so that it is effective in your facility. 4. Document your decisions.

14. 2-3 Nursing assistants try the tool Report on their experience using it Suggestions for next trial 4-6 Nursing assistants use the tool Gather feedback 8-12 Ditto (How long would it take you to reach all Nursing assistants with this tool?)

15. Intervention or Idea TestWho?Lesson Learned Decision Try Stop & Watch Complete the tool on 2 example residents Joan & LaTisha  Adapt  Adopt  Abandon  Adapt  Adopt  Abandon  Adapt  Adopt  Abandon  Adapt  Adopt  Abandon

17. Consider the following: Make paper copies of the tool. Giving a laminated card to record, then information could be transferred into a report/communication book. Make a “pad” for carrying in pockets

18. Key Question: How can you ensure the early warning tool is used by everyone, consistently? Plan: 1. How will you educate everyone? 2. How will you assess the effectiveness? 3. When will use of the Early Warning Tool be added to policy and procedure?

19. 1. Do you know the tool was used when there is a review of readmission cases? 2. Do you know SBAR was in use? 3. Do you see a decrease in avoidable readmissions?

20. Any idea how you might test or begin using the Stop and Watch tool? Please be sure your phone lines are muted (*6) to keep background noise to a minimum.

21. How well are you able to keep pace with the introduction of the INTERACT II tools?  We are keeping up very well  We are a little behind, but working on it.  We are struggling to keep up  We haven’t begun implementing any INTERACT II tools Results of this poll will be shared at next months webinar.

22.  Review the Stop and Watch Tool with staff  Have volunteers try the Tool through cycles of small tests  Evaluate the tests  Decide to adapt/adopt/abandon  Submit data An on-line Feedback Tool will be sent after October 3 rd to assess your progress on these tasks.

23. Thank you! See you next month Next month: Acute Change in Condition Tools