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

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

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

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

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

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

8. 8 Stop and Watch is 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. Overview of INTERACT Clinical Practice Tools

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

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

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

12. 12  The INTERACT Change in Condition File Cards include recommendations  Immediate vs. non-immediate notification for specific:  Vital signs  Lab results  Symptoms and signs Overview of INTERACT Clinical Practice Tools Change In Condition File Cards

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

14. 14  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 Overview of INTERACT Clinical Practice Tools Care Paths

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

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

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

18. 17 Overview of INTERACT Clinical Practice Tools

19. Use available information Determine the wishes of the resident for care Front line staff may not be comfortable with these converstations 18 Overview of INTERACT Clinical Practice Tools

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

21. 20 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

22. 22 Overview of INTERACT Clinical Practice Tools Advance Care Planning

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

24. 24  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 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 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)www.caringinfo.org/Home.htm  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) www.agingwithdignity.org/5wishes.html Overview of INTERACT Clinical Practice Tools Advance Care Planning Additional Resources for ACP and End-of-Life Care

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

26. 22 Overview of INTERACT Clinical Practice Tools

27. 23 Overview of INTERACT Clinical Practice Tools

28. 24 Overview of INTERACT Clinical Practice Tools

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