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

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.

The INTERACT Interdisciplinary Team

Joseph Ouslander, MD Florida Atlantic UniversityRuth Tappen, EdD, RN, FAAN Florida Atlantic UniversityJill Shutes, GNP Florida Atlantic UniversityNancy Henry, PhD, GNP Florida Atlantic UniversityMaria Rojido, MD Florida Atlantic UniversitySanya Diaz, MD Florida Atlantic UniversityLaurie Herndon, MSN, GNP-BC Mass Senior Care FoundationJo Taylor, RN, MPH The Carolinas Center for Medical ExcellenceGerri Lamb, PhD, RN, FAAN Arizona State UniversityAnnie Rahman, PhD, MSW USC Davis School of GerontologyDan Osterweil, MD California Association of Long Term Care MedicineMary Perloe, GNP Georgia Medical Care FoundationJohn Schnelle, PhD Vanderbilt UniversitySandra Simmons, PhD Vanderbilt UniversityAlice Bonner, PhD, GNP Centers for Medicare and Medicaid Services

In collaboration with participating nursing homes


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 ToolOverview of INTERACT Clinical Practice Tools

Communication Tools

Decision Support Tools

Advance Care Planning Tools

Quality Improvement Tools

Overview of the INTERACT Program

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


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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

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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


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Stop and Watch is the primary method forCNAs to alert the LPN/RNs of changes in the resident’s conditionand for the nurse to hear what the CNAs have to say.


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• What to report• When to use it• Who should use it• How it helps


Further Assessment of Mr.

Salvi

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Decision Support Tools:Change in Condition File Cards and Care Paths


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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 ToolsChange In Condition File Cards

Mr. Salvi

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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 ToolsCare Paths

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• Improved communication

• Same language• Standard criteria• Efficient and

effective communication

• Improved documentation


Mr. SalviThe Complete Picture

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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?

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• Use available information

• Determine the wishes of the resident for care

• Front line staff may not be comfortable with these converstations

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Advance Care Planning Tools

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Overview of INTERACT Clinical Practice ToolsAdvance 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

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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


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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)


Additional Resources for ACP and End-of-Life Care

http://www.coalitionccc.org/advance-health-planning.php

http://www.alz.org/national/documents/brochure_DCPRphase3.pdf

http://www.caringinfo.org/Home.htm

http://www.agingwithdignity.org/5wishes.html

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The INTERACT Quality Improvement Program is designed to prevent UNNECESSARY ACUTE CARE TRANSFERS, not all transfers.

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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

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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

Documents

Module 4 Overview of INTERACT Clinical Practice Tools