Joseph G. Ouslander, MD Professor and Associate Dean for Geriatric Programs Charles E. Schmidt College of Medicine Professor (Courtesy), Christine E.

Joseph G. Ouslander, MD

Professor and Associate Dean for Geriatric ProgramsCharles E. Schmidt College of Medicine

Professor (Courtesy), Christine E. Lynn College of NursingFlorida Atlantic University

Professor of Medicine (Voluntary), University of Miami

Session 1

Overview of the INTERACT Program and Curriculum

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

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Session 1Overview of the INTERACT

Program and Curriculum

Teleconference Instructions

Session 1Overview of the INTERACT

Program and Curriculum

Call in Number 1-888-808-6959

Conference Code 3588988 #During the call, please mute your line Press * 6

To un-mute your line Press # 6

If the leader is not on the call when you call in, please wait

Welcome and Introductions

Session 1


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


• 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.

[email protected]

The INTERACT Interdisciplinary Team

Laurie Herndon, GNP Mass Senior Care FoundationGerri Lamb, PhD, RN, FAAN Arizona State UniversityRuth Tappen, EdD, RN, FAAN Florida Atlantic UniversitySanya Diaz, MD Florida Atlantic UniversityJohn Schnelle, PhD Vanderbilt UniversitySandra Simmons, PhD Vanderbilt UniversityAnnie Rahman, MSW Miami UniversityJo Taylor, RN, MPH The Carolinas Center for Medical ExcellenceAlice Bonner, PhD, GNP Center for Medicare and Medicaid Services

In collaboration with participating nursing homes


Definition and goals of INTERACT Why it matters to you and your organization Overview of the INTERACT curriculum Preparing for your participation

What This Session Will Cover


Please complete the Pre-Session Quiz If you take the Quiz in a paper and pencil format, please

make sure your facility champion or co-champion gets a copy If you are reviewing this session on-line, you can take the on-

line Quiz, or take the Quiz using a hard copy obtained from your facility champion or co-champion, and return it to them

Pre-Session #1 Quiz


INTERACT – definition and goals

INTERACT stands for “Interventions to Reduce Acute Care Transfers”

It is a program designed to improve the care of nursing home residents by: Identifying situations that commonly result in transfers

to the hospital – and working together to manage them effectively and safely in the nursing home without transfer whenever possible



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



The INTERACT program was:

Originally developed in a project supported by the Center for Medicare and Medicaid Services (CMS)

Revised based on input from staff from several nursing homes and national experts in a project supported by The Commonwealth Fund



The INTERACT program includes clinical tools, strategies to implement them, and related educational resources

The INTERACT program is located on the internet at:

http://interact2.net



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:



The INTERACT tools are designed to be:

As simple as possible Efficient for use in daily care routines Based on scientific evidence and/or expert

recommended clinical guidelines where available

Consistent with federal regulations and guidance for surveyors



1. Identify changes in residents condition

2. Assess these changes

3. Manage some conditions in the nursing home

4. Document the changes and how they were assessed and managed

5. Communicate effectively:

a. With staff in your nursing home

b. With staff at your local hospitals

The INTERACT tools are designed to help you:


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


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 assessment 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


Why it matters – a national perspective (1)

Emergency room visits, hospitalizations, and re-hospitalizations of nursing home residents are:

Common : 1 in 4 residents admitted to a nursing home from a hospital are re-admitted to the hospital within 30 days

Expensive: hospitalizations that might not be necessary cost Medicare and Medicaid billions of dollars every year



Hospitalizations can contribute to many complications:

Distress and discomfort for the resident Delirium Polypharmacy Falls Incontinence and catheter use Hospital acquired infections Unintentional weight loss and poor nutrition Immobility, de-conditioning, pressure ulcers




Reducing avoidable hospitalizations will help:

Allow limited Medicare and Medicaid funds to be used to improve care in our nursing homes rather than for unnecessary hospital stays

Preserve Medicare benefits for all of us


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


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 assess and manage acute changes in status

You need to be prepared!


12 sessions over a 6-month period (for teleconference participants) Some facilities will participate on-line only with completion of 9

sessions Not all staff need to complete every session

The facility champion and co-champion will serve as the coordinators of the curriculum

Participating staff will be asked to document their consent to participate and complete a pre and post quiz and an evaluation for each session

Practice using the tools between sessions Follow-up calls to individual facility champions to discuss progress

The INTERACT Curriculum


Evening, night, and weekend staff will go through curriculum sessions on an individual basis The sessions will be available on-line, but can

also be printed and reviewed in hard copy if access to the project website is limited

Nurses can earn CEUs for participation

The INTERACT Curriculum (2)


Your participation and evaluation and feedback is critical to help further improve the INTERACT program

You will be asked to complete an evaluation of each session, and of the overall curriculum This is required for nursing staff earning

CEUs



Week 1

Session 1: Rationale and Overview of the INTERACT Program and Curriculum

Week 2

Session 2: Tracking Transfers, the Concept of “Avoidability”, and the QI Review Tool

Week 3

Session 3: Stop and Watch

Champion DON Key RNs and

LPNs Lead CNAs

Medical Director Key MDs,

NPs/PAs Social worker Administrator


LPNs Lead CNAs



Champion DON Key RNs, LPNs Lead CNAs



Week 5

Session 4: SBAR

Week 7

Session 5: Care Paths and Change in Condition File Cards

Week 9

Session 6: Information Transfer and Interacting with Your Hospitals


LPNs


NPs/PAs


LPNs


NPs/PAs

Champion DON Key RNs, LPNs





Week 11

Session 7: Advance Care Planning Tools (1)

Week 13

Session 8: Advance Care Planning Tools (2)

Week 15

Session 9: QI Review Tool Revisited


LPNs Lead CNAs




LPNs Lead CNAs


NPs/Pas Social worker Administrator

Champion DON Key RNs, LPNs

Medical Director Administrator



Week 17

Session 10: Case Studies: Stop and Watch

Week 19

Session 11: Case Studies: SBAR, and Care Paths

Week 21

Session 12: Wrap Up: Overcoming Barriers and Achieving Sustainability


LPNs Lead CNAs Champion DON Key RNs and

LPNs



Champion DON Key RNs, LPNs Lead CNAs





Put the dates of curriculum calls on your calendar

Review the INTERACT website Meet as a team to discuss participation

before the second session Let your affiliated hospitals know about

the program

Planning Your Participation


Your facility’s project champion is responsible for coordinating INTERACT implementation. She or he may ask you to complete specific activities before the next teleconference or before you review the next session on-line

Suggested implementation activities before the next session include reviewing portions of the INTERACT website: Go to the home page (http://interact2.net) and read it Click on “About INTERACT” and read the page On the “About INTERACT” page, click on “Tool Table” and review the

list of tools and then click on “INTERACT II Overview Figure”, and review it.

Finally, click on “INTERACT II Tools”, and review the Acute Care Transfer Log and QI Review Tool by clicking on them

Implementation Assignment before the Next Session


http://interact2.net/

Un-mute the line: Press # 6Please re-mute your line after talking: Press * 6

Questions and suggestions on Session 1 can also be directed to Dr. Ouslander by email at:

[email protected]

Please insert in the Subject Line: “Question about the INTERACT Curriculum”

For teleconference participants:Questions, Suggestions, Comments?


mailto:[email protected]

Week 2

Session 2: Tracking Transfers, the Concept of “Avoidability”, and the QI Review Tool


LPNs Lead CNAs

Medical Director

Key MDs, NPs/PAs

Social worker Administrator

The Next Session


The next teleconference will be held at the same time next week

The topic and participants are listed below

Please complete the Post-Session Quiz and Evaluation 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 on-line, you can take the on-line Quiz and complete the evaluation on-line.

Post-Session #1 Quiz and Evaluation


Joseph G. Ouslander, MD Professor and Associate Dean for Geriatric Programs Charles E. Schmidt College of Medicine Professor (Courtesy), Christine E.

Documents

curriculum slide

university of miami

curriculum joseph

commonwealth fund slide

organization overview

medical care

quality of care

quality improvement