“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP) Navigating the ROP Changes: Are You in Compliance? 1 1
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
Navigating the ROP Changes: Are You in Compliance? 1 1
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
Navigating the ROP Changes: Are You in Compliance? 1 2
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Antipsychotic PIP Project
Sunshine NH Rate
National Average
Track Your Progress Over Time
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
Navigating the ROP Changes: Are You in Compliance? 1 3
Making QAPI Dynamic
QAPI
Educate
Motivate
Innovate
Motivation for Adult Learning1. Social relationships: to make new friends, to meet a need for associations and
friendships. 2. External expectations: to comply with instructions from someone else; to fulfill
the expectations or recommendations of someone with formal authority. 3. Social welfare: to improve ability to serve mankind, prepare for service to the
community, and improve ability to participate in community work. 4. Personal advancement: to achieve higher status in a job, secure professional
advancement, and stay abreast of competitors. 5. Escape/Stimulation: to relieve boredom, provide a break in the routine of home or
work, and provide a contrast to other exacting details of life. 6. Cognitive interest: to learn for the sake of learning, seek knowledge for its own
sake, and to satisfy an inquiring mind.
Knowles, Malcolm. (1986) The Adult Learner: A Neglected Species. Houston: Gulf Publishing.
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
Navigating the ROP Changes: Are You in Compliance? 1 4
Motivate the Millennials• They want positive feedback
– Signed poster of appreciation– Recognition in front of their peers
• They want to feel fulfilled at their job• They are technologically savvy• They want to feel inspired
https://money.usnews.com/money/blogs/outside‐voices‐careers/articles/2017‐03‐09/3‐ways‐to‐motivate‐millennials‐at‐work
Organizational Culture• Can be defined by a company’s mission, goals, and values
• Culture is defined by those things that influence the working environment itself and the behaviors of those who work there
• Your culture has its own spoken and unspoken rules of conduct
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
Navigating the ROP Changes: Are You in Compliance? 1 5
Why is it important?• Those unwritten rules that govern the care delivered in your nursing homes
• These unwritten rules play directly into staff turnover and employee satisfaction
• Negative culture can lead to sub‐optimum care
Motivate by LeadershipConcept Leadership ManagementMotto Do the right thing Do things rightChallenge Change ContinuityFocus Purpose Procedures
Method Strategy SchedulesOutcomes Journeys DestinationPeople Potential Performance
Questions Why? Who? What? When? Where? How?
Time Frame Present to future Past to present
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
Navigating the ROP Changes: Are You in Compliance? 1 6
Make the Staff Heart Connection• Walk a mile in your shoes• Staff scavenger hunt• Front line staff participate in “I” care plan meetings
• Thank you for being a “life‐saver”
• Staff become resident for a day
Team Building• Use Learning Circles for Problem Solving• Sunshine Jar to start off meetings• Red Carpet ceremonies to reward hard work• Create a group of “imagineers” – the sky is the limit
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
Navigating the ROP Changes: Are You in Compliance? 1 7
Empower Resident Relationships• Let staff be “dream catchers”• Memory boards• Prom night• Fashion show• Virtual Cruise
Making QAPI Dynamic
QAPI
Educate
Motivate
Innovate
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
Navigating the ROP Changes: Are You in Compliance? 1 8
Create C.S.I. Investigators
CareSceneInvestigation
• Put the participant in the driver’s seat
• Participants receive a ‘crime sheet’ that they can use during the workshop to keep track of clues
• Witness Testimony• Real Life Situations
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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The Case of Smiling FacesNursing Home: A Pressure Ulcer Mystery
Witness Testimony: The Wound Care Nurse
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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Witness Interview: The CNA(currently under Federal Witness Protection) The Conclusion: We Solve the Case
• Grab your Investigation Case Sheet to crack the mystery case
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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Another Workshop Idea:Encourage Interaction in Workshops
What’s Wrong with this Picture?
Another Mystery• Mrs. Jones is about to develop a pressure ulcer. In our quest to prevent it, what’s wrong with the picture?
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
Navigating the ROP Changes: Are You in Compliance? 1 12
What is wrong with this picture? What else is wrong?
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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Nutritional Clues Case Solved! It’s all in the evidence
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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The Annual Pressure Ulcer In-service• Is your in‐service:
– The same old same old?– Scheduled on payday? – Enough notification for staff to plan to be present?
– Enough chairs to sit down comfortably and listen?
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
Navigating the ROP Changes: Are You in Compliance? 1 15
The Barrier Reef Barrier Reef ExerciseSee the water beading up on right hand?
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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The Daily Post• Use a moisture barrier to help protect the skin from stool and urine
• Barrier creams and ointments only work if they are applied, and applied correctly
• These creams can be the first line of defense for your elder to stop a pressure ulcer before it develops
Treasure Hunt
• The picture on the right is view from glasses with petroleum
Seeing through the resident’s eyes
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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The Daily Post• Assist residents to eat as necessary
• Notify the nurse if there is a decline or change in a resident’s eating habits
• In the dining room, consider using different color placements to identify those that need assistance with eating
Terrors of the Deep
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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Terrors of the DeepStage 1 Stage 2
Stage 3 Stage 4
The Daily Post• Stage IV pressure sores take the longest to heal
• In some residents, stage IV can develop in a matter of hours; for example, if left on the wrong surface too long
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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Solving the Puzzle ofThe Braden Scale*
Nutrition
Mobility
Friction and Sheer
MoistureActivity
*Refers to The Braden Scale for Predicting Pressure Sore Risk, Barbara Braden and Nancy Bergstrom, 1988
Sensory Perception
You Just Need Prizes from a Dollar Store
• Quiz Bowl – Based on your favorite TV game show
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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Prevention A & P Risk Factors Nutrition Positioning/Repositioning
The best treatment for pressure sores is________________.
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
Navigating the ROP Changes: Are You in Compliance? 1 21
Prevention What is the body’s first line of defense against infections/microorganisms?
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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THE SKIN
The skin needs to be intact to keep germs out.
Making QAPI Dynamic
QAPI
Educate
Motivate
Innovate
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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Innovate with Cutting Edge Best Practices
• INTERACT• TeamSTEPPS• IA‐ADAPT• Geriatric Pain
INTERACT: http://interact2.netInterventions to Reduce Acute Care Transfers
is a quality improvement program that focuses on the management of acute change in resident condition. It includes clinical and educational tools and strategies for use in everyday practice in long term care facilities.
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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Quick Guide to Get Started• This is intended to help reveal opportunities for further implementation.
• Great to use in a QAPI Performance Improvement Project (PIP).
Quality Improvement Tools
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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“Initiative based on evidence derived from team performance…leveraging
more than 25 years of research in military, aviation, nuclear power, business and
industry…to acquire team competencies”
Team Strategies & Tools to Enhance Performance & Patient Safety
TeamSTEPPS Website
https://www.ahrq.gov/teamstepps/longtermcare/index.html
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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All Modules Can Be Downloaded For Free The Tools of TeamSTEPPSCommunica‐tion
Leadership Situation Monitoring
Mutual Support
•SBAR•Call‐Out•Check Back•Handoff•I PASS THE BATON
•Effective Team Leaders•Team Events•Brief Checklist•Debrief Checklist
•Situation Monitoring Process•STEP•Cross‐Monitoring•I'M SAFE Checklist
•Task Assistance•Feedback•Advocacy and Assertion•Two‐Challenge Rule•CUS
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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University of Iowa
https://igec.uiowa.edu/ia‐adapt
IA-ADAPT Resources• Training Videos
– Introduction/Overview– Assessment– Delirium– Non‐Drug Management– Shared Decision Making– Antipsychotic Selection– Antipsychotic Monitoring
• Family/Patient Information– Shared Decision Making
Guide– Managing a crisis
• Pocket Guides– Overview of evidence‐based
approach + evaluation of problem behaviors
– Delirium assessment and management
– Non‐drug management– Drugs that may cause
delirium or problem behaviors
– Antipsychotics guides• Other Guides
– Algorithm for symptoms of dementia
– Managing a crisis
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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University of Iowa – Geriatric Pain
https://geriatricpain.org/pain‐management
More Resources to Make Things Easy
http://qioprogram.org/nursing‐home‐training‐sessions
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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Quality Insights Can Assist
QAPI Resources• Action Planning Worksheet• QAPI at a Glance• QAPI Toolkit• Fishbone RCA• 5‐Whys RCA• Goal Setting Worksheet• Sustainability Guide• Topic Example Documents
Examples of our Topic Resources
• Antipsychotics– Trigger Tools, Step‐by‐Step
Guides to reduction
• Fall Management– Care Plans, Risk Assessments
• Pressure Ulcer Prevention– Skin Care Fair
• Pain Management– Audit Tools, Team Tools
Your Louisiana Quality Improvement Specialist
Julie Kueker318‐294‐[email protected]
“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)
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Thank you
This material was prepared by Quality Insights, the Medicare Quality Innovation Network‐Quality Improvement Organization for West Virginia, Pennsylvania, Delaware, New Jersey and Louisiana under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication number QI‐LA‐C2‐022618