HQIN: Simple Strategies for Summer Emergency Preparedness

 
July 2024

Simple Strategies:
Summer Emergency Preparedness

Emergency preparedness is important in every season, but it is especially important in the summer. Summer storms, tornadoes and hurricanes often come with damaging winds and rain, and have similar preparations even though they occur in different areas of the country.
 

In This Newsletter:

Learning Opportunities

 
Extreme Heat
Across the nation we have been experiencing heat waves. Extreme temperatures can negatively affect people, especially populations like nursing home residents. Both staff and residents must take necessary precautions to prevent complications related to excessive heat. Nursing home residents are among the most vulnerable to heat exhaustion and heatstroke.
 
Some suggested interventions for your facility may include the following:

  • Establish a facility protocol with guidance from the medical director about when outdoor activities can/should occur. If residents must be out, such as for transport to medical appointments, etc. be sure they are dressed appropriately for extreme temperatures and be sure to pack them with hydration materials. 
  • Alert staff to monitor residents for the signs and symptoms of heat exhaustion and heatstroke. Notify the resident’s physician of such observations and obtain medical services as needed.
  • Request clinical pharmacist monthly reviews to highlight potential medications that might create higher risks. Review resident medications and identify those that may cause residents to become more susceptible to harm from heat and sunlight.
  • Assure that facility policies and procedures for heat emergency situations are current, complete and staff are trained.
  • Monitor temperatures in care areas and resident rooms.
  • Monitor residents’ choice of clothing to ensure it is appropriate in extreme temperatures. Loose-fitting, light-colored cotton clothing is best to allow the skin to breathe.
  • Help decrease temperatures by closing window blinds and turning off unneeded lights in the daytime.
  • Assist residents to maintain adequate fluid intake. In addition to water, consider popsicles, Jell-O, sherbet and juices to keep residents hydrated.
  • When outside, encourage residents to sit in shaded areas and to use sunscreen.
  • Close windows, doors and blinds during the daytime and open them at night after the outside temperature cools sufficiently.

Check out the following resources to take proactive steps in ensuring you stay cool, hydrated and recognize signs and symptoms of heat-related illness:

Extreme heat should be treated as a major weather emergency, just like an extreme storm and the possibility of power outages. Now is the time to pull out the facility emergency and disaster plans, ensure they are up to date, and be sure staff are educated about what to do.

 
Safe Temperatures in Nursing Homes
There are regulations requiring long-term care facilities to maintain safe temperatures.

F-Tag 584 pertains to comfortable and safe temperature levels in nursing homes. According to the regulation, facilities initially certified after October 1, 1990, must maintain an air temperature range of 71°F to 81°F. Ensuring a comfortable environment is crucial for residents’ well-being, minimizing susceptibility to hypothermia or hyperthermia.

Residents with a history of dehydration, cardiovascular disease or pulmonary disease are particularly susceptible to heat-related illnesses and complications. All staff should be aware and monitor for signs, symptoms and consequences of heat exhaustion, heatstroke and heat cramps.

Use this NHICS response guide as a checklist to ensure tasks are addressed and completed regarding severe weather.

 
Power Outages
Nursing homes across the country may experience power outages for various reasons. Many of these reasons are centered on natural disasters, such as hurricanes and tornadoes. Electrical interruption may also be caused by failing systems, such as electrical grid brownouts or blackouts. When nursing homes lose power, especially for extended periods of time, disaster can strike.

How can nursing homes prepare for the possibility of a power outage? The Federal Emergency Management Agency (FEMA) has published guidelines to facilitate the preparation process.

Among the preparation steps, FEMA recommends:

  • Analyzing risks, particularly those systems and components that can interfere with the ability to deliver care when power outages occur.
  • Identifying specific at-risk residents, such as those receiving temperature-stabilized medications or who may need power-operated support systems.
  • Securing temporary power support, including the use of generators.
  • Setting up redundant cooling systems for food supplies and medications, including off-site or temporary refrigeration facilities.
  • Establishing a maintenance and resupply chain for emergency power systems.
  • Establishing a plan to access resident records during power outages.
  • Establishing communication with organizations like emergency services, local or state health departments, emergency management agencies and evacuation shelter facilities.
  • Enhanced staff training to develop emergency-response skills and to ensure that all staff members understand their specific duties during a power outage.
  • Ensuring that nursing home insurance policies provide coverage for natural disasters that result in loss of electrical service.
  • Identifying shelters that are able to maintain healthcare services for residents if they are forced to evacuate.

By taking these steps in advance of a power outage, nursing homes will be better equipped to provide continuous and safe care to residents, all without subjecting residents and staff to the risks associated with electrical service interruption.

 
Hurricanes
Hurricanes are dangerous and can cause major damage from storm surge, wind damage, rip currents and flooding. They can happen along any U.S. coast or in any territory in the Atlantic or Pacific oceans. Storm surge historically is the leading cause of hurricane-related deaths in the United States.

Hurricane season is here, take time to understand and prepare for how a hurricane could affect you. You can start your hurricane preparedness efforts by downloading FEMA’s Hurricane Hazard Information Sheet.

Visit Ready.gov/hurricanes for more information and tips about hurricanes. You can also download the FEMA app (free of charge) to learn how to prepare for common hazards, receive real-time alerts from the National Weather Service and search for additional disaster preparedness guidance.
 
Tornadoes
Tornadoes are violently rotating columns of air that extend from a thunderstorm to the ground. Tornadoes can destroy buildings, flip cars and create deadly flying debris.

A tornado can:

  • Happen anytime and anywhere.
  • Bring intense winds, over 200 miles per hour.
  • Look like funnels.

The National Weather Service (NWS) provides numerous tornado safety resources. They can be accessed directly at Tornado Safety.

 
 

Shelter In Place: A Critical Component of Your Emergency Operations Plan: Updates from an Expert

by HQIN Consulting Subject Matter Expert Jordan Rennie, Owner and Principal of Rennie Consulting

Jordan assists the Health Quality Innovation Network (HQIN) as a subject matter expert working with nursing homes on emergency preparedness plan reviews and emergency preparedness education.

In the face of emergencies, healthcare facilities must be prepared to make quick and informed decisions to protect residents, staff and resources. A well-crafted Shelter in Place (SIP) section within your Emergency Preparedness Plan (EPP) is essential to ensuring operational continuity and safety. Here is a concise guide on key elements your SIP strategy should cover:
 

1. Preparation and Planning
 
Risk Assessment: Conduct a thorough risk assessment to identify potential scenarios that may necessitate SIP, such as severe weather, hazardous materials incidents or infrastructure failures. Tailor your SIP plan to these specific threats. This can be done while completing your annual Hazardous Vulnerability Assessment (HVA).

SIP Locations: Identify and designate safe areas within the facility where residents and staff can gather. These areas should be protected from external hazards and have access to necessary resources.

Supplies Inventory: Ensure a robust inventory of emergency supplies, including medications, food, water and medical equipment. Stock enough to sustain operations for at least 72 hours.

Upstaffing: Plan for increased staffing levels in anticipation of an SIP event. Arrange for additional clinical and support staff to be on site to handle increased demands and resident care needs.

Family: Ensure your family is prepared at home with their own shelter in place plan. You will not be able to adequately respond to an emergency at your facility if you are worried about folks at home.

2. Decision-Making: Shelter or Evacuate?
 
Criteria for SIP vs. Evacuation: Establish clear criteria to guide the decision on whether to shelter in place or evacuate. Consider factors such as the nature and scope of the threat, the condition of the facility and the safety of evacuation routes.

Decision Authority: Define who has the authority to make the SIP or evacuation decision. Ensure this individual or team is trained and has access to real-time information and communication channels.

Communication Plan: Develop a communication strategy to relay the decision to staff, residents and their families. Ensure everyone understands the protocol and their specific roles during an SIP event.

3. Proactive Measures
 
Resource Management: Maintain increased levels of critical supplies. Establish relationships with vendors to ensure quick resupply of essentials such as food, water, fuel and medical supplies. In addition, consider having a list of vendors both in your area and outside. This will increase resilience should vendors in your area be impacted as well.

Generator Capacity: Verify that your backup power systems, including generators, are functional and can support critical operations for extended periods. Regularly test these systems and ensure fuel supply arrangements are in place. Consider installation of generator “quick connects” that allow easy deployment of external generators.

Environmental Controls: Ensure that HVAC systems and other environmental controls can be managed during an SIP to maintain safe and comfortable conditions for residents and staff.

4. Communication with External Entities
 
Local Emergency Management: Establish and maintain open lines of communication with local emergency management agencies. Share your SIP plans and seek alignment with community emergency response strategies. Local emergency management leaders can assist you in making the decision to shelter in place or facilitate evacuation.

Vendor Coordination: Develop agreements with vendors for emergency delivery of essential supplies, including fuel, water, food and medical goods. Ensure contact information is current and establish protocols for rapid response.

Information Sharing: Implement mechanisms to share and receive information with external partners during an SIP event. This includes updating local authorities on your facility’s status and needs and receiving critical updates from emergency management agencies.

5. Training and Drills
 
Regular Training: Conduct regular training sessions for all staff on SIP procedures. Ensure everyone understands their roles and responsibilities during an SIP event.

Drills and Exercises: Perform regular SIP drills to test your facility’s preparedness. Use these exercises to identify gaps in your plan and refine your strategies.

6. Regulatory Requirements and Resources
 
Planning and preparation are great practices. They can assist in creating a more resilient and safer environment for staff and residents. However, it is also important to keep regulatory requirements in mind. The following E-Tags are covered by the CMS Emergency Preparedness Rule relating to SIP and Evacuation.

Regulatory E-Tags: E0018, E0020, E0022, E0015, E0041

For more information, refer to the CMS Emergency Preparedness Rule Webpage.
 

Conclusion
A comprehensive SIP plan is vital to the resilience of healthcare facilities during emergencies. By focusing on preparation, clear decision-making processes, proactive measures and robust communication with external entities, you can ensure that your facility is ready to protect and care for residents and staff when the unexpected occurs.

 
Training and Education Importance
Emergency Preparedness Plan training and education is crucial for both staff and residents in nursing homes.

You want your staff to be prepared and you want your residents to feel safe.
You can accomplish this by providing staff with:

  • Knowledge and Skills: Staff need to be well trained in emergency procedures, including evacuation, communication and response protocols. Training ensures they know what to do during various emergencies.
  • Drills and Exercises: Regular drills and exercises help staff practice their roles, understand evacuation routes and learn how to handle different scenarios.

Trained staff can respond efficiently, minimizing risks to residents and themselves.

For resident safety, providing residents with:

  • Awareness: Residents should be informed about emergency plans, evacuation routes and safety measures. Training helps them understand what to expect during emergencies.
  • Shelter In Place and Evacuation Readiness: Residents need to know how to safely shelter in place, evacuate safely and how to follow instructions from staff.
  • Reducing Panic: Proper training reduces panic and confusion during emergencies, ensuring residents can follow procedures calmly.

Remember, ongoing training, exercises and evaluation are essential to ensure staff and residents respond appropriately during emergencies.

 
Is Your Emergency Preparedness Plan Survey Ready?

See What People Are Saying About Our EPP Review Assessment Tool:

“I truly appreciate your insights. This was extremely helpful as I get my EPP updated.”
“Thanks for your insight and expertise.”
“I’m so grateful for your help.  This review was exactly what I needed.”
“Time well spent.”

Are You in Need of a Turnkey,
Ready to Implement, Tabletop Exercise?

The team of experts at the Health Quality Innovation Network (HQIN) is offering free support to ensure your facility’s emergency preparedness plan meets all the necessary criteria.
 
Take our online assessment, which guides you through a series of questions that will quickly identify what could be missing in your current emergency preparedness plan. After you submit your responses, an HQIN quality improvement advisor will review your responses and provide you with tools and resources to help support survey readiness. In addition, we will send you a complete, ready to implement, Tabletop Exercise and After-Action report.

Ready to get started? Scan the QR code or click the button below:

 
Click HERE to Take the Assessment
 
After Action Report Improvement Plan Template
Download our After Action Report Improvement Plan Template, which is a tracking form that allows teams to record real emergency events and exercises to document the scenario, capabilities tested, strengths, areas for improvement and more.

Nursing Home Excellence:
Prepare, Prevent, Protect (3P) Top Performer Program
The Health Quality Innovation Network’s (HQIN) Prepare, Prevent, Protect (3P) Top Performer Program recognizes participating nursing homes who are proactive in delivering high quality care to their residents and ensuring a safe environment for residents, staff and visitors.

The 3P Top Performer facilities achieve success in the following three designations:

  • PREPARE: Implement planning, policies and training on emergency preparedness and infection prevention.
  • PREVENT: Prevent avoidable resident emergency department visits, readmissions and hospitalizations.
  • PROTECT: Commit to ongoing, proactive immunization program.

Congratulations on achieving success in all three designations! Share with your staff and recognize them for their contributions.

Download the list of nursing home facilities being recognized.

 
Emergency Protocol for Long-Term Care Homes
The Emergency Protocol was developed in 2007 for communication between long-term care homes and the Section for Long-Term Care Regulation (SLCR), in the event a disaster occurs resulting in a loss of a necessary service (electricity, water, gas, telephone, etc.). This protocol was established to streamline communication so that homes can focus on what is most important – the safety and well-being of the residents.

This protocol provides the cellular telephone number corresponding to the region in which your home is located if you experience a loss in a necessary service that has the potential to affect resident safety or well-being. You are encouraged to contact the regional office main office telephone number during normal business hours because survey staff carry the cell phone and may be conducting a survey or inspection during working hours and may not answer immediately.

Download the Emergency Protocol Handout for Facilities for the phone number to use in your area.

This protocol is NOT to be used to self-report incidents normally reported to the Elderly Abuse & Neglect Hotline (1-800-392-0210).

If you have any questions about the Emergency Protocol for Long-Term Care Homes, please contact the Section for Long-Term Care Regulation at 573-526-8524.

 
 

Learning Opportunities

Facility Assessment: More Than a Regulatory Requirement

Learn CMS Required Regulatory Components Due by August 8!

July 17 at 10 a.m. ET
Join us on July 17 where we will focus on the new facility assessment requirements from the Centers for Medicare & Medicaid Services (CMS). You will not want to miss this opportunity to learn what needs to be done by August 8 to ensure your facility assessment meets all required regulatory components
 
The facility assessment is referenced 172 times in the 329-page staffing rule and is also the first requirement in preparation for the staffing requirement. F838 has been in play since 2016 but is taking on a new shape and focus with less than a month to make the required updates by August 8.
 
At the end of the session, you will:

  • Understand the revised facility assessment requirements and regulatory updates.
  • Understand how to complete the facility assessment process with your team.
  • Understand how to identify resources that are necessary to care for residents competently during normal day-to-day operations and emergencies.
  • Understand how to link the facility assessment to your emergency preparedness plan (EPP) and QAPI program.

Learn how the Health Quality Innovation Network (HQIN), as your Quality Improvement Organization, can provide assistance.

Register Here
 
 

Learning Modules for Nursing Home Staff, Visitors and Residents Teach Infection Prevention

Infections can be deadly in nursing homes. Solid infection prevention practices, coupled with the COVID-19 vaccine, are key to protecting those who live and work there.

Download our flyer and post it in your nursing home to encourage staff, visitors and residents to learn how to prevent infections. The brief learning modules, which are accessible through a link on the flyer or by scanning the QR code, review the dangers of infections and how to prevent them.

 
 

Newly Updated CMS Training for Frontline Nursing Home Staff and Management – Modules 5 and 8

Learn about the impact of dementia in caring for nursing home residents with COVID-19 and how to protect the emotional health of nursing home staff through this no-cost, updated Quality, Safety & Education Portal (QSEP) online training developed by the Centers for Medicare & Medicaid Services (CMS).

View scenarios In Module 5: Caring for Residents with Dementia to gain more understanding of the special needs that residents with dementia have and how to best care for them. Master content at your own pace, learning anytime and anywhere, even on your mobile devices.

While many concerns rest on the physical health and well-being of nursing home staff and residents, emotional health is also important. Module 8: Emotional Health, is designed for nursing home managers to learn how to develop creative strategies to promote and support emotional health for staff and residents.

 
 

New Learning Modules on Diabetes Available Now!

We are pleased to announce the release of our comprehensive new learning modules on diabetes. These modules are designed to enhance your knowledge and skills in identifying, treating and managing diabetes, providing you with the latest best practices for optimal resident care. To access these modules, and others on a variety of topics, visit HQI Academy, our online learning management system.  
 
New to HQI Academy? After you follow the link, click “SIGNUP” in the upper right. Fill out the short form to create your account. Once logged in, you’ll have access to a variety of courses on the main dashboard. Simply click on the cover of any course to start learning.
Access HQI Academy
 
 
About the Health Quality Innovation Network
Led by Health Quality Innovators and its quality improvement partners, Constellation Quality Health, KFMC Health Improvement Partners and the Kansas Healthcare Collaborative, HQIN is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Kansas, Missouri, South Carolina and Virginia. To learn more about HQIN visit https://www.hqin.org.
 

Celebrate & Support Nursing Assistants

National Nursing Assistants Week was celebrated June 13-19, 2024. Join CDC’s Project Firstline to recognize Certified Nursing Assistants (CNAs) across the nation who show an unwavering commitment to providing quality care to their patients and residents.

CNAs are skilled, vital members of the healthcare team, and we express our gratitude for their commitment to serving on the frontlines each day. CNAs dedicate themselves to infection prevention and control and help maintain safe and healthy environments for all patients and residents.

Show your Support

Support CNAs in your facility by saying “thank you” and acknowledging their contributions, which enhance infection control knowledge and make a significant impact in people’s lives.

Build their Knowledge

Utilize these important resources with CNAs in your facility to continue to build knowledge and strengthen infection control practices:

  • Interactive infection control activities: CNA’s can test their knowledge in real time and learn how to apply infection control solutions to stop the spread of germs.
  • Infection Control training toolkits: View ready-made materials and resources to host facilitated training sessions on a variety of infection control topics.
  • Micro-learn series: Use a series of guided discussions to help your staff recognize common infection risks and stop the spread of germs.
  • Enhanced Barrier Precautions resources: If you work in a nursing home, share these resources to help support your staff in understanding and effectively using Enhanced Barrier Precautions to protect residents and themselves.

Frequently asked questions
Pocket card
Overview video

Missouri’s Master Plan on Aging Needs to Hear From You!

Help us make the State of Missouri a great place to live and age with dignity!

On June 13, we will be launching the State of Missouri 2024 Needs Assessment Survey on Polco, our online civic engagement platform. Randomly selected households will receive mailed survey invitations around that time. If you receive an invite and meet the criteria listed, please follow the instructions to participate!

If you aren’t selected for this initial survey effort, stay tuned: in July, the survey will be open to all adults age 50+, adults (age 18+) with disabilities, and unpaid caregivers (adults 18+ who provide care for another adult).

To receive an email notification when this survey is available, click the link below, select “Follow” next to Missouri Association of Area Agencies on Aging, and set up a Polco account.

Thank you for helping to create a better community for all!

Set Up a Polco Account

Thanks to all of our champions who work tirelessly to create communities in Missouri where we can all age well.

Your Voice Matters!

2024 SLCR Annual Provider Meetings

Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation

There is no cost to attend any of these meetings. Please see the flyer.

September 4, 2024: Region 2
Location: Drury Plaza Hotel & Convention Center, Cape Girardeau

September 5, 2024: Region 7
Location: Crowne Plaza St. Louis Airport, Bridgeton

September 18, 2024: Region 1
Location: Oasis Hotel & Convention Center, Springfield

September 24, 2024: Region 6
Location: Special Olympics Missouri, Jefferson City

September 26, 2024: Region 5
Location: Moberly Municipal Auditorium, Moberly

October 1, 2024: Region 4
Location: Stoney Creek Hotel, St. Joseph

October 2, 2024: Region 3
Location: Adams Pointe Conference Center, Blue Springs

MO Health Ambassador Trainings

Attention Missouri Nursing Homes!

Register for a Free In-Person Health Ambassador Training

Sessions Will Be Held in Jackson/Cape Girardeau, Saint Louis and Springfield

Don’t miss this opportunity to register two individuals from your nursing home for a free regional in-person Health Ambassador Training in Missouri being presented by the Health Quality Innovation Network (HQIN) and Johns Hopkins University.

This training uses the Be REAL framework which focuses on building trust by forming relationships, targeting resources responsive to a facility’s population, and always keeping the door open for interactions to improve health outcomes such as immunizations and infection prevention.

Two people may register per facility and a maximum of 40 participants will be allowed for each session. Recommended participants include all staff, such as:

  • Nurses
  • Infection Prevention Nurses
  • Nursing assistants
  • Social services
  • Dietary
  • Environmental services
  • Also, please consider sending a resident, family member or volunteer.

These sessions will be interactive and include group discussion, small-group activities, games, and an opportunity to practice what has been learned. 

MO Health Ambassador Trainings

For questions, please contact us at ltc@hqi.solutions.

These trainings have been made available by the Health Quality Innovation Network (HQIN) and the Institute for Vaccine Safety – Johns Hopkins Bloomberg School of Public Health.

Cyber Security Preparedness Reminder

Managers from the Division of Regulation and Licensure within the Missouri Department of Health and Senior Services recently attended an update meeting with the CMS Regional Office in Kansas City. An informative presentation was provided by Captain Skip Payne, Director of the Emergency Preparedness & Response Operations (EPRO). Please see the attached key points and reminders.

HQIN Strategies to Use During Your Nursing Home Stand-Up Meetings

Entire Series Now Available for Download!

The Health Quality Innovation Network’s free 9-week education series is now available for download on our Resource Center. Download the topic(s) that you want to focus on in your facility or download the entire series and work through all nine weeks.

The five short, concentrated evidence-based talking points in each week can easily be included in daily stand-up meetings to increase staff knowledge on relevant topics. The program is designed to empower nursing home staff with practical knowledge to foster a safer environment and decrease preventable emergency room visits and hospital readmissions.

We’d appreciate your feedback on this education series. Please share your experience in using the content and materials offered in the Nursing Home Stand-Up Series.

VOYCE’s Upcoming Events

April 16, 2024: Community Education: Tips to Remain Fiscally Fit as You Age

Are you worried about being financially scammed, missing bill payments, or neglecting to review your bank account statements? Or have you struggled to update your beneficiaries? If so, a daily money manager can help. These financial professionals offer personal services to individuals, families, older adults, people with disabilities, busy professionals, high-net-worth individuals, and small businesses. Learn more about their services and how you can protect your assets as you grow older.

April 22, 2024: Caregivers’ Resilience and Family Resources

Becoming a sudden caregiver for your loved one can be overwhelming. Identify tips on how to sustain your lifestyle and invest in self-care.

May 2, 2024: Professional Development Webinar: Cultivating an LGBTQ+ Friendly Community

The National Gay and Lesbian Task Force has outlined that the population of LGBTQ+ older adults in the U.S. is expected to double in size, becoming six million strong by 2030. Questions about the availability of inclusive housing for older LGBTQ+ people are rising. The purpose of this presentation is to inform attendees about the barriers that LGBTQ+ elders face when seeking out housing and long-term care services. This presentation will also introduce attendees to the Long-Term Care Equality Index (LEI), a tool founded by SAGE and the Human Rights Campaign to assist Long Term Care Communities in becoming more inclusive to LGBTQ+ elders. Attendees will leave this presentation with actionable steps on how to get connected to the LEI and how to start making their communities more inclusive to LGBTQ+ older adults.

May 7, 2024: Legacy Planning 101: Don’t Leave Your Family Guessing

With proper assistance, planning for the next chapter of life need not be stressful. Learn from an elder law attorney about the five essential documents to honor friends’ and relatives’ wishes.

May 20, 2024: ABUSE – Verbal, Physical, Sexual, Financial – Help Protect Your Loved Ones

Learn how to identify the signs of abuse, how and where to report it, and how to support your loved one, friend, or family member if they are experiencing abuse.

MC5 Upcoming Meetings

April 19, 2024: We Honor Veterans Program and End-of-Life Care for Veterans
Location: Cape Girardeau Public Library, Cape Girardeau

The purpose of this program is to bring awareness to issues veterans face at end-of-life and to explain the We Honor Veterans Program. Veterans face different issues at end-of-life that are not often experienced by non-veterans. The We Honor Veterans Program helps navigate caregivers through these issues as well as provides education regarding resources within the community.

April 26, 2024: Person-Centered Program Planning
Location: Brentmoor Retirement Community, St. Louis

Programming is at the center of a community’s culture and can have a ripple effect throughout a community, by fostering inclusivity and an all-hands-on deck approach. We will be discussing various ways to incorporate person-centered values during the programming planning process; as well as giving examples of real-life programming that embodies the whole team and whole community approach. Attendees will be asked to bring a copy of the community activity calendar for an interactive approach to looking at those calendars through another set of lens’.

MANHA’s 2024 Annual Convention

June 2-5, 2024: Kick Off Your Summer with an Unforgettable MANHA Experience!
Location: The Resort at the Lake of the Ozarks

Missouri Association of Nursing Home Administrators is pleased to invite you to attend the 2024 Annual Convention. The goal of this conference is to provide meaningful, forward thinking, and real-time education to pave the path forward while acknowledging the past and working together.

HQIN Strategies to Use During Your Nursing Home Stand-Up Meetings (Purposeful Conversations)

HQIN is presenting an educational series tailored for nursing home stand-up meetings, aimed at decreasing preventable emergency room (ED) visits and hospital readmissions. HQIN is sending out talking points that can be included in daily stand-up meetings to increase staff knowledge on relevant topics like effective communication, adverse drug events and infection prevention. The program is designed to empower nursing home staff with practical knowledge to foster a safer environment.

This week is the final week of the series. This week’s strategies include Purposeful Conversations. Below is an overview of information and resources.

  • Purposeful conversation refers to intentional and meaningful communication that serves specific objectives or goals. It goes beyond casual chitchat and aims to achieve specific outcomes.
    Print and discuss with the team the following resource, Go to the Hospital or Stay Here. Social services staff or nurses can use this decision guide to facilitate clear and informative conversations of a resident’s choice to “Go to the Hospital or Stay Here.”
  • Do all of your residents have a documented advanced directive? Review which residents are a full code, and which are a Do Not Resuscitate (DNR). Discuss how staff know which residents are DNR and what the current process is to communicate this to all staff.

Print and discuss Education on CPR for Residents/Patients and their Representatives with the clinical team to guide conversations when providing education for residents and their family.

Advanced directives should be reviewed upon admission, quarterly, and if a change in condition would warrant it. Use this Advance Care Planning Tracking Form to assist with tracking these reviews.

  • It is often helpful to involve the physician or healthcare provider, in addition to the resident and their family, in purposeful conversations during care plan meetings. You may want to have an ad hoc care plan meeting if a decline in condition is noted.  Discuss with the team the importance of being proactive with change in condition. Consider inviting the physician or nurse practitioner to participate in a care plan meeting to participate in difficult conversations.

Print and discuss A Patient’s Guide to Serious Illness Conversations from the Institute for Healthcare Improvement to guide these conversations.

  • Advanced care planning for vaccinations is a best practice. The Planning for COVID-19 Care Conversation Tool can assist with having purposeful conversations centered around vaccinations upon admission and at quarterly care plan meetings. Print and share the same resource with the admissions and clinical care plan team and discuss how it can be incorporated into current practice.

HQIN Strategies to Use During Your Nursing Home Stand-Up Meetings (Falls)

HQIN is presenting an educational series tailored for nursing home stand-up meetings, aimed at decreasing preventable emergency room (ED) visits and hospital readmissions. HQIN is sending out talking points that can be included in daily stand-up meetings to increase staff knowledge on relevant topics like effective communication, adverse drug events and infection prevention. The program is designed to empower nursing home staff with practical knowledge to foster a safer environment.

This week’s strategies include Falls. Below is an overview of information and resources.

  • Talk about environmental hazards that may contribute to a resident falling.
    How many can your staff name (wet floors, poor lighting, incorrect bed height, improperly fitting wheelchair, poor shoes, or resident needs such as the need to use bathroom, items not in reach, call bell not in reach)?
    Print the Environmental Safety resource and review with your team, then post it for other staff members to have for reference. Create a Falls bulletin board to display educational resources to reduce falls for your team.
  • How many times have you seen a resident try to stand, transfer or walk unassisted? It takes a team, working together, to reduce falls.
    If you see a resident that looks unsafe, let someone know. Purposeful rounding can be conducted by anyone (housekeeping, dietary, maintenance, nursing, social services, activities and volunteers) who is “walking” in the facility.
    Print the Falls Prevention resource and share with team members, then post it for others to reference.
  • What are the 4 P’s to reduce fall risk? Pain. Potty. Positioning. Possessions. Implementing purposeful rounding for all staff can significantly reduce fall risk.
    Print and post the following resource on The 4 P’s of Reducing the Risk of Falls and discuss them in depth with your staff. Also, download these 4 P’s Cards that can be cut out and shared with staff.
  • Who is tracking falls in your facility and are they including it as part of QAPI? Is there a system of sharing information on falls and letting all members of the team know the facility’s fall data?
    Designate a “falls champion” today and continue to find great information on fall reduction to share with your team. Charts and graphs can be great to share! Download the Health Quality Innovation Network (HQIN) Nursing Home Falls Tracking Tool and implement it into your team processes.

Eden Conference

June 2-4, 2024: MOVE MOUNTAINS and Embrace Possibilities
Location: King of Prussia, PA

The Eden Alternative 30th Anniversary International Conference

Together, transform challenges into possibilities and make the impossible possible. Share new tools to sharpen skills and reimagine new paths to empowerment. Let’s build a foundation of courage and resilience to strengthen care partner teams who take on this meaningful work – and discover global innovations that translate worldwide.

We are filled with gratitude for all care partners, including Elders, residents, families, friends, and employees, as we celebrate 30 years of revolutionizing care.

HQIN Strategies to Use During Your Nursing Home Stand-Up Meetings (Discharge Analysis)

HQIN is presenting an educational series tailored for nursing home stand-up meetings, aimed at decreasing preventable emergency room (ED) visits and hospital readmissions. HQIN is sending out talking points that can be included in daily stand-up meetings to increase staff knowledge on relevant topics like effective communication, adverse drug events and infection prevention. The program is designed to empower nursing home staff with practical knowledge to foster a safer environment.

This week’s strategies include Discharge Analysis. Below is an overview of information and resources.

  • Any time an emergency department (ED) visit, unplanned discharge or adverse event occurs, we can identify areas where improvement is possible.
  • Do you have a process in place to review ED visits and unplanned discharges?
  • Does an interdisciplinary team conduct these reviews?
  • Are they done after each transfer or adverse event?

Discuss current strategies for improvement.

If not already established, consider assembling an interdisciplinary team consisting of leadership, the medical director and direct care staff to review these events.

  • A resident may discharge unexpectantly for a number of different reasons. It might seem like there was nothing that would have prevented an ED visit or hospitalization but often processes could have identified a problem before it resulted in discharge. Facilities must have processes in place for early identification of changes in condition and to communicate those changes to ensure timely interventions.

Assess your facilities communication processes. Do you have a huddle meeting with frontline staff to share and discuss important information? If not, consider using the HQIN Huddle Toolkit to implement huddles at start of shift and end of shift, quality improvement huddles, new resident huddles or “Everyone Stands Up Together” huddles where the daily standup meeting is conducted on the unit(s) with frontline staff.

Also, INTERACT® (Interventions to Reduce Acute Care Transfers) offers communication tools at no cost including Stop and Watch Early Warning Tool, SBAR (Situation, Background, Appearance and Review and Notify) and the Medication Reconciliation Worksheet.

  • Other adverse events should trigger the same evaluation as unplanned discharges. Reviewing adverse events helps to find opportunities for improvement that can prevent future ED visits or hospitalizations.
    • When issues are identified or communicated, how are these issues reviewed?
    • Are they reviewed at risk management meetings?

Discuss how possible opportunities are communicated to the risk management team. Use the EMR to help identify factors like changes in condition, falls, medication errors, etc. to include in risk management meetings.

  • Residents and families play an important role in preventing ED visits and hospitalizations. Care planning and advanced care planning should be discussed with patients and families regularly. Review CMS’ Go to the Hospital or Stay Here Decision Guide for patients and families. Make use of the resource to assist patients and families to plan for future care.

INTERACT® (Interventions to Reduce Acute Care Transfers) also offers care planning tools at no cost including the Advance Care Planning Communication Guide and Identifying Residents who may be Appropriate for Hospice or Palliative/Comfort Care Order. Choose your favorite resources as a team and make sure they are available to assist with care planning.

  • Sometimes the root cause of an adverse event is not immediately clear. Root cause analysis can help uncover the cause, and a fishbone diagram can assist with finding it. Fill out the problem (adverse event) at the head of the fish. As you brainstorm possible causes, group them into categories. Use these categories to identify areas where improvement would be beneficial.

When you have identified a problem and root cause, you will want to implement quality improvement interventions. Consider the problems and root causes you have noted this week. Use the QAPI Sustainability Decision Guide to assist with choosing effective interventions.

INTERACT® Version 4.5 Tools For SNFs/Nursing Homes also offers quality improvement resources including an Acute Care Transfer Log, Calculating Hospitalization Rates, Hospitalization Rate Tracking Tool, Quality Improvement Tool for Review of Acute Care Transfers and Quality Improvement Summary Worksheet.

MDS Case Mix Review Training

The Missouri Department of Social Services has contracted with Myers and Stauffer to conduct provider training. This webinar will be divided into two sessions. You may choose to participate in one or both sessions.

The Morning Session (9:00 am – 10:00 am CST) will include:

    • Case Mix Review Process
    • Web Portal Access and Submissions

The Afternoon Session (1:00 pm – 2:30 pm CST) will include:

    • Supportive Documentation Requirements

Please plan to join us during one or both of the scheduled sessions. Registration is required.

March 19, 2024
Morning Session: 9:00 am – 10:00 am CST
To register for this webinar, click here!
To join by phone, dial: 1-844-740-1264
Access Code: 2421 836 0727
Event Password: MOTraining

Afternoon Session: 1:00 pm – 2:30 pm CST
To register for this webinar, click here!
To join by phone, dial: 1-844-740-1264
Access Code: 2428 242 0685
Event Password: MOTraining

March 26, 2024
Morning Session: 9:00 am – 10:00 am CST
To register for this webinar, click here!
To join by phone, dial: 1-844-740-1264
Access Code: 2438 288 2508
Event Password: MOTraining

Afternoon Session: 1:00 pm – 2:30 pm CST
To register for this webinar, click here!
To join by phone, dial: 1-844-740-1264
Access Code: 2437 705 7018
Event Password: MOTraining

MC5 Conversations Event

March 27, 2024: Supporting Person Centered Cultures
Special Guest: Stacey Bergmann, Director of Community and Network Relations, Center for Innovation (CFI)

In her role at CFI, Stacey is carrying on the mission of Pioneer Network, working together with leaders from the state culture change coalitions. Together with MC5 board member and conversation host, Kim Fanning, attendees will explore with Stacey what is happening around the country as CFI, along with state coalitions, work to find ways to help providers grow their person-centered cultures.

MC5 Hybrid Meeting

April 3, 2024: Care Connection – Opportunities to Create Positive Aging Experiences
Location: First United Methodist Church Celebration Center, Sedalia
Presenters: Wendy Martin, MHA; Rona McNally, Care Connection; Marilyn Gunter, BSW,MSW

Join facilitators from Care Connection who will provide information about their person-centered approach to services. During this presentation it will be shared how Care Connection maintains a person-centered focus in the development and delivery of services. Attendees will learn the importance of family caregiver support for person-centered care and how the Long-Term Care Ombudsman program supports individuals’ rights and choices, serving as advocates and educators. Also, the Missouri SMP (Senior Medicare Patrol), will inform attendees of current Medicare/Medicaid fraud trends and the importance of protecting health care benefits.

HQIN Strategies to Use During Your Nursing Home Stand-Up Meetings (Medication Reconciliation)

HQIN is presenting an educational series tailored for nursing home stand-up meetings, aimed at decreasing preventable emergency room (ED) visits and hospital readmissions. HQIN is sending out talking points that can be included in daily stand-up meetings to increase staff knowledge on relevant topics like effective communication, adverse drug events and infection prevention. The program is designed to empower nursing home staff with practical knowledge to foster a safer environment.

This week’s strategies include Medication Reconciliation. Below is an overview of information and resources.

  • If a resident’s medication orders reflect the wrong medication, the wrong dose, the wrong time, or the wrong route, adverse drug events are likely. Review which staff reconciles medication on admission. Discuss with the team the policy for admission medication reconciliation.
    • How many times are admission orders reviewed?
    • Is the contacted pharmacy made aware when orders are for a new admission?
    • How are diagnoses, indications and allergies identified?

Are medications reviewed with the previous facility during report?
Review the Interact Medication Reconciliation Worksheet. How does this compare to the facility’s medication reconciliation processes?

  • After admission, every nurse that gives medication is responsible for giving medication correctly. Along with the Five Rights of medication administration (right patient, right drug, right dose, right route, right time), nurses will need to be aware of the indications for medications, any needed lab work or monitoring and possible adverse reactions.
    Discuss the systems in place at your facility to ensure medications are given properly. Review the Five Rights with staff.
  • Doctors, nurse practitioners and pharmacists should be involved in medication reconciliation.
    Ask your team these questions:
    • When is this review triggered in your facility?
    • If there has been a behavior change, is medication reviewed for possible side effects?
    • Who can you reach out to internally and at the contracted pharmacy if you are unsure if orders or administration are appropriate or with any other questions?
  • Medication reconciliation should not stop at admission. Changes in condition or changes in locations should trigger a medication review.
    Are physicians or pharmacists notified when a resident’s condition changes?
    Are they notified when a resident becomes more or less compliant with medication or diet?
    These changes could result in the need for closer monitoring or changes to medications. Residents with over eight scheduled medications are at higher risk for drug-to-drug interactions. Do you have a process to handle those higher risks?
  • Medication needs to be administered according to company policy. Using a computer system to assist with medication administration helps prevent medication errors. Discuss the drawbacks staff see in using the computer system.
    Do you experience fatigue due to repeated drug interaction alerts? How can those drawbacks be eliminated? Review some lessons learned about implementing and using technology in a clinical setting.

HQIN Strategies to Use During Your Nursing Home Stand-Up Meetings (Opioids)

HQIN is presenting an educational series tailored for nursing home stand-up meetings, aimed at decreasing preventable emergency room (ED) visits and hospital readmissions. HQIN is sending out talking points that can be included in daily stand-up meetings to increase staff knowledge on relevant topics like effective communication, adverse drug events and infection prevention. The program is designed to empower nursing home staff with practical knowledge to foster a safer environment.

This week’s strategies include Adverse Drug Events – Opioids. Below is an overview of information and resources.

  • Adverse drug events are commonly experienced by people taking opioids as well as anticoagulants. Like anticoagulants, you will want to ensure staff caring for residents know which residents are at risk and what risk factors and sign/symptoms of adverse events may be. Discuss opioid risk factors, adverse event signs/symptoms and interventions using the Opioid Tip Sheet for Frontline Nursing and CMT Staff.
  • Using non-medication pain relief methods can decrease the need for opioids. Communicating with residents and families will help find the most effective pain relief methods for each patient. Sometimes facilities use methods like applying heat/cold, massage, ultrasound, or stretching exercises to help ease pain. Remember to evaluate things like positioning, bed choice and seating choice when you are working to reduce pain.
  • Knowledge of risk factors, signs and symptoms of adverse drug events, and the best ways to stay safe can prevent them and assist with early identification. Review your policy for medication education and explore Opioid Resources for Patients and Caregivers.
  • Opioids can be useful for controlling pain, but it is important to remember they carry a high risk for adverse events. Review the Opioid Adverse Drug Events Self-Assessment with your team. Use the Plan-Do-Study-Act Worksheet to work toward improvements.
  • Narcan (Naloxone) is a medication used to reverse the effects of opioids. It is often discussed for treatment of overdose with illicit drugs but is often needed for people who are prescribed opioids. Every nursing home should have a policy for Narcan use. Review your facility’s policy with staff. Can staff identify where Narcan is kept and when it should be given? Post the Opioid Information Card to educate residents and caregivers.

HQIN Strategies to Use During Your Nursing Home Stand-Up Meetings (Anticoagulants)

HQIN is presenting an educational series tailored for nursing home stand-up meetings, aimed at decreasing preventable emergency room (ED) visits and hospital readmissions. HQIN is sending out talking points that can be included in daily stand-up meetings to increase staff knowledge on relevant topics like effective communication, adverse drug events and infection prevention. The program is designed to empower nursing home staff with practical knowledge to foster a safer environment.

This week’s strategies include Adverse Drug Events – Anticoagulants. Below is an overview of information and resources.

  • An adverse drug event (ADE) is harm that results from medication use. These events can be due to allergic reactions, side effects, overmedication and medication errors. Anticoagulant medications are necessary for the treatment of some conditions but are also a leading cause of ADEs resulting in ER visits or hospitalization. Review ADE risk factors and sign/symptoms on this Anticoagulant Antithrombotic Tip Sheet.
  • Also, review the Centers for Disease Control and Prevention’s (CDC) Adverse Drug Events in Adults for more safety information.
  • Review your policy for medication education. Blood Thinner Pills: Your Guide to Using Them Safely provides resources for educating residents and families.
  • Evaluating your facility’s anticoagulant program can assist you with identifying and addressing opportunities for improvement.
  • This Anticoagulant Adverse Drug Events Self-Assessment provides a checklist for anticoagulant programs.

DMH Free Webinars – Tools for Everyone

March 5, 2024: Registration
March 14, 2024: Registration
March 20, 2024: Registration

Tools of Choice is an evidence-based program focused on the implementation of universal positive practices. This two-hour introductory training is open to community members, parents, and professionals. It covers key concepts of the Tools of Choice curriculum, including: What is behavior, building positive relationships, and how to increase desirable behavior. Join the Positive Support Consultants in learning strategies to make positive change by implementing universal positive practices.

Registration is also available on the Upcoming Webinar Webpage.