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.

 

DHSS Antibiotic Stewardship Survey

The Missouri Antimicrobial Stewardship Educational Collaborative is working with Washington University on an antibiotic stewardship project and are seeking input from Skilled Nursing Facility and other Long Term Care Facilities (Intermediate, Assisted, and Residential Care Facilities), in addition to MO hospitals. Please take a few minutes to complete their survey.

Washington University School of Medicine is performing a survey on behalf of the Missouri Department of Health and Senior Services, Hospital Associated Infections and Antimicrobial Resistance Program.

The survey can be found at the attached link here: Survey Link. It should take approximately 15 minutes to complete.

This survey is intended to evaluate the current state of antimicrobial stewardship activities at Missouri long-term care facilities. Please forwards it to whomever at your facility is most involved with the antimicrobial stewardship and the management of antimicrobial use, or if no such person exists your medical director or pharmacy leadership. We request this survey be completed by March 1, 2024.

For any questions regarding this facility antimicrobial stewardship survey, please submit a new email to mo.stewardship@wustl.edu; use “MO DHSS Antimicrobial Stewardship Survey” in the subject line.

We appreciate the time you take to complete these surveys!