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!

VOYCE’s Upcoming Events

February 20, 2024: Put the Care in Caregiving

The pressures of caregiving, whether inside or outside the home, can lead to a lack of empathy and several physical symptoms, known as caregiver compassion fatigue or burnout. In the wake of a pandemic that claimed over 5.5 million lives, knowing your limits and what to do when you’ve reached them is essential. Learn the signs of caregiver compassion fatigue to identify them in yourself or others and explore options for relief.

February 29, 2024: Summit to Protect Older Adults and Adults with Disabilities

This summit is a conversation with the community, professionals, older adults, and others to learn what needs to be fixed in the adult protection system.

March 18, 2024: Navigating Long-Term Care Choices and Understanding Nursing Home Residents’ Rights

A Professional Care Manager helps to develop care plans while resolving family conflicts. Find out how a care manager can help you to have autonomy in your life. An Ombudsman Professional will be on hand to understand Residents’ Rights in the long-term care facility.

March 19, 2024: Community Education: Driving Yourself Lonely

Loneliness and lack of connection in older adults have recently been reported as a public health crisis in the United States, the consequences of such potentially being an increased risk of heart disease, stroke, dementia, and premature death. What role does transportation play in exacerbating this problem, and how is this being addressed in St. Louis? Get your questions answered in this webinar!

MC5 Webinar

March 6, 2024: The Validation Method:  Connect and Communicate with Older Adults
Presenter: Vicki deKlerk, Executive Director, The Validation Institute

Over 37 years ago, when reality orientation was the norm, Naomi Feil, a woman with unique empathy and insight into the world of disoriented elders, created the Validation Method, motivating older adults with cognitive decline to communicate more, relieve stress, and enhance dignity and happiness in their final stage of life.

Today, the validation method is practiced around the world, and her daughter, Vicki deKlerk, continues her work through the Validation Training Institute, providing education, quality standards and easy pathways for learning this evidence-based method.

Through the magic of Zoom, Vicki will join us from the Netherlands, using interactive exercises, she will describe, demonstrate and share 2 key prerequisite skills of the Validation Method. There will be an opportunity to share in conversation and engage in a Q & A with attendees.

MLN Nursing Home Administrator Conference

May 21-23, 2024: 33rd Annual Nursing Home Administrator Conference
Location: Downstream Casino, Quapaw, OK

Elevate your leadership at the 33rd Annual NHA Conference hosted by the Missouri League for Nursing at Downstream Casino from May 21-23, 2024. Join MLN for a Quad-State Extravaganza that promises unmatched insights, networking, and celebration tailored to meet the unique challenges and opportunities in the realm of nursing home administration.

VOYCE Professional Development Webinar

March 7, 2024: Climb Out of the Cost Burden: Resources Available for Low-Income Housing Needs

Over 10 million households headed by someone 65 and older are cost-burdened, meaning they pay more than 1/3 of their income on housing. Service providers encountering clients needing low-income housing must be aware of the available programs and services to ensure smooth transitions. Join VOYCE to understand the current issues in St. Louis regarding low-income housing for older adults and what factors in individuals’ lives impact, and sometimes inhibit, their capacity to live independently in low-income housing. This presentation will explore St. Louis-based aid that can help people mitigate unique barriers to housing and locate their next home, including Show-Me Home, Missouri’s Money Follows the Person program.

DMH Free Webinars – Tools for Everyone

February 8, 2024: Registration
February 13, 2024: Registration
February 21, 2024: Registration
February 29, 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.