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Hot Topics: Culture Change in Action

Monthly Webinars for the whole team from Pioneer Network

Thursday, April 23, 2015
3:00- 4:00 p.m. EDT
QI Closest to the Resident: Engaging Staff to Prevent Avoidable Hospitalizations and Use of Antipsychotic Medications

This webinar provides the how-to for a simple, potent process of moving QI out of the conference room to the staff closest to the residents. During the webinar, speakers apply QI closest to the resident to preventing avoidable hospitalizations and use of antipsychotic medications for residents living with dementia but the practice can be used for any quality improvement effort. Involving the staff who provide every day care in prevention efforts brings their timely accurate information about residents' condition, routines, and needs into individualized interventions. Barbara Frank of B&F Consulting will explain how QI closest to the resident positions organizations for the new value-driven government mandates by shortening the amount of time between staff recognizing acute clinical and behavioral episodes in their early stages and the whole team treating them effectively in-house. A team from Seaview Nursing Home in Staten Island, NY describes several mechanisms they use to engage everyone in avoiding the use of antipsychotics. Clare Hays, MD, a Medical Director in Birmingham, AL, will explain what conditions leading to hospitalizations that CMS is considering to be potentially avoidable, the early warning signs of such conditions, clinical interventions that would prevent the situation from becoming acute, and operational practices that can be used to help staff recognize the early warning signs and put these early interventions in place. A team from Wynhoven Healthcare Center in Marrero, LA describes how they engaged staff in tracking and trending to learn causes of residents' distressed behaviors and identify individualized interventions. Barbara will conclude with how-to information for QI huddles and rounding with the staff to prevent avoidable adverse events.

  • Barbara Frank, co-founder of B&F Consulting, Warren, RI
  • Clare Hays, MD, Medical Director, Birmingham Nursing and Rehabilitation Center, Birmingham, AL, and Medical Director of Alabama CMS Innovation Center Project to Reduce Avoidable Hospitalizations among Nursing Home Residents, an AQAF initiative

Teams from
  • Seaview Hospital Rehabilitation Center and Home, Staten Island, NY
  • Wynhoven Healthcare Center, Marrero, LA

Presenter Bios:
Barbara Frank is co-founder with Cathie Brady, of B&F Consulting. Through learning collaboratives and on-site assistance, B&F helps organizations improve services and outcomes by engaging staff in continuous improvement. They developed their method for engaging staff through a 21 state individualized care quality improvement pilot, Improving the Nursing Home Culture, led by Rhode Island's QIO, and applied it to distressed homes as they supported New Orleans area nursing homes recovering from Hurricane Katrina. This method was used successfully in several regional, state, and national collaboratives, including by 18 critical access nursing homes in four states working with Advancing Excellence to stabilize staffing and improve quality. Through a Pioneer Network Learning Collaborative, 49 nursing homes used this method of engaging staff in individualizing care to discontinue antipsychotic use for many residents. Currently B&F is part of the team working with AQAF on its grant from the Centers for Medicare & Medicaid Services (CMS) to reduce avoidable hospitalizations for nursing home residents in Alabama. AQAF is one of only seven organizations in the nation chosen for the "Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents." Using a quality improvement model with a RN "care pathways coach" at the core, AQAF is on-site at 23 nursing homes in Alabama. B&F is also creating a step by step method for discontinuing use of antipsychotics for people living with dementia, working with LEADER, the culture change coalition in Louisiana, on its CMS funded initiative.

Dr. Clare Hays is double board certified in Internal Medicine and Geriatric Medicine and is an Associate Professor in the Division of Gerontology, Geriatrics and Palliative Care at the University of Alabama Birmingham, where she has been in practice since 1987. She has been practicing and teaching exclusively in the long-term care setting since 1997. Dr. Hays is a Certified Medical Director and currently serves as medical director of two nursing homes. She serves as an attending physician for both post-acute and long-stay nursing home residents and teaches the principles of nursing home care and geriatric medicine to medical students, internal medicine residents, and Geriatric and Palliative Medicine fellows. Dr. Hays is a past president of the Alabama Medical Directors Association. She is the medical director for the Alabama CMS Innovation Center Project to Reduce Avoidable Hospitalizations among Nursing Home Residents, through AQAF, which is using a quality improvement model with an RN "care pathways coach" on-site at 23 nursing homes.

QI Closest to the Resident: Engaging Staff
to Prevent Avoidable Hospitalizations and Use of Antipsychotic Medications

Thursday, April 23, 2015
Registration fee is $99.

Tuesday, May 26, 2015
2-3 p.m. EDT
Safety vs. Autonomy for Elders: What if Maslow was Wrong?

Elder care staff are faced with similar dilemmas every day: The person living with diabetes who loves ice cream and wants to eat it every day; the elder at high risk of falling who refuses to use a walker. How do you balance respect for individual choice and the desire to protect the person from harm? This presentation will explore the complex issues involved in trying to honor the personal preferences of elders within the context of a long-term care environment obsessed with "safety." The rationale for this emphasis on safety is often Maslow's Hierarchy of Needs, the pyramid that places "physiological needs" at its base, followed by "safety," then "love and esteem" and finally "self-actualization." During this webinar, we will examine case studies and generate ideas and strategies to help care providers make well-reasoned decisions when the values of autonomy and safety collide.

Learning Objectives:
  • Explore the different meanings of the word "safety" and how it impacts care to older adults.
  • Examine the ethical principles that underlie decision-making for older adults.
  • Consider the challenges that arise when tension between resident safety and autonomy exists.

Theresa (Terri) A. Harvath, Ph.D., RN, FAAN, is a Clinical Professor at the Betty Irene Moore School of Nursing at UC Davis. She is committed to improving the health and health care of frail older adults through the integration of theory, practice and research. Dr. Harvath is particularly interested in exploring the complex clinical issues that often arise in the care of persons living with dementia.

Safety vs. Autonomy for Elders: What if Maslow was Wrong?
Tuesday, May 26, 2015
Registration feeis $99.