Engaging Staff in Individualizing Care Five-Part Webinar Series


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These webinars are products from Pioneer Network’s National Learning Collaborative on Using the MDS as an Engine for High Quality Individualized Care, made possible with the support of The Retirement Research Foundation. The Collaborative incubated B&F Consulting’s method for improving outcomes by engaging staff in individualizing care. The method first puts in place four foundational practices — consistent assignment, huddles, involving CNAs in care planning, and Quality Improvement (QI) closest to the resident — and then uses the practices to individualize care for improvements in high priority clinical areas. Forty-nine nursing homes incubated these practices through fifteen-month learning collaboratives led by five Culture Change Coalitions and four corporations, achieving accelerated improvements in clinical, quality of life, human resource, and organizational outcomes. Teams from incubator homes watched 12 webinars covering the foundational practices, clinical applications, customary routines, reducing use of antipsychotic medications, and by improving teamwork. The webinars provide the building blocks for transformation of organizational and care practices.

Set of 12 Downloadable Webinars
Webinars are provided as mp4s. Facilitator’s Guides and Handouts are provided with each webinar for in-service training.

Series 1:
Integrating the MDS 3.0 into Daily Practices
(3 webinars)
Webinar One:
Integrating the MDS 3.0 Into Daily Practice: How to Improve Clinical and Business Outcomes
Hear the clinical and business case for engaging hands-on caregiving staff in the MDS process. Practitioners explain how to align documentation at the bedside with MDS coding to achieve better clinical outcomes and capture care provided so it can be paid for. Administrators, Directors of Nursing, and MDS Coordinators will provide the step-by-step process to align CNA flow sheets and daily nurse charting with key elements of the MDS such as residents’ mood, functional status, cognition, appetite, and clinical condition, and information about residents’ preferences and satisfaction.

Webinar Two:
Integrating the MDS 3.0 Into Daily Practice: How to Put Organizational Systems into Place

This webinar explains how to put in place the organizational practices that integrate the MDS into daily care. Administrators, Directors of Nursing, and other practitioners discuss three key areas: (1) maximizing hand-offs between shifts and using start-of-shift and end-of-shift huddles to capture care provided, resident needs, and any risks and opportunities; (2) making the care planning process responsive to daily developments in care and facilitating CNA involvement in care planning; and (3) maintaining consistency of assignments through hiring and scheduling practices so staff know residents intimately.

Webinar Three: Integrating the MDS 3.0 Into Daily Practice:
MDS and Quality Improvement

Learn how to use MDS 3.0 to link daily care with interdisciplinary unit-based problem solving and quality improvement. Practitioners share how to use the team approach to the MDS to tackle clinical areas and how they are measuring the results. This webinar applies the organizational practices described in Webinars One and Two to case examples through which practitioners are able to prevent and reverse declines and promote residents’ health and well-being. QI experts and practitioners will explain how to establish a dynamic process of “just-in-time” information sharing, education, and critical thinking to continually assess residents’ conditions and needs and intervene as needed to achieve the highest practicable well-being of each resident.

Series 2:
Clinical Applications: An Interdisciplinary Approach to Health Promotion
(3 webinars)
Webinar Four:
Promoting Mobility and Reducing Falls by Individualizing Care and Eliminating Alarms
Joanne Rader, who pioneered tie-on restraint elimination, describes the similar detrimental effects of alarms – because they limit mobility and independent function – and provides a primer on alarm elimination. Using the “use it or lose it” rule, she explains that promoting mobility and core strength is the best “safety” plan for reducing falls with serious injury. Highlighting key sections of the MDS, Rader describes how to work with an interdisciplinary team to assess individuals and their environment to assist with independent transfer. She explains how therapy can provide mobility devices and customize seating. Two nursing homes then share their experience of promoting mobility. Sycamore Village in Kokomo, IN graduated from being a Special Focus Facility, by using strong teamwork, consistent assignment, huddles, and just-in-time care planning to individualize care. As they removed alarms, they reduced their falls. Hear about their “out of the box” approach to therapy and willingness to try something different. Sycamore’s administrator, Director of Nursing, and Rehabilitation Coordinator describe their experience. Their sister home in Greenfield, Indiana learned what they were doing and used the same process to eliminate alarms and reduce falls in their organization. Doing this, says their administrator, has changed the culture and the environment, from one of rushing in reaction to the noise, to anticipating and calmingly meeting residents’ needs. Her message: it’s all about trust.

Webinar Five:
Individualizing Dining: New Practice Standards

How do we put the ideals of individualized dining into daily practice? In this webinar, Carmen Bowman interviews a team from Brookshire House in Denver, Colorado, about how knowing each person and honoring their food choices improved their outcomes. One of the residents shares her perspective on how the “give and take” with the staff helped heal a serious pressure ulcer. The Brookshire team also discusses how they individualized dining service for a man at risk for choking. A physician, Director of Nursing, Dietitian, Dietary Manager, Activities Director, and CNA describe how they worked these tough clinical issues through and got excellent outcomes both for nutrition and for quality of life by listening to residents’ preferences. Carmen shares information about the Dining Practice Standards, developed by a Task Force convened by Pioneer Network and facilitated by Carmen, and strategies for implementing them.

Webinar Six:
Smooth Transitions in Care: Getting New Residents Off to a Good Start

You only have one chance to make a good first impression for new residents and their family. How you prepare and welcome them can make all the difference in the quality of their stay. Smooth transitions from the hospital can prevent re-hospitalization, and promote the return to home for short-stay residents. An effective hand-off process between the hospital and nursing home staff helps residents maintain their highest practicable well-being. This webinar features three nursing homes, one primarily serving people with advanced dementia, another primarily serving people with short-term rehabilitation needs, and a third with a mix of residents. For each home, knowing residents’ personal routines and history is key to ensuring that they get off to a good start to their stay. Internal coordination among CNAs, nurses, admissions staff, dining, rehab staff, and others in your nursing home is crucial to making sure a new resident’s transition to the nursing home is comfortable and seamless. Hear from nursing home staff about how their care teams support residents and families through a smooth transition and a good welcome.

Series 3:
Individualizing Care and QAPI: Two Keys for Reducing Antipsychotic Medications
(2 webinars)
Webinar Seven:
MDS and Quality of Life: Operationalizing Customary Routines
What does home mean to you? The experience of being at home is described by Judith Carboni, RN, as falling along a continuum from the most at home: an intimate fluid relationship between person and place, to the least at home: a severely damaged relationship between person and place. We feel at home in our rhythms of life — waking, sleeping, eating, bathing, listening to music. Our ability to maintain our customary routines contributes to our physical, mental, and psycho-social well-being. In this webinar, surveyors will describe how they have come to understand the importance of these elements of quality of life, and Karen Schoeneman, who oversaw quality of life efforts at CMS for over twenty years provides her perspective. A team from St. Camillus Health Center, Whitinsville, MA describes how they operationalize these customary routines from day one and a resident of St. Camillus will describe what that has meant to her.

Webinar Eight:
MDS and QAPI: A High Involvement Approach

The Quality Assurance Performance Improvement (QAPI) requirements in the Federal nursing home regulations include focusing on fostering high engagement of staff closest to the resident in performance improvement activities. Hear from an MDS coordinator about the interplay between MDS and QAPI, and from nursing home teams how they used performance improvement projects (PIP) to foster staff engagement in individualizing care. One team increased CNA and resident involvement in care planning. Another brought individualized music to residents through iPods. Another brought the management team morning meeting out to staff closest to the resident. Now “Everyone Stands Up Together” a couple of mornings a week so that staff engage in on-the-spot problem solving that catches problems early and addresses them immediately. These teams provide a blueprint for the type of involvement in individualizing care that will help homes reduce anti-psychotic medications.

Series 4:
Reducing Anti-Psychotics Through Individualized Care – Medical Perspectives and Case Studies
(2 webinars)
Webinar Nine:
Individualizing Care and Environments: Non-pharmacologic Interventions Instead of Anti-Psychotic Medications
The evidence is conclusive that anti-psychotic medications rarely have a benefit for people with dementia. Indeed, they often cause serious harm because of their sedative affect and how they mask the needs being expressed by residents through their behavioral communication. Except when used on a short-term basis in response to an acute condition, often the dangers of medications far outweigh the benefits. Research indicates major adverse outcomes with antipsychotics over the 6-12 weeks (Schneider et al 2005, Ballard et al 2009), including gait disturbance, increased respiratory infections, edema, accelerated cognitive decline, and higher risk for stroke and death. These risks increase over longer periods of drug use, while benefits diminish. Individualizing care and environments is often the most effective non-pharmacologic intervention to prevent and alleviate the distressed behaviors that the medications aim to quell. Dr. Al Power, author of Dementia Beyond Drugs and Dementia Beyond Disease, describes key practices needed to create the safety and well-being for residents with dementia. Hear case examples from a team of nursing home staff about how they individualize each resident’s care routines and living environment to reduce distress and promote well-being by learning about residents’ routines, understanding what they are communicating when they express distress, and reducing their distress rather than masking it with medications.

Webinar Ten:
Promoting Mental Health Through Team-based Individualized Assessment and Care

When we understand what residents are communicating, we can meet their needs instead of escalating their sense of crisis. Agitation means “Help Me!” while aggression means “STOP!” Geriatric psychiatrist, Susan Wehry, explains the meaning behind distressed behaviors and the organizational practices, such as consistent assignment, that help staff build the relationships with residents necessary to understand and respond to this communication. Staff and residents from Sunbridge nursing homes in Massachusetts join their regional staff in describing how they use five key principles to promote well-being among their population of residents with mental illness. These principles are: (1) Person Centered: Care based on the person, their likes, dislikes, hopes and dreams; (2) Strength Based: Care based on what a person can do, not on what they cannot do or what disease they have; (3) Recovery Based: Living each day to the best of their abilities; (4) Meeting Needs: All behavior is a form of communication, and (5) Group Programming: Skill based groups that give the resident the skills they may need. Laurie Herndon shares how these principles have been used successfully in homes across Massachusetts to reduce use of medications by reducing residents’ distressed behaviors that are commonly treated with medications.

Series 5:
Working Together for Better Outcomes – Relational Coordination for Quality Improvement
(2 webinars)
Webinar Eleven:
It Tasks a Team to Prevent and Heal Pressure Ulcers
When CNAs interviewed for this webinar were asked what the most important factor in preventing and healing pressure ulcers was, they uniformly said, “Teamwork!” There are many sources of information about the clinical protocols for pressure ulcer prevention and healing. This webinar focuses on the communication and problem-solving systems needed to implement these protocols. Hear from teams at two nursing homes about how they work together to identify residents at risk and implement effective interventions to prevent pressure ulcers from occurring and to heal those that do. They use four key “relational coordination” practices: consistent assignments, shift huddles, CNA involvement in care planning, and QI among staff closest to the resident. Clinicians use these everyday “get togethers” to hear what the CNAs are observing, determine together the underlying causes and effective interventions, and then monitor continuously. With the right systems in place for staff to work together, and with support from management and all departments, staff closest to the resident are able to individualize care to each resident’s customary routines and prevent or heal pressure ulcers. The outcomes are great because, as one CNA said, “If it’s a sore, it’s everybody’s sore. We want to get rid of it…We all work together to make sure we get to that goal quicker.” Relational coordination in action: frequent, accurate, timely, problem-solving communication for shared goals, shared knowledge, and mutual respect.

Webinar Twelve:
It Takes a Team to Provide and High-Quality Individualized Care

Amy Elliot, Ph.D., Evaluation Consultant for Pioneer Network’s National Learning Collaborative, narrated this webinar which includes staff from the nursing homes that participated in the Learning Collaborative who talk about how they improved individualized care through consistent assignment (where CNAs develop relationships and really know residents) and then translated that knowledge to daily operations by increasing communication and teamwork through daily huddles, involving CNAs in the care planning process and incorporating CNAs into quality improvement efforts that happen on the spot to problem-solve for residents just when they need it most. These relational coordination practices, taken together, provide a framework for high quality individualized care that translates to improved quality and efficiency outcomes.

Downloadable files are available for one year from purchase date. You will receive a purchase confirmation with links to download the files.

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Pioneer Network is extremely grateful to Barbara Frank and Cathie Brady of B&F Consulting who were the expert content leads for the National Learning Collaborative to Engage Staff in Individualizing Care and gave their hearts and souls to the project. They developed the content and provided everything that the state coalitions and corporations needed to teach the learning sessions for the participating nursing homes. They also partnered with Pioneer Network to develop and produce the webinars that you are about to see as well as the Facilitator’s Guides and Handouts that accompany the webinars. Pioneer Network is also grateful to Dr. Amy Elliot who was our Evaluation Consultant for the project and narrates the final webinar (Webinar 12).