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 daycare 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 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, 49nursing 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.