Joseph G. Ouslander, MD
Professor and Associate Dean for Geriatric ProgramsCharles E. Schmidt College of Medicine
Professor (Courtesy), Christine E. Lynn College of NursingFlorida Atlantic University
Professor of Medicine (Voluntary), University of Miami
Session 1
Overview of the INTERACT Program and Curriculum
The development and evaluation of the INTERACT quality improvement program and Curriculum are supported by grants from the Retirement Research Foundation and The Commonwealth Fund
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Session 1Overview of the INTERACT
Program and Curriculum
Teleconference Instructions
Session 1Overview of the INTERACT
Program and Curriculum
Call in Number 1-888-808-6959
Conference Code 3588988 #During the call, please mute your line Press * 6
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If the leader is not on the call when you call in, please wait
Welcome and Introductions
Session 1
Overview of the INTERACT Program and Curriculum
This session is designed for the entire interdisciplinary team, including the:
• Project champion and co-champion• DON, key RNs, LPNs, and CNAs• Medical director, primary care MDs, and NPs/PAs• Social workers• Administrators
Overview of the INTERACT Program and Curriculum
• Joseph G. Ouslander, M.D. is Professor and Associate Dean for Geriatric Programs at the Charles E. Schmidt College of Medicine, and Professor at the Christine E. Lynn College of Nursing of Florida Atlantic University in Boca Raton Florida. He is a past-President of the American Geriatrics Society and is the Executive Editor of the society's Journal. He is a co-author of Essentials of Clinical Geriatrics and Medical Care in the Nursing Home, and an editor of Hazzard's Textbook of Geriatric Medicine and Gerontology.
• Dr. Ouslander’s work is now focused on improving the quality of care and quality of life for older people, and reducing unnecessary health care expenditures through programs such as INTERACT.
The INTERACT Interdisciplinary Team
Laurie Herndon, GNP Mass Senior Care FoundationGerri Lamb, PhD, RN, FAAN Arizona State UniversityRuth Tappen, EdD, RN, FAAN Florida Atlantic UniversitySanya Diaz, MD Florida Atlantic UniversityJohn Schnelle, PhD Vanderbilt UniversitySandra Simmons, PhD Vanderbilt UniversityAnnie Rahman, MSW Miami UniversityJo Taylor, RN, MPH The Carolinas Center for Medical ExcellenceAlice Bonner, PhD, GNP Center for Medicare and Medicaid Services
In collaboration with participating nursing homes
Overview of the INTERACT Program and Curriculum
Definition and goals of INTERACT Why it matters to you and your organization Overview of the INTERACT curriculum Preparing for your participation
What This Session Will Cover
Overview of the INTERACT Program and Curriculum
Please complete the Pre-Session Quiz If you take the Quiz in a paper and pencil format, please
make sure your facility champion or co-champion gets a copy If you are reviewing this session on-line, you can take the on-
line Quiz, or take the Quiz using a hard copy obtained from your facility champion or co-champion, and return it to them
Pre-Session #1 Quiz
Overview of the INTERACT Program and Curriculum
INTERACT – definition and goals
INTERACT stands for “Interventions to Reduce Acute Care Transfers”
It is a program designed to improve the care of nursing home residents by: Identifying situations that commonly result in transfers
to the hospital – and working together to manage them effectively and safely in the nursing home without transfer whenever possible
Overview of the INTERACT Program and Curriculum
INTERACT – definition and goals
The goal of INTERACT is to improve care quality, not to prevent all hospital transfers In fact, INTERACT can result in more
rapid transfer of residents who need hospital care
Overview of the INTERACT Program and Curriculum
INTERACT – definition and goals
The INTERACT program was:
Originally developed in a project supported by the Center for Medicare and Medicaid Services (CMS)
Revised based on input from staff from several nursing homes and national experts in a project supported by The Commonwealth Fund
Overview of the INTERACT Program and Curriculum
INTERACT – definition and goals
The INTERACT program includes clinical tools, strategies to implement them, and related educational resources
The INTERACT program is located on the internet at:
http://interact2.net
Overview of the INTERACT Program and Curriculum
INTERACT – definition and goals
Communication Tools
Care Paths
Advance Care Planning Tools
INTERACT includes 3 types of tools for you to use in your daily work in the nursing home:
Overview of the INTERACT Program and Curriculum
INTERACT – definition and goals
The INTERACT tools are designed to be:
As simple as possible Efficient for use in daily care routines Based on scientific evidence and/or expert
recommended clinical guidelines where available
Consistent with federal regulations and guidance for surveyors
Overview of the INTERACT Program and Curriculum
INTERACT – definition and goals
1. Identify changes in residents condition
2. Assess these changes
3. Manage some conditions in the nursing home
4. Document the changes and how they were assessed and managed
5. Communicate effectively:
a. With staff in your nursing home
b. With staff at your local hospitals
The INTERACT tools are designed to help you:
Overview of the INTERACT Program and Curriculum
The different INTERACT tools are meant to be used together in your daily work in the nursing home
INTERACT – definition and goals
INTERACT can result in reduced hospital transfers by helping you to:
1.Prevent conditions from becoming severe enough to require hospitalization through early identification and assessment of changes in resident condition
2.Manage some conditions in the NH without transfer when this is feasible and safe
3.Improve advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization for some residents
Overview of the INTERACT Program and Curriculum
Why it matters – a national perspective (1)
Emergency room visits, hospitalizations, and re-hospitalizations of nursing home residents are:
Common : 1 in 4 residents admitted to a nursing home from a hospital are re-admitted to the hospital within 30 days
Expensive: hospitalizations that might not be necessary cost Medicare and Medicaid billions of dollars every year
Overview of the INTERACT Program and Curriculum
Why it matters – a national perspective (2)
Hospitalizations can contribute to many complications:
Distress and discomfort for the resident Delirium Polypharmacy Falls Incontinence and catheter use Hospital acquired infections Unintentional weight loss and poor nutrition Immobility, de-conditioning, pressure ulcers
Overview of the INTERACT Program and Curriculum
Overview of the INTERACT Program and Curriculum
Why it matters – a national perspective (3)
Reducing avoidable hospitalizations will help:
Allow limited Medicare and Medicaid funds to be used to improve care in our nursing homes rather than for unnecessary hospital stays
Preserve Medicare benefits for all of us
Overview of the INTERACT Program and Curriculum
Why it matters – to you and your facility (1)
INTERACT will help you and facility:
Improve quality of care for your residents Benefit from tools to help your team work
together more effectively Take advantage of everyone’s contributions to
resident care
Overview of the INTERACT Program and Curriculum
Why it matters – to you and your facility (2)
The current situation, which favors hospital transfers, is going to change Medicare is planning changes in payment
that will reward lower rates of avoidable hospitalizations
Surveyors will be examining how facilities assess and manage acute changes in status
You need to be prepared!
Overview of the INTERACT Program and Curriculum
12 sessions over a 6-month period (for teleconference participants) Some facilities will participate on-line only with completion of 9
sessions Not all staff need to complete every session
The facility champion and co-champion will serve as the coordinators of the curriculum
Participating staff will be asked to document their consent to participate and complete a pre and post quiz and an evaluation for each session
Practice using the tools between sessions Follow-up calls to individual facility champions to discuss progress
The INTERACT Curriculum
Overview of the INTERACT Program and Curriculum
Evening, night, and weekend staff will go through curriculum sessions on an individual basis The sessions will be available on-line, but can
also be printed and reviewed in hard copy if access to the project website is limited
Nurses can earn CEUs for participation
The INTERACT Curriculum (2)
Overview of the INTERACT Program and Curriculum
Your participation and evaluation and feedback is critical to help further improve the INTERACT program
You will be asked to complete an evaluation of each session, and of the overall curriculum This is required for nursing staff earning
CEUs
The INTERACT Curriculum (3)
Overview of the INTERACT Program and Curriculum
Week 1
Session 1: Rationale and Overview of the INTERACT Program and Curriculum
Week 2
Session 2: Tracking Transfers, the Concept of “Avoidability”, and the QI Review Tool
Week 3
Session 3: Stop and Watch
Champion DON Key RNs and
LPNs Lead CNAs
Medical Director Key MDs,
NPs/PAs Social worker Administrator
Champion DON Key RNs and
LPNs Lead CNAs
Medical Director Key MDs,
NPs/PAs Social worker Administrator
Champion DON Key RNs, LPNs Lead CNAs
The INTERACT Curriculum (3)
Overview of the INTERACT Program and Curriculum
Week 5
Session 4: SBAR
Week 7
Session 5: Care Paths and Change in Condition File Cards
Week 9
Session 6: Information Transfer and Interacting with Your Hospitals
Champion DON Key RNs and
LPNs
Medical Director Key MDs,
NPs/PAs
Champion DON Key RNs and
LPNs
Medical Director Key MDs,
NPs/PAs
Champion DON Key RNs, LPNs
Medical Director Key MDs,
NPs/PAs Social worker Administrator
The INTERACT Curriculum (4)
Overview of the INTERACT Program and Curriculum
Week 11
Session 7: Advance Care Planning Tools (1)
Week 13
Session 8: Advance Care Planning Tools (2)
Week 15
Session 9: QI Review Tool Revisited
Champion DON Key RNs and
LPNs Lead CNAs
Medical Director Key MDs,
NPs/PAs Social worker Administrator
Champion DON Key RNs and
LPNs Lead CNAs
Medical Director Key MDs,
NPs/Pas Social worker Administrator
Champion DON Key RNs, LPNs
Medical Director Administrator
The INTERACT Curriculum (5)
Overview of the INTERACT Program and Curriculum
Week 17
Session 10: Case Studies: Stop and Watch
Week 19
Session 11: Case Studies: SBAR, and Care Paths
Week 21
Session 12: Wrap Up: Overcoming Barriers and Achieving Sustainability
Champion DON Key RNs and
LPNs Lead CNAs Champion DON Key RNs and
LPNs
Medical Director Key MDs,
NPs/PAs Social worker Administrator
Champion DON Key RNs, LPNs Lead CNAs
Medical Director Key MDs,
NPs/PAs Social worker Administrator
The INTERACT Curriculum (6)
Overview of the INTERACT Program and Curriculum
Put the dates of curriculum calls on your calendar
Review the INTERACT website Meet as a team to discuss participation
before the second session Let your affiliated hospitals know about
the program
Planning Your Participation
Overview of the INTERACT Program and Curriculum
Your facility’s project champion is responsible for coordinating INTERACT implementation. She or he may ask you to complete specific activities before the next teleconference or before you review the next session on-line
Suggested implementation activities before the next session include reviewing portions of the INTERACT website: Go to the home page (http://interact2.net) and read it Click on “About INTERACT” and read the page On the “About INTERACT” page, click on “Tool Table” and review the
list of tools and then click on “INTERACT II Overview Figure”, and review it.
Finally, click on “INTERACT II Tools”, and review the Acute Care Transfer Log and QI Review Tool by clicking on them
Implementation Assignment before the Next Session
Overview of the INTERACT Program and Curriculum
Un-mute the line: Press # 6Please re-mute your line after talking: Press * 6
Questions and suggestions on Session 1 can also be directed to Dr. Ouslander by email at:
Please insert in the Subject Line: “Question about the INTERACT Curriculum”
For teleconference participants:Questions, Suggestions, Comments?
Overview of the INTERACT Program and Curriculum
Week 2
Session 2: Tracking Transfers, the Concept of “Avoidability”, and the QI Review Tool
Champion DON Key RNs and
LPNs Lead CNAs
Medical Director
Key MDs, NPs/PAs
Social worker Administrator
The Next Session
Overview of the INTERACT Program and Curriculum
The next teleconference will be held at the same time next week
The topic and participants are listed below
Please complete the Post-Session Quiz and Evaluation If you take the Quiz and complete the Evaluation in a paper and
pencil format, please make sure your facility champion or co-champion gets a copy
If you are reviewing this session on-line, you can take the on-line Quiz and complete the evaluation on-line.
Post-Session #1 Quiz and Evaluation
Overview of the INTERACT Program and Curriculum