January 7, 2016

11:30 am – 12:30 pm EST

INTERACT Implementation

Learning in Action Collaborative

Webinar 4: SBAR

AQIN – SC QIO Team:

Sarah Stein Banyai, MPH

Quality Specialist

SStein@thecarolinascenter.org

803.212.7521

Heather Jones, MHA, PTA, CPHQ

Manager Care Coordination

HJones@thecarolinascenter.org

803.212.7584

Karen Southard MHA, RN

State Program Director, SC-AQIN/QIO

KSouthard@thecarolinascenter.org

803.212.7518

Marilee Mohr, RN

Quality Specialist

MMohr@thecarolinascenter.org

803.212.75

Learning In Action Collaborative

During this 6 month, action oriented, virtual collaborative

participants will:

– Receive education, coaching, and resources from experts in the

field

– Develop strategies to reduce avoidable hospital readmissions

– Learn about evidence-based INTERACT tools and have the

opportunity to implement interventions to reduce hospital

readmissions: QI tools, capabilities list, transfer forms, SBAR,

and STOP and WATCH

– Build a community of practice with their peers and share

successes and challenges

– Learn to use data in a meaningful way to improve care

Welcome

• All webinars will be recorded and can be accessed at

http://atlanticquality.org/initiatives/care-coordination/care-

coordination-sc/

• Meeting norms:

• Flexibility and understanding with technology

• Engagement and participation in discussions and

peer-to-peer sharing

• Focused attention

Collaborative Timeline (All webinars are scheduled on Thursdays from 11:30 am -12:30 pm EST)

October 8, 2015 – Kickoff Webinar #1: Readmission Tracker

October 19-23, 2015 Check in/Coaching call (15-30 min)

November 5, 2015 – Webinar #2: Capabilities List

November 9-13, 2015 Check in/coaching call (15-30 min)

November 19, 2015 – Webinar #3: Transfer Forms

December 7- 16, 2015 Check in/coaching call (15-30 min)

January 7, 2016 – Webinar #4: SBAR

January 25-29, 2015 Check in/coaching call (15-30 min)

February 18, 2016 – Webinar #5: Stop and Watch

February 29- March 4, 2015 Check in/coaching call (15-30 min)

March 10, 2016 – Webinar #6: Lessons Learned and Next Steps

The INTERACT Program

Opportunities for You and Your Facility

Shared Savings

for Providers

Low

Low High

$ Cost

Qu

ali

ty

High Reduce Preventable

Hospitalizations

Costs Avoided $

Improve Quality,

Reduce Costs

Where will you be in 5 Years?

NH/HHA

ACO

Bundled Payment

Model

Mergers and

Acquisitions

Value Based

Purchasing

Process Improvement Principles

Leadership Involvement

Data and QI Tools

Prevent Overcorrection

Continuous Improvement

Staff Empowerment

Resident Focus

Team-Based

Just Culture

INTERACT tools are meant to be used together in your

daily work in the nursing home or home health agency.

INTERACT tools will help identify common causes of

readmission.

INTERACT aligns with QAPI initiatives.

https://interact2.net/

Alignment of QAPI and INTERACT

QAPI INTERACT

Improves communication Provides communication tools

Driven by leadership and empowers staff

to be part of the decision making

Leadership sets the charter and works with

staff to implement

Standardize practice Evidence-based tools

Data drives the change Data helps identifies the opportunity to

improve

Provides a system to monitor effectiveness

of care

Provides tools to analyze process,

provides care paths to deliver care in a

consistent manner

Systemwide improvement Utilize PDSA cycles and spreads success

across the organization

Organizes the change plan into a

performance improvement project

INTERACT is a performance improvement

project

SC Diagnosis-Specific Readmissions

11.4% 13.4%

19.9%

16.3%

10.1% 11.3%

0%

5%

10%

15%

20%

25%

CY 2014

AMI

COPD

DIAB

HF

PNE

Other

SC overall readmission rate is 11.7%

Tracking in Real Time

• Track and trend transfer measures using QI Tool

• Conduct root cause analysis using QI Tool

– Analyze transfers

– Look for common patterns

• Choose interventions based on your findings

Building Partnerships

Engaging Your Hospitals – Communication Tool

Communication Tools

Capabilities List

• Standardized, pre-populated checklist of nursing home/

home health capabilities for decisions about transfers

back into facility

• Distribute to EDs and hospital discharge planners

• Marketing and education tool

https://interact2.net/tools_v4.html

Using the Tool in Different Ways

• Combines the QI Review for readmission and compare

to your capabilities list – gaps?

• Allows you to build a business case for service line

expansion within the facility

• Establishes a quality scorecard using the most frequent

admission DRG/readmission QI review tool and facility

capabilities list

• Targets both internal and external education to staff and

other providers

https://interact2.net/docs/INTERACT%20Version%204.0%20Tools/INTERACT

%20Acute_Care_Transfer_Log%20Dec%2016%202014.pdf

Plan – Track Data – Analyze

Establish baseline

See patterns

Pinpoint opportunity

Monitor progress

Quality Improvement Tool

For Review of Acute Care Transfers

SECTION 1: Risk Factors for Hospitalization and Readmission

Conditions that put the resident at risk for hospital admission or readmission:

Cancer, on active chemo or radiation therapy Fracture (Hip)

CHF Multiple active diagnoses and/or co-morbidities

COPD (e.g. CHF, COPD and Diabetes in the same patient/resident)

Dementia Polypharmacy (e.g. 9 or more medications)

Diabetes Surgical complications

End-stage renal disease

SECTION 2: Describe the Acute Change in Condition and Other

Non-Clinical Factors that Contributed to the Transfer

Date the change in condition first noticed ________ / ________ / _________

Briefly describe the change in condition and other factor(s) that led to the transfer and then check each

item below that applies

SECTION 3: Describe Action(s) Taken to Evaluate and Manage the

Change in Condition Prior to Transfer Briefly describe how the changes in Section 2 were evaluated and managed and check each item that applies

Check all that apply

Tools Used

….Stop and Watch

….SBAR

….Care Path(s)

….Change in Condition File Cards

….Transfer Checklist

….Acute Care Transfer Form

(or an equivalent paper or

electronic version)

….Advance Care Planning Tools

….Other Structured Tool or Form

(describe)_ __________________

Medical Evaluation

….Telephone only

….NP or PA visit

….Physician visit

….Other

(e.g. in a specialist office or

while at dialysis)

Interventions

….New or change in medication(s)

…. IV or subcutaneous fluids

…. Increase oral fluids

….Oxygen (if available)

….Other (describe)

________________________

Testing

….Blood tests

….EKG

….Urinalysis and/or culture

….Venous doppler

….X-ray

….Other (describe)

___________________________

Quality Improvement Tool

For Review of Acute Care Transfers

Quality Improvement Tool

For Review of Acute Care Transfers

SECTION 4: Describe the Hospital Transfer

Date of transfer __________ /__________ /__________ Day _____________________ Time (am/pm)

________________________

Clinician authorizing transfer: Primary physician Covering physician NP or PA Other (specify)

Outcome of transfer: ED visit only Held for observation Admitted to hospital as inpatient

Hospital diagnosis(es) (if

available)_______________________________________________________

SECTION 5: Identify Opportunities for Improvement

In retrospect, does your team think this transfer might have been prevented? No Yes (describe)

Does My Team Need SBAR?

• Reasons for Transfer

Worsening Condition

after treatment/

Unstable

No Interventions attempted, referred to

ED

Family insistence

Condition not within scope of

care

SBAR

Situation

Background

Assessment/Appearance

Request

Reduce Stress

• Rounds to check in on people, not up on people

• All Hands on Deck

• Community meetings

Stabilize Staffing

• Identify and support best employees

• Improve attendance and schedule

• Hire for character and give new employees a good welcome

Develop a Positive Chain of Leadership

• People development

• Develop nurses as leaders

• Help hold people accountable

Promote Relational Coordination and Critical Thinking

• Consistent assignment

• Shift huddles and inter-shift communication

• CNAs active in care planning

• QI among staff closest to resident

Achieve Quality Improvement through Individualized Care

• Transform from institutional to individualized care delivery systems to promote mobility and reduce antipsychotic meds and re-hospitalizations

Cumulative Effect of Changes Addressing Many Interrelated Root Causes

TIPPING

POINT

FROM Vicious Cycle of Instability TO Positive Cycle of Steady Improvement

© David Farrell and B & F

Consulting, Inc., 2013

www.BandFConsultingInc.com

SBAR Develops Professional Team

• Advances the professionalism of the nurse

• Increases confidence and respect among team members

• Enhance critical thinking

• Increase clinical competency

• Empowers staff Valued/Contributor to the

Team

SBAR: More than one purpose

• Communication tool

– Contact MD/NP

– Change of shift report

– Morning meeting/huddle/change of status meeting

• Documentation tool

– Progress note

– Transfer note to send to ED

• Educational tool

– Just in time and scheduled in-service

SBAR Examples

• http://www.youtube.com/watch?v=NBNrYOBFwDs

without using SBAR

• http://www.youtube.com/watch?v=1r31pL1aZDQ with

SBAR

Tips to Implement: PDSA

P – Begin with one team

D – Educate staff and MDs,

reinforce in daily huddle

S – Data to collect:

# of times tool is used

# of times hospital transfer averted

A – Huddle with staff.

What is working? What needs to

be modified? If no modification,

then spread to other shifts.

Communication Tools

Evaluation of SBAR

• Review the SBAR completed form

• Gain feedback from Medical Leadership

• Trend deficits in clinical assessment skills

• Involve staff development in developing ongoing

education

Action Items:

• Schedule a follow-up call with the AQIN-SC team

• Track and review hospital readmission data and transfer

data using the QI tools

• Share your Capabilities List with your hospitals

• Educate staff on SBAR tool and begin collecting data on

utilization

• Register for INTERACT Implementation Webinar #5 –

STOP and WATCH – February 18, 2016

https://qualitynet.webex.com

(800) 922-3089 • (803) 212-7500 • www.atlanticquality.org

Thank you!