Successful implementation of the INTERACT program often starts like this:

“We introduced the SBAR twice before, but it didn’t work.  We tried again and this time our nurses are actually using it.”

“The Stop and Watch is being used inconsistently.  It’s used on one station but at the other station, the nurses have to keep reminding the nurse aides to complete it.”

“We’ve in-serviced the nurses on the care paths, but sometimes I do individual role modeling on the floor to show a nurse how to use them.”

Time and again participants in our Bootcamp coaching calls tell us what we all know is true: Change takes time, and so sometimes in-services must be repeated, staff must be reminded, and new routines must be reinforced.  Participants also tell us that success in one area is not necessarily followed by success in another.  One nursing home, for example, rolled out the SBAR without a glitch but struggled with staff resistance to using the Stop & Watch.  Another nursing home experienced the opposite: staff embraced the Stop & Watch, but nurses needed reminders to use the SBAR.

What strategies do nursing homes use to stick-with-it?  Here are tips our participants have shared with us:

• Ask the intended recipients of INTERACT tools for help: Nurses can remind nurse aides to use the Stop & Watch; doctors can remind nurses to use the SBAR.
• Assign a champion to each INTERACT tool.  In one nursing home, for instance, the nurse aides “elected” one of their peers as the facility’s “Stop & Watch” champion.  If a nurse aide perceives a problem with using the Stop & Watch — for instance, a nurse does not respond prompted when alerted to a potential problem — that aide can go to the Stop & Watch champion for help and advice.
• Assign a nurse supervisor to review completed Stop & Watch forms or SBARs and provide one-on-one feedback as needed if a form is incomplete or needs improvement.
• Role model recommended practice.
• Reinforce new routines with positive feedback.  Some nursing homes use “A Job Well Done” cards to recognize staff members for, you guessed it, a job well done.
• Offer staff incentives to adopt new routines.  In one nursing home, nurse aides receive a can of soda when they submit a Stop & Watch.
• Train, retrain, and retrain again.
• Take advantage of “teachable moments.”  When a nurse failed to respond promptly to a problem identified in a Stop & Watch, one facility’s Quality Assurance nurse pointed out to the staff as a whole the possible critical consequence that could have resulted.  Since then, all nurses have responded promptly to the Stop & Watches.