Pay-for-Performance financially penalizes facilities that have excessive hospital readmission rates. To some extent, though, this depends on the intrinsic readmission risk of the patients accepted for admission. When you admit sicker, higher-risk patients, you should be able to capture the added cost through your PDPM reports. However, even with higher-risk patients, systems that identify potential changes of conditions before they become serious may allow effective onsite care.
This was the purpose of the INTERACT (Interventions to Reduce Acute Care Transfers) program developed by Dr. Joe Ouslander and others. This excellent toolkit was challenging to implement, but CALTCM SNF 2.0® had success helping multiple facilities implement it with significant reductions in their rates of acute hospital care. For information on this intervention, please contact [email protected]g. The full INTERACT Toolkit is available online free of charge. It is available as a module in Point Click Care EHR, but I have been told by several facilities that it may be too expensive to purchase by an individual facility.
I recently provided a facility Inservice on this subject using helpful materials readily available on the internet. I have attached the INTERACT “Stop and Watch” tool, which may trigger an early warning of a possible significant COC (Change of Condition). Typically, this tool has targeted CNAs, who have the most front-line contact with residents, but other staff from dietary, housekeeping, and even family could prompt an assessment using this tool.
SBAR (Situation, Background, Assessment, Recommendations) has become ubiquitous in the Acute Hospital setting of care. This tool was developed in the 1970s for use by technicians in our nuclear submarines and was adapted to health care settings in the 1990s. Unfortunately for nursing homes, this tool has many complicated variations that are hard to use and commonly not a part of their EHR, which can lead to duplicative charting. With staffing shortages, this may not be sustainable. For this reason, I found an SBAR concise training tool from the UK (attached) that provides nursing a personalized way of efficiently assessing, documenting, and communicating a COC with the resident’s attending clinician.
In years past, this facility provided AMDA’s (-The Society for Post Acute and Long-Term Care Medicine, soon to be known as the Post-Acute and Long-Term Care Medical Association) “Know It All Before You Call” diagnostic booklet on each med cart so that nurses could have added support for thorough COC assessments. While this is not necessary for completing an SBAR, it does support a more precise assessment that considers multiple explanations for the specific COC. This type of critical thinking supports rapid and appropriate responses by medical providers, which could include an early transport to the acute hospital as the best approach, rather than the default approach. This booklet is available for review at https://fliphtml5.com/zlds/eefd/basic and is available at a discounted rate for AMDA members. Know-It-All tools are also widely available in the Matrix EHR frameworks.
However, AMDA does have an app for members (Google and Apple platforms) that has a free version for non-members with a digitized version of this booklet that is easy to use. This tile for this app is “AMDA.” I highly recommend this tool for licensed nurses and your providers, but you may need to incentivize your nurses to do so. Physicians and NP/PAs have been using medical apps for decades, but at this facility in-service, not a single nurse has used medical apps. This is consistent with what I have observed at multiple other SNFs.
Thinking of nudges, now may be the time to become an AMDA member. AMDA has wonderful CPGs (Clinical Practice Guidelines) that cover the common conditions and geriatric syndromes of our patients. For a small annual fee, these CPGs are available on the AMDA app. In addition, AMDA offers free high-impact webinars to its members, which once viewed become available on this app.
Let’s make 2024 a year of active team learning that reduces the chaos associated with COC management and improves our “bottom line”, while most importantly, providing person-centered care to our frail residents in the setting that’s safest and most appropriate for them.
Resources
For INTERACT Tool Suite (Stop & Watch): https://pathway-interact.com/interact-tools/interact-tools-library/ (Free tools)