Introduction to a Webinar Series: Improving Patient Safety...

Introduction to a Webinar Series: Improving Patient Safety in

Long-Term Care Facilities

Supplemental Material to Accompany the Webinar

The Instructor Guide can be found at: http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcinstructor.html.

A PDF version of the Instructor Guide can be downloaded and printed by clicking on the download button at the top of the page.

The Instructor Guide comprises all three modules, including suggested slides, pretests, and posttests to gauge the student's knowledge level before and after training. Separate Student Workbooks are available for each module.

Ordering Information Printed copies of the Instructor Guide and student modules can be ordered separately or as a set from the AHRQ Publications Clearinghouse.

To request copies of the printed materials, send an e-mail to the AHRQ Publications Clearinghouse at [email protected] or call 1-800-358-9295. Be sure to specify the AHRQ Publication number when ordering.

Instructor Materials The 96-page Instructor Guide can be ordered separately or as a complete set that includes one copy of the Instructor Guide and one copy each of the Student Workbooks for Modules 1, 2, and 3.

Single copies are free; charges may apply for additional quantities and for shipping to addresses outside the United States. There are no copyright issues with this material. You may print additional copies from the Web site if you want to avoid the charges associated with ordering multiple copies.

• Instructor Guide, 96 pp. (AHRQ publication no. 12-0001-1) (describes how to use the materials in the Student Workbooks as a teaching session, including suggested slides, pretests, and posttests to gauge the student's knowledge level before and after training).

• Instructor Set (AHRQ Publication no. 12-0001) (includes one instructor guide and one copy each of the three Student Workbooks).

Student Materials Separate Student Workbooks are available for each module. The workbooks can also be ordered separately or as a Student Workbook set. Copies of the Student Workbooks are also included in the Instructor Set.

There is no charge for single copies; charges may apply for additional quantities and for shipping to addresses outside the United States.

http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcinstructor.html


http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcinstructor.htm

mailto:[email protected]

• Module 1. Detecting Change in a Resident's Condition: Student Workbook, 20 pp (AHRQ Publication No. 12-0001-2). Available to download at: http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcmodule1.html

• Module 2. Communicating Change in a Resident's Condition: Student Workbook, 19 pp (AHRQ Publication No. 12-0001-3). Available to download at: http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcmodule2.html

• Module 3. Falls Prevention and Management: Student Workbook, 19 pp (AHRQ Publication No. 12-0001-4). Available to download at: http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcmodule3.html

• Student Workbook Set (includes one copy each of the Student Workbooks for the three-module set) (AHRQ Publication No. 12-0001-5).

http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcmodule1.html






Improving Patient Safety in Long‐Term Care Facilities: Introduction to the Webinar SeriesMarch 12, 2014

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Improving Patient Safety in Long-Term Care Facilities:

Introduction to the Webinar Series

Marian Edmiston, DEd, MSN, RN-BC

Recorded Version

• AHRQ► http://ce.ahrq.gov/nurses/

• National Gerontological Nursing Association► http://www.ngna.org/

• National Association of Directors of Nursing Administration in Long-Term Care► https://www.nadona.org/

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Disclosures

• This Webinar has been funded and developed by the Agency for Healthcare Research and Quality (AHRQ); there has been no outside commercial support.

• Presenter(s)/staff have no conflicts of interest or relevant financial relationships to disclose.

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Requirements for Successful Completion, CE

• Be present for the entire Webinar.

• Complete an online evaluation.

• Pass the posttest with a grade of 80% or higher.

• Complete and submit the evaluation/ posttest within 30 days of the Webinar.

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Designation Statements

The following Continuing Education (CE) credits will be available to participants of the live Webinar.

• The American Association of Nurse Practitioners (AANP) designates this education activity for a maximum of 1 contact hour.

• The Arizona Nurses Association (AzNA) designates this education activity for a maximum of 1 contact hour.

• The Commission for Case Manager Certification (CCMC) designates this continuing education activity for a maximum of 1 clock hour.

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Accreditation Statements

• This program was planned in accordance with American Association of Nurse Practitioners (AANP) CE Standards and Policies and AANP Commercial Support Standards.

• This program has been approved by the Commission for Case Manager Certification to provide continuing education credit to Certified Case Managers (CCMs).

• This continuing nursing education activity was approved by the Arizona Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

• Accreditation refers to recognition of continuing nursing education only and does not imply AANP, AzNA, or ANCC Commission on Accreditation approval or endorsement of any commercial products discussed or displayed in conjunction with this educational activity.

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Introduction

Priscilla Novak, MPH

Health Communications Specialist

AHRQ

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Agency for Healthcare Research and Quality (AHRQ)

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Webinar Objectives

At the end of this presentation, participants will be able to: 1. Describe the format and purpose of the four-part

Webinar series, based on the AHRQ curriculum Improving Patient Safety in Long-Term Care Facilities.

2. Apply strategies to engage an audience of learners using methods that promote maximum participation and knowledge retention.

3. Demonstrate how to promote team dynamics and avoid barriers to communication.

4. Explain how to implement strategies to monitor residents’ safety.

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Introduction

Marian Edmiston, DEd, MSN, RN-BC

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Purpose of the Series

• Highlight and review AHRQ’s educational materials for use in training front-line personnel

► Materials are organized into 3 modules:o Module 1: Detecting Change in a Resident's Condition.

o Module 2: Communicating Change in a Resident's Condition.

o Module 3: Falls Prevention and Management.

► Materials include an Instructor Guide and three Student Workbooks

► Upcoming Webinars include PPT slide decks for you to use directly with staff

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Content Overview

• Best practices for group instruction

• Overview of AHRQ content: Improving Safety in Long-Term Care Facilities

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Engaging Your Learners

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Characteristics of Adult Learners

Self-Concept Experience

Readiness to Learn

Orientation to Learning

Motivation Need to Know

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Best Practices for Adult Learning

Determine what learners should know

Address motivation

Provide clear goals

Tap into their experience

Respect their concerns

Keep it relevant15

Possible Barriers to Communication

• Age

• Gender

• Culture

• Native language

• Motivation

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Engaging Your Learners

• Use body language

• Visual aids

• Monitor the environment

• Encourage participation

• Vary the pace

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Choosing the Most Effective Teaching Modality

• Lecture

• Problem-Based Learning► Case studies and

simulations

► Visual aids

► Role-play

► Discussion

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Lecture

• Most widely used

• Requires frequent breaks

• Useful for summarizing materials, providing context

• Can generate interest and introduce new ideas

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Problem-Based Learning

• Encourages critical thinking

• Instructor should be facilitator

• Strategies► Case studies

► Visual aids

► Role-play

► Discussions

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Case Studies

• Challenge learners to analyze, make judgments, express opinions

• Introduce real-world problems, emphasize relevance of training

• Require active participation

• Can lead to innovative solutions

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Visual Aids

• Subject matter can be absorbed quickly

• Good for visual learners

• Can be technology-based but simple tools can also be effective

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Role-Play

• Helps participants to experience or empathize with a particular perspective

• Can have scripted or improvised dialogue

• Should be realistic and relevant

• Opportunity to practice communication and listening skills

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Discussion

• Encourages active participation, critical thinking

• Allows personal interaction with instructor and other learners

• Educator should pose problem, monitor discussion, summarize conclusions

• Facilitates information retention, problem-solving, attitude change

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Group Discussion

When you are training a group, which

teaching modalities have you found to

be the most effective?

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Overview: AHRQ Modules 1-3

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Instructor Guide

Available at: http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcinstructor.html

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Student Workbooks

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Additional Teaching Tools

• Detecting Change in a Resident’s ConditionModule 1

• Communicating Change in a Resident’s ConditionModule 2

• Falls Prevention and ManagementModule 3

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Module 1: Detecting Change in a Resident’s Condition

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Recognize Baseline Status

• Staff need to:► Know the resident’s baseline► Recognize different types of changes

► Recognize change early on

Any significant change from baseline can signal an important change!

Physical changes

Non-physical changes

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Physical Changes

• Walking

• Urination/bowel patterns

• Skin quality

• Level of weakness

• Falls

• Vital signs

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Non-physical Changes

• Demeanor

• Appetite

• Sleep

• Confusion

• Agitation

• Pain

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Key Points, Module 1

• Detecting changes early can prevent illness from getting worse

• Staff must

Know the resident’s baseline

Be aware of the different types of changes

Understand the need to watch for changes

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Module 2: Communicating Change in a Resident’s Condition

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Why Report Change?

Changes must be:

• Recognized

• Documented

• Reported

When in doubt, report!36


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Communicating Change

• Essential to patient care

• Helps keep residents safe

• Changes should be reported openly whenever they happen

• Show you care by speaking up!

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Promoting an Open Team Dynamic for Communicating Change

• Each team member is responsible for patient safety

• Nursing assistants: ‘eyes and ears’ of the health care team

• Communicate, don’t place blame!

• Open and honest communication among ALL staff keeps residents safe

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How to Report Change

• Team meetings►Speak up►Communicate clearly►Listen

• Shift changes►Direct verbal communication►Charting

• Tools

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Communication and Reporting Tools

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Stop and Watch Early Warning Tool

If you have identified an important change while caring for a resident today,

please circle the change and discuss it with the charge nurse before the end of your shift.

Name of Resident ______________________________________

Seems different than usual

Talks or communicates less than usual

Overall needs more help than usual

Participated in activities less than usual

Ate less than usual (Not because of dislike of food)

N

Drank less than usual

Weight change

Agitated or nervous more than usual

Tired, weak, confused, or drowsy

Change in skin color or condition

Help with walking, transferring, toileting more than usual

Staff_________________________________________________

Reported to ___________________________________________

Date _____ / _____ / ________ Time ________________


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• Everyone is responsible for reporting change

• Team meetings/shift changes

• Changes must be documented and shared

• Tools

► SBAR

► Early Warning Tool

► CUS41

Module 3: Preventing Falls

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Falls Are Serious Business

• Serious, unwanted events

http://www.ncbi.nlm.nih.gov/books/NBK2653/

3 of 4 residents in long-term care fall every year

Most common cause of non-fatal

injury in people > 65

Fall-related injuries = up to

15% of rehospitalizations

Cost is $16-19 billion/year

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Defining a Fall

Unintentional change in position, coming to rest on the ground or next lower surface that does not result from

• Being pushed down

• Collapsing as the result of a sudden medical condition

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Physical Risk Factors

Previous falls

Diminished strength

Gait/balance impairment

Medications Low blood pressure

Vision impairment

Dementia Poor foot care

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Managing Physical Risk Factors

Review medications frequently

Check vital signs frequently

Use canes/walkers effectively

Shoes fit properly

Eyeglasses are in good condition

Restraints DO NOT prevent falls!46


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Environmental Risk Factors

• Design issues

• Space issues

• Obstacles

• Equipment use or misuse

• Inadequate staffing and organization of care

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Managing Environmental Factors

• Install handrails

• Raise toilet seat height

• Add grab bars to showers

• Avoid dangling extension cords

• Improve lighting

• Remove scatter rugs

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HEAR ME

Hazards

Education

Anticipate

Round

Materials

Exercise

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• Is it really a fall?

• Preventing falls

►Environment

►Physical factors

• Managing risk factors

• HEAR ME

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Case Study

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Mary Edwards: Sep 21, 2013

• Age 83

• Resident x 5 months

• Walks with walker, s/p hip fracture

• Eyeglasses at all times

• BP 135/68

• Enjoys meals in dining room

• Participates in current events and art classes

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Mary Edwards, Oct 5, 2013

• 7 AM:

►Resident found lying on floor

►Awake and alert

►Complains of hip pain

►No walker or eyeglasses nearby

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Mary Edwards, Oct 5, 2013

• BP past 3 days: 118/65; 105/64; 100/58 (today)

• Roommate: “Hasn’t been herself lately.”

• Dining room staff: “Has eaten less than 25% of each meal for the last 2 days.”

• Group leader: “Has missed past 2 days of current events class.”

• Transferred to the hospital.

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Discussion

• What points in this case highlight whether Ms. Edwards was at risk of a fall?

• What elements of this case can you use to reinforce the importance of recognizing and reporting change?

• How does this case emphasize the importance of teamwork in communicating change?

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Questions?

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Remember!

• This is the first of a four-part series of Webinars

• Next three Webinar dates are:► Detecting Change in a Resident’s Condition

Wednesday, April 23, 2014 / 1:00 PM – 2:00 PM (ET)► Communicating Change in a Resident’s Condition

Wednesday, June 18, 2014 / 1:00 PM – 2:00 PM (ET)► Falls Prevention and Management

Wednesday, August 13, 2014 / 1:00 PM – 2:00 PM (ET)

• Technical assistance calls are available after each of these three Webinars

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Wrap-up

• To obtain credit:

►Complete an online evaluation.

►Pass the posttest with a grade of 80% or higher.

►Complete and submit the evaluation/posttest within 30 days of the Webinar.

If you have any problems, please contact us at [email protected] or by phone at 267-498-7926

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Thank you!

See you at our next Webinar on April 23!

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Improving Patient Safety in Long-Term Care Facilities: Introduction to the Webinar Series

Live Webinar: March 12, 2014

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Questions & Answers Responses to group discussion question asked during the live webinar: 1. Q: When you are training a group, which teaching modalities have you found to be the most effective?

• Visual aides • Storytelling/case studies • Talking about specific situations • I love small group interaction then coming back to the larger group to share • Small group discussions, practice facilitation, hands on participation • How effective are using falls risk assessments for those residing in SNFs or assisted living facilities • Brainstorming and practice teaching • Interactive; combination of discussion, slides, and visual aids • Hands-on, if applicable • Visual aids and discussions • Role play has often helped with dementia training • Visual aids, and role playing are effective • Small group work • Have staff role play. Include staff you may know have concerns and are not bringing them forward. • Case studies are most effective with role play and discussion next • Case studies • Small groups with real-life experiences and situations • Visual aids and case studies • Demonstration, real-life scenarios, and role play has always worked well with my group. • Sometimes we do games • Asking questions and including the audience in the presentation • Presenting the information in the form of a story • Questions regarding the case being discussed • A combination of lecture, with breaking into small groups for case studies, discussion, etc. • Make sure the participants are engaged. Allowing staff to share experiences. • We are most successful in role playing. It seems the staff learns best by being put in the real-life situations. • Case study has been the best for me. Discussions. • Visual aids, role playing, hand outs • Role playing and doing skits to give examples of things works well for us • Paper to look at and involve them in discussion so they do not become too bored • Use of three or more of the strategies in one use is most effective • Discussion and case studies • Case studies • Lecture • Slide show and discussion • Role playing, discussion • Discussion with story and experience sharing • Role play and problem-based learning



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• Real case studies • Case discussion and visual slides • Varies widely of course, but mixing up the modalities is most effective...with consideration to the audience,

topic, etc. • Using visual aid • Discussion and visual • A mixture of video, situational role play, data as relevant and having fun is essential. Make material relevant to

practice. • Interactive activities, where the audience has to share • Interactive small-group discussion • Small group problem solving using visual aids like flip charts • Small group sessions • Group discussion and case studies • Role play and case studies • It depends greatly upon the group I am teaching

2. Q: Dr. Edmiston, would you please address if there is a brief method to assess the learning style of the audience?

Often, I don't always know the audience before I arrive at the training. A: Learning styles generally consist of three categories: visual, auditory, and kinesthetic learners. Characteristics of these categories describe how the person best receives, processes, and retain knowledge. There are many sources of information about this online. One excellent source that I have used includes a table of characteristics for each category. You can find this in an article in Urologic Nursing (2006) by Sally Russell. The article is available online through Medscape at: http://www.medscape.com/viewarticle/547417_3.

3. Q: Can the presenter repeat at the end of the session how the slides will be available?

A: The webinar recording will be available via a link on these sites within a few days: • AHRQ: http://ce.ahrq.gov/nurses/ • National Gerontological Nursing Association: http://www.ngna.org/ • National Association of Directors of Nursing Administration in Long-Term Care: https://www.nadona.org/

There is a slide deck intended for training staff on the different modules included in the AHRQ Instructor Guide: http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcinstructor.html.

4. Q: Has anyone addressed the question of certified nurses aids concerned about reprimand that a client would

have fallen vs knowing that this information is needed to do a proper assesment for the client? A: Yes, the issue is one that really needs attention and we will be addressing this in Module 2 of the Improving Patient Safety in Long-Term Care Facilities series. I think there is a critical need to emphasize mutual respect across all levels of nursing practice. There should be a focus on empowering both nurses and nursing assistants to value all roles in patient care. One of the best communication tools for nursing assistants to use is the “Stop and Watch” tool. What is important to emphasize to nursing assistants is that the tool should be completed whenever they see a change. This tool can be used in a conversation between the nursing assistant and the nurse. This provides both verbal and written communication of a possible change in condition.

http://www.medscape.com/viewarticle/547417_3

http://ce.ahrq.gov/nurses/

http://www.ngna.org/

https://www.nadona.org/




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5. Q: Are all of the materials on the website? A: The Instructor Guide and Student Workbooks are available on the AHRQ website. This link will take you to the Instructor Guide access page and there are links from that page to the Student Workbooks for each of the 3 modules: http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcinstructor.html.

Materials from the webinar are available from links on these sites:

• AHRQ: http://ce.ahrq.gov/nurses/ • National Gerontological Nursing Association: http://www.ngna.org/ • National Association of Directors of Nursing Administration in Long-Term Care: https://www.nadona.org/

6. Q: Will we receive instructions regarding participation/CE document?

A: If you have not already received these instructions, please contact us at [email protected] and we will assist you.

7. Q: When will we have information on the dates/times of follow-up webinars?

A: This is the first of a 4-part Webinar series. The next 3 Webinars include:

• Detecting Change in a Resident’s Condition – Wednesday 4/23/2014 from 1-2 pm ET • Communicating Change in a Resident’s Condition – Wednesday 6/18/2014 from 1-2 pm ET • Falls Prevention and Management – Wednesday 8/13/2014 from 1-2 pm ET

Following each of the next 3 live Webinar events, we will offer technical assistance calls for attendees of each event. The purpose of the technical assistance calls is to discuss challenges and barriers to implementation of these patient safety training modules and to have a chance to get some expert input from Dr. Marian Edmiston. The dates for the technical assistance are:

• Wednesday 6/4/2014 from 1-2 pm ET • Wednesday 7/30/2014 from 1-2 pm ET • Wednesday 9/24/2014 from 1-2 pm ET

8. Q: Can you still obtain credit if you listen to the webinar at a later date?

A: Yes, you can listen to the webinar recording and then complete the evaluation and posttest; the recording will be available for Continuing Education (CE) credit until March 22, 2016.

9. Q: Are CE's available? If so, can we pass them on to the staff we educate?

A: The following CE credits will be available to participants of the live Webinar and the recorded version: • The American Association of Nurse Practitioners (AANP) designates this education activity for a maximum of

1 contact hour. • The Arizona Nurses Association (AzNA) designates this education activity for a maximum of 1 contact hour. • The Commission for Case Manager Certification (CCMC) designates this continuing education activity for a

maximum of 1 clock hour.

Your staff would need to attend the live Webinar or the Webinar recording to obtain the CE credits.






mailto:[email protected]



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10. Q: Is there any copyright concerns we should be aware of?

A: The content in this presentation and in the AHRQ Patient Safety Modules (Student and Instructor Guide) is in the public domain and there are no copyright issues with that material. The “Early Warning Stop and Watch” tool requires a license agreement but is available without a fee for clinical use; you can get more information about this at the INTERACT® website: http://interact2.net/agreement.aspx.

11. Q: Given the development of all the new technology, can you share if there has been an app or any new programs

developed that staff can use to notify administration of significant change? One that ties into the electronic care plan or EMR. A: EMR systems provide many communication functions, including dashboard alerts, daily reports, and e-mail functions that can aid in effective communication among staff. Check with your EMR provider to ask about this capability. I am familiar with the Point Click Care (PCC) EMR system and Point of Care (POC) documentation for unlicensed staff. There is capability in both to send alerts that are visible to staff on the dashboard and within the care plan. “The Interact Stop and Watch” tool has recently been made available within POC. Just a thought to remember: there is still an essential need for verbal communication among the staff.

12. Q: What about family communicating with administration?

A: As we all know, effective communication among all stakeholders is the key to ensuring patient safety. With this in mind, I’m assuming that your question relates to whether we should encourage families and significant others to express their thoughts and concerns with administrators in addition to regular communication with clinical staff. I feel strongly that both staff and administrators have a duty to engage family members in frequent dialog regarding all issues that surround the care of the resident. This includes safety issues. Families have a right to be fully informed and to participate in this communication process.

13. Q: Where did you obtain the definition of a fall? Is this a regulatory definition? A: The definition for a fall is located in the Resident Assessment Instrument (RAI) manual in Chapter 3, Section J 1700: Fall History on Admission/Entry or Reentry. It is also included in the State Operations Manual (SOM) under F-tag 323 Section 483-25(h) Accidents – Definitions. 14. Q: Just so you know, we have a concern that the definition of a fall does not match the CMS/SOM definition.

A: Thank you very much for this comment. I agree that clarification is needed. The definition of a fall in this presentation does include the language used in both the RAI manual and the SOM. However, the additional statement included on our slide “collapsing as a result of a sudden medical condition” is not a part of the definitions from these two sources. We will make the changes as needed in the Webinar materials for Module 3 – Preventing Falls.

15. Q: Will medication changes be included in the falls presentation. I am concerned about following the new OIG release and it does include medication management for those residents who are at risk for falls. A: Yes. Medications are one of the most significant risk factors for falls, and the importance of frequent and consistent review of the effects of medications will be included in the Webinar and in the materials for Module 3 – Preventing Falls.

http://interact2.net/agreement.aspx



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16. Q: Will your information be including any of the INTERACT content for condition change? SBAR or Stop and Watch documents to name a couple. A: The upcoming Webinars will discuss SBAR and Stop and Watch in more detail and those tools are described in Module 2 of AHRQ’s Instructor Guide and Student Workbook on Improving Patient Safety in Long-Term Care Facilities. If you want to use the INTERACT content, please go to this website (http://www.interact2.net/qagreement.aspx) to sign the license agreement. The tools are available at no fee for clinical use.

17. Q: Are these modules helpful only for falls prevention or also for other indicators? If yes, examples please?

A: The modules are helpful for other issues related to the safety of residents in long-term care facilities because they focus on observing and communicating any type of change or safety concern, which could have implications for appropriate type, dosage, and administration of medication; handling, repositioning, and transport of residents; the health status of a resident, etc. If you have specific issues you’d like to address, please join one or more of the technical assistance calls—the first one will be on Wednesday June 4 at 1 pm ET. You will have the opportunity to discuss issues with your peers and with Dr. Marian Edmiston, who has extensive experience in training staff in long-term care facilities.

18. Q: How do you deal with staff members who don't really pay much attention to their assigned residents...really I

think it comes down to the fact that they don't care. Thus, it causes the center many problems! A: Trying to find solutions to low levels of motivation and the problematic attitudes of staff members can be very difficult and frustrating. Your description here points to the need for your Director of Nursing and Administrator to work with Human Resources (HR) to address these issues individually with staff members and to support an environment that promotes staff engagement. There are many reasons why staff don’t or can’t perform their duties effectively, and it is the responsibility of leadership and HR to provide support, coaching, and effective management strategies to aid staff in improving their performance. It may be helpful to discuss your concerns with nursing and administrative leadership about how these behaviors place your residents at risk.

19. Q: Hi! Regarding restraints, how can I explain to family members who are persistently pushing the use of belts on

the resident's bed that it is not helping at all? We've tried numerous times to explain to them and tried to discontinue it but they don't want to have it discontinued and threatens to sue the facility if anything happens to resident. A: Talking with families about the use of restraints is always a challenge. In Long Term Care we know that helping families understand the risks and benefits of restraints can be difficult. Sometimes families may see the use of restraints as the only way to ensure that their loved one is safe. They may not be aware of the alternatives to restraints that are available in the facility or that they can actively participate in measures that can reduce the need for restraints.

I think it is best to teach families about the philosophy and policies concerning restraints in your facility when the resident is admitted. If possible, create a handout that outlines how and why restraints may be used and how families can collaborate with staff to help reduce the need for restraints. In presenting this information at a time when there may not be a need for the restraint, family members have the opportunity to understand and ask questions about how a situation will be managed if the need arises.

20. Q: How will future/additional course offerings be communicated/disseminated?

http://www.interact2.net/qagreement.aspx



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A: There will be notifications on the AHRQ, NGNA, and NADONA websites, as well as on the Hayes, Inc. homepage, when the next webinar is open for registration. Please check after March 24th.

• AHRQ: http://ce.ahrq.gov/nurses/ • National Gerontological Nursing Association: http://www.ngna.org/ • National Association of Directors of Nursing Administration in Long-Term Care: https://www.nadona.org/ • Hayes, Inc.: http://www.hayesinc.com/hayes/

21. Q: Will the webinars also be free of charge?

A: Yes, all of the Webinars are free of charge, as are the training materials. 22. Q: Page49 is a very fast review. I would like to see this page again. Thank you.

A: Slide 49 Defining a Fall Unintentional change in position, coming to rest on the ground or next lower surface that does not result from:

• Being pushed down • Collapsing as the result of a sudden medical condition

The final webinar in the series will provide detailed information about falls and fall prevention. This webinar will be presented on August 13, 2014, at 1 pm ET. If you’d like to review any material presented in the Webinar you attended, the recording will be available shortly—it can be accessed at any one of these websites:

• AHRQ: http://ce.ahrq.gov/nurses/ • National Gerontological Nursing Association: http://www.ngna.org/ • National Association of Directors of Nursing Administration in Long-Term Care: https://www.nadona.org/

23. Q: On page45, what was CUS?

A: The CUS tool was developed by AHRQ and is described in Module 2. We will cover the CUS tool in more detail in the Webinar on June 18 at 1 pm ET. In brief, here’s a brief description of the tool: CUS (Concerned, Uncomfortable, Safety) CUS is a way to emphasize concern when it seems like someone is not listening. If you are communicating with a fellow team member, and worry that your communication is not getting through, CUS may be helpful. It stands for:

• I am Concerned about my resident’s condition. • I am Uncomfortable with my resident’s condition. • I believe the Safety of the resident is at risk.

CUS can sometimes overcome barriers to communication by emphasizing our personal stake in our residents’ well-being. It should not be used routinely. Only use CUS when the situation is urgent.

24. Q: Thank you. I am not actually in a facility, so did not respond to all questions. I have visited facilities frequently

as an NP, and I am currently job seeking. I hope you don't mind me attending. It is all still very useful as I have worked mostly in geriatrics.




http://www.hayesinc.com/hayes/






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A: Anyone interested in patient safety is welcome to attend any or all of the webinars—we appreciate your attendance and any input you have—your clinical experience is very relevant for this material.

25. Q: Concerning fall risk assessment (admission), which one do you recommend?

A: The CMS and AHRQ websites have great information and resources available to assist with determining what is appropriate for a risk assessment. A falls risk assessment for nursing staff on admission should include the risk factors mentioned in this presentation. There are also several tools that are appropriate for therapists to assess a resident’s ability to stand, transfer, and ambulate safely. The Centers for Disease Control and Prevention (CDC) website contains several tools that can be adapted for both purposes at: http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html. The NICHE (Nurses Improving care for Health System Elders) site has additional resources at: http://www.nicheprogram.org/niche_encyclopedia-assessment-fall_risk_assessment#.

26. Q: How do you address the LOW-risk residents who fall...? This has been a significant issue in our facility.

A: Your question is an excellent one and emphasizes the purpose and goals of this patient safety series! When a resident has been assessed and found to be at low risk for a fall, the fall risk reduction strategies used by your facility are usually not implemented because the resident is functioning at a level that minimizes risk and has a right to live in the least restrictive environment needed. However, any resident can experience a change in condition that temporarily or permanently places them at risk for falls. In long-term care it is important to remember that observation and assessment of residents must be continuous. Constant observation of residents and the effective reporting, documentation, and follow-up of signs of a change in the resident’s physical, mental, or emotional condition is essential to keeping our residents safe. It was a pleasure to respond to your questions. I hope that I have provided the information that you requested. Please attend the 3 upcoming Webinars to learn more about the Improving Patient Safety in Long-Term Care Facilities program.

http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html

http://www.nicheprogram.org/niche_encyclopedia-assessment-fall_risk_assessment

http://www.nicheprogram.org/niche_encyclopedia-assessment-fall_risk_assessment

Introduction to a Webinar Series: Improving Patient Safety...

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Transcript of Introduction to a Webinar Series: Improving Patient Safety...