INTERACT Curriculum

Joseph G. Ouslander, MDProfessor and Associate Dean for Geriatric ProgramsCharles E. Schmidt College of MedicineProfessor (Courtesy), Christine E. Lynn College of NursingFlorida Atlantic University

Wrap-Up and Strategies for Implementation and Sustainability The development and evaluation of the INTERACT quality improvement program and Curriculum are supported by grants from the Retirement Research Foundation and The Commonwealth FundINTERACT Curriculum Final Session There are no notes for this slide

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Next slide3Welcome and IntroductionsThis session is designed for the entire interdisciplinary team, including the:

Project champion and co-championDON, key RNs, LPNs, and CNAsMedical director, primary care MDs, and NPs/PAsSocial workersAdministratorsINTERACT Curriculum Final Session Welcome to the final educational session on the INTERACT program.

We want to again acknowledge the support of The Commonwealth Fund and the Retirement Research Foundation in the development of INTERACT and the curriculum.

This final session is designed for the entire interdisciplinary team.

Before proceeding I want to re- introduce myself and my colleagues.

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4Joseph 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. Ouslanders 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.

jousland@fau.eduINTERACT Curriculum Final Session Just as a reminder, Im Joe Ouslander. I was your host for the first session. I am physician trained in internal medicine and geriatrics. My current titles and background are outlined on this slide. I am a geriatrician who has spent the last 30 years providing care to nursing home residents, serving as a medical director of nursing homes, and developing teaching, research, and quality improvement programs in the nursing home setting.

My current work is 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.

Next slide5The INTERACT Interdisciplinary Team

Laurie Herndon, GNP Mass Senior Care FoundationGerri Lamb, PhD, RN, FAANArizona State UniversityRuth Tappen, EdD, RN, FAAN Florida Atlantic UniversitySanya Diaz, MDFlorida Atlantic UniversityJohn Schnelle, PhDVanderbilt UniversitySandra Simmons, PhDVanderbilt UniversityAnnie Rahman, MSWMiami UniversityJo Taylor, RN, MPHThe Carolinas Center for Medical ExcellenceAlice Bonner, PhD, GNPCenter for Medicare and Medicaid ServicesIn collaboration with participating nursing homesINTERACT Curriculum Final Session 6By now you should be familiar with the INTERACT program team, listed on this slide. Our team is interdisciplinary, and includes advanced practice nurses, physicians, an individual with a social work background, and psychologists. You have met many of our team members in previous sessions.

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Review of: The goals of INTERACTWhy it matters to you and your organizationHow the INTERACT tools work together in everyday practiceStrategies for effective implementation and sustainability of the program

What This Session Will Cover

INTERACT Curriculum Final Session In this final session, we will briefly review the goals of INTERACT and how the tools work together in an overall quality improvement program. Well review why INTERACT matters to you and your organization. We will then outline strategies for ongoing implementation and sustaining the program.

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7There is no Pre-Session Quiz for this session!Pre-Session QuizINTERACT Curriculum Final Session This slide just informs you that there is no Pre-Quiz for this session. However, the evaluation for this session is very important, since it is an overall evaluation of the curriculum.8The INTERACT team congratulates and thanks you for your participation in this curriculumWe would greatly appreciate your feedback by completing the Final Evaluation formFor licensed nurses you will receive CEUs for your participation Congratulations and Thanks!INTERACT Curriculum Final Session Before moving forward with the rest of the session, we want to congratulate and thank all who have participated in the curriculum

We would greatly appreciate your feedback by completing the Final Evaluation form

For licensed nurses we are arranging for you to receive CEUs for your participation and will be contacting facility champions to coordinate this.

9INTERACT review of definition and goalsINTERACT or Interventions to Reduce Acute Care Transfers is a quality improvement program designed to improve the care of nursing home residents

INTERACT Curriculum Final Session As you know, INTERACT is a quality improvement 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

Next slide10The 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 careINTERACT Curriculum Final Session INTERACT review of definition and goalsThe goal of INTERACT is to improve care quality, not to prevent all hospital transfers

As we have emphasized throughout this curriculum, not all transfers are preventable. In fact, INTERACT can result in more rapid transfer of residents who need hospital care through use of some of the clinical practice tools that are part of the program.

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11 INTERACT can result in reduced hospital transfers by helping you to:Prevent conditions from becoming severe enough to require hospitalization through early identification and evaluation of changes in resident conditionManage some conditions in the NH without transfer when this is feasible and safeImprove advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization for some residents

INTERACT Curriculum Final Session INTERACT review of definition and goalsThe INTERACT program and tools are designed to help your facility improve care and reduce unnecessary hospital transfers using one or a combination of three strategies:

First, INTERACT can help you to prevent conditions from becoming severe enough to require hospitalization through early identification and evaluation of changes in resident conditionSecond, INTERACT can help you to manage some conditions in the NH without transfer to the hospital when it is feasible and safe to do soAnd third, INTERACT can help you to improve advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization for some residents

Next slide12SadieSaraSamA Tale of Three Siblings

INTERACT Curriculum Final Session Lets illustrate how INTERACT works with 3 cases a Tale of Three Siblings . These are based on real cases I have seen as a practicing geriatrician.

Next Slide13Hospitalized for UTI and dehydrationDischarged back to the NH after 4 daysRe-hospitalized 7 days later for dehydration and recurrent UTISadieA 96 year old long-stay NH resident

Avoidable?INTERACT strategy:Prevent conditions from becoming severe enough to require hospitalization through early detection and evaluation

INTERACT Curriculum Final Session Sadie is a 96 year old long-stay NH resident who is:

Hospitalized for a Urinary tract infection (UTI) and dehydrationDischarged back to the NH after 4 days in the hospitalRe-hospitalized 7 days later for dehydration and recurrent UTI

At the time she was discharged back to the NH , lab tests showed that she was fully hydrated. She became dehydrated over 7 days in the NH. Dehydration does not occur overnight. Sadie must not have been eating and drinking adequately, and probably had other signs, such as a mental status change. But no one recognized or documented these changes.

Was this transfer avoidable? In all likelihood, if Sadies symptoms had been recognized and acted upon, this transfer would have been avoidable.

The INTERACT strategy for cases like this is to Prevent conditions from becoming severe enough to require hospitalization through early detection and evaluation

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14Hospitalized for a lower respiratory infection, but had normal vital signs and oxygen saturationDeveloped delirium in the hospital, fell and fractured her hip

Sara (Sadies younger sister)A 92 year old long-stay NH residentAvoidable?INTERACT strategy:Manage some conditions in the NH without transfer

INTERACT Curriculum Final Session

The second case is Sara - Sadies younger sister. Sara is a 92 year old long-stay NH resident. She is hospitalized for a lower respiratory infection because of a cough and possible infiltrate on chest xray. However, all of her vital signs and oxygen saturation were normal. She developed delirium while in the hospital, and then climbed out of bed and fell and fractured her hip.

Was this hospitalization and the complication avoidable? According to the INTERACT evidence-based care path for pneumonia, Sadies condition did not meet criteria for transfer to the hospital, because her vital signs and oxygen saturation were normal. Sara could have been cared for safely in her NH, and thus avoiding the complications of hospitalization.

The INTERACT strategy is to Manage some conditions in the NH without transfer when it is safe and feasible to do so.

15Hospitalized for the 4th time in 2 months for aspiration pneumonia related to end-stage Alzheimers diseaseTransferred to hospice on the day of admissionSam (Sara and Sadies older brother)A 101 year old long-stay NH resident

Avoidable?INTERACT strategy:Improve advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalizationINTERACT Curriculum Final Session The third case is Sam - Sara and Sadies older brother. He is 101 and is hospitalized for the fourth time in 2 months for aspiration pneumonia related to end-stage Alzheimers disease. He is transferred to hospice on the day after hospital admission.

Was this hospitalization avoidable? While coming to a decision to limit care at the end-of-life is difficult for many residents and families, Sams course was predictable. In his case, the discomforts of repeated hospitalizations probably outweigh the benefits .

The INTERACT strategy is to Improve advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization. The INTERACT Advance Care Planning Tools are designed to help in this process.

This Tale of Three Siblings, Sadie, Sara, and Sam, illustrates three examples of potentially avoidable hospitalizations and how the INTERACT program can help prevent them. Next slide

16Communication ToolsCare PathsAdvance Care Planning ToolsINTERACT includes 3 types of tools for you to use in your daily work in the nursing home:INTERACT Curriculum Final Session INTERACT review of definition and goalshttp://interact2.net As you are aware, the INTERACT program includes 3 types of tools for you to use in your daily work in the nursing home: communication tools, care paths, and advance care planning tools.

You have had a chance to learn about the specific tools during the course of this curriculum. They are available for you to use on the INTERACT website.

Many questions arise about modifying the tools. Our team wants the tools to be used flexibly. However, you should acknowledge the source of the tools even if you modify them, and only use the INTERACT trademark when using tools from the website, or very minor modifications of them, and you should maintain the copyright for tools that have been copyrighted.

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The different INTERACT tools are meant to be used together in your daily work in the nursing homehttp://interact2.net This slide should be familiar to you, and illustrates how the different INTERACT tools are meant to be used together in your daily work in the nursing home. Our team believes that the program will be more effective if you use all of the tools in an integrated program. However, your facility may choose to use only some of the INTERACT tools and strategies

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18Why it matters to you and your facility (1)INTERACT will help you and facility:

Improve quality of care for your residentsBenefit from tools to help your team work together more effectivelyTake advantage of everyones contributions to resident careINTERACT Curriculum Final Session As you implement INTERACT, it is important to keep in mind why this program matters to you and your facility.

INTERACT will help you and facility improve the quality of care for your residents when they have a change in condition. INTERACT provides an integrated set of tools that will help your team work together more effectively. Effective use of the INTERACT tools will allow you to take advantage of everyones contributions to resident care.

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19Why it matters to you and your facility (2)The current situation, which favors hospital transfers, is going to changeMedicare is planning changes in payment that will reward lower rates of avoidable hospitalizationsSurveyors will be examining how facilities evaluate and manage acute changes in status

You need to be prepared!INTERACT Curriculum Final Session In addition, you should understand that the current Medicare and Medicaid payment systems, which favor hospital transfers, are going to change.

Medicare is planning changes in payment that will reward lower rates of avoidable hospitalizations, and, surveyors will be examining how facilities evaluate and manage acute changes in condition of their residents.

You need to be prepared for these changes. Implementing the INTERACT program can help you be ready and successful.

Next slide20Effective implementation of INTERACT is critical to long-term sustainability of the program

The program cannot be effectively implemented or sustained without strong support from facility leadership

INTERACT Curriculum Final Session Implementation and SustainabilityIn the next part of this presentation, well talk about strategies to successfully implement and sustain the INTERACT program. Effective implementation of INTERACT is critical to lay the foundation for long-term success and sustainability.

Similar to any other program in your facility, INTERACT cannot be effectively implemented or sustained without strong support from your leadership. Your leaders must understand why the program is important to improve the quality of care you provide your residents, and to changes that will occur in the way your facility is paid by Medicare, as well as in meeting federal regulatory standards related to management of changes in condition.

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21General Principles

Make INTERACT a key aspect of your facilitys quality improvement activities

Implementation of the INTERACT program should be consistent with the way you provide care in your facility

Integrate the INTERACT program and tools into your everyday practice

Recognize that organizational change takes time - programs such as INTERACT can take several months to fully implement

INTERACT Curriculum Final Session Implementation and SustainabilityThis slide lists 3 general principles which are keys to successful implementation and sustainability of the INTERACT program. First, INTERACT must be a key aspect of your facilitys quality improvement activities. Second, implementing the INTERACT program should be consistent with the way you provide care in your facility . You can accomplish this by integrating the INTERACT tools into your everyday practice s. Third, recognize that organizational change takes time be patient - programs such as INTERACT can take several months to fully implement - including training, rolling out the tools, and making the program a part of your everyday work.

Taking advantage of these keys to success will go a long way towards ensuring that he INTERACT program will be implemented most effectively and sustained over time.

Now lets review 6 critical strategies for effective implementation and long term sustainability of the INTERACT program.

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22Select Your TeamPearl of Wisdom:

Selection of the Champion and Co-Champion is one of the most important decisions you will make

INTERACT Curriculum Final Session Implementation and SustainabilityNow we will discuss 6 strategies which we have learned from NHs that have successfully implemented INTERACT. First, effective implementation requires involvement from all clinical staff . Selection of a core team is essential to set the tone for the work and to keep the program on track .Your core team should schedule a regular time to review goals and progress as the program gets started.

Selection of the Champion is one of the most important decisions you will make. You know best who can motivate your staff and who has the skills to coordinate the program. Experience suggests that it does not matter what discipline the Champions are from. Successful champions have been LPN or RN unit managers, DONs , ADONs or other nurse leaders, medical directors, and administrators. Appointment of a Co-Champion is strongly recommended in case the Champion becomes unavailable to continue their program responsibilities.

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23Find the Gaps

Pearl of Wisdom:

Avoid redundancy - the INTERACT program should fill in gaps in your care processes and not create more work for your staff.

INTERACT Curriculum Final Session Implementation and SustainabilitySecond, the INTERACT program should not be duplicative of what you already do. In order to get started, it is helpful to review your current processes and identify the gaps. You may already have some processes in place that work. Next, review the INTERACT tools to determine where you want to start. For example, you may already have a protocol for notification of physicians and a template for an acute change in condition nursing progress note. I n this situation, you may not want to use the SBAR communication tool .

In other words, it is critical to avoid redundancy. The INTERACT program should fill in gaps in your care processes and NOT CREATE MORE WORK for your staff.

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24Carefully Plan Your Training

INTERACT Curriculum Final Session Implementation and SustainabilityFacility CharacteristicsStart with one unit or one tool at a time and have all of the tools implemented by a set dateImplement the whole toolkit all at once throughout the whole facilityWe are a small facility with no other major initiatives underway.xOur champion does very well teaching one on one.xOur champion is our in-service director and is experienced conducting large in-services.xWe usually roll out programs for everyone at the same time.xWe are a large facility with several nursing units.xWe have a short time line to carry out the training and implement the programxThird, plan your training carefully. Consider what else you have going on in your facility, what resources you have to devote to the training, and what traditionally works best for your facility. The table on this slide provides some tips from facilities that have successfully implemented INTERACT.

For example, smaller facilities may want to train all staff and implement the program throughout the entire facility, whereas larger facilities with several nursing units may want to implement the program on one unit at a time. Another factor is the time line you have for program implementation. You may want to do all of the training up front, especially if you have a relatively short time frame to implement the program . Otherwise, you may want to spread the training out over several weeks, with time for implementation exercises and review of the program in between.

Next slide25Make the Tools Visible in for Easy Use in Everyday Practice

Pearls of Wisdom:

Remove old forms from nursing units to avoid confusion and to encourage standard use of new tools and formsSuccessful INTERACT Champions have found ways to keep the program visible on a daily basis through discussions at stand up meetings, on rounds and other strategies

INTERACT Curriculum Final Session Implementation and SustainabilityFourth, the INTERACT Tools must be visible for easy use in everyday practice in order for the program to be effectively implemented and sustained.

The INTERACT tools are not meant to be stored away in a notebook. They need to be visible and readily available. Examples of formats for the tools that facilities have found useful are illustrated in the Tool Table on the INTERACT website. You can be creative and use what you think will work best in your facility. You may want to contact a local printer to consider printing larger quantities of some of the tools in various formats.

Successful INTERACT Champions have found other ways to keep the program visible. Daily stand up rounds at each nursing station to review residents who have had an acute change; asking about acute care transfers as part of morning report; and monitoring the use of the tools are strategies that can help make the program successful.

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26Once You Are Started Take the Next Steps

Pearls of Wisdom:

Complete Quality Improvement tools as soon after acute care transfers as possible so that details are fresh If the transfer is determined to be preventable, implement a plan to improve right awayUse the data to improve care processes and to focus educational activitiesContact and meet with your local hospitals leadership and Emergency Room staff to inform and educate them about INTERACT

INTERACT Curriculum Final Session Implementation and SustainabilityFifth, once you get started, take the next steps. Consistent review of Quality Improvement Tools is critical: successful facilities engage the front line staff in this process.You should complete the tool as soon after the acute care transfer as possible so that all of the details are fresh. If the transfer was determined to be preventable, use this information to guide changes in your care processes , as well as to focus educational efforts.

Another critical strategy is to contact and meet with leadership of your local hospitals . Let them know that you are beginning a program to reduce avoidable acute care transfers. You can also share with them a copy of your Nursing Facility Capabilities List, which is one of the INTERACT Communication tools . There is no substitute for in person communication and building mutual trust and respect in implementing and sustaining a program that involves inter-facility communication and shared clinical responsibility.

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27Continue Tracking Your Data and Looking for Ways to Improve Your Care

Pearls of Wisdom:

Make data tracking part of your everyday routine, as well as your overall quality improvement activitiesOngoing data collection and analysis is key to determining if you have actually improved care for your residents Set your own benchmarks and work on improving

INTERACT Curriculum Final Session Implementation and SustainabilitySixth, in order to sustain the program continue tracking your transfer data and looking for ways to improve your care. Make data tracking part of your everyday routine, as well as your overall quality improvement activities. This type of ongoing data collection and analysis s key to determining if you have actually improved care for your residents . You should set your own benchmarks, either based on your own data for the last 6-12 months, corporate data, or data available in the literature, and work on improving your outcomes.

Next slide28INTERACT Curriculum Final Session Select Your Team and ChampionFind the GapsCarefully Plan Your TrainingMake the Tools Useful and Visible in Everyday Practice in the Facility Once You Are Started Take the Next StepsContinue Tracking Your Data and Looking for Ways to Improve Your CareStrategies for Effective Implementation and SustainabilityTo summarize, we recommend 6 specific strategies for implementing INTERACT:

First, select Your Team and your Champion, and begin to meet on a regular basisSecond, find the Gaps in your care processes and fill them in. Avoid redundancy.Third, Carefully Plan Your TrainingFourth, Make the Tools Useful and Visible in Everyday Practice in the Facility. Dont implement INTERACT as a notebook that gathers dust.Fifth, Once You Are Started Take the Next Steps, including using the Quality Improvement tool to change care processes and guide education, and meeting with leadership of your local Emergency Room to familiarize them with the program.Finally, Continue Tracking Your Data and Looking for Ways to Improve Your Care

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INTERACT Curriculum Final Session Overcoming Barriers to Implementation

Now lets take a few minutes to review some common barriers that facilities have reported in attempting to implement and sustain the INTERACT program . We will share strategies that you might be able to use to overcome them. Implementing a major quality improvement program such as INTERACT is hard work, and you will run in to barriers. But there are ways you can hurdle these barriers and successfully implement and sustain the program.

Next Slide30INTERACT Curriculum Final Session Overcoming Barriers to Implementation (1)BarriersStrategies to OvercomeWe dont have a problem with hospital transfersRegularly track hospital transfers and follow trends; you may have a problem and not know itWe dont have control over who gets admittedUsing INTERACT tools to improve management of acute changes and communication with physicians and emergency rooms staff will give you more controlThe doctors wont cooperateThe medical director and the primary care providers must buy in to the INTERACT programOne barrier is thinking that you dont have a problem with the way you manage changes in condition and hospital transfers, when you dont really know and might in fact have room for improvement. The quality improvement approach is to objectively measure outcomes, track them over time, and compare them to benchmarks. Only through this process will you know if there is a need to improve and in what specific areas improvement is needed.

Staff may perceive that they do not have control over who gets transferred and admitted to the hospital. Using INTERACT tools to improve management of acute changes in condition and communication with physicians and emergency rooms staff will give you more control over who gets transferred and admitted.

Doctors may ignore or not cooperate with the use of the INTERACT tools. Getting the buy-in of the medical director and as many primary care providers as possible to understand the value of the INTERACT tools will go a long way towards better interdisciplinary collaboration.

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31INTERACT Curriculum Final Session Overcoming Barriers to Implementation (2)BarriersStrategies to OvercomeFamilies want residents hospitalizedFamilies need to be educated about the risks as well as benefits of hospitalizationWe could get sued There is no fail-safe way to prevent law suits but the INTERACT program provides tools for evidence-based and expert recommended care, and improves communication and documentationAnother frequently mentioned barrier is that families may insist on hospital transfers. In order to overcome this barrier, families need to be educated about the risks as well as benefits of hospitalization. If they understand the potential discomforts and risks of hospitalization, and trust your facilitys clinical capabilities, demands for hospital transfer should be reduced.

Administrators and staff may also be concerned about getting sued because of trying to manage an acute condition in the facility , especially if things do not go well. Although there is no fail-safe way to prevent law suits the INTERACT program provides tools for evidence-based and expert recommended care, and improves communication and documentation that can help protect you. Implementation of the program should be of great value in documenting best practices and defending against legal actions related to quality of care.

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32INTERACT Curriculum Final Session Overcoming Barriers to Implementation (3)BarriersStrategies to OvercomeWe dont have the staff or timeImproving the management of acute changes in condition has to be a priority of the facility and its leadershipWe have too many other things going onINTERACT must be one of the major quality improvement initiatives at the facilityWe are in our survey windowINTERACT implementation will result in improved care and adherence to multiple F Tags and other requirementsA third set of barriers relates to very realistic concerns about time and priorities. Unless improving the management of acute changes in condition and reducing avoidable hospital transfers is a priority of the facility and its leadership, the INTERACT program should not be implemented because it will not be successful without such support. Moreover, INTERACT must be one of the major quality improvement initiatives at the facility in order for it to be effectively implemented and sustained over time. Facilities only have the capacity to focus on a small number of quality improvement initiatives at one time.

With regard to concerns about surveyors, INTERACT implementation will result in improved care and adherence to multiple F Tags related to change in condition and can play an important role in better survey outcomes

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33INTERACT Curriculum Final Session Overcoming Barriers to Implementation (4)BarriersStrategies to OvercomeThings dont go well when the Champion is not hereAppointing a co-champion and embedding INTERACT tools into everyday practice will help overcome staff absences and turnoverWe already have similar forms and processesUse your tools, or use or modify the INTERACT tools based on what your facility already has in placeA final set of barriers relates to practical challenges in program implementation. As emphasized earlier, the Champion is critical to the success of the program, and if the Champion is not available, the program will not go well. We therefore strongly recommend appointing a co-champion who can take over if needed. Ensuring that the INTERACT program and tools are firmly embedded into everyday practice will also help overcome staff absences and turnover.

A frequent comment is We already have similar forms and processes. We have tried to emphasize that the INTERACT tools are not fixed in stone. You should use your tools if they work for you, or use or modify the INTERACT tools based on what your facility already has in place. When using the INTERACT tools or minor modifications of them you should provide appropriate credit in all written materials, and maintain the copyright when there is one.

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34Make INTERACT a permanent part of your quality improvement activitiesBe sure that you have ongoing leadership supportContinue to track changes in rates of hospital transfer and how you manage acute changes in conditionLearn from you Quality Improvement Review toolsVisit the INTERACT website for updates and new resources: http://interact2.net Dont hesitate to contact us through the websiteINTERACT Curriculum Final Session Sustaining the ProgramKeep up the good work and Good Luck!This slide summarizes several keys to sustaining the INTERACT program that we want to emphasize:

Make INTERACT a permanent part of your quality improvement activities;Ensure that you have ongoing leadership support for the program;Continue to track changes in rates of hospital transfer and how you manage acute changes in condition; andLearn from your Quality Improvement tools and continue to try to improve

And please remember :

Visit the INTERACT website for updates and new resources: http://interact2.net Dont hesitate to contact us through the INTERACT website

Keep up the good work and Good Luck!

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35Please complete the Post-Session Quiz and Evaluation We really want and need your feedback to continue to improve the program!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 copyIf you are reviewing this session online, please take the online Quiz and complete the evaluation onlineFinal Quiz and Program EvaluationINTERACT Curriculum Final Session Thank you very much!We really want and need your feedback to continue to improve the INTERACT program. So please take the Post Session Quiz and complete the final Evaluation.

Thank you very much for your participation.

Next slide36Un-mute the line:Press # 6Please re-mute your line after talking: Press * 6Questions and suggestions on Session 1 can also be directed to Dr. Ouslander by email at: jousland@fau.edu

Please insert in the Subject Line: Question about the INTERACT Curriculum

For teleconference participants:Questions, Suggestions, Comments?INTERACT Curriculum Final Session For teleconference participants, follow the instructions on this slide to ask questions.

For all participants, you can address questions about this session directly to me at the email address shown. Please put Questions about the INTERACT Curriculum in the Subject Line.37