September 2012

Your hosts: Jody Rothe, MetaStar Stephanie Sobczak, WHA

Thank you to these organizations for sponsoring this webinar series:

A special thank you to the Wisconsin Clinical Resource Center for serving as the home base for recorded webinars and materials related to the INTERACT II collaborative

July Overview & Case Review Tools

August Communication ToolsSeptember Early Warning ToolsOctober Change in Condition ToolsNovember Resident Transfer ToolsDecember Continuous Improvement

Tools

Share experiences with SBAR Early Warning Signs Stop and Watch Tool Implementing the Stop and Watch Tool 30 day Action Items

Results of Feedback Tool

Discussion: How did trying or testing SBAR go?

What went well? What didn’t work well?

Can you share your plans for implementation?

Please be sure your phone lines are muted (*6) to keep background noise to a minimum.

Why this is important:

1.Patients conditions can change suddenly, but can also be very subtle.

2.Patients may under report their symptoms or concerns, “They don’t want to be a bother”.

3.Usually assistants are the first to hear about or see changes in a patient’s condition.

Early warning signs that are missed can result in: Adverse outcomes from delayed treatment Avoidable transfers Patient & Family dissatisfaction Worsening of chronic conditions over time Unnecessary time spend in a hospital bed State survey citations (F157)

This is an Early Warning Tool to recognize, then report changes in a patients condition.

It serves as a reminder to discuss with a charge nurse before the end of a shift.

It is known as

“STOP AnD WATCH”

S – Seems different than usualT – Talks or communicates less than ususalO – Overall needs more help than ususalP – Participated in activities less than usual

A – Ate less than ususal (not because of dislike of food served)

nD – Drank less than usual

W – Weight changeA – Agitated or Nervous more than ususalT – Tired, Weak, Confused or DrowsyC – Change in Skin Color or conditionH – Help with Walking, Transferring, Toileting

more than ususal

Name of Resident

Circle the changes noted

Complete your name, reported to, date and time.

Submit the tool to the appropriate person on staff.

1. Start small2. Find staff volunteers willing to try the tool.3. Be willing to “tweak” the tool, or the

process for using the tool so that it is effective in your facility.

4. Document your decisions.

2-3 Nursing assistants try the toolReport on their experience using itSuggestions for next trial

4-6 Nursing assistants use the toolGather feedback

8-12 Ditto (How long would it take you to reach all

Nursing assistants with this tool?)

Intervention or Idea

Test Who? Lesson Learned

Decision

Try Stop & Watch

Complete the tool on 2 example residents

Joan & LaTisha

Adapt Adopt Abandon

Adapt Adopt Abandon Adapt Adopt Abandon Adapt Adopt Abandon

Consider the following:

Make paper copies of the tool.

Giving a laminated card to record, then information could be transferred into a report/communication book.

Make a “pad” for carrying in pockets

Key Question: How can you ensure the early warning tool is used by everyone, consistently?

Plan:1.How will you educate everyone?2.How will you assess the effectiveness?3.When will use of the Early Warning Tool be

added to policy and procedure?

1. Do you know the tool was used when there is a review of readmission cases?

2. Do you know SBAR was in use?3. Do you see a decrease in avoidable

readmissions?

Any idea how you might test or begin using the Stop and Watch tool?

Please be sure your phone lines are muted (*6) to keep background noise to a minimum.

How well are you able to keep pace with the introduction of the INTERACT II tools?

We are keeping up very well We are a little behind, but working on it. We are struggling to keep up We haven’t begun implementing any

INTERACT II tools

Results of this poll will be shared at next months webinar.

Review the Stop and Watch Tool with staff Have volunteers try the Tool through cycles

of small tests Evaluate the tests Decide to adapt/adopt/abandon Submit data

An on-line Feedback Tool will be sent after October 3rd to assess your progress on these tasks.

Thank you!

See you next month

Next month: Acute Change in Condition Tools