Joseph G. Ouslander, MD Professor and Associate Dean for Geriatric Programs

1. Joseph G. Ouslander, MD Professor and Associate Dean for Geriatric Programs Charles E. Schmidt College of Medicine Professor (Courtesy), Christine E. Lynn College of Nursing Florida Atlantic University Professor of Medicine (Voluntary), University of Miami Session 1 Overview of the INTERACT Program and Curriculum The development and evaluation of the INTERACT quality improvement program and Curriculum are supported by grants from the Retirement Research Foundation and The Commonwealth Fund

2. Session 1 Overview of the INTERACT Program and Curriculum • If you are participating in a teleconferenceproceed to the next slide for instructions • If you are reviewing this session as a self-learning activity: • Proceed to slide # 4 • Click the speaker at the bottom of each slide to listen to the audio • If you do not have audio, click on “View” on the toolbar, and select “Normal” to view the text below each slide – if necessary select “Zoom” to make all of the slide and text visible.

3. Session 1 Overview of the INTERACT Program and Curriculum Teleconference Instructions • If the leader is not on the call when you call in, please wait

4. Session 1 Overview of the INTERACT Program and Curriculum Welcome and Introductions • This session is designed for the entire interdisciplinary team, including the: • Project champion and co-champion • DON, key RNs, LPNs, and CNAs • Medical director, primary care MDs, and NPs/PAs • Social workers • Administrators

5. Joseph 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. Ouslander’s 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. Overview of the INTERACT Program and Curriculum jousland@fau.edu

6. Overview of the INTERACT Program and Curriculum • The INTERACT Interdisciplinary Team • Laurie Herndon, GNP Mass Senior Care Foundation • Gerri Lamb, PhD, RN, FAANArizona State University • Ruth Tappen, EdD, RN, FAAN Florida Atlantic University • Sanya Diaz, MD Florida Atlantic University • John Schnelle, PhD Vanderbilt University • Sandra Simmons, PhD Vanderbilt University • Annie Rahman, MSW Miami University • Jo Taylor, RN, MPH The Carolinas Center for Medical Excellence • Alice Bonner, PhD, GNPCenter for Medicare and Medicaid Services In collaboration with participating nursing homes

7. Overview of the INTERACT Program and Curriculum What This Session Will Cover • Definition and goals of INTERACT • Why it matters to you and your organization • Overview of the INTERACT curriculum • Preparing for your participation

8. Overview of the INTERACT Program and Curriculum Pre-Session #1 Quiz • Please complete the Pre-Session Quiz • If you take the Quiz in a paper and pencil format, please make sure your facility champion or co-champion gets a copy • If you are reviewing this session on-line, you can take the on-line Quiz, or take the Quiz using a hard copy obtained from your facility champion or co-champion, and return it to them

9. Overview of the INTERACT Program and Curriculum INTERACT – definition and goals • INTERACT stands for “Interventions to Reduce Acute Care Transfers” • It is a 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

10. Overview of the INTERACT Program and Curriculum INTERACT – definition and goals • The 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 care

11. Overview of the INTERACT Program and Curriculum INTERACT – definition and goals • The INTERACT program was: • Originally developed in a project supported by the Center for Medicare and Medicaid Services (CMS) • Revised based on input from staff from several nursing homes and national experts in a project supported by The Commonwealth Fund

12. Overview of the INTERACT Program and Curriculum INTERACT – definition and goals • The INTERACT program includes clinical tools, strategies to implement them, and related educational resources • The INTERACT program is located on the internet at: http://interact2.net

13. Overview of the INTERACT Program and Curriculum INTERACT – definition and goals • INTERACT includes 3 types of tools for you to use in your daily work in the nursing home: Communication Tools Care Paths Advance Care Planning Tools

14. Overview of the INTERACT Program and Curriculum INTERACT – definition and goals • The INTERACTtools are designed to be: • As simple as possible • Efficient for use in daily care routines • Based on scientific evidence and/or expert recommended clinical guidelines where available • Consistent with federal regulations and guidance for surveyors

15. Overview of the INTERACT Program and Curriculum INTERACT – definition and goals • The INTERACT tools are designed to help you: • Identify changes in residents condition • Assess these changes • Manage some conditions in the nursing home • Document the changes and how they were assessed and managed • Communicate effectively: • With staff in your nursing home • With staff at your local hospitals

16. The different INTERACT tools are meant to be used together in your daily work in the nursing home

17. Overview of the INTERACT Program and Curriculum INTERACT – definition and goals • INTERACT can result in reduced hospital transfers by helping you to: • Prevent conditions from becoming severe enough to require hospitalization through early identification and assessment of changes in resident condition • Manage some conditions in the NH without transfer when this is feasible and safe • Improve advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization for some residents

18. Overview of the INTERACT Program and Curriculum Why it matters – a national perspective (1) • Emergency room visits, hospitalizations, and re-hospitalizations of nursing home residents are: • Common : 1 in 4 residents admitted to a nursing home from a hospital are re-admitted to the hospital within 30 days • Expensive: hospitalizations that might not be necessary cost Medicare and Medicaid billions of dollars every year

19. Overview of the INTERACT Program and Curriculum Why it matters – a national perspective (2) • Hospitalizations can contribute to many complications: • Distress and discomfort for the resident • Delirium • Polypharmacy • Falls • Incontinence and catheter use • Hospital acquired infections • Unintentional weight loss and poor nutrition • Immobility, de-conditioning, pressure ulcers

20. Overview of the INTERACT Program and Curriculum

21. Overview of the INTERACT Program and Curriculum Why it matters – a national perspective (3) • Reducing avoidable hospitalizations will help: • Allow limited Medicare and Medicaid funds to be used to improve care in our nursing homes rather than for unnecessary hospital stays • Preserve Medicare benefits for all of us

22. Overview of the INTERACT Program and Curriculum Why it matters – to you and your facility (1) • INTERACT will help you and facility: • Improve quality of care for your residents • Benefit from tools to help your team work together more effectively • Take advantage of everyone’s contributions to resident care

23. Overview of the INTERACT Program and Curriculum Why it matters – to you and your facility (2) • The current situation, which favors hospital transfers, is going to change • Medicare is planning changes in payment that will reward lower rates of avoidable hospitalizations • Surveyors will be examining how facilities assess and manage acute changes in status • You need to be prepared!

24. Overview of the INTERACT Program and Curriculum The INTERACT Curriculum • 12 sessions over a 6-month period (for teleconference participants) • Some facilities will participate on-line only with completion of 9 sessions • Not all staff need to complete every session • The facility champion and co-champion will serve as the coordinators of the curriculum • Participating staff will be asked to document their consent to participate and complete a pre and post quiz and an evaluation for each session • Practice using the tools between sessions • Follow-up calls to individual facility champions to discuss progress

25. Overview of the INTERACT Program and Curriculum The INTERACT Curriculum (2) • Evening, night, and weekend staff will go through curriculum sessions on an individual basis • The sessions will be available on-line, but can also be printed and reviewed in hard copy if access to the project website is limited • Nurses can earn CEUs for participation

26. Overview of the INTERACT Program and Curriculum The INTERACT Curriculum (3) • Your participation and evaluation and feedback is critical to help further improve the INTERACT program • You will be asked to complete an evaluation of each session, and of the overall curriculum • This is required for nursing staff earning CEUs

27. Overview of the INTERACT Program and Curriculum The INTERACT Curriculum (3)

28. Overview of the INTERACT Program and Curriculum The INTERACT Curriculum (4)

29. Overview of the INTERACT Program and Curriculum The INTERACT Curriculum (5)

30. Overview of the INTERACT Program and Curriculum The INTERACT Curriculum (6)

31. Overview of the INTERACT Program and Curriculum Planning Your Participation • Put the dates of curriculum calls on your calendar • Review the INTERACT website • Meet as a team to discuss participation before the second session • Let your affiliated hospitals know about the program

32. Overview of the INTERACT Program and Curriculum Implementation Assignment before the Next Session • Your facility’s project champion is responsible for coordinating INTERACT implementation. She or he may ask you to complete specific activities before the next teleconference or before you review the next session on-line • Suggested implementation activities before the next session include reviewing portions of the INTERACT website: • Go to the home page (http://interact2.net) and read it • Click on “About INTERACT” and read the page • On the “About INTERACT” page, click on “Tool Table” and review the list of tools and then click on “INTERACT II Overview Figure”, and review it. • Finally, click on “INTERACT II Tools”, and review the Acute Care Transfer Log and QI Review Tool by clicking on them

33. Overview of the INTERACT Program and Curriculum For teleconference participants: Questions, Suggestions, Comments? • Un-mute the line:Press # 6 Please re-mute your line after talking:Press * 6 • Questions 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”

34. Overview of the INTERACT Program and Curriculum The Next Session • The next teleconference will be held at the same time next week • The topic and participants are listed below

35. Overview of the INTERACT Program and Curriculum Post-Session #1 Quiz and Evaluation • Please complete the Post-Session Quiz and Evaluation • 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 copy • If you are reviewing this session on-line, you can take the on-line Quiz and complete the evaluation on-line.