interact.geriu.org

2. Implementation

The INTERACT II tools are designed to fit into everyday practice in the nursing home.

IMPLEMENTATION GUIDE
Nursing home teams are very busy these days. We know that instituting any type of change in healthcare systems can be a challenge. But not all changes need to be sweeping or overwhelming. Making small, steady changes can be very effective in improving patient care.

Deciding When and Where to Start

For this program, you might consider starting with just one unit, with one or two nurses and CNAs, getting them familiar with the tools and systems and working out any glitches with a small, focused group initially. These individuals will then be able to help others in the facility to learn the INTERACT II systems.

Tips for Training Staff

There are many ways to share new information with staff. Start with strategies that you know work in your facility.

  • Involve frontline staff in decisions about the best schedule for staff training sessions
  • Short, frequent training sessions may be necessary to allow staff time to evaluate content and utility of tools and to allow for feedback and suggestions for implementation
  • Keep the training resident-centered by using Case Studies
  • Utilize principles of adult learning during training sessions

Several facilities have found it helpful to download and print all of the INTERACT II materials, placing each tool and instruction sheet in a plastic sleeve in a 3 ring binder. Tab dividers may be used to designate sections for Communication tools, Clinical tools (Care paths and Change in Condition File Cards) and Advance Directives tools. Having these binders available on each nursing unit may aid with program implementation

Informing Residents and Family Members about INTERACT II

You may wish to highlight your facility’s participation in the INTERACT II program for residents and families, and encourage their participation as well. You can use the INTERACT II Information for Residents and Families to introduce the project and begin discussions with residents and family members.

Improving Communication with the Hospital

One of the most important aspects of INTERACT II is the relationship between the nursing home and hospital/emergency room staff. Improved communication between nurses and providers across settings is critical to reducing avoidable acute care transfers. We strongly encourage at least one face to face meeting between nursing facility leadership and emergency room leadership (at the hospital where the majority of residents are transferred or admitted), to facilitate ongoing discussions and collaboration around nursing home resident transfers. Communities that have arranged such collaboratives have reported significant improvement in communication between nursing home and hospital staff, and improved care for residents. Consider utilizing the Nursing Facility Capabilities List tool to inform the local Emergency Departments what resources your facility has that would make transfer to your facility from the Emergency Department possible.

QUALITY IMPROVEMENT REVIEW AND FEEDBACK

An essential part of the INTERACT II program involves a quality improvement review process for residents who are transferred to the acute care facility. The Quality Improvement Tool for Review of Acute Care Transfers is listed under communication tools on the INTERACT II Tool Table. Initially, you may want to complete this review on all hospital transfers. Eventually, you may wish to do just a sample of transfers from each unit.
Reviewing the transfers and answering the questions on the Quality Improvement Tool provides an opportunity to discuss the transfer process with all staff, to share strategies on ways to prevent unnecessary transfers, and make changes to your systems based on staff input and experience. It also provides a means of collecting data for future analyses.