PowerPoint Presentation · 2017-11-02 · 3/25/2016 1 ©Pathway Health 2015 Sue LaGrange, RN, BSN,...

3/25/2016

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©Pathway Health 2015

Sue LaGrange, RN, BSN, NHA, CDONA, CIMTDirector of EducationPathway Health

10 Operational Strategies for the New DON


Upon completion of this presentation, attendees will be able to:

1. Verbalize 3 key organizational tips for the new DON

2. Describe the importance of staff relations

3. Verbalize strategies on keeping up with regulatory requirements

Objectives

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Organizational Tips for the New DON

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DON Checklist: (Facility Info)• Address

• Phone

• Fax

• Email

• Number of Beds/Units

• Number of Private Rooms

• Ownership

• Date of Last Survey and POC

• Union or non union

Keep a “Need to Know” File

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• Location of Emergency Equipment and Supplies

• EMS system

• Transfer Policies

• Coroner name and number

• Police non emergency number

• Vulnerable adult/abuse reporting

– Policy

– Who does what? (investigating, reporting, etc.)


5©Pathway Health 2015

• Safety Management

– Accident/Incident process

– Elopement procedures

– Restraints

– Process for Medication Errors

– Safe Resident Handling

– Do you have a Safety Committee?


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Vendors (Names and Numbers):

• Pharmacy

• Lab

• X-Ray

• Medical Supplies

• Dentist

• Audiologist

• Vision Services

• Podiatrist



Key Contact Information:

• Medical Director(s)

• Pharmacy Consultant

• Therapy

• Hospice

• Hospital Partners


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Up-to-Date Resources• State Operations Manual

• State Regulatory Manual

• Policy and Procedure Manual

• Infection Prevention and Control Manual

• MDS 3.0 RAI Manual

• Pharmacy Manual

• Lab manual

• Employee/Facility Handbook

• Employee List and Phone Numbers

• Department Head Phone List and Home/Cell Numbers

• Emergency Contact Numbers for Vendors for after hour needs


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©Pathway Health 2015 10

Day-to-Day Tips


Another Day!


Tips to Help!

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Organizational Tips

• Daily Organization

• Meeting Management

• Unit Rounds

• Planning and Preparing


• Starts the day before!

– Make your list for the next day!

– Clean up your desk before you leave

– Prepare for any meetings

– Review your current list to see if everything was taken care of!

Daily Organization

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Effective Meeting Management


• Meetings are essential in all facilities to communicate critical and valuable information for the health care team.

• Meetings sometimes can be time consuming and may take away from necessary time on the units.

Meeting Management


• Morning “Stand-Up”

• Department Head

• Unit Meetings

• Medicare Meetings

• Fall Committee Meetings

• Behavior Team Meetings

• Safety Committee Meetings

• Quality Assurance Committee Meetings

• Weight Management Meetings

• Nursing Department Meetings

Examples


• Essential Meeting Nuts and Bolts:

– Meetings should have a set agenda

– Meetings should have an identified purpose

– Meetings should have a set timeframe

– Information that is not necessary for the entire team should be discussed by those involved outside the meeting

Meeting Management

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Importance of an Agenda:

• Gives direction to the team on items to be discussed

• Keeps everyone on task and focused

• Organizes the order for the meeting minutes

• Can prevent wasted time from the group “Free for all”

Setting the Agenda


• PRO’s of Meetings:

– Sharing of valuable information

– Sets direction for team members for the day

– Directives are given for follow-through to team members

– Ensures everyone is on the same page!

– Provides expectation of accountability!

Meeting Management


• PITFALLS:

– Time consuming:

• Takes away from the daily duties of all team members

• Who is “minding the store” when the meetings are taking place?

• There is a lot of resources spending time “discussing” rather than “doing”.

• Sometimes there are team members that spend a lot of time repeating information or discussing topics not relevant to the goals of the team.

Meeting Management


The Director of Nursing will want to:

– Set the tone of the meeting

– Moderate the meeting

• Keep members on the right direction

• Keep the pace of the meeting

• Bring in the reigns when others stray off the topic

• Make suggestions when topics can be discussed privately outside the meeting

• Give directives to team members for the day

• Outline expectations for members for assignments

Meeting Management


Director of Nursing Rounds


Morning Rounds

• Recommendations:

– First thing in the morning

– Hit the road! Walk through each unit:

• Observations along the way

• Review each 24 hour report

• New admission review

• Spot check documentation with changes of conditions, accidents, incidents, etc.

– Assessment – Notifications

– Follow Up – Appropriate documentation

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As you review the 24 hour report, keep in mind:

• Are ALL changes of condition included?

• Is it clear and concise?

• Are new admissions included?

• Family/Significant Other Concerns?

• New Pertinent Physician Orders?

• Follow up after falls/accidents/incidents, change of conditions?

Review of the 24 Hour Report


• Infections?

• Appointments? Lab work? Prep directions?

• Behaviors?

• I&O’s?

• New Medications (Observe for SE and effectiveness)

• CP Updates?

Continued

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1. Dining Room Observations

2. Hallway Observations

3. Resident Room Observations

4. Check the Tub Rooms

5. Check the C.N.A. Assignments

6. Check the Med Room

7. Check the Utility Rooms

8. Check the kitchenettes

9. Condition of the nursing station, med carts, treatment carts, supply rooms, etc.

10.Resident Observations

Effective Rounds:


11.C.N.A. documentation (i.e. behaviors, restorative, B&B, etc.)

12.Physician Rounds/orders

13.ADL Documentation

14.Restraints/Side Rails

15.Catheters

16.Observe for “extra duties” on the C.N.A. assignment (cleaning wheel chairs, etc.)

17.Observe for timeliness of answering call lights

Effective Rounds: (cont.)

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• Try to limit to 30-45 minutes or less (Unless significant findings)

• Keep a notebook with you to jot down significant findings

• Use all of your senses!

• Talk with nurses briefly to ensure pertinent information has been added to the 24 hour report.

• If you need to correct an issue—gather

everyone involved as a learning experience!

Morning Rounds


New Admission Review:

Are the basics correct?

• Face Sheet

– Admission date, time, date of birth, race, religion

– ***Emergency Contact, Responsible Party

– Attending Physician and hospital preference

• Physicians Orders

– Meds, treatments, diet orders, rehab potential, code status, activity level, follow up lab/x-ray

• Diagnosis List

• History and Physical

• Discharge Summary

• Allergies

Effective Rounds

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• Do you have a 3 day Admission/Assessment Form?

• 24 hour vitals, observations

• Body Audit on shift of admission

• Admission Care Plan

• B&B 3 day diary and Assessment

• Skin Risk Assessment (also Tissue Tolerance)

• Fall Risk Assessment

• Pain Assessment

• AIMS/DISCUS (if applicable)

• Psychotropic Drug Assessment (if applicable)

• Restorative Nursing Functional Assessment

Assessments


• Self-Administration of Medications

• Safety/Fall Assessment

• Smoking Assessment

• Nutritional and Hydration Assessment (Wt. & Ht.)

• Elopement Risk Assessment

• Social History

• Depression Screening

• Activities/Therapeutic Recreation Assessment

• Leisure Interest Inventory

• Physical Device Assessment (if applicable)

• Facility Specific Assessments

Assessments (continued)

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• Consents:

– Physical Device (if applicable)

– Psychotropic Medication (if applicable)

– Influenza/Pneumococcal Vaccine

• Advanced Directive Review, Care Plan and Communication

– Is this adequately documented in the resident record?

• Inventory of Personal Belongings

Other Admission Responsibilities


Morning Rounds

• Benefits of the morning rounds:

– Ensures that pertinent information is brought to the morning meeting

– Observations will provide valuable opportunities for education and follow through with staff

– Can help to eliminate “surprises”

– Sets the expectations for the staff on a daily basis

– Visibility of the DON


Benefits of Morning Rounds-continued:

• You become much more familiar with the residents, family and staff

• Will help to foster working relationships for communication

• Gives you an opportunity to see what they are doing RIGHT and praise staff!

Morning Rounds


End of the Day Wrap Up and Planning for the Next Workday!

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• Unforeseen issues will happen

• Organize day with “buffer” room to deal with changes

• Don’t let “time stealers” take your time because in the end—you will suffer!

• Expect others to do their part!

• Keep your workday organized

– Remember…..Make your lists!

– Prepare your tasks/skills

Planning the Day


• Walking rounds

• Check the 24 hour report

• Review any necessary follow up and documentation

• End of the day review

• Gives you visibility with:

– Residents

– Staff

– Visitors/Families

End of the Day Rounds


• Take a few minutes-close your door and unwind for the day:– Review your daily list to ensure all necessary items have

been accomplished

– Look at your desk—do you need to tidy it up some? (A few min. everyday at the end of the day will help with organization)

– Review the staffing for the evening, night and next day shift--discuss any upcoming staffing needs with the scheduler

– Touch base with the administrator for any concerns/follow-up from the day

– Complete your meeting agenda for any meetings the next day

End of the Day Organization!


• You leave for the day not feeling like you may have forgotten to do something!

• You leave for the day knowing you are prepared for the next day

• You have given the direction to the staff before you leave for any necessary follow up (Staff are aware of your expectations)

• You will start the next morning with a plan of action!

Benefits for End of the Day Organization


Importance of Staff Relations


“Well-trained and dedicated employees are the only sustainable source of competitive

strength.”

-Robert Reich

Retention

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Positive Working Environment

• Have you surveyed current employees on an ongoing basis regarding work environment

• How do employees treat each other• How visible is management staff• Do we really listen to employee input• Do employees really feel like they are able

to contribute to decision making in the

facility

Staff Relations


How is Morale?

Morale Boosters:

– Ability to feel valued in the company– Feedback is ongoing– Staff bonding– Professional Courtesy and Respect

Staff Relations

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How is Morale?

Morale killers:

– Employees get only negative feedback– Employees who don’t pull their weight

are not dealt with

– Employees feel their voice is not heard– “One bad apple” syndrome

Staff Relations


Ongoing Feedback

• During rounds

• Whenever exceptional care is observed

• Timely feedback

We all know…

Discipline in private

Praise in public!

Staff Relations

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Ongoing Training for Employee Development

• How often do we have educational opportunities

• Are we only doing the “required” training• Are we PROACTIVE or REACTIVE

Staff Relations


Ongoing Verbalization of Expectations

• Have we reviewed our job descriptions lately

• Do we review them with employees annually

• Review of the Nurse Practice Act

• Are our Policies and Procedures current and available

• How often do we have meetings

• Do employees have ability to discuss or give input

Staff Relations

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Nurse Leadership

How are we determining leadership skills of the charge nurses?

1. Are the Charge Nurses leading the care on the units?

2. Do the Charge Nurses know what the C.N.A.’s are doing?

3. Do the Charge Nurses routinely monitor the care on the units?

4. Are the Charge Nurses aware of the current Standards of Practice?

5. Are they treating staff with respect and kindness?

Staff Relations


We need to expect accountability

1. Begin with ensuring nurses and C.N.A.’s

are educated and understand their role. Give input as to their role.

2. Expand the learning to include valuable organizational information. Think about the nurses….the organized nurse can get more done in less time-effectively!

3. Provide a positive and open environment for problem solving and discussion.

Staff Relations

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Teaching Nurses to Coach & Lead

• Many times “Seasoned” Nurses and the new generation of nurses have different

ideas of leading

• Have we invested time in teaching the new and re-educating the experienced?

• Have we worked together to develop a system that all can work with (and all have input in)?

Staff Relations


ARE WE INCLUDING ALL STAFF IN OUR PROCESSES?

Do we solicit input?

– Small focus groups

– Ongoing discussions

– Department Meetings

– On-the-spot opportunities

Staff Relations

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Preparation for Success

1. Provide staff clear communication of expectations.

2. Audit and monitor performance.

3. Praise positive observations.

4. Utilize information from audits to develop

content for nursing meetings.

Staff Relations


Preparation for Success-continued

5. Be prepared to hold the nurses and C.N.A.’s accountable if they do not deliver!

6. Remember consistency with all staff!

7. Utilize objective observations for

Performance Evaluations.

8. Illicit and consider staff input.

9. Enjoy your successes!

Staff Relations

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Preparation for Success-continued

• Include time everyday for staff discussion• When there is a problem—let them be

involved in solving it

• When there are successes—make sure everyone involved gets adequate praise

Staff Relations


When YOU are POSITIVE, STAFF are POSITIVE!!!

Remember….

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Location of Key Resources


CMS.gov: Nursing Homes (website):

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/NHs.html

Location, Location, Location!

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CMS-Centers for Medicare and Medicaid Services


CMS-Centers for Medicare and Medicaid Services

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http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/NHs.html

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State Operations Manual (CMS):

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf



CMS

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Federal Updates

CMS Memo’s:

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html



CMS

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CMS


CMS

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http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html

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MDS 3.0 RAI Manual:

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html

MDS 3.0 RAI Manual


MDS 3.0 RAI Manual

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MDS 3.0 RAI Manual


Office of Inspector General Reports (OIG):

http://oig.hhs.gov/reports-and-publications/oei/subject_index.asp

• Reports found under “Skilled Nursing Facilities (SNFs)”


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OIG


OIG

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http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html

http://oig.hhs.gov/reports-and-publications/oei/subject_index.asp

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Centers for Disease Control and Prevention (CDC):

http://www.cdc.gov/



CDC

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CDC


CDC

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FDA: U.S. Food and Drug Administration:

http://www.fda.gov/

• Medication approvals, warnings, recalls, etc.

• Medical Devices: Recalls, Alerts and Medical Device Reporting:

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm

FDA


FDA

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http://www.cdc.gov/

http://www.fda.gov/

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm

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FDA


Wisconsin - DHS

80https://www.dhs.wisconsin.gov/regulations/nh/introduction.htm


There are other specific websites and contact numbers of importance:

• State Medicaid or Case Mix Contacts

• Insurance Company Contacts

• Local Health Department Contacts

• Key Hospital Contacts

• State Nursing Home Association Contacts

• Many, Many More!

Location, Location, Location:


Having these websites and contact information saved to your favorites will be easy for you to retrieve and be able to reference at anytime!

**Don’t forget to access state specific memo’s and updated regulatory direction!


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Other suggestions for keeping current:

• Review trade publications

• See what educational offerings are being offered

• Association Conferences

• DON, Administrator, IDT specific Meetings/Conferences

• Local Industry Groups

• Encourage the ENTIRE team to keep up with their discipline associated network as well!

Other Suggestions


• Check the CMS Provider Memo website once a week

• All Administration and IDT leaders consider sharing any trade publications, notices, updates, regulatory notices or important correspondence

• Get yourself signed up to receive updates from the CMS website as well!

http://www.cms.gov/About-CMS/Agency-Information/Aboutwebsite/EmailUpdates.html

Other Suggestions

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https://www.dhs.wisconsin.gov/regulations/nh/introduction.htm

http://www.cms.gov/About-CMS/Agency-Information/Aboutwebsite/EmailUpdates.html

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How can we use this

information for quality

and compliance?

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Review the updated regulatory information:

• Take note of any updates and changes to the system

– What are the expectations?

– What is the date due?

Review

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• Pull out the facility policy and procedures and review to note areas needing updates.

• Discuss the specifics of the updates with the leadership team, cross-referencing the current P&P and addressing updates to be included.

• Involve the entire IDT-including the Medical Director, possibly the Pharmacy Consultant and any corporate supports as indicated

Action Steps


Action Plan

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Questions?

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Thank You For Attending Today’s Presentation!

Sue LaGrange, RN, BSN, NHA, CDONA, CIMTDirector of Education

Pathway Health

3/25/2016

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This presentation is copyrighted information of Pathway Health. This presentation is not to be sold or reused without written authorization of Pathway Health.

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PowerPoint Presentation · 2017-11-02 · 3/25/2016 1 ©Pathway Health 2015 Sue LaGrange, RN, BSN,...

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