BUILDING CULTURE CHANGE ON A QUALITY SYSTEMS FOUNDATION
BUILDING CULTURE CHANGE ON A QUALITY SYSTEMS FOUNDATION
Elliott Nursing & Rehab CenterElliott Nursing & Rehab Center
We are a Diversicare / Advocat Facility The facility is a 75 bed facility located in
rural Northeastern Kentucky We are dually certified in Medicare &
Medicaid
We are a Diversicare / Advocat Facility The facility is a 75 bed facility located in
rural Northeastern Kentucky We are dually certified in Medicare &
Medicaid
The Beginnings of Person Centered Care
The Beginnings of Person Centered Care
We have been on a journey toward Person Centered Care since 2005
Started with permanent staff assignments, creation of neighborhoods, some increase in choice and staff education about encouraging resident choice and increasing dignity
We have been on a journey toward Person Centered Care since 2005
Started with permanent staff assignments, creation of neighborhoods, some increase in choice and staff education about encouraging resident choice and increasing dignity
Continued with added food choices with meals and improving the dining experience
More effort to request resident feedback and act on their suggestions
Continued with added food choices with meals and improving the dining experience
More effort to request resident feedback and act on their suggestions
Education & DiscussionEducation & Discussion
Educated administration and entire staff by watching videos and reading books about other homes who had initiated Person Centered Care programs
Held group meetings with all levels of staff about what programs could be implemented in our facility
Educated administration and entire staff by watching videos and reading books about other homes who had initiated Person Centered Care programs
Held group meetings with all levels of staff about what programs could be implemented in our facility
Set GoalsSet Goals
Create more flexible schedules and less regimented routines
Decrease the institutional aspects of our facility Add choice and variety Increase resident involvement in everyday
decision making for self Maintain or improve quality of nursing care and
key outcomes
Create more flexible schedules and less regimented routines
Decrease the institutional aspects of our facility Add choice and variety Increase resident involvement in everyday
decision making for self Maintain or improve quality of nursing care and
key outcomes
Identify Staff Related ChallengesIdentify Staff Related Challenges
Staff feel that a large population of residents cannot make decisions for self
Fear of change Staff question if the quality of care can be
maintained with a less structured regimen
Staff feel that a large population of residents cannot make decisions for self
Fear of change Staff question if the quality of care can be
maintained with a less structured regimen
Review Quality Measures and Quality Indicators to Identify Trends
& Challenges
Review Quality Measures and Quality Indicators to Identify Trends
& Challenges Large population of Diabetic Patients Patients at risk for skin breakdown Many polypharmacy residents Many patients who exhibit behaviors and
receive antipsychotics or behavior modification meds
Large population at risk for falls
Large population of Diabetic Patients Patients at risk for skin breakdown Many polypharmacy residents Many patients who exhibit behaviors and
receive antipsychotics or behavior modification meds
Large population at risk for falls
Identify Proposed Person Centered Care Programs Identify Proposed Person Centered Care Programs
Sweet Dreams Rise & Shine Anytime 5 Meal or Peak Dining Home-Like Medication Regimen
Sweet Dreams Rise & Shine Anytime 5 Meal or Peak Dining Home-Like Medication Regimen
Sweet DreamsSweet Dreams
Goal is to increase quality of life for all residents by providing a more home-like atmosphere. Also, to decrease behaviors and related medications by modifying our schedules to allow for meaningful sleep time for patients
Goal is to increase quality of life for all residents by providing a more home-like atmosphere. Also, to decrease behaviors and related medications by modifying our schedules to allow for meaningful sleep time for patients
Sweet DreamsSweet Dreams
Quiet hours implemented from 9p.m. to 9a.m.
Only essential care is performed at night
Lights in hallways turned to lowest setting
Staff to use quiet voice
Quiet hours implemented from 9p.m. to 9a.m.
Only essential care is performed at night
Lights in hallways turned to lowest setting
Staff to use quiet voice
No overhead lights in resident rooms unless absolutely necessary
Overnight briefs Implemented
Elimination of unnecessary turning and repositioning at night
No overhead lights in resident rooms unless absolutely necessary
Overnight briefs Implemented
Elimination of unnecessary turning and repositioning at night
Residents are evaluated for use of overnight briefs
Residents are evaluated for use of overnight briefs
Review Skin Assessments Bed Mobility SRNA/Nursing Report Empower SRNA’s to make immediate status
changes Daily, weekly, and quarterly review ongoing
Review Skin Assessments Bed Mobility SRNA/Nursing Report Empower SRNA’s to make immediate status
changes Daily, weekly, and quarterly review ongoing
Rise & Shine AnytimeRise & Shine Anytime
Goal is to allow residents to sleep undisturbed until they awaken naturally unless medically contraindicated.
Goal is to allow residents to sleep undisturbed until they awaken naturally unless medically contraindicated.
Rise & Shine AnytimeRise & Shine Anytime
Identified preferences of all residents regarding sleep with interview and observation
All facility schedules reevaluated and updated to accommodate resident preferences
Identified preferences of all residents regarding sleep with interview and observation
All facility schedules reevaluated and updated to accommodate resident preferences
Quiet hour until 9 a.m. Lights stay low and
voices quiet until 9a.m.
All daily routines reevaluated and updated
Update preferences and adjust ongoing
Quiet hour until 9 a.m. Lights stay low and
voices quiet until 9a.m.
All daily routines reevaluated and updated
Update preferences and adjust ongoing
Outcomes for Sweet Dreams And Rise & Shine Anytime ProgramsOutcomes for Sweet Dreams And Rise & Shine Anytime Programs Fewer combative residents LTCQ data revealed behavioral symptoms
improved from “Needs improvement” to “Exceptional”
Depression decreased from 23% in Sept 2007 to 7% in March 2008. (Programs were implemented Sept 20th, 2007)
Fewer combative residents LTCQ data revealed behavioral symptoms
improved from “Needs improvement” to “Exceptional”
Depression decreased from 23% in Sept 2007 to 7% in March 2008. (Programs were implemented Sept 20th, 2007)
Outcomes ContinuedOutcomes Continued
Identified a decrease in episodes of shear No negative outcomes from use of
overnight briefs
Identified a decrease in episodes of shear No negative outcomes from use of
overnight briefs
5 Meal or “Peak Meal” Dining5 Meal or “Peak Meal” Dining
Goal is to allow residents more food choices and greater flexibility regarding meal times to accommodate overall preferences. Program is also intended to address the needs of the diabetic population through appropriate monitoring.
Goal is to allow residents more food choices and greater flexibility regarding meal times to accommodate overall preferences. Program is also intended to address the needs of the diabetic population through appropriate monitoring.
5 Meal or “Peak Meal” Dining5 Meal or “Peak Meal” Dining
Continental Breakfast Brunch Siesta Fiesta Dinner Night Cap Snack
Continental Breakfast Brunch Siesta Fiesta Dinner Night Cap Snack
5 Meal or “Peak Meal” Dining5 Meal or “Peak Meal” Dining
Housekeeping and activities staff assist SRNA’s in passing trays
All staff assist with meals on their neighborhoods Meals in dining room as served buffet style with
two meals and added choices. SRNA’s take orders from each table to create a
dining out feel and encourage choice
Housekeeping and activities staff assist SRNA’s in passing trays
All staff assist with meals on their neighborhoods Meals in dining room as served buffet style with
two meals and added choices. SRNA’s take orders from each table to create a
dining out feel and encourage choice
5 Meal or “Peak Meal” Dining5 Meal or “Peak Meal” Dining
Therapeutic diets are limited to lower concentrated sweets and mechanically altered diets
Choices are honored regardless of diet Diabetic patients are monitored as needed
and A1C levels for all diabetics are tracked and trended.
Therapeutic diets are limited to lower concentrated sweets and mechanically altered diets
Choices are honored regardless of diet Diabetic patients are monitored as needed
and A1C levels for all diabetics are tracked and trended.
Outcomes of “Peak Meal” DiningOutcomes of “Peak Meal” Dining
No weight loss in observation period that were not expected outcomes of disease process
Improvement in A1C levels in 11 of 15 diabetic residents
Weight Gain was a negative result in two alert and oriented residents. Their preferences are honored but risks and benefits explained
Some desirable weight gains in patients who were difficult to encourage to eat or ate very small portions
No weight loss in observation period that were not expected outcomes of disease process
Improvement in A1C levels in 11 of 15 diabetic residents
Weight Gain was a negative result in two alert and oriented residents. Their preferences are honored but risks and benefits explained
Some desirable weight gains in patients who were difficult to encourage to eat or ate very small portions
Home-Like Medication RegimenHome-Like Medication Regimen
Goal is to develop an individualized medication program for each resident while also accommodating daily routines and preferences as much as possible.
Goal is to develop an individualized medication program for each resident while also accommodating daily routines and preferences as much as possible.
Home-Like Medication RegimenHome-Like Medication Regimen
Meet with Medical Director & Pharmacist to develop a plan of implementation.
Interview residents to determine current preferences of sleeping, waking, activities,etc.
Review each resident’s MAR to determine if frequencies can be reduced or unnecessary meds eliminated.
Meet with Medical Director & Pharmacist to develop a plan of implementation.
Interview residents to determine current preferences of sleeping, waking, activities,etc.
Review each resident’s MAR to determine if frequencies can be reduced or unnecessary meds eliminated.
Home-Like Medication RegimenHome-Like Medication Regimen
All Q day administered once a day as indicated
All BID meds are administered upon rising & at bedtime
All TID meds are administered upon rising, afternoon, and bedtime.
All QID meds are administered upon rising, early afternoon, late afternoon, and bedtime.
All Q day administered once a day as indicated
All BID meds are administered upon rising & at bedtime
All TID meds are administered upon rising, afternoon, and bedtime.
All QID meds are administered upon rising, early afternoon, late afternoon, and bedtime.
Home-Like Medication Regimen Outcomes
Home-Like Medication Regimen Outcomes
No survey deficiencies for med pass Does away with the traditional 2 hour med
pass time frame. Allows flexible resident schedules Reduced overall number of pills passed
No survey deficiencies for med pass Does away with the traditional 2 hour med
pass time frame. Allows flexible resident schedules Reduced overall number of pills passed
Ongoing MonitoringOngoing Monitoring
Continue to utilize methods of monitoring and screening patients for participation in all programs and update as needed based on resident need and assessment.
Track and trend customer satisfaction results, QM’s, QI’s, and other quality information and address negative outcomes or trends
Continue to ask residents and staff about changing needs and preferences
Continue to utilize methods of monitoring and screening patients for participation in all programs and update as needed based on resident need and assessment.
Track and trend customer satisfaction results, QM’s, QI’s, and other quality information and address negative outcomes or trends
Continue to ask residents and staff about changing needs and preferences
Contact InformationContact Information
Benita Adkins, Administrator
Nancy Lowe, Dietary Manager
Michelle Adkins, LPN
Elliott Nursing & Rehab Center
P.O. Box 694
Sandy Hook, KY 41171
Phone: 606-738-9400
Email: [email protected]
Benita Adkins, Administrator
Nancy Lowe, Dietary Manager
Michelle Adkins, LPN
Elliott Nursing & Rehab Center
P.O. Box 694
Sandy Hook, KY 41171
Phone: 606-738-9400
Email: [email protected]
Top Related