Browsing "Hospitalizations"

Hospitalizations – Entry 2

Dear Diary:

After helping the nursing staff avoid another hospitalization for Hattie last week, I decided to investigate what we can do to avoid unnecessary hospitalizations. I reviewed some of our recent hospitalizations to see if others could have been avoided. That wasn’t easy since we’re not currently tracking hospitalization rates. I remember at INTERACT training hearing about the Advancing Excellence Safely Reduce Hospitalizations Tracking Tool. We’re registered for that campaign, but I must admit I haven’t been to that website in months. I went to the website and looked at the hospitalization tracking tool. It looks like it’ll be a great way for us to track and trend hospitalization data, as well as do some root cause analysis. My plan is to bring this tool to our next interdisciplinary team meeting to see how we can work together to gather the information, enter it into this tracking tool each month, and use the information to help reduce unnecessary hospitalizations.

I also spent some time walking around the neighborhoods to see how many “Stop and Watch” forms were being turned in to the nurses. Very few! This was one of the tools that was introduced in our facility-wide INTERACT training a few months ago. I guess just introducing tools and not doing any follow up doesn’t lead to success. Mary, one of the nurses on the transitional care unit (TCU), seems excited about this tool and has been encouraging her team to use it. So, I asked her to be the “Stop and Watch” champion. She has agreed to use this tool regularly and get others on the TCU to use it. When they figure out what works best for them, she’ll help me spread their work to the other neighborhoods. Glad I have some support with this!

Once changes have been implemented in our systems to support the use of the “Stop and Watch” forms, I think we should tackle the INTERACT Care Paths. What changes in our workflow will we need to make to successfully implement all of the INTERACT tools?

Signed, Donna

2 Comments

  • Dear Donna,
    We use the hospital transfer portal which is part of our EHR from PointClick Care. It tracks our admissions, transfers, trends, and hospital rates all electronically and alerts us to those residents in their 30 day window at risk for re-hospitlization. We are able to see patterns and which reasons are the most often that our residents are being sent back to the hospital. This helps to identify areas for education.We also use the electroinc “stop and watch” tool in POC which is part of PointClick Care as well. Next month we will be piloting the elctronic version of the interact QI form to analysis if transfer was avoidable and what could have been done to care for our resident in house.(We currently use the paper version) The next step in our process will be the interact electroinc SBAR/Care Path work flow process currently under development. We currenlty have imbeded the care paths into the SBAR for ease and efficiency for the nursing staff along with a trigger to check the residents POLST to maintain the resident choses and direction. We have been using interact for four years now and it has been very exciting to see this come alive in the elctroinic version thru PointClick Care software.
    We have been able to reduce re-hospitlazations since the start of using interact. We have seen an increase in the use of SBAR since developing templates in PCC and anxiously await the electronic version. We have had better compliance with the use of the SBAR since devolping templates in PCC than the paper version.
    We have improved the quality for our residents since using the interact program and use of the electronic version with Point Click Care software.
    Hang in there Donna it does work!

  • Oh my Donna I forgot to tell you we also use the electronic eInteract transfer form in PointClick Care too. Many of the answers auto poplulate from the resident medical record thereby saving the nurse valuable time if a transfer is unavoidable. We will soon be testing transmitting the transfer form to the hospital electronically Imagine this critical information could get to the hospital ER before the resident! The best part is that at some point the nurse can send over all the critical information and go back and finish the transfer form to idenify other areas of care and send that over electronically as well. Imagine no more illegiable handwriting. It only took me less than five minutes to fill out.
    This has been awesome and excitng to think of the improved quality for our residents.

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Hospitalizations – Entry 1

Dear Diary:

We nearly had to send Hattie back to the hospital today. I feel so bad for her. She hasn’t done so well after returning from the hospital following her hip pinning. This morning, Hattie’s daughter, Carol came to my office very concerned. Carol told me that Hattie hasn’t been eating or drinking well for a few days. Yesterday Hattie didn’t recognize her when she came to visit, which has never happened before. She’s been talking to Sherry, the nursing assistant, about her concerns for the past two days, but Carol doesn’t think anyone has called the doctor. Apparently, Hattie’s temperature was 100.5 today. The nurses are talking about sending Hattie to the hospital again, and Carol isn’t sure Hattie will make it through another hospitalization.

I had a talk with Hattie’s nurse, Anna. It sounds like Hattie may have developed a urinary tract infection, probably from the indwelling catheter inserted when she had her hip surgery. Anna wasn’t aware of Hattie’s decreased appetite or increased confusion until today. She assured me that she put a call in to the physician and has the SBAR form ready to report the change in condition. I’m so happy she’s using the form! However, she’s concerned about Hattie’s fever, is afraid she may be septic, and would like to recommend to the physician that she be transferred to the hospital. I reminded Anna that we have been trying hard to avoid unnecessary hospital admissions; might this be one of those?

Remembering our recent INTERACT training, I reviewed the UTI Care Path with Anna. We are able to monitor Hattie’s vital signs, push fluids, give antibiotics, and even IVs if we need to. Anna made those suggestions to the physician when he called back and he agreed to treat Hattie here as long as she is closely monitored. I’m not sure that would have been the case had Anna just asked for a transfer order. So, that transfer has been avoided, but there’s still work to be done! Why wasn’t Anna aware of Hattie’s change of condition earlier? What can we do to improve communication among staff? What can we do to stop the nurses from asking physicians to send residents to the hospital as their first option? I’m afraid I found out about this potential hospitalization by accident which makes me wonder just how often this is happening with other residents.

Signed, Donna

2 Comments

  • SS and I review each of our hospitalizations monthly. We look for patterns such as same Physician sending to ER/Admitting, review what tx the resident had at the hospital if it oucld have been done at the care center. We still need to get our nurses to suggest to Physician to keep resident here and to try tx here.

  • I had a meeting with both the nurses and the CNAs here. The focus was on how to prevent unnecessary rehospitalizations. I wanted the CNAs to know that the work they do is appreciated and that they are the ones in the front lines. They are the ones who are most likely to notice subtle differences in the patients/residents. I re-introduced the Stop and Watch program. Some of the aids told me that they have (in the past) given a Stop and Watch paper to the nurse only to have the issue ignored. So now the aids are making a copy of their concerns and putting them in my mailbox to make sure the issues are addressed. I tried hard to focus on the fact that it takes all of us paying attention and acting on changes to help keep our residents and patients here. I stressed that we can provide many of the services required and re-introduced the form our medical director came up with for nurses when they plan to call a doctor. I have also started providing education so that our nurses can actually perform as nurses. Our lab is not open after 6PM M-SA and is closed on Sunday. I have an inservice next week so that we can draw our own labs after hours and on weekends and have them sent to the hospital via courier. I am noticing that many of the rehospitalizations involve residents who are declining rapidly and are still a FULL CODE. So I am working with the nurses to learn how to tactfully approach family members regarding the subject of Comfort Care. I hope my ideas help someone else.

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