October 2012
Your hosts: Jody Rothe, MetaStar
Stephanie Sobczak, WHA
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Thank you to these organizations for
sponsoring this webinar series:
A special thank you to the Wisconsin Clinical Resource Center
for serving as the home base for recorded webinars and
materials related to the INTERACT II collaborative
July
August
September
October
November
December
Overview & Case Review Tools
Communication Tools
Early Warning Tools
Change in Condition Tools
Resident Transfer Tools
Continuous Improvement Tools
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Share experiences with the Stop and Watch
Tool
Overview of the change in condition
indicators
Review the File Card examples
Review the Care Paths examples
Implementing the Change in Condition Tools
through small tests with staff.
30 day Action Items
Please share your experiences with the Stop
and Watch tool.
What did you learn from the small tests?
Did you make any changes in order to use the
Stop and Watch tool?
Why this is so important:
For the frail elderly population, status can
change very rapidly.
Many times, there are early signs that would
indicate something has changed
Staff are the first “line of defense”!
Any symptom, sign or apparent discomfort that
is:
Sudden – in onset
A Significant change – more severe in relation to
usual symptoms and signs
Unrelieved – by measures already prescribed
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F157 – Notification of Physician of Change of
Condition
AMDA Guidelines (see WCRC) for a standard
of practices related to this.
Appendix 7 and 8 for AMDA Guidelines for
notification of physician with acute changes
of condition.
An INTERACT II Tool set that matches signs or
symptoms and what would be noticed for a
status of:
Immediate
Non-Immediate
Routine
These tools are intended to be used by
front-line staff for immediate reference
as well as education.
INTERACT II – Change in Condition Cards
INTERACT II – Change in Condition Cards
INTERACT II – Change in Condition Cards - From A
INTERACT II – Change in Condition Cards - to W
Print your set of Change in Condition File cards
and review with your team:
 How would staff access these?
 What procedures would you need to put in
place for using these?
 Case study using these (either real-time or
review a chart) – what does the team learn as
a result?
A Care Path is a document standard approach
to various clinical conditions
 Hospital have used care pathways
successfully to reduce variation in patient
care.
 Also an important education tool.
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An immediate resource for staff encountering
one of the conditions.
Should be led by staff nurse, but include CNA
and others from the interdisciplinary care
team.
Tie in with the other INTERACT tools in use
(Stop & Watch, Early Warning Signs)
Utilize SBAR for physician contact when the
care pathway indicates.
YES
Assistant notices changes and completes
& Watch Tool
Stop
Nurse references the Early Warning / Change in
Condition cards and reviews the situation with assistant;
determines Care Path should be used.
Care path indicates that physician should be
contacted immediately
Nurse gathers clinical information and uses
SBAR when speaking to the doctor
Who will try out the tool?
How many staff should try the tool?
Does this tool align with current procedure or
policy (if not, consider changing)
Teach staff how to use the tool.
Staff try the
tool
Develop Plans for
training all staff
How will you know
it is used?
How will new staff
learn the tools?
Team gathers
feedback from the
testers
Determine:
(Quick huddle?)
Adopt?
Decide to
adopt it
formally
Adapt?
Abandon?
If needed,
continue
testing.
When enough
staff approve
the use…
Try testing
these tools in
parallel with
different
groups of staff
Test Change in Condition
File Cards
Test Use of Care Paths
Test Use of Stop & Watch Tool
What percent of staff should have
had a chance to test and give
feedback before formally
adopting a tool?
 Around 10%
 25%
 Half
 More than half
 Almost everyone
How would you approach getting
more staff involved in testing both
the Change in Condition cards and
Care Paths ?
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Review the Change in Condition Tools with Staff
Review Care Paths with Nursing Staff
Have 2 different groups of volunteers test the
Change in Condition Cards and Care Paths
through small tests.
Evaluate the tests and Decide to
adapt/adopt/abandon based on results
Submit data
An on-line Feedback Tool will be sent
after November 7th to assess your
progress on these tasks.
Thank you!
See you next month
Next month:
Resident Transfer Tools