9/30/2015
Quick Study: A Program For Very
Busy Lifelong Learners
Andrea Allen MD, HPM
Chief Medical Officer, Arkansas Hospice
&
Deanna May RN, CHPN
Education & Quality Coordinator, Arkansas Hospice
Quick Study - Agenda
•Recognize barriers to effective education in your
organization
•Choose innovative solutions to your barriers
•Design tailored educational programs for your
organization
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9/30/2015
Quick Study
Barriers to excellent education?
Quick Study - Barriers
•Time
• Material Development
• Learner Opportunity
•Distance
• Multiple locations
• Remote locations
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Quick Study - Barriers
•Learner motivation
•Business requirements
•Clinical education needs
•Regulatory requirements
•Staff alienation
•Non pertinent education
•Time
•Old information
Quick Study - Barriers
•IT and Software Limitations
•Audio/video streaming
•Continuous availability
•Storage
•Ability to quickly change content or focus
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Quick Study - Barriers
•Financial constraints
• Choose wisely…
•Organizational constraints
• Fragmented training
• Ad hoc training
•Ineffective training
Quick Study - Barriers
•Trainer characteristics
•Energy/enthusiasm
•Internal marketing
•Adult learner approach
•Orientation to research, evidence base
•Ability to synthesize
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Quick Study – Innovative Solutions
•Avoid barriers
•Allow topical education
•Available 24/7 if appropriate
•Timely
•Don’t take much production time
Quick Study – Our Environment
•33 counties
•ADC 550
•8 offices
•3 inpatient units
•425 employees
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9/30/2015
Quick Study – Our Environment
•Medical Services Department
•4 employed full time physicians
•10 part time contracted physicians
•4 APNs
•4 pharmacists
Quick Study – Medical Services Dept.
•Requirements for Medical Services Department
Education
•Short
•Targeted to specific functional needs
•Coordinated with other staff education
•Testable
•Feedback from learners important
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9/30/2015
Quick Study –
10 Minute Clinical Education
•Single topic
•10 PP slides
•4-item quiz
•Complete every 2 weeks (IDG)
•Emailed; complete on any device
•Directed to physicians, APN’s, pharmacists,
nursing leaders
•Available to all staff
Quick Study –
10 Minute Clinical Education
•Results
•Quiz return 75%
•Rating scores average 9, low of 8
•Positive comments by physicians
•Referral use by clinical managers
•For other staff
•For physicians
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Quick Study –
10 Minute Clinical Education
•Time to construct: 1-2 hours CMO time
•Some of the topics
•Relatedness
•The Admission Phone Call
•Delirium
•Eligibility
•ICD-10 (top tips for hospice physicians)
•COPD and MDI’s
Quick Study –
10 Minute Clinical Education
•Benefits
•Topic change at a moment’s notice
•Achievable goal
•Accountability
•Reference availability
•Cost
•Time
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9/30/2015
The Confusion Assessment Method
(CAM)
Andrea Allen, MD
Chief Medical Officer
The Confusion Assessment Method
(CAM)
• The Confusion Assessment Method (CAM) is a
rapid screening tool for the identification of
delirium for use by nurses and other medical
professionals.
– Validated with 94% sensitivity and 89% specificity
for widely varied populations, settings, and
observers
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585541/
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The Confusion Assessment Method
(CAM)
• Delirium is extremely common in palliative care patients
– 59-88% of palliative inpatients in weeks to hours before death 25-85%
of terminally ill patients
• Delirium may be reversible and it is treatable
– 50% of delirium cases at the end of life may respond to
• Medication changes
– Removal of psychoactive drugs
– Treatment with antipsychotics
– Treatment of infection, impaction, hypoxia, dehydration
http://www.ncbi.nlm.nih.gov/pubmed/22988044
http://www.aafp.org/afp/2001/0915/p1019.html
Lawlor PG, Fainsinger RL, Bruera ED. Occurrence, causes and outcome of delirium in advanced cancer patients: a prospective study. Arch Intern Med. 2000;160:786–
794
Morita T, Tei Y, Tsunoda J, Inoue S, Chihara S. Underlying pathologies and their associations with clinical features in terminal delirium of cancer patients. J Pain
Symptom Manage.2001;22:997–1006
The Confusion Assessment Method
(CAM)
• Why should we reverse delirium when we can do so?
– Patients and families are traumatized by delirium
• High reports of distress during delirium
• Particularly agitated delirium
– Educating patients and families about delirium may reduce
the trauma of delirium
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752862/
http://gerontologist.oxfordjournals.org/content/early/2014/05/21/geront.gnu035.full.pdf?keytype=ref&ijkey=U1o0dXtlG7mEWHz
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9/30/2015
The Confusion Assessment Method
(CAM)
• We do not recognize delirium well
– 70-80% of delirium not recognized as such by clinicians
– This means we do not reverse it when possible to do so
– This also means we are not able to educate
patients/families about delirium as it is occurring
http://archinte.jamanetwork.com/article.aspx?articleid=649403
The Confusion Assessment Method
(CAM)
• CAM is now part of the Arkansas Hospice
nursing assessment for patients with altered
mental status
• A brief assessment of orientation and sustained
attention (naming months of the year
backwards) precedes the CAM assessment
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The Confusion Assessment Method
(CAM)
• CAM
Feature 1: Acute Onset or Fluctuating Course
This feature is usually obtained from a family member or nurse and is shown by
positive responses to the following questions: Is there evidence of an acute
change in mental status from the patient’s baseline? Did the (abnormal)
behavior fluctuate during the day, that is, tend to come and go, or increase
and decrease in severity?
Feature 2: Inattention
This feature is shown by a positive response to the following question: Did the
patient have difficulty focusing attention, for example, being easily
distractible, or having difficulty keeping track of what was being said?
The Confusion Assessment Method
(CAM)
• CAM
Feature 3: Disorganized thinking
This feature is shown by a positive response to the following question: Was the patient’s
thinking disorganized or incoherent, such as rambling or irrelevant conversation,
unclear or illogical flow of ideas, or unpredictable switching from subject to subject?
Feature 4: Altered Level of consciousness
This feature is shown by any answer other than “alert” to the following question:
Overall, how would you rate this patient’s level of consciousness? (alert [normal]),
vigilant [hyperalert], lethargic [drowsy, easily aroused], stupor [difficult to arouse],
or coma [unarousable])
A positive screen for delirium by CAM requires the presence of features 1 and 2 and
either 3 or 4.
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The Confusion Assessment Method
(CAM)
• CAM in Suncoast
Confusion Assessment Method. Copyright 1988, 2003, Hospital Elder Life Program. Not to be reproduced without permission. Adapted from: Inouye SK, et al. Ann Intern Med.1990;113:941-8.
The Confusion Assessment Method
(CAM)
• Summary
–
–
–
–
–
Delirium is very traumatic for patient and families
Delirium is very common in our patient population
We may not recognize delirium well
The CAM helps us to identify delirium
We should use the CAM to identify delirium when it is
present so we can
• Try to reverse it
• Educate families about it
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9/30/2015
The Confusion Assessment Method
(CAM)
• A positive screen with the CAM should prompt a nurse
call to the physician for management
• A call for agitation or confusion from a nurse should
prompt the physician to ask for results of the CAM
• See the 10 Minute Clinical Education module on
Management of Delirium
The Confusion Assessment Method
(CAM)
• Thanks for participating in 10 Minute Clinical
Education.
• Please take the test and evaluate this episode
of 10 Minute Clinical Education.
• Please let us know what topics you would like
covered in 10 Minute Clinical Education…we
are here to serve you.
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9/30/2015
Quick Study –
10 Minute Clinical Education
Name
TEST
10 Minute Clinical Education
Confusion Assessment Method (CAM)
Mr. Garry, 82, has been hallucinating and claiming he has to urinate “every five
minutes” according to his wife. She is exhausted trying to care for him. “You
have to do something!” she says to Nurse Mary. Mary should first:
1.
2.
3.
4.
Call the physician for an order for a UA and C&S
Call the physician for a lorazepam order
Put in a Foley
Check the CAM
Quick Study
On a scale of 1 to 10, how helpful was this 10 Minute Clinical Education?
Not helpful 1
2
3
4
5
6
7
8
9
10 Very Helpful
If you learned something from this 10 Minute Clinical Education, what was it?
Is there another topic that you would like covered in 10 Minute Clinical
Education?
Thanks from your 10 Minute Clinical Education Team!!
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Orientation
Orientation – Online Learning
Self Learning Modules “SLM’s”
• Pre requisite to some “in person” learning
• Program graduation requirements
• Refresher training/remediation
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9/30/2015
Orientation – Online Learning
Self Learning Modules “SLM’s”
• Available 24/7
• Easy to use
• Testing required
• Evaluation online
• Tracking by Education Dept.
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STANDARD HEADER
Place body copy text here.
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Education Evaluation
Name (Optional):
First Last
5/5
1. The materials expanded my understanding of the content to a new level or deeper degree.
2. The technology part of this course was 5/5
well organized, easy to navigate, and logical.
3. How would you improve on this course?
This was great!
4. What topics/subjects would you like to see presented?
NA
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9/30/2015
Orientation – In Person Learning
• Lecture
• Interactive
• Role play
• Case study
• Game play
• Discipline Specific
Orientation – In Person Learning
OWL U Week 1
Day 1-3: Nurse, SW, CHP
Day 4: C.N.A. Only
OWL U Week 2
Day 1: Mandatory Monday (All Visiting Staff)
Day 2: General Orientation (per HR)
Day 3-4: Nurse Only
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9/30/2015
Orientation – In Person Learning
OWL U Week 3
Day 1-4:
Day 1-3:
Nurse
SW, CHP
OWL U Week 4-7
Experientials with Preceptor at the staff members home
office
Orientation – In Person Learning
OWL U Week 8
2 Days:
½ Day:
RN only
SW, CHP
OWL U Week 9-12
Experientials, Assuming caseload, with Preceptor
supervision
Completion of “Graduate” SLM’s
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Orientation – In Person Learning
• Evaluation
Orientation – Development
•
•
•
•
Staff Educators: 2 RN’s, 1 SW
Development of SLM’s: 2 months
Development of classes: 4 months
Daily education: 17 educator-days/month
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Ad Hoc Education
• Added on to Education Plan as needed
• Online or In Person
• Continued use for future training
Annual Education
• Regulatory, Compliance & Agency Specific
Requirements
• Online/Paper
• Test required
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9/30/2015
In Person – Skills Fair
•
•
•
•
•
Multiple locations
Several date/time options
Online pre-requisite
Easy & Fun
Quick return to work
In Person – Train the Trainer
• Good for complex issues
• Availability for questions
• Reminders/review capability
• Reach masses quickly
• Trainer able to provide
education
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9/30/2015
In Person – Leader Delivered Education
• CEO
• Program Leader
• Top topics
Quick Study
Take home solutions?
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9/30/2015
Quick Study
Questions or comments?
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