Session 3
Using the INTERACT Early Warning Tool:
Stop and Watch
This session is designed for:
• Certified nursing assistants (CNAs)
• All non-nursing staff with regular
direct resident contact such as
those working in activities, dietary,
and environmental services
departments
•Project champion
•DON
•RNs
•LPNs
• Rehabilitation Therapists
The development and evaluation of the INTERACT quality improvement
program have been supported by grants from The Commonwealth Fund
and the Retirement Research Foundation.
Using the INTERACT Early Warning
Tool: Stop and Watch
The INTERACT Interdisciplinary Team
Joseph Ouslander, MD
Ruth Tappen, EdD, RN, FAAN
Jill Shutes, GNP
Nancy Henry, PhD, GNP
Maria Rojido, MD
Sanya Diaz, MD
Laurie Herndon, MSN, GNP-BC
Jo Taylor, RN, MPH
Gerri Lamb, PhD, RN, FAAN
Annie Rahman, PhD, MSW
Dan Osterweil, MD
Mary Perloe, GNP
John Schnelle, PhD
Sandra Simmons, PhD
Alice Bonner, PhD, GNP
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Mass Senior Care Foundation
The Carolinas Center for Medical Excellence
Arizona State University
USC Davis School of Gerontology
California Association of Long Term Care Medicine
Georgia Medical Care Foundation
Vanderbilt University
Vanderbilt University
Center for Medicare and Medicaid Services
In collaboration with participating nursing homes
Using the INTERACT Early Warning
Tool: Stop and Watch
What This Session Will Cover
• Purpose of Stop and Watch
• Staff who should use Stop and Watch
• Changes in resident condition to identify
and report
• Common barriers to communicating early
changes
• How to implement Stop and Watch in
your facility
[Video of expert talking]
Using the INTERACT Early Warning
Tool: Stop and Watch
o “Stop and Watch”
Purpose
 To guide direct care staff through a brief
review of early changes in the resident’s
condition
 To improve communication between frontline
staff and the nurse in charge
Using the INTERACT Early Warning
Tool: Stop and Watch”
Purpose
 To improve the quality of care for
residents
 To prevent unnecessary transfers
to hospital
Benefits of INTERACT Participation
For Your Residents:
• Continuity of care
• Familiar environment
• Avoid discomfort and long waits in emergency
room
• Eliminate risk of complications from hospital
Benefits of INTERACT Participation
For staff:
• Knowledge to identify and manage acute
changes in the facility when safe and practical
• Knowledge to identify residents who require
acute care transfers more rapidly
• Maintain connection and provide support to
resident and family
• Ability to improve care using clinical practice
tools
Benefits of INTERACT Participation
For facility:
• Better resident outcomes
• Improved resident and family satisfaction
• Reduced time associated with transfers
• Preparation for payment reform
• Improved communication and documentation
Stop and Watch is
the way for
CNAs to alert the
LPN/RN of changes in
resident condition
AND
for the nurse to hear
what the CNA has
to say.
Using the INTERACT Early Warning
Tool: Stop and Watch
Those who should use Stop and Watch
 Direct care

CNA’s and other nursing staff, rehabilitation and
activities therapists, dietary and housekeeping staff,
and any staff member with direct resident contact
 Others

Family and close friends with regular direct contact
Using the INTERACT Early Warning
Tool: Stop and Watch
Examples of Using Stop and Watch
• CNA notices an early change in mental status during AM care and lets her
charge nurse know that the resident is more confused than normal
• CNA reports to the charge nurse that her resident was up three times during
the night shift because of increased agitation and anxiety
• The housekeeper notices and reports that a resident slept most of the
morning and did not respond when she said hello
• The physical therapy assistant who reports to the nurse supervisor that the
resident’s strength and coordination was much less on Friday than it was on
Wednesday
• The daughter who reports that her father’s memory loss has changed since
her visit the day before and that even long term memory is impaired for the
first time
Using the INTERACT Early Warning
Tool: Stop and Watch
Early changes in resident condition to
identify and report
 Changes in mental status – sleepy, confused,
agitated, anxious
 Changes in physical status – problems with
walking, transferring
 Changes in function – problems with ADL’s
 Changes in behavior – wandering, combative,
yelling, verbal or physical aggression
 Changes in pain level
Using the INTERACT Early Warning
Tool: Stop and Watch Tool: “Stop
In Summary
Important changes to report are:
 Actions or behaviors that are not part
of the resident’s normal routine
 A change from the resident’s baseline
Common barriers to communicating
early changes in residents
Unit nurses are busy
giving medications,
taking physician
orders, and admitting
new residents
CNA’s are very busy
giving direct care
Stop and Watch
can help
close the gap!
Using the INTERACT Early Warning
Tool: Stop and Watch
When to Report Changes Using Stop and Watch
 During your shift
 Make it a part of your normal routine
Waiting to report a change in your resident’s
condition may have serious results!
Early Warning Tool: “Stop and Watch”
Video Clip
A CNA notices one of her residents
becoming more confused throughout the
day. She knows this is not a normal
behavior pattern for this resident.
Early Warning Tool: “Stop and Watch”
Instructions for Stop and Watch
If you noticed a change in a resident today,
please circle the change. Report it to the
charge nurse today.
More than one change may be marked on
the same form.
Name of Resident ____________________
STOP
Seems different
 Not their usual self? Change in personality or behavior?
Talks or communicates less

Quieter? Drowsier? Confused? Change in speech?
Overall needs more help
 Needs more assistance? Changes in gait, transfer or
balance?
Participated in activities less
 Withdrawn? Decline in ADL’s? Change in normal routine?
Pain level increased
AND
Ate less than usual
(Not because of dislike of food)
No bowel movement in 3 days
or diarrhea
Drank less than usual
WATCH
Weight gain or loss
Agitated or nervous
Tired, weak, confused, or drowsy
Change in skin color or condition
Help with walking, transferring, or toileting
more than usual
Early Warning Tool: “Stop and Watch”
Instructions: Stop and Watch
Your name: ____________________________
Reported to: ____________________________
Date: __/__/__ Time: ____________
Nurse response:
______________________________
Date: _ /____/___ Time: _____________
Nurse’s name: _______________________
Using the INTERACT Early Warning
Tool: Stop and Watch
How to Implement Stop and Watch in
Your Nursing Home
 Keep the pocket card with you at all times.
 Complete the Stop and Watch form during your
shift before you leave.
 Give the Stop and Watch form to the nurse
taking care of the resident.
 If you have copies, keep a copy and follow up on
what happened after you reported the change
Using the INTERACT Early Warning
Tool: Stop and Watch
Quiz and Evaluation
•
•
Please complete the Post-Session Quiz and Evaluation
If you do not complete them:
–
–
You will not receive continuing education credit
If your facility is tracking who completes specific modules, you
will not be counted