• Innovation in Action

Aug 19, 2020

Recognition of Residents’ Changing Health Conditions More Important Now Than Ever

Doctor Talking To Elderly Patient

Early recognition of changing health conditions among nursing home residents is critically important, especially in this time of COVID-19. A set of tools called Interventions to Reduce Acute Care Transfers (INTERACT®) such as “Stop and Watch” and “SBAR Communication Form,” are among a series of INTERACT tools that help nursing home staff, residents and their families detect early changes, keep residents healthy and avoid hospital transfers.

“Stop and Watch” is an early warning tool to help front line staff communicate to licensed nursing staff about residents’ physical and non-physical changes such as weight change, declines in eating/drinking, new or worsening pain, etc.  SBAR is a framework to guide communication between licensed nurses and providers about a resident’s change in condition. When the INTERACT SBAR tool is used, nursing staff give a short statement of the problem , provide relevant clinical information about the problem, summarize  what was found, and review findings with the provider to determine what actions should be taken.

“I cannot stress enough the importance of using documentation like Stop and Watch,” says Sue Shumate, RN, CHTS-IS, Health Information Coordinator for the Missouri Quality Initiative (MOQI) at the University of Missouri Sinclair School of Nursing (MUSSON). “It demonstrates the role everyone has in identifying something that appears different with a resident. It’s that documentation, rather than simply mentioning something in passing, that gives staff the ability to measure a trend that may need addressed.”

Successful implementation of INTERACT tools depends on the watchful eyes of staff at all levels, from janitors to nurses to members of the leadership team, as well as residents’ family members. This is especially important during COVID-19 when early recognition of change is key. For example, an environmental services team member might notice a resident who is normally talkative when her room is being cleaned seems less interested in striking up a conversation, or a family member visiting through FaceTime might notice the resident’s breathing is more labored than normal. With Stop and Watch, front line staff and family members are empowered to report changes in a resident’s condition to the nurse.

To assess COVID-19-related changes, the staff at the Quality Improvement Program for Missouri (QIPMO) at MUSSON created a printable SBAR for COVID-19. The tool guides staff using the traditional SBAR framework (situation, background, assessment, and recommendation) but focuses on changes in a resident’s condition related to COVID-19. For example, the Situation section includes documentation for respiratory and cardiovascular changes; the Background section includes documentation for common and less common signs and symptoms of COVID-19; and the Recommendation section includes options for emergency or non-emergency transport of a resident to the hospital.

For additional COVID-19 tools and information for nursing homes both in and outside of Missouri, visit https://nursinghomehelp.org/educational/important-information-helpful-links-on-coronavirus-covid-19/.

Acknowledgement: This project is supported by grant numbers 1E1CMS331080 and 1E1CMS331489 from the Centers for Medicare & Medicaid (CMS) Innovations Center and Medicare-Medicaid Coordination Office (http://innovation.cms.gov/initiatives/rahnfr/), which is focused on improving care and outcomes for Medicare-Medicaid enrollees residing in nursing facilities. The content is solely the responsibility of the authors and does not necessarily represent the official views of CMS. We also acknowledge the participation of 16 nursing homes in the St. Louis area, their staff, and the Advanced Practice Registered Nurses (APRNs) and other staff of the MOQI Initiative. The Quality Improvement Program for Missouri is supported by grant number AOC19380271 from the Missouri Department of Health and Senior Services.

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