Interventions to Reduce Acute Care Transfers (INTERACT II)
Nursing facility residents who become acutely ill are often transferred to acute care hospitals for evaluation and treatment. Although often appropriate, studies have suggested that some residents could be cared for more cost effectively and with better clinical outcomes by remaining with trusted caregivers in a familiar nursing facility setting.
A Centers for Medicare and Medicaid Services (CMS) special project conducted in three Georgia nursing facilities in 2008 demonstrated a significant reduction in unnecessary hospital transfers using a tool kit developed through a project called INTERACT (Interventions to Reduce Acute Care Transfers).
In 2009, the next phase of the INTERACT project included 10 nursing facilities each in Massachusetts, New York, and Florida. A significant reduction in acute care transfers was again demonstrated among the participating facilities .
The Massachusetts Senior Care Foundation took the lead in working with nursing facility staff in Massachusetts to tailor the INTERACT II tools and resources to enhance nursing assessment skills, improve communication, and promote the discussion of advance directives. The revised toolkit is .available at www.interact2.net
The toolkit is now being disseminated to additional facilities in Massachusetts as part of the Massachusetts Strategic Plan for Care Transitions. The Practice Change Fellowship, awarded to Alice Bonner PhD, RN, Director of the Massachusetts Bureau of Health Care Safety and Quality partially funds the strategic plan and the dissemination of the INTERACT II toolkit.
The INTERACT II project is one of several care transitions initiatives that the Massachusetts Senior Care Foundation is leading. For more information, please contact our Director of Clinical Quality, Carolyn Blanks.
The Pioneer Network in New York has been a driver of the culture change movement to transform nursing homes into resident-centered communities. The Pioneer Network has been awarded a grant from the Picker Institute to move forward in their initiative to promote consumer engagement with person-centered culture change values, as it relates to long term care.
The Pioneer Network approached the Massachusetts Senior Care Foundation, in conjunction with the Massachusetts Culture Change Coalition, as one of three states to participate in the pilot study that will test strategies to optimize consumer involvement in culture change.
Through this grant, leaders in each state have been trained to hold small discussion groups in private homes that focus on culture change. This is a model similar to a book club and has been successfully implemented in other regions. The goal of this project is to increase consumer knowledge about aging and culture change. For questions, or if you are a consumer interested in attending a culture change focus group, please contact Mass Senior Care's Helen Magliozzi.
Patient Safety Culture
Eight nursing facilities in Massachusetts participated in the Patient Safety Culture Project led by researchers at the Institute for Health Policy at Partners Healthcare and Harvard Medical School . Facility staff completed a survey and answered questions about how they deliver safe care, how errors are reported and treated in their facility, and whether they would recommend the facility to a friend or neighbor as a safe place for residents.
Researchers are now scheduling meetings with facility administrators and directors of nursing to discuss individual facility survey results and make recommendations for improving the patient safety culture in long term care. For more information or to learn more about patient safety culture surveys for your facility, contact Carolyn Blanks.
The Massachusetts Board of Registration in Nursing (BORN) has released a report on the prevention of nursing errors. The report, “A Study to Identify Evidence-Based Strategies for the Prevention of Nursing Errors,” includes findings from the Board's analysis of the possible human performance and system factors associated with selected nursing practice complaints and provides recommendations for evidence-based error-prevention strategies. Please contact Carol Silveira if you have questions.
The Massachusetts Board of Registration in Nursing has been awarded a grant from the State Boards of Nursing to study medication errors in nursing facilities. In earlier studies, some nurses reported that they were afraid to report medication errors because they feared losing their jobs. In fact, systems exist to re-educate and retrain nurses who have made and reported errors.
As more is known about medication safety, studies suggest that it is most often a poorly designed system that caused the error and not an individual decision. The BORN will be studying different strategies for remediation of nurses who have made an error in a small number of pilot homes. Instead of a focus on disciplinary action, an intervention to remediate and re-educate nurses will be employed. The Massachusetts Senior Care Foundation, the Department of Public Health, Commonwealth Medicine, and others are partners on this grant.