WEBINARS Reducing Antipsychotic Use in Nursing Homes: A Team Approach, Wednesday, April 7PM Dr. Chuck Crecelius

Transcription

1 WEBINARS Reducing Antipsychotic Use in Nursing Homes: A Team Approach, Wednesday, April 30 7PM We encourage facilities to participate in this important webinar! Information has been circulating all month, but we hope you all will have staff participate in this! Dr. Chuck Crecelius, the Medical Director for the MOQI Initiative will be the presenter and he is has an excellent presentation planned. Behavioral symptom management and the use of antipsychotics in today s healthcare arena is an important topic to discuss. Antipsychotic drugs are associated with increased CV, falls, dysphagia, and other neurological risks. New Centers for Medicare & Medicaid Services (CMS) measures have been implemented, but Missouri still ranks as one of the highest states using antipsychotics (sixth). Objectives: 1. Discuss recent regulatory changes regarding antipsychotic prescribing 2. Review recent national efforts to decrease antipsychotic use 3. Compare the role of various team members in ensuring appropriate antipsychotic use 4. Recognize the elements of an effective gradual dose reduction program Presented by Charles A. Crecelius, MD, PhD, CMD: a geriatrician/internist, multi-facility medical director for Delmar Gardens Nursing Homes, and Assistant Clinical Professor of Internal Medicine and Geriatrics at Washington University School of Medicine in St Louis, Missouri. Communicating Sub-Acute Changes in Condition to Avoid Re-Hospitalization of Nursing Home Residents, Tuesday, May 6 6PM This is for the Physicians and Advanced Practice Registered Nurses working in nursing Homes participating in the Missouri Quality Improvement Initiative funded by the Centers for Medicare and Medicaid. The objectives of this webinar are: Describe Interact tools used in nursing homes to communicate about resident change in condition Apply evidence based use cases to demonstrate the use of Interact and Car during communication about resident change in condition using health information exchange systems Apply the use of a health information exchange system (Car ) during a simulated subacute change in condition of a nursing home resident. Define future uses of health information exchange systems to improve communication and reduce re-hospitalization rates in nursing homes. The Office of Continuing Education, School of Medicine, University of Missouri is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Office of Continuing Education, School of Medicine, University of Missouri designates this live educational activity for a maximum of1.0 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. PAGE1

2 Thanks for Participating in the MOQI Facility Monthly Performance Reports Webinar We appreciate everyone s participation in the webinar for Leadership and APRNs to explain the annual, quarterly, and monthly performance feedback reports for each facility in the MOQI Initiative. The Webinar was very well attended and participants had good questions and comments for improvement ideas. Reports were sent to each facility before the Webinar with information summarizing total hospitalizations, emergency visits, change of conditions, medication reviews, advanced directive documentation, and advance directive discussions across all 16 facilities and for each facility from September 2013 through February These reports will be sent monthly to leaders, RCCs, and APRNs in each facility. The source of the information within each report is the MOQI data base that is maintained by the APRNs and the RCCs in each facility. Feel free to share these bar graphs with other staff in the facility and work with your APRN to breakdown your information by unit so each unit can see their progress. Also explained in the webinar was more detailed information about conditions that put the resident at risk for hospital admission. This report is from the data from Interact Quality Improvement Tool for Review of Acute Care Transfers that the APRNs complete about each hospitalization in a facility. This information is displayed in a pie chart so that it is easy to see what conditions are causing the hospitalizations. This information can help focus educational efforts to help staff pick up on these conditions early, and prevent the conditions from escalating to the point that hospitalization occurs. This report will be sent monthly to leaders, RCCs and APRNs in each facility. Again, feel free to share this info with staff. The last report explained was a summary of the CMS Initiative Dashboard for the Initiative across all 7 ECCP sites nationwide, our Missouri summary, and each facility specific summary. This report is prepared by CMS each quarter from the data we submit from each facility (data that the RCC and APRNs input into the MOQI data base). These summary numbers are tracked by CMS to monitor the progress of our facilities. An important metric we discussed on the webinar is the Hospitalization Admission Rate per 1000 resident days. The average for last quarter (Oct., Nov., and Dec. of 2013) for our MOQI Initiative was 1.90, higher than the average across the 7 nationwide sites that was We will be receiving these quarterly reports from CMS with updated numbers because we submitted our data in April for January, February and March When we get the updated Dashboard, it will be shared with all facilities and APRNs. We are planning a follow up webinar for review of the Quarterly Dashboard report and updated April monthly reports on Tuesday, May 20 th at 10AM. We have set up the webinar to accommodate up to 500 call-ins so we will not have a space constraint so this can be more convenient for participants. However, if it helps to have people gathered around a computer, then do that, so there is good participation to review each report. We will send out the reports prior to the webinar. You must register for the webinar in order to access it - UPCOMING RTI EVALUATION VISITS AND CONTACTS IN JUNE One part of the MOQI Initiative is the evaluation by CMS of all of the seven national sites for the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. Recall, the aim of the Initiative is to reduce avoidable hospitalizations among long-stay nursing facility residents; improve the health outcomes of the residents; improve transitions between nursing facilities and PAGE2

3 acute care hospitals; and reduce overall health care spending without restricting access to choice of care provider. CMS has hired RTI International, a nonprofit research organization, to conduct the evaluation of the Initiative and how well MOQI is achieving our expected goals. RTI has subcontracted with the Long- Term Care Institute (LTCI) to assist in collecting information for the evaluation. LTCI staff will be contacting the Sinclair School of Nursing as the ECCP, and the administrators of four pre-selected nursing facilities. They will be arranging a site visit with these facilities and will contact them about 3-4 weeks prior to the visit, to arrange the timing and discuss a possible interview schedule for appropriate facility staff. LTCI will use a standardized site visit approach and phone interview protocols to gather information from key stakeholders and staff involved in the initiative s implementation. Their aim is to gather as much information as possible while minimizing the burden on your time and resources. LTCI teams will be making in-person visits to four facilities between June 24 th and June 27 th, then conducting phone interviews with staff at the remaining twelve facilities. In addition, each participating facility will be sent a brief online questionnaire. We have not been informed yet as to the four nursing homes to be visited, but as soon as we know we will inform the homes. The other nursing homes in the MOQI Initiative will receive a telephone call from LTCI staff using standardized phone interview protocols to gather as much information as possible about their involvement in the project. We thank you in advance for your cooperation in this process. As in any research project, doing evaluations and gathering information is essential for success. If you have any questions, please don t hesitate to contact Marcia Flesner at [email protected], (573) , or Marilyn Rantz at [email protected], (573) NATIONAL HEALTHCARE DECISIONS DAY - WHAT A SUCCESS!!! Missouri Quality Initiative launched a National Healthcare Decisions awareness campaign on April 16 th at all participating nursing home facilities. The informative campaign is designed to help educate nursing home residents, their families and employees of the facility about the importance of advance directives. Opportunities to enact advance directive documents were provided to residents, families and staff. Facilities report in their results, 42 long-term residents, 3 rehab residents, 11 family members, 59 employees, and 49 community persons enacted advance directives on that day, for a grand total of 157 enactment. There were many other inquiries and questions that were answered in addition to these enactment numbers. Thanks to everyone who helped make this event a success. A big thank you goes out to Brigid Fernandez (Attorney Coordinator of this event) attorney volunteers from the Missouri Bar, volunteers from hospice agencies, and volunteer notaries for their assistance in providing this opportunity to the MOQI project! Special recognition goes to Adrienne Holden, Pam Shipman, Mike Roth, Jan Doerr, Annette Lueckenotte, and Patty Muich for all of their assistance in coordinating the trainings, logistics, and assisting with media coverage of the event. CARE TRANSITIONS Adrienne Holden, Care Transitions Coach, worked diligently with all 16 of the participating facilities within the MOQI project to make National Healthcare Decisions Day a success. In addition to working with the NF s she also obtained the following Banks to participate as notaries for the event; Great Southern Bank of O Fallon, MO, and First Bank of Creve Coeur. Adrienne spent time with providing PAGE3

4 education to families, employees and residents of various facilities such as; Delmar Gardens West, Delmar Gardens of Creve Coeur and Grand Manor Nursing and Rehabilitation. The presentations were successful in encouraging appropriate end of life decisions and providing strategies for staff, families and residents with these difficult conversations. Providing these educational presentations ignited insightful dialogue amongst staff and families during these sessions and really show cased within the NFDD outcomes of participation, enactments of advance directives and ongoing inquiries from the communities and families. Adrienne will continue to provide education to the APRN s, Social Workers, employees of the facilities and residents regarding end of life decisions, advance care planning and discussions. We continue to build the advance directive toolkit for nursing facility social workers and APRN s in order to provide more state of the art educational resources for staff, residents and their families/responsible parties. Adrienne is also building hospital rapport and contacts in order to coordinate the use of the Interact- Hospital transfer to Post Acute forms as well as encouraging involvement as an active stakeholder with the MOQI project. She has made several visits and presented to the Palliative Care Network on the MOQI. We offered two successful educational seminars on advance directives presented by Brigid Fernandez, elder law attorney - one for the APRN s and one for facility social workers. We plan to offer additional continuing education seminars for facility social workers. Suggestions were received from them about future topics to offer. PAGE4

5 ADVANCED DIRECTIVES SUBCOMMITTEE The Advance Directive Subcommittee is making final additions to the toolboxes which will be distributed to the facilities finalizing the toolboxes. Each facility will be getting a notebook and a flash drive containing some excellent resources that the subcommittee identified as some of the best material available. We will be periodically updating this notebook as we identify additional tools that may be useful. Since the National Health Care Decisions Day was such a success, we are talking about ways that we may be able to continue providing the opportunity for advance directive education and enactment opportunities throughout the year. The committee is also planning a community education event on differences between palliative care and hospice care. More information on this event to follow. Voyce is sponsoring a conference titled Changing the Landscape of Long-Term Care on Friday, June 13 th. This conference will have a track for professionals and one for community members. Dr. Chuck Crecelius is one of the featured speakers. For more information please call (314) The next meeting will be on May 22 nd from 3-5PM at Delmar Gardens Corporate. Members of the subcommittee are Dr. Colleen Galambos, PhD, LCSW; Dr. Charles Crecelius, MD; Mike Roth, LNFA; Adrienne Holden, MSW, ACSW; Dr. Lori Popejoy, PhD, APRN, GNS-BC; Patty Abele, MSN, RN, FNP-BC; Annette Lueckenotte, MSN, RN, GCNS-BC, FNGNA; Yvonne Schwandt, RN, BSN; Brigid Fernandez, Elderlaw attorney; Jan Doerr, social worker, Delmar Gardens of O Fallon; Roger Schomburg, Chaplain, Alexian Brothers Corporate; and Teresa Buehler, Voyce. Please contact Colleen if you have any issues or concerns about advance directives or if you are looking for some guidance. The subcommittee generally meets on the 4 th Thursday of the month from 3-5pm. We are looking to expand membership on this committee. We are looking for a facility DON, ADON, or MDS coordinator from one of the 16 facilities to join the group. If you are interested or know of someone who is interested in participating in this subcommittee, please contact Colleen. UPDATES ON DATA COLLECTION: ALL FACILITIES As a reminder, you can find the latest and greatest Resident Roster Instruction Manual here on the MOQI website. Also, in order for the reports to be accurate, please try to remember to make sure that all discharged residents have a discharge date and a discharge reason entered. The reports are only as accurate as the data! As always, please contact Jess, Janice, or Sue if you have any questions or problems with the functionality of the database so it may be addressed immediately. HIT AND MHC CAR We have been working with the administration and leadership at Delmar Gardens to develop a plan for implementing Car across this system. Initial training focus will be with the staff designated for the social services mailbox. Plans are being made to train the facilities participating in the St. Luke s pilot program involving electronic discharge summaries. These plans include a webinar for all 16 nursing facilities so that their staff designated to the social services Car mailbox will be prepared when they begin seeing the electronic discharge summaries in the near future. Nursing home and Car system administrators, please be on the lookout for this information in your e- mail. It is advisable for all system administrators to verify accessibility to their Car box PAGE5

6 and that of the social services box. In addition, please verify the staff that will be allowed access to that mailbox. The team will also continue to identify the hospitals and physician practices commonly used by the nursing homes residents and will work with these providers to bring Car Direct to these facilities as well. Discussions have been held with members of BJC, Mercy, and SSM health organizations recently with more scheduled. Contact is also being made with smaller community hospitals such as Mineral Area and Parkland. As hospitals prepare to meet the goals of meaningful use, we will see more opportunities for electronic communication regarding patient transfer information. At the Leadership and stakeholder meetings, Dr. Greg Alexander discussed the pilot program between St. Luke s hospital and five of our NFs in close proximity to the hospital. They are Delmar Gardens of Chesterfield, Delmar Gardens of Creve Coeur, Delmar Gardens on the Green, and Delmar Gardens West in addition to NHC Healthcare, Town and Country. The style sheet has been created to make the CCD document from St. Luke s EMR, Cerner, into a readable format. Work is being finalized to the process and training for this endeavor. It is expected that this same format will be followed by other hospital systems in the St. Louis area and our NFs will be ready! We have been made aware of progress regarding the integration of the Interact tools into Electronic Medical Records. The following was received regarding the process involved to integrate into your EMR: INTERACT Program tools and other copyrighted materials with the INTERACT trademark can be incorporated into electronic medical records and other health information technology if the software vendor has a license agreement to do so with Florida Atlantic University. Taking part in the NIH grant does not provide a right to build INTERACT into software. This restriction is clearly spelled out in the click-through agreement on the INTERACT website, and at the bottom of each tool. A list of software vendors that currently have, or are in the process of obtaining a license agreement is shown below. If a vendor does not have a license agreement with Florida Atlantic University, but is interested in a license they can contact Dr. Jeffrey Anderson at: Jeffrey M. Anderson, PhD Associate Vice President for Research, Director of Technology Transfer Division of Research, Florida Atlantic University (FAU) (561) Office [email protected] Any questions about incorporation of INTERACT Program tools and materials into electronic records can be asked via the Contact Us section of the INTERACT website, or by contacting Dr. Anderson directly. Vendors with License Agreements ADL Data Systems American HealthTech AOD Software BV HealthCare (associated with Sushoo.com) DartChart Health MedX Interactive Health Network LoopBack Analytics Optimus EMR PatientOrderSets PointClickCare/Wescom Vendors in the Process of Obtaining License Agreements BlueStrata HER BlueStep Systems MatrixCare Please contact Sue Shumate if you would like further information! PAGE6

7 Remember that an evaluation team from St. Louis University is conducting an evaluation of Missouri Health Connection; because the 16 facilities in the MOQI project are using (or beginning to use) Car , you may be contacted by SLUCOR to complete a survey about MHC. Please remember that any personnel change from the assigned list of users for your facility needs to be communicated to Mike Elvin at [email protected]. CONGRESS EXPECTED TO PASS SGR PATCH BILL; NEW SNF VBP PROGRAM INCLUDED Congress is set to pass a bill that would temporarily stop the scheduled 24% cut to Medicare physician payments on April 1 st. The "doc fix" is the 17 th time Congress has passed a temporary fix on the sustainable growth rate (SGR) formula pay cuts. This bill comes after efforts to permanently repeal the SGR stalled when there was no agreement on how to pay for the bi-partisan, bi-cameral legislation. Included in the new legislation are several extenders to a variety of other health care related programs among those are a year extension to the therapy caps exception process and further delay of the new "two mid-night" rule. The bill also delays official implementation of new ICD- 10 codes until October 1 st, Additionally, the bill creates a new approach to skilled nursing facility (SNF) reimbursement. The new skilled nursing facility value-based purchasing (SNF VBP) program will make value-based incentive payments to SNFs beginning in fiscal year 2019 for facilities that improve hospital re-admissions rates. During the next four years, industry would work to develop measures against which SNFs will be scored for re-admissions. Incentive payments would come from Medicare withholding 2% of SNF payments and then allotting 70% of that money for bonus payments to facilities that perform well against the quality measures developed. Top-performers could even earn back more than the 2% withhold. The program is estimated to save Medicare $2 billion over 10 years and has industry support. MOQI GOALS FOR With feedback reports in place, MOQI team and APRNs will work side-by-side with NF staff to complete root cause analysis of underlying causes of hospitalizations and reduce hospitalizations for their residents 2. MOQI Team and APRNs will focus on working side by side with NF staff to implement improved care systems for mobility, hydration, and continence improvement of the NF residents 3. MOQI Team, APRNs, and NF leaders and staff will implement improved care systems that promote clear advance directives for NF residents 4. MOQI Team will reinforce Car use by all NFs for the transfer of PHI to/from NF/hospitals/primary care settings; Car use will increase steadily throughout 2014 UPCOMING MEETINGS!! Our next MOQI NF LEADERSHIP GROUP meeting will be Thursday, July 17 th at Delmar Gardens meeting room from 10-11:30AM! Mark your calendars and plan to attend! Delmar Gardens Home Office, North Outer 40 Road, 3 rd floor, Chesterfield, MO meetings: July 17 th, 2014 October 16 th, 2014 PAGE7

8 All meetings will still be held at Delmar Gardens Home Office in Chesterfield, at the same time of 10-11:30am. Our next MOQI STAKEHOLDER ADVISORY BOARD meeting will be Thursday, July 17 th at Delmar Gardens meeting room from 1-2PM. Mark your calendars and plan to attend! Delmar Gardens Home Office, North Outer 40 Road, 3 rd floor, Chesterfield, MO Feel free to join in this group as you would like! We always welcome additional perspectives. TOPICS FOR UPCOMING MOQI UPDATES; CONTACT INFORMATION If you have a particular request, please submit to Jess and we will be sure to cover it. If you would like others to be added to this communication list, please contact Jess at [email protected]. WEBSITE SECTION FOR YOUR USE There is a special section on the site for us to use for the Initiative. It contains contact information, material/overviews, copies of all of the updates, etc. Use the link below or type it in and bookmark it: If there is something you would like to request be added, please Jess. Participating nursing home administrators, please share these weekly MOQI Updates with your director of nursing and other leadership staff so they start getting informed about the MOQI Initiative. Attachments: April 30 webinar flyer May 6 webinar flyer PAGE8

9 WEBINAR Reducing Antipsychotic Use in Nursing Homes: A Team Approach Wednesday, April 30, p.m. Behavioral symptom management and the use of antipsychotics in today s healthcare arena is an important topic to discuss. Antipsychotic drugs are associated with increased CV, falls, dysphagia, and other neurological risks. New Centers for Medicare & Medicaid Services (CMS) measures have been implemented, but Missouri still ranks as one of the highest states using antipsychotics (sixth). Objectives: 1. Discuss recent regulatory changes regarding antipsychotic prescribing. 2. Review recent national efforts to decrease antipsychotic use. 3. Compare the role of various team members in ensuring appropriate antipsychotic use. 4. Recognize the elements of an effective gradual dose reduction program. Speaker: Charles A. Crecelius, MD, PhD, CMD, is a geriatrician/internist, multifacility medical director for Delmar Gardens Nursing Homes, and Assistant Clinical Professor of Internal Medicine and Geriatrics at Washington University School of Medicine in St Louis, Missouri. Dr. Crecelius is a Fellow in the American College of Physicians, and is listed in both Best Doctors and Top Doctors in America. Register: CME Approved The Office of Continuing Education, School of Medicine, University of Missouri is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Office of Continuing Education, School of Medicine, University of Missouri designates this webinar educational activity for a maximum of 1 AMA PRA Category 1 Credit(s). Physicians should only claim the credit commensurate with the extent of their participation in the activity. MO PREV 2014 This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

10 Missouri Quality Improvement Initiative University of Missouri Sinclair School of Nursing COMMUNICATING SUB-ACUTE CHANGES IN CONDITION TO AVOID RE- HOSPITALIZATION OF NURSING HOME RESIDENTS Dr. Charles Crecelius, MD, PHD, FACP, CMD Mike Elvin, BS Tuesday, May 6 th, :00pm Please register to attend: Target audience: Physicians and Advanced Practice Registered Nurses working in nursing Homes participating in the Missouri Quality Improvement Initiative funded by the Centers for Medicare and Medicaid Objectives: 1. Describe Interact tools used in nursing homes to communicate about resident change in condition 2. Apply evidence based use cases to demonstrate the use of Interact and Car during communication about resident change in condition using health information exchange systems 3. Apply the use of a health information exchange system (Car ) during a simulated sub-acute change in condition of a nursing home resident. 4. Define future uses of health information exchange systems to improve communication and reduce re-hospitalization rates in nursing homes. Speaker Disclosure: Dr. Charles Crecelius and Mike Elvin have no conflict of interest disclosures to report The Office of Continuing Education, School of Medicine, University of Missouri is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Office of Continuing Education, School of Medicine, University of Missouri designates this live educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.