Minnesota PIPP Annual Conference 2012

May 17, 2012       8:30 AM to 4:00 PM
Holiday Inn East, 2201 Burns Ave., St. Paul, Minnesota

Poster Session 1:45pm - 2:45pm

Andrew Residence - Strive to Thrive! A Minnesota 10X10 Initiative

Andrew Residence in Minneapolis is a community based residential treatment facility serving 212 adults living the challenges of severe, persistent mental illness. Statistically, individuals with mental illness, primarily schizophrenia, die 25 years before their peers – of physical health issues including diabetes, heart disease, lung disease and cancer. Our PIPP funding began six months ago and enables us to implement our Strive to Thrive! program which is integrating a healthier culture including more movement and exercise, relaxation, good nutrition. The measurable focus is twofold: weight reduction and smoking reduction/cessation. Come learn about some of our strategies to engage residents – and staff! – in this important initiative.

Benedictine Health Services - BeHS Well Falls Prevention Program

Benedictine Health Services has redefined traditional activity programming by incorporating customized, daily exercise regimens that are based on quarterly assessments of strength, endurance, balance, and flexibility. Our Therapy Department reinforces the program's benefits, when appropriate, through the use of specialized balance and exercise equipment provided by PIPP funding. There are 12 sites involved in BWFPP. Each site tracks falls data for both participants and non-participants, and there is a quarterly meeting to share and compare results. Falls continue to be a challenge for these facilities, but there has been significant improvement. Participants love the program and have shown improvement in ADL's, mood, social interaction, and mobility.

Benedictine Health Services - Med-error Red

“Med-error Red” is a PIPP-in-progress involving 13 Benedictine Health Services facilities that are implementing an electronic medication administration record (eMAR) to reduce medication errors within a culture of safety. This poster presentation will outline the goal, main steps, challenges, and expected outcomes of this multi-faceted project.

Benedictine Health Services - Mobility Courtyard

BHS proposes to reduce community and facility falls by developing a ”Mobility Courtyard and Rehab Challenge Course Program” in three BHS facilities. This is not merely a construction project, but rather the development of an active program complete with protocols for maximum effectiveness and training of staff involved. The Courtyard program consists of converting existing but under-utilized outdoor space into real-life community simulations that replicate many of the various walking surfaces, obstacles, and mobility challenges faced by patients attempting to return to safe functional mobility in the “real world.” This program will benefit both short-stay and long-term care residents through improved balance, judgment, visual cueing, strength, and gait. Our goals are to reduce re-hospitalization and re-admission to the SNF as a result of falls. We also hope to return SNF residents with marginal mobility skills to a level where they are judged safe to move to a higher level of independence.

Benedictine Health Services - PIPP Success at BHS

Since 2008, the Benedictine Health System has been (will be?) the fortunate recipient of almost $11 million in PIPP funding for eight projects that have improved quality and performance at 22 of their 40 facilities. This session will expound upon the internal process they use for developing PIPP projects and proposals, including lessons learned over the years.

CareChoice - Resident Centered Care Connections

CareChoice Resident Centered Care Connections (RCCC) PIPP has a triple aim of reducing avoidable hospital admissions, enabling effective transitions across care settings and putting a palliative care program in 17 nursing homes. Although only half way through its three year duration, the project has already demonstrated significant reductions in 30-day hospital readmissions, an increased number of residents with completed POLST forms, an increased number enrolled in palliative care and improved nurse competency in caring for residents having the conditions that most often lead to hospital readmissions. The project employs multiple strategies including INTERACT, POLST, electronic access with hospitals, revised discharge protocols adapted from Project RED and lots of staff education

Care Ventures - Fit 4 Life

Fit 4 Life is an exercise and wellness program for seniors first developed in 2004 to promote improved physical well-being and stability. The philosophy of the program is to balance the traditional medical model of care and rehabilitation services with empowering wellness opportunities. Care Ventures adopted the program at all its organizations two years later with financial assistance from a Pay-for-Performance Incentive payment Project (PIPP) grant through the Minnesota Department of Human Services. Fit 4 Life involves a focus on the physical aspect of wellness by providing assistance, personal training and physical fitness consultation to individuals on strength training, conditioning, physical fitness, and general exercise topics. Since its inception, the program has expanded to each local community with around 1000 participants in total. The benefits of the program have resulted in a significant reduction in falls in seniors living in care facilities and the greater communities, improved strength and stability, and increased socialization.

Ebenezer - Honoring Choices

Honoring Choices Minnesota is an Advance Care Planning (ACP) philosophy that Ebenezer will implement to help normalize end of life discussions, incorporating them as a routine part of our care delivery process. The primary goal of HCM is to improve the resident experience by facilitating informed decision-making conversations around end-of-life care beyond code status and documenting those wishes on a signed POLST (provider order for life sustaining treatment) form. Our plan is to initiate ACP conversations with 100% of the Long Term Care and Transitional Care Unit residents in our skilled nursing facilities. We believe implementing the HCM philosophy will ensure that our residents wishes are known, communicated, and honored across the Ebenezer system. This will, in effect, improve clinical outcomes by preventing undesired and non-beneficial care and reduce total cost of care by reducing unnecessary and unwanted treatments and hospitalizations.

Ebenezer Ridges Campus - INTERACT II

INTERACT II is an acronym for “Interventions to Reduce Acute Care Transfers. The interventions are designed to improve the identification, evaluation and communication about changes in resident status. The overall goals we have established with the program are: improved communication with physicians regarding medical/status changes, reduction of unnecessary hospitalization and developing useable tools for nurses and nursing assistants. We have utilized the SBAR (situation-background-assessment-recommendation) tools to improve communication. The SBAR’s that are currently being used are: CHF, UTI, Fever, and Hydration. We continue to educate on current SBAR’s as well as new ones, monitor for compliance and review hospitalizations to identify any education/training to reduce unnecessary hospitalizations. We have seen re-hospitalization rates dip to 3%. It is an on-going process of quality improvement.

Ecumen - Awakenings

The Awakenings Initiative is a comprehensive program designed to look at reducing potentially unnecessary medications for people with dementia and for other people who reside in skilled nursing facilities.  Fifteen of Ecumen's care centers (1219 total beds) were awarded a three year Performance Based Incentive Program (PIPP) grant from the Minnesota Department of Human Services (DHS) in 2010.  Goals of the Awakenings program include improving quality of life of nursing facility residents, reducing the use of unnecessary medications, and improving quality of care by facilitating culture change. The Awakenings Initiative relies on involvement of residents, families, facility management, and the entire interdisciplinary treatment team. Increased access to psychology, psychiatry, and pharmacy consulting services has also been important. Alternative care plan approaches (versus medications) including restorative nursing care play a major part in the program's success.

Empira - Fall Prevention and Reduction: Challenging the Conventional Standards of Practice

The cost of a resident fall in a skilled nursing facility costs on average between $9,100 to $13,500, according to the CDC. In 2008 Empira, a Minnesota consortium of older adult service providers, applied for and received a MN Department of Human Services’ Performance Incentive Payment Program funding to prevent and reduce resident falls in fifteen of their skilled care centers. The Empira fall prevention program is a combination of nationally recognized evidence-based, fall prevention practices and the practical applications from the most recent research findings. Empira, however, challenged some of the standards of practice for reducing falls. Learn their program outcomes from skilled nursing facilities that are implementing an “alarm-free, corrected bed heights (no low beds) no floor mats and proper footwear” protocol. Empira’s skilled nursing facilities were able to collectively achieve an average of 20% - 30% reduction in the prevalence of resident falls. These findings, coupled with a significant reduction in the number of repeated falls makes this poster session one that you will want to attend. This poster session provides insights into the implementation of a comprehensive fall prevention and reduction program. Lessons learned from implementing a program that tests the current and dated practices for fall prevention within the aging services provider community will be highlighted.

Essentia Health - Evidenced Based Practice for Fall Prevention – Does it Really Work?

Essentia Health, though a hospital/clinic based operation – has 6 Long Term Care Facilities in the State of Minnesota. The clinical leaders of these facilities have established a clinical practice group called “The LTC Affinity Group”. As we developed our clinical score card together, we knew that we needed to improve our falls rates in our facilities. As we researched best practice for a falls program, we took advantage of learning’s from other DHS grant quality improvement projects and learned of Sue Ann Guilderman’s published evidenced based practices for reducing falls. The Essentia Health Affinity group modeled the falls program around those practices. Did it work? Come and see!

Heritage of Foley - Dementia Care: Enriching Lives through Person Focused Care and Complimentary Therapies

At Heritage of Foley, we are confident in the clinical care we are providing but feel that there is more to life than simply being “medically stable”. We want our residents to thrive, and to be as emotionally and mentally healthy as they are physically. This project was written and designed to improve the quality of life for our residents with dementias. The specific point of reference we used to pinpoint that this was a place where we needed improvement was the Meaningful Activity Domain score, from the Minnesota Nursing Facility Quality of Life Satisfaction Survey. To improve this score, and more importantly the lives of our residents, we are happy to implement a more person focused care model as well as intensify our use of complimentary therapies such as aromatherapy, brushing technique, massage, music therapy and more!

Golden Living - PEARL: Program of Excellent Alternative Therapies in Residents’ Lives

Five of the Golden Living facilities were chosen to participate in the PEARL program. PEARL is comprised of 3 complementary or alternative therapies that include: Dance/Movement Therapy, Art Therapy and Healing Touch. The desired outcome is to assist residents in reducing pain, depression or anxiety, prevalence of falls and to increase ADL’s and functioning. A program leader was designated for each participating facility and was then trained in each of the 3 alternative therapies. One of the many success stories include a resident with chronic pain who was able to fall asleep and had little pain after a healing touch session. Her doctor witnessed the experience and was unable to explain, but requested to have healing touch performed on this resident on a regular basis.

Hilltop Care Center, Watkins - Medications in Residents’ Rooms: Electronic Charting

We started with putting medication cupboards in the residents’ rooms and immediately saw positive results. Staff members have more time to talk with residents and residents have more privacy. This new system has also allowed us to get rid of the big, clunky med cart. We are now in the process of implementing eMARs and Smart Charting. One challenge we are facing is our facility has been sold but we are working with the new owners to stay on schedule during this transition.

Lac Qui Parle Network - Putting Fun into Restorative Nursing

The facilities of the Lac Qui Parle Health Network changed the focus of their restorative nursing programs from traditional exercises to using the exercise actions in new fun ways. These “new” exercises incorporate the resident’s previous activities and interests and provide physical, mental, and emotional benefits. Since the implementation of this program, residents are more motivated to participate in the restorative nursing program. Residents who have never participated in any exercise program are now involved in the restorative nursing program and are actually asking for specific exercises programs.

Sanford Health/Sylvan Court Canby - Improving Resident Satisfaction via Blended Workers

Resident satisfaction is measured in twelve domains by the DHS validated survey tool and process annually. Because the survey is administered consistently and uniformly, change from one year to the next year can be measured and analyzed. Sylvan Court proposed to increase our DHS Quality of Life/Resident Satisfaction Survey Results for Relationships, Individuality, and Meaningful Activity by implementing the hiring and training of blended workers. Incorporating the blended worker program facilitates culture change; and at the same time, improves resident satisfaction. It involved training employees from various departments to assist residents with their personal, social and environmental care needs. Only very minor changes were made to the 40-year old physical plant.

St. Elizabeth’s Nursing Home and Healthcare Center - Person Centered Care: Turning Small Steps into Great Gains

St. Francis Health Services - The Incontinence Eradication Project

When St. Francis Health Services launched this project in 11 skilled nursing facilities, there was a reasonable expectation that with a better understanding of bowel and bladder assessment we could reduce the level of incontinence experienced by our residents. And we did demonstrate an 18.38% decrease in worsening continence. Additional benefits included a better understanding of how to approach residents with dementia, stronger Restorative Programs, reduced incontinence product costs, decreased urinary tract infections and decreased indwelling catheter usage.

Tealwood Care Centers - The Implementation of INTERACT II: Things We’ve Learned Along the Way

Much of the success of the Interact II Program rests on the competence and skills of each communities licensed staff. As we began implementing the early components of our project, we quickly learned that we needed to invest more time on the basic skills of assessment and communication. The development and implementation of training and skills for licensed staff and direct care staff are essential to the sustainability of the program.