Better Care, Better Quality

Rantz, Marilyn; Flesner, Marcia; Franklin, JoAnn; Galambos, Colleen; Pudlowski, Jacki; Pritchett, Angelita; Alexander, Gregory L.; Lueckenotte, Annette

doi:10.1097/ncq.0000000000000145

Cited by 26 publications

(10 citation statements)

References 3 publications

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“…Studies showed that LTCF residents’ unexpected ED visits are generally caused by clinical emergencies such as sudden changes in their physiological signs, changes in their mental states, and accidents [43]; nurses’ care experience, judgment, and ability to handle these situations are the main factors determining whether a resident is transferred to an ED when a clinical episode occurs [2,44]. Other studies showed that improving LTCF nurses’ ability to accurately assess and handle LTCF’s residents’ health situations can decrease the occurrence of inappropriate ED visits [25,26,45], thereby lowering nurses’ distress levels. This study found that the clinical episodes dimension had an explanatory variance of 37.49%, revealing that when deciding whether to transfer an LTCF resident to an ED, the most pronounced barrier or difficulty experienced by nurses was judging the severity of a clinical episode.…”

Section: Discussionmentioning

confidence: 99%

Patient Transfer Decision Difficulty Scale: Development and psychometric testing of emergency department visits by long-term care residents

et al. 2019

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Background and objectivesNurses serve as gatekeepers of the health of long-term care facility (LTCF) residents and are key members deciding whether residents should visit an emergency department (ED). Inappropriate decisions as to ED visits may result in ED overcrowding, excessive medical expenses, and nosocomial infections. Currently, there is a lack of effective tools for assessing the barriers and level of difficulty experienced by LTCF nurses. The purposes of this study were to develop a Patient Transfer Decision Difficulty Scale (PTDDS) and test its effectiveness.MethodsThis study randomly sampled LTCFs in Taiwan and surveyed two or three nurses in every institution selected. Registered return envelopes were provided for participants to return self-completed questionnaires. Three steps were used to develop the scale and items: in step I, the instrument was developed; in step II, psychometric testing was conducted, which entailed performing an exploratory factor analysis (EFA) to verify the construct validity and reliability of the developed items; and in step III, a confirmation study was conducted using a confirmatory factor analysis (CFA) and structural equation modeling to cross-validate the factors and items.ResultsThe cumulative sum of variance explained by the measurement models of the three factors in the PTDDS was 63.54%.When deciding whether to transfer LTCF residents to EDs, the most pronounced barrier experienced by nurses were for judging the severity of “clinical episodes”, which had an explanatory power of 37.49%. The second and third pronounced barriers and decision difficulty experienced by nurses were “communication and information” and “timing of the residents’ emergency visits,” which explained 16.81% and 9.24% of the variance, respectively.ConclusionsThe cross-validation results obtained using the EFA and CFA showed favorable reliability and validity of the PTDDS. For future studies, this study recommends performing large-scale investigations of the level of decision difficulty and related factors experienced by nurses in LTCFs of varying levels and types.

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Section: Discussionmentioning

confidence: 99%

Patient Transfer Decision Difficulty Scale: Development and psychometric testing of emergency department visits by long-term care residents

et al. 2019

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“…The measure is based on 12 months of data compiled by CMS [4]. [7]. In some cases, rehospitalization rates were higher for nursing home clients than the geriatric population in the community.…”

Section: Significance Of the Practice Problemmentioning

confidence: 99%

Effect of INTERACT on Promoting Nursing Staff’s Self-Efficacy Leading to a Reduction of Rehospitalizations from Short-Stay Care

Potter¹

2019

OJN

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One in four clients discharged from an acute care facility to a skilled nursing facility (SNF) required readmission to the hospital within 30 days. Neuman, Wirtalla & Werner believe that two-third of those readmissions are avoidable. Reducing the frequency of rehospitalization from short-stay care is essential for two primary reasons: 1) Clients are exposed to hospital-acquired infections that lead to increased comorbidities, and 2) potentially avoidable hospitalization will decrease the amount of funding distributed by Medicare. The setting for the proposed change initiative was a for-profit, nondenominational SNF in Missouri. Of the 120 beds, 16 were devoted to short-stay care. The convenience sample included four registered nurses and eight licensed practical nurses who had agreed to participate in the pilot. The purposive sample included short-stay clients. Interventions implemented at the pilot skilled nursing facility are components of the validated INTERACT quality improvement program. INTERACT (Appendix A) is comprised of several tools designed to assist and guide front-line staff in early identification, assessment, communication, and documentation about acute changes in client condition. Measured results examined the effectiveness of the proposed intervention. The outcome being assessed in the project was the number of avoidable hospital admissions after implementation of the INTERACT quality initiative tools. The long-term objective for the pilot was a 2% decrease in client rehospitalizations from the short-care unit during the eight weeks of practice implementation. The clinical question for the proposed practicum project was, "For the nursing staff on a short-term rehab unit, does the implementation of an evidence-based patient evaluation tool, INTERACT lead to a reduction in avoidable hospital admissions?".

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“…The project promotes the use of Interventions to Reduce Acute Care Transfers (INTERACT), which is a set of evidence-based clinical practice tools and strategies developed with funding from CMS to reduce hospitalizations from nursing homes. The tools and strategies assist nursing home staff in early identification, assessment, communication, and documentation about changes of condition in nursing home residents (Rantz et al, 2014(Rantz et al, , 2015.…”

Section: The Missouri Quality Initiative Projectmentioning

confidence: 99%

“…The APRN works collaboratively with facility staff on assessment and management of chronic and acute conditions, early illness recognition, and the use of INTERACT II tools; to enhance goals of care and EoL discussions and AD decision making; and to increase the use of health information technology for improved communication. The care transitions component is led by a PhD-prepared licensed clinical social worker, and a licensed MSW serves as the care transitions coach (CTC) (Rantz et al, 2014(Rantz et al, , 2015.…”

Section: The Missouri Quality Initiative Projectmentioning

confidence: 99%

“…Specific CTC duties are as follows: (a) oversee development of AD educational programs for staff, residents, and families; (b) work with NF staff members and APRNs to improve the AD discussion process with residents and families; and (c) assist staff and administration in developing AD policies and procedures resulting in quality improvement. An interdisciplinary approach is used in education, training, and discussions about ADs and involves the medical director, APRNs, and facility staff to advance the palliative care goals of the project (Rantz et al, 2014(Rantz et al, , 2015. The literature supports the need for improved interdisciplinary education in nursing homes, particularly in the areas of palliative care and EoLC (Liao & Ackerman, 2008).…”

Section: The Missouri Quality Initiative Projectmentioning

confidence: 99%

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Analysis of Advance Directive Documentation to Support Palliative Care Activities in Nursing Homes

et al. 2016

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As part of an intervention to improve health care in nursing homes with the goal of reducing potentially avoidable hospital admissions, 1,877 resident records were reviewed for advance directive (AD) documentation. At the initial phases of the intervention, 50 percent of the records contained an AD. Of the ADs in the resident records, 55 percent designated a durable power of attorney for health care, most often a child (62 percent), other relative (14 percent), or spouse (13 percent). Financial power of attorney documents were sometimes found within the AD, even though these documents focused on financial decision making rather than health care decision making. Code status was the most prevalent health preference documented in the record at 97 percent of the records reviewed. The intervention used these initial findings and the philosophical framework of respect for autonomy to develop education programs and services on advance care planning. The role of the social worker within an interdisciplinary team is discussed.

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Better Care, Better Quality

Cited by 26 publications

References 3 publications

Patient Transfer Decision Difficulty Scale: Development and psychometric testing of emergency department visits by long-term care residents

Patient Transfer Decision Difficulty Scale: Development and psychometric testing of emergency department visits by long-term care residents

Effect of INTERACT on Promoting Nursing Staff’s Self-Efficacy Leading to a Reduction of Rehospitalizations from Short-Stay Care

Analysis of Advance Directive Documentation to Support Palliative Care Activities in Nursing Homes

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