Session 3Using the INTERACT Early Warning Tool:

Stop and Watch

This session is designed for:

• Certified nursing assistants (CNAs)• All non-nursing staff with regular

direct resident contact such as those working in activities, dietary, and environmental services departments

The development and evaluation of the INTERACT quality improvement program have been supported by grants from The Commonwealth Fund

and the Retirement Research Foundation.

•Project champion•DON•RNs •LPNs• Rehabilitation Therapists

The INTERACT Interdisciplinary Team

Joseph Ouslander, MD Florida Atlantic UniversityRuth Tappen, EdD, RN, FAAN Florida Atlantic UniversityJill Shutes, GNP Florida Atlantic UniversityNancy Henry, PhD, GNP Florida Atlantic UniversityMaria Rojido, MD Florida Atlantic UniversitySanya Diaz, MD Florida Atlantic UniversityLaurie Herndon, MSN, GNP-BC Mass Senior Care FoundationJo Taylor, RN, MPH The Carolinas Center for Medical ExcellenceGerri Lamb, PhD, RN, FAAN Arizona State UniversityAnnie Rahman, PhD, MSW USC Davis School of GerontologyDan Osterweil, MD California Association of Long Term Care MedicineMary Perloe, GNP Georgia Medical Care FoundationJohn Schnelle, PhD Vanderbilt UniversitySandra Simmons, PhD Vanderbilt UniversityAlice Bonner, PhD, GNP Center for Medicare and Medicaid Services

In collaboration with participating nursing homes

Using the INTERACT Early Warning Tool: Stop and Watch

What This Session Will Cover

• Purpose of Stop and Watch• Staff who should use Stop and Watch• Changes in resident condition to identify

and report • Common barriers to communicating early

changes• How to implement Stop and Watch in

your facility

Using the INTERACT Early Warning Tool: Stop and Watch

[Video of expert talking]

Purpose

To guide direct care staff through a brief review of early changes in the resident’s condition

To improve communication between frontline staff and the nurse in charge

Using the INTERACT Early Warning Tool: Stop and Watcho “Stop and Watch”

To improve the quality of care for residents

To prevent unnecessary transfers to hospital

Purpose

Using the INTERACT Early Warning Tool: Stop and Watch”

Benefits of INTERACT Participation

For Your Residents:• Continuity of care• Familiar environment• Avoid discomfort and long waits in emergency

room• Eliminate risk of complications from hospital

Benefits of INTERACT Participation

For staff:• Knowledge to identify and manage acute

changes in the facility when safe and practical• Knowledge to identify residents who require

acute care transfers more rapidly• Maintain connection and provide support to

resident and family• Ability to improve care using clinical practice

tools

Benefits of INTERACT Participation

For facility:• Better resident outcomes • Improved resident and family satisfaction• Reduced time associated with transfers• Preparation for payment reform• Improved communication and documentation

Stop and Watch is the way for

CNAs to alert the LPN/RN of changes in

resident conditionAND

for the nurse to hear what the CNA has

to say.

Using the INTERACT Early Warning Tool: Stop and Watch

Those who should use Stop and Watch

Direct care CNA’s and other nursing staff, rehabilitation and

activities therapists, dietary and housekeeping staff, and any staff member with direct resident contact

Others Family and close friends with regular direct contact

Using the INTERACT Early Warning Tool: Stop and Watch

Examples of Using Stop and Watch

• CNA notices an early change in mental status during AM care and lets her charge nurse know that the resident is more confused than normal• CNA reports to the charge nurse that her resident was up three times during the night shift because of increased agitation and anxiety• The housekeeper notices and reports that a resident slept most of the morning and did not respond when she said hello •The physical therapy assistant who reports to the nurse supervisor that the resident’s strength and coordination was much less on Friday than it was on Wednesday• The daughter who reports that her father’s memory loss has changed since her visit the day before and that even long term memory is impaired for the first time

Early changes in resident condition toidentify and report

Changes in mental status – sleepy, confused, agitated, anxious

Changes in physical status – problems with walking, transferring

Changes in function – problems with ADL’s Changes in behavior – wandering, combative,

yelling, verbal or physical aggression Changes in pain level

Using the INTERACT Early Warning Tool: Stop and Watch

In Summary

Important changes to report are:

Actions or behaviors that are not part of the resident’s normal routine

A change from the resident’s baseline

Using the INTERACT Early Warning Tool: Stop and Watch Tool: “Stop

Unit nurses are busy giving medications,

taking physician orders, and admitting

new residents

CNA’s are very busy giving direct care

Stop and Watchcan help

close the gap!

Common barriers to communicating early changes in residents

When to Report Changes Using Stop and Watch

During your shift

Make it a part of your normal routine

Waiting to report a change in your resident’s condition may have serious results!

Using the INTERACT Early Warning Tool: Stop and Watch

Video Clip

A CNA notices one of her residents becoming more confused throughout the

day. She knows this is not a normal behavior pattern for this resident.

Early Warning Tool: “Stop and Watch”

Instructions for Stop and Watch

If you noticed a change in a resident today, please circle the change. Report it to the charge nurse today.

More than one change may be marked on the same form.

Name of Resident ____________________

Early Warning Tool: “Stop and Watch”

STOPSeems different

Not their usual self? Change in personality or behavior?

Talks or communicates less Quieter? Drowsier? Confused? Change in speech?

Overall needs more help Needs more assistance? Changes in gait, transfer or

balance?

Participated in activities less Withdrawn? Decline in ADL’s? Change in normal routine?

Pain level increased

AND

Ate less than usual

(Not because of dislike of food)

No bowel movement in 3 days or diarrhea

Drank less than usual

WATCH

Weight gain or loss

Agitated or nervous

Tired, weak, confused, or drowsy

Change in skin color or condition

Help with walking, transferring, or toileting more than usual

Instructions: Stop and WatchYour name: ____________________________

Reported to: ____________________________

Date: __/__/__ Time: ____________

Nurse response:

______________________________

Date: _ /____/___ Time: _____________

Nurse’s name: _______________________

Early Warning Tool: “Stop and Watch”

How to Implement Stop and Watch in Your Nursing Home

Keep the pocket card with you at all times.

Complete the Stop and Watch form during your shift before you leave.

Give the Stop and Watch form to the nurse taking care of the resident.

If you have copies, keep a copy and follow up on what happened after you reported the change

Using the INTERACT Early Warning Tool: Stop and Watch

Using the INTERACT Early Warning Tool: Stop and Watch

Quiz and Evaluation

• Please complete the Post-Session Quiz and Evaluation• If you do not complete them:

– You will not receive continuing education credit– If your facility is tracking who completes specific modules, you

will not be counted