The RAVEN (Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents) project by the University of Pittsburgh Medical Center (UPMC), aimed at improving quality of care for people residing in long-term care (LTC) facilities by reducing avoidable hospitalizations, is set to enter phase two in October 2016. Here, April Kane, UPMC's RAVEN project co-director, describes a pair of key resources that have enhanced communication between providers, particularly those at the eighteen nursing homes collaborating with UPMC on the RAVEN project.
Currently INTERACT (Interventions to Reduce Acute Care Transfers) is a quality improvement project and has been funded through Medicare. It is designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities (SNFs). The goal of INTERACT is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital. These tools are free online.
INTERACT is used in multiple settings, but in our long-term care setting, we've been primarily encouraging the use of two INTERACT tools. There are a wealth of others. First is the Stop and Watch tool. This is a very easy early detection tool that would be used by members of your nursing home staff, such as nurses aides, custodial or housekeeping staff, and other workers who have a lot of one-on-one engagement with residents.
Using this tool, they may notice subtle changes, such as a patient who isn't as well engaged, who has been eating or drinking a little less, or is not as communicative as they had been before. It's a very easy one-page tool. Sometimes it's a card where they can circle if they're seeing something different, for example, "The resident seems a little different," or "They ate less."
The goal would be to take that tool to either the LPN or the RN in charge of the unit they're working on and say, "You know, I was with Mrs. Smith today. This is what I've been seeing that's a little different with her." That nurse should take that tool, validate its usage and then from there, go in and assess the patient.
If appropriate, they should utilize a second INTERACT tool, SBAR (Situation, Background, Assessment, Recommendation), to provide a more thorough assessment of what is going on and determine if this is a true changing condition. The SBAR allows the nurse to provide feedback to physicians in the very structured format physicians are used to reviewing. This allows them to place all the vitals and information in one place.
When they do make that call to the physician, they're well prepared to update them with what is going on with a particular resident. The physician then feels comfortable in deciding whether to provide further treatment on site or if appropriate, to transfer out to the hospital, depending on that resident's need.