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Local Success Stories

El-Jen Convalescent Reduces the Use of Restraints by 50 Percent
By Jackie Buttacio, BS, CPHQ, HealthInsight; Sheri Patridge, RN, El-Jen Convalescent

Have you ever heard the saying “two heads are better than one?” Well, El-Jen Convalescent in Las Vegas decided to take this to the next level by asking, “if two heads are truly better than one, then imagine the possibilities if there were more.” Sheri Patridge, RN, director of nursing services at El-Jen Convalescent would often hear stories of restraint free facilities and wonder how they did it. With the assistance of HealthInsight and the Wellspring modules that took place over the last two years, El- Jen was able to aim interventions at restraint reduction. The creation of a “fall team” that not only looked at falls, but also restraint use was their first action item. The team was skeptical at first and even somewhat embarrassed that their restraint usage was at 29.9 percent. They knew that something needed to be done. A new mindset and a strong commitment from all staff, in all departments, across all shifts were necessary.

El-Jen wanted the fall team to be interactive rather than reactive. Keeping privacy and dignity in mind, it was soon evident that when a fall occurred it wasn’t ideal for overhead announcements to say “fall in room four.” The team got creative and decided to call themselves “Autumn Leota.” The new team with their new name soon discovered that the staff were just as excited about restraint reduction as they were. From that point forward, whenever a fall occurred in the facility, an overhead announcement would be made saying “Autumn Leota to room four.” When this page is heard, the Autumn Leota team, the nurse on the unit, and the Certified Nursing Assistant (CNA) for that resident move to the scene. By doing this they learned they had more eyes and ears to identify and investigate any out of the ordinary concerns and make clearer determinations as to what the resident was trying to do prior to the fall. The Autumn Leota team continued to put their heads together, trying to find additional innovative interventions to reduce restraints and soon the team implemented a fall hotline titled, “Fallson- Call.” The primary purpose of this intervention was to create a support network for the evening shifts when falls are most common. The on-call responsibilities are shared among staff who are called upon to help the staff back at the facility make sense of the situation, ask critical questions, and offer their expertise on alternatives to restraint use. In order to create a feedback loop related to the new Falls-on-Call process, a cabbage patch doll named Autumn Leota became their mascot and she proudly sits on a swing on the unit that has had the least falls. Restraint and fall risk evaluations have been changed to include alternatives for restraints and if a restraint was identified to be necessary for a resident, the least restrictive device is now readily available. Sheri comments on their success and says, “Our actions became like a recipe to us. We’re proud to say that our dedication and commitment helped us to recognize that not only were we not using restraints as often, but thorough evaluations became a by-product of our team work and a whole new way of thinking was now in place.” El-Jen’s restraint usage is currently at 14 percent - over a 50 percent improvement! Congratulations El-Jen Convalescent! In order to create a feedback loop related to the new Falls-on- Call process, a cabbage patch doll named Autumn Leota became their mascot and she proudly sits on a swing on the unit that has had the least falls.

Making Changes in the Nursing Home Culture – Utah Nursing Home

Hillside Rehabilitation Center in Salt Lake City, Utah is working on culture change in their facility. In order to give their residents more freedom and choices in their daily lives, they have implemented the Choices Program, which includes offering residents five meals a day. By offering meals at these times, residents are given the opportunity to awaken at their preferred time instead of being awakened for a traditional early morning meal. As a result of this change, the signs and symptoms of depression has decreased from 9.8 percent to 2.4 percent. The facility even had to purchase additional chairs for the dining room because more residents were coming out of their rooms at mealtime.  Employees at Hillside Rehabilitation are also improving the admission process to include a questionnaire that will help staff learn about new residents and assist them in implementing a person- centered plan of care to meet their individual needs. Part of the person-centered care plan included offering residents alternative pain management therapies, such has massage, which has dramatically improved the percentage of residents experiencing moderate to sever pain from 16.7 percent to 2.2 percent. Other clinical measures have also improved as a result of the shift towards individualized care. The percentage of residents with restraints has decreased from 7.5 percent to 1.9 percent. The focus of the efforts at Hillside Rehabilitation is enhancing the daily lives of the residents by creating a home for each individual while enriching the experience of staff and family members.

A Success Story from South Lyon Medical Center LTC – NV Nursing Home

South Lyon Medical Center LTC reduced chronic pain in residents by 86.81% from a baseline of 31.04% in 2004 to 4.09% in 2007. This was achieved through a collaborative effort of the entire nursing and ancillary staff. We began by attending and participating in the Wellspring Group through HealthInsight. SLMC sent staff members to the workshops to gain insight into identifying and implementing changes in our process to address our high percentile of residents that scored in the excessive chronic pain measurement. Our team returned from the workshops and formed a multi-disciplinary committee to initiate process revisions. They identified targeted residents, developed and implemented strategies to reduce the incidence of pain, and met on several occasions with the medical staff to encourage their buy-in into the process. Each targeted resident had specific care plans developed and implemented. Throughout this process, the committee also revised the method of scoring chronic pain on the MDS form in order to focus on residents that were actually demonstrating chronic pain that was not being addressed by the medical staff or through appropriate pain relieving modalities. An example was a resident who receives routine narcotic analgesics daily, and when reviewing her Medication Administration Record (MAR), she had not received a PRN analgesic for the past 3 months indicating that her chronic pain was effectively being treated. The reason we chose to participate in this process was to aggressively address targeted residents. Through our staff committee and the medical staff, we have significantly reduced the number of residents affected with chronic pain. We have medical staff, physical therapy and additional ancillary services we can positively demonstrate evidence-based improvement in assessing and treating chronic pain. The role of the QIO has been a critical component in the positive resident outcomes. The QIO has provided essential training and equipped the staff with the tools required to meet the challenges in today’s health care environment.

A Success Story from Nevada State VA – NV Nursing Home

Nevada State Veterans Home in Boulder City, Nevada is working with HealthInsight to change the culture of the nursing home from institutional to more resident-centered. In order to help build strong relationships between their residents and staff, the VA Home implemented consistent resident assignments on specified care units and helped foster nurturing and healthy living environments by including their residents in discussions called Learning Circles, where residents are encouraged to listen and speak from the heart. Employees are encouraged to build a sense of community and create a home-like environment enabling greater self-determination and personal growth for residents while creating a warm, satisfying workplace.