June 14-21
National Nursing Assistants' Week
June 26, 1-2pm ET
Finding the Balance: Enhancing Self-Efficacy in Persons Living with Dementia
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Elder Abuse Awareness Month
A long term care community was looking for a way to reduce readmission rates. Using the Campaign’s Hospitalizations Tracking Tool, staff was able to pinpoint an avoidable source of hospital transfers and implement communication strategies to effect change. Read on for the first-hand account of how this team was able to face their challenge head on and achieve improvement success.
Our goal was to reduce hospitalization rates. We had to ask ourselves why things were happening and have frank conversations with doctors and nurses. As we asked “why?” the solutions became clear—we needed to take actions to resolve the situation.

Our hospitalization rates decreased, including zero one month. We would like to keep a low rate. We knew it was a success because you can't argue with a zero!
Look inside to see the graphs this community used to find their opportunity.

Using the Campaign’s Hospitalizations Tracking Tool, we were able to identify the doctor who was sending the most residents out to the hospital. Some of our doctors felt nursing staff were pushing them to transfer residents. We talked with the medical director and educated the doctor group and provided written material to them on doing in-house diagnostics, labs, ultrasounds and x-rays. The medical residents got some education on re-hospitalizations during their geriatric rotations. We educated the nursing supervisor and nurses on this as well.

Our intervention primarily involved medical directors and nursing staff. We involved medical directors, nurses and nurse aides during existing meetings, and used simple, educational print-outs. We repeated the same information over and over again.

Our medical directors’ practice is in-house five days a week. We can get our residents looked at frequently and have consistency of the same doctors taking calls on nights and weekends. Dietary and housekeeping staff are also reporting if they see changes in the residents. 
"This is the way we have always done it." Some staff felt that sending residents to the ER solved the problem and they wouldn’t have to deal with it. We had to educate, educate, educate and have supervisors closely monitoring.
-Submitted by D. Bake. Her community is a Full Active Participant in the Campaign.
OUR TIP: Track down individual providers and look for trends if certain nurses are sending residents out. The nurses may need some more training/information. Check for trends on off-shifts and weekends.
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This material was prepared by Telligen, National Nursing Home Quality Improvement Campaign contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-CO-NNHQIC-03/18-001