Best Practice: Antibiotic Stewardship
Antibiotic Stewardship is essential to preventing the overuse of antibiotics, which may lead to increased antibiotic resistance. In the Resident Centered Medication Safety (RCMS) project, CareChoice used the MDH Gap Analysis Tool, MDH Action Steps and Strategies, and CDC Core Elements of Antibiotic Stewardship for Nursing Homes to guide and measure facilities in the development of their antibiotic stewardship programs.
CareChoice created training specific to nursing communication, families, and providers. The core nursing communication tool introduced was an adapted SBAR that aligns with Minimum Criteria for Initiating Antibiotics in Long Term Care. This SBAR combines AHRQ tools for UTI, Respiratory and Skin infections on one form, allowing nurses to identify appropriate assessments prior to contacting providers about suspected infections.
To engage providers in developing antibiotic prescribing patterns that are immersed in best practice, a provider antibiotic stewardship prescribing guideline and provider feedback letter were developed. To assist facilities in developing and implementing an antibiotic stewardship guideline for their facility in collaboration with their providers, this provider guideline development process was created. Lastly, an informational brochure for residents and families was created to introduce them to facility antibiotic stewardship efforts and encourage their support of the program.
Best Practice: INTERACT
INTERACT is an evidence-based quality improvement program to reduce avoidable hospitalizations from nursing homes. The INTERACT website provides program information, forms and instructions which can be downloaded and used without charge. Key INTERACT tools used by CareChoice include SBAR, QI audit tool, Acute Change in Condition Card Files and care paths. Below are key CareChoice adapted INTERACT care paths that can be used in guiding evaluation of specific symptoms that commonly cause acute care transfers.
Best Practice: Hospital to ER Transfer Form
This ER transfer form is intended to facilitate communication between nursing home and emergency room staff by presenting key information in a “quick read” format. The form was developed with input from ER personnel and geriatric primary care providers.
Best Practice: Provider Orders for Life Sustaining Treatment (POLST)
The POLST is a form that makes a patient/resident’s wishes for Advanced Directives and end-of-life care into actionable physician orders. The POLST process begins with conversations between patients, loved ones, and health care professionals and is designed to ensure that seriously ill or frail patients can choose the treatments they want or do not want and that their wishes are documented and honored. It is completed at admission to the nursing home, signed by the patient and the medical provider and reviewed routinely and when there are changes in condition. POLST information and resources can be found on the National POLST Paradigm website. The Minnesota POLST form is endorsed by the Minnesota Medical Association and the Emergency Medical Services Regulatory Board.
Best Practice: Palliative Care
Palliative Care is a philosophy of care particularly appropriate for those with advanced chronic disease for which there is no cure and for those who choose comfort and quality of life as their most important goal of care. Palliative care strives to provide optimal pain and symptom management while focusing on the psychosocial and spiritual needs of the individual. Key components of palliative care include pain and symptom management as well as spiritual and psychosocial care. Palliative care differs from hospice in that it can include curative interventions and does not require a six-month prognosis. CareChoice endorses the provision of palliative care for those for whom it is appropriate. Palliative care includes but is not limited to hospice care and comfort care. Comfort care is a term sometimes used to direct care orders when a resident is nearing end of life. Comfort care may also be specified by the physician on the POLST. The Minnesota Network of Hospice and Palliative Care website offers resources and information on this best practice.
Best Practice: Pain Management
Included here are CareChoice tools developed to support a pain management program that addresses the interdisciplinary identification and treatment of pain in both the short and long term care population. The Pain Protocol and Pain Management Policy outline facility position and expectations for the management of pain. The Pain Identification/Review form is intended to be used routinely to detect indications of resident pain. The Pain Assessment provides a framework for a thorough assessment of pain in both cognitively intact and impaired individuals. A successful pain management program should include staff education on pain management using both medication and non-medication interventions.