Increasing Early Identification and Reporting of Condition Changes in Post-Acute Long-Term Care

Background: Potentially avoidable hospitalizations (PAH) in post-acute long-term care (PALTC) settings contribute to increased morbidity and mortality of older adults. Previous quality improvement research and projects have led to the creation of programs and tools that have been successful at reducing PAH. These tools are not always used correctly or consistently and may lead to suboptimal outcomes. One such program is the Interventions to Reduce Acute Care Transfers (INTERACT). One of the tools in the INTERACT program is the Stop and Watch Early Warning Tool (SWEWT) which is used to identify and communicate early changes in condition. Purpose/Objective: To increase the use of evidence-based early warning tools used for the identification and communication of changes in condition among PALTC residents. Method: Two PALTC facilities participated in a quality improvement project designed to increase the use of the SWEWT with a pre/post design measurement of the behavior. Intervention: An educational module was designed and implemented for caregivers of older adults in PALTC settings. Following the intervention, modest changes were made to modify environmental and motivational factors driving the behavior. Findings/Results: Out of 95 Staff members from the two facilities 39 (41%) began the training; 32 (82%) completed all components. There was a statistically significant increase (17%) in mean scores of the perceived self-reported competence for using the SWEWT from before the training to after the training t(32) = -2.77, p <0.05. There was a statistically significant increase (8%) in the mean knowledge levels based on assessment scores for using the SWEWT from before the training to after the training t(32) = -3.46, p < 0.05. Stop and Watch Early Warning Tool use increased 73% in one facility and 55% in the other within two months of the training. Conclusions/Implications for Practice: A quality improvement project including an educational intervention guided by behavior change models can improve the utilization of validated tools to report changes in resident condition.