Retirement Research Foundation - PDF document

10/21/2014 Nursing Home Social Work Network Welcome! This webinar series is made possible through the generosity of the Retirement Research Foundation http://clas.uiowa.edu/socialwork/nursing-home-social-work-network Paige Hector, LMSW Communicating with Families: Addressing Perceptions, Managing Paige Ahead Risk & Documenting Outcomes Healthcare Education & Consulting, L.L.C. 520-955-3387 paigehector@gmail.com www.paigeahead.com Traeon Beicher , RNB-C, ARM, CHRM,WCS, FCCWS, WCC Paige Hector , LMSW Tra Beicher, RNB-C, ARM, CHRM, WCS, Objectives FCCWS, WCC • Discuss the elements of essential and therapeutic communication Director of Risk • Define Service Recovery and its function Management Support • Emphasize the significance of F250 Medically Services Related Social Services in relation to TIS Insurance Services, communication Inc. 865-691-4847, ext. 3242 • Review the pitfalls of electric medical entries tbeicher@tisins.com Hector and Beicher: Communicating with Families 1

10/21/2014 Information Sharing: Communication Four Components • Communication Regulatory • Notification • Documentation Emotional Legal • Service Recovery Ethical Economic Communication: FACTS Anticipate Miscommunication Beyond Your Control Recognize the Barriers: • The circumstances which brought this resident to • Work schedules of Nursing Management, the facility Administration and Social Services • Non-modifiable contributing factors that impact • Unit Nurses working in a vacuum of their shift caregiving • Clinicians’ learn to think clinically • Some adverse events • Time constraints • Family dynamics are way beyond • Will always be some insensitivities to clinical • Most communication by staff is by phone intervention and some irrationalities to care delivery • Compassion at times can overtake facts at the system bedside • Family complaints are seldom clinical • Families often do not know the questions to ask • No adverse events are expected Essential Communication Questions to Ask When a decline is recognized, families who are • At the time of admission not prepared tend to find problems with • The first 4 weeks of service caregiving or ask multiple questions (How is • During the care plan process Dad eating? Has Dad gone to the bathroom?) • When families visit The real problem is the decline. • Would you like to talk about the changes in • The unexpected outcomes your father? • The expected outcomes • Would you like more information about his o Progression of Disease Timeline medical issues? • Would you like to review the care plan again? Hector and Beicher: Communicating with Families 2

10/21/2014 Notification: FACTS Progression of Disease Time Line • Families seldom expect adverse events Walking → increased confusion → • How and who you disclose to should depend on increased falls → non ambulatory → severity refusals → combativeness → lack of • Clinicians trained to notify, not how to notify interest in food → inability to swallow → • Clinicians are often unclear about responsibility loss of weight → stiffness → and accountability compromised skin → Death Notification: The Five Rights Documentation: FACTS • The right information • Nurses are required to make and keep records of their • The right time professional practice • The right sequence • There are no proficient standards for documentation • There are many limitations to the nursing record for • The right person care delivery • The right attitude • There is no way to fix a broken record that will not be in question • Electronic medical records will gather more data but may not accurately reflect the resident Service Recovery Documentation: Communication Resuming caregiving following service • Should be planned in advance disruption; restoring confidence to residents, • Should be taught families and staff: • Should meet procedural expectations • Resolve clinical situation efficiently based on • Keep it fact based skill and protocol • Timing matters • Identify failure points in the system (even for • Call in the team a near miss…staff knows it occurred) • Provide understanding, empathy, guidance and nurturing for those involved Hector and Beicher: Communicating with Families 3

10/21/2014 F250 Medically Related When Staff Should Refer to Social Services Social Services The facility must provide medically-related • Lack of effective family/support system social services to attain or maintain the • Behavioral symptoms highest practicable physical, mental, and • Resident aggression • Presence of a chronic disabling medical or psychosocial well-being of each resident. psychological condition • Depression • Chronic or acute pain • Difficulty with personal interaction and socialization skills Social Services Referrals, cont. Additional Factors for F250 • Presence of legal or financial problems Factors with a potentially negative effect on • Abuse of alcohol or other drugs physical, mental, and psychosocial wellbeing include an unmet need for: • Inability to cope with loss of function • Dental / denture care • Need for emotional support • Podiatric care • Changes in family relationships, living • Eye care arrangement, and/or resident’s condition or • Hearing services functioning • Equipment for mobility or assistive eating devices • A physical or chemical restraint • Need for home-like environment, control, dignity, • Resident who develop mental disorders privacy Pitfalls of Electronic Medical Regardless of the Software… Records (EMRs) • All sections must be complete • Write narratives, especially when your assessment differs from the MDS 23 Hector and Beicher: Communicating with Families 4

10/21/2014 Beware of Inadequate Example: Section 3 Mood Software Assessments  Mood is appropriate to circumstances • Some EMRs offer thorough clinical  Shows symptoms of depression, crying, assessments and tools (skin, falls, bowel withdrawals from activities, etc. and bladder)  Restless, anxious, complaints, etc. • Psychosocial assessments lacking  Diagnosis affects mood o Check boxes are often inadequate and do not  Unable to determine convey the depth of the assessment o An assessment asks about discharge goals, but Describe, if necessary: not aspects of prior living (ADLs and IADLs) Example: Section 8 Another EMR Example Physical Condition Psychosocial Evaluation and Social History  Adjusted to physical limitations Section B: Quality of Life  Does not fully understand physical limitations  Does the resident have enough clothing?  Does not accept physical limitations  Does the resident feel compatible with roommate?  Repetitive health complaints  Is the resident’s room personalized and homelike?  Unable to determine  Is the resident aware of the spiritual services offered in the facility and how to engage in them? Describe, if necessary: What Social Workers DO Same EMR, Different Section • Conduct assessments based in systems Section D: Mood and Behavior perspective  Has the resident been free of weight loss and • Identify barriers, possible solutions or ways to sleep pattern disturbance? ease hardship  Has the resident been free of abuse? • Recognize the bigger picture of the entire  Is the resident free from any adjustment/mood/ care process behavior problem? • Share information in the stand-up meeting  If yes to above questions, what problems does the resident have? • Check in with family, see how they are doing • Provide thorough and timely documentation Hector and Beicher: Communicating with Families 5