Applied behavior analysis (ABA) supervision is necessary to ensure that practitioners are correctly implementing services and are developing professionally. The Behavior Analysis Certification Board^® (BACB^®) requires supervision for those seeking to become Board Certified Behavior Analysts^® (BCBA^®) or Board Certified Assistant Behavior Analysts^® (BCaBA^®). The BACB also requires ongoing supervision for BCaBAs and for Registered Behavior Technicians (RBT^®).

In December 2018, the BACB announced changes to supervision content and supervisor qualifications, as well as requirements for supervising trainees, RBTs and BCaBAs. While most of these changes go into effect November 2019, some were effective as of January 2019.

Changes in Effect Now

The BCBA/BCaBA Experience Standards: Monthly System went into effect in January. In preparing for major changes to fieldwork standards coming in 2022, the BACB decided that implementing the monthly system now would provide supervisors and trainees more flexibility than the previous weekly/biweekly system.

Under the new monthly system, supervisors and trainees can develop their own system for documenting supervision experiences. Individualized systems acknowledge that supervision experiences are diverse and therefore documentation of these experiences should differ as well. In addition to individualized systems, supervisors and supervisees must complete the BACB monthly experience form and the final experience form.

While the number of supervision contacts and hours remains the same, there are now explicit guidelines and restrictions for trainee supervision. No more than half of supervision hours can be held in a group format. Trainees must also be observed working with a client at least one time during each monthly supervisory period. While in-person and on-site observation is preferred, it is acceptable to use recorded video or live video conferencing.

New qualifications of those who can supervise RBTs went into effect January 2019. RBTs can now be supervised by a “noncertified RBT supervisor.” Noncertified RBT supervisors are licensed behavioral health providers in good standing who can document experience in ABA and who have completed the eight-hour BACB supervisor training. They must create a BACB Gateway account and complete the noncertified RBT supervisor form with attestation from their organization’s “responsible certificant.”

A responsible certificant ensures that all BACB requirements are met across an organization. Currently, BCaBAs may serve in this role. Beginning November 2019, only BCBAs and BCBA-Ds may serve as responsible certificants.

Changes Taking Effect November 2019

The addition of noncertified RBT supervisors highlighted the need for clarifying the relationship between the responsible certificants (BCBAs or BCBA-Ds) and the RBT. Responsible certificants must have client-specific knowledge so they can provide effective clinical direction. As of November 2019, responsible certificants, supervisors and RBTs should be employed by the same organization or have a contractual relationship with the RBT’s client.

Starting in November, the eight-hour training required for supervisors must be based on the Supervisor Training Curriculum Outline 2.0. The current training curriculum includes content for both supervision of trainees and ongoing supervision of RBTs and BCaBAs, but it does not distinguish the differences in expectations for both types of supervisee. The new curriculum distinguishes between items specific to trainees and items specific to those receiving ongoing supervision.

The newer version of the training curriculum also provides more explicit details of what supervisors must do in order to create an effective supervision experience. It includes a section on preparing for supervision and information about the outcomes of ineffective supervision.

The curriculum details how to deliver effective feedback and behavioral skills training. It also lists observable expected responses from supervisees during feedback sessions that are indicators of supervision effectiveness. Specific examples of products that demonstrate a supervisee’s application of knowledge are provided within curriculum items.

Perhaps one of the biggest benefits of this enhanced curriculum outline is the list of research and other resources. Behavior analytic supervision research is a newly emerging area of study, so there has not been a great deal of literature published to guide supervisors. This is beginning to change. Supervisors can look forward to more resources to use when providing both ongoing and trainee supervision.

The Impact of the Changes

Supervision is the process by which new professionals are ushered into the profession and those who provide direct services maintain and improve their skills and decision making. As the numbers of practitioners continues to grow, the need to clarify the definition of an effective ABA professional does also. The BACB’s changes to supervision offer both supervisors and supervisees a better understanding of practice expectations and an opportunity to do even a better job of serving clients and their families.

The post Changes to BACB Supervision: What You Need to Know appeared first on Relias.

Knowing how to prevent falls is an important responsibility for all home care providers, as falls are the leading cause of injury in older adults. Each year about one out of every four adults 65 and older falls, according to the National Institute on Aging. Tragically, falls lead to around 33,000 deaths every year in people over age 65, the Centers for Disease Control and Prevention (CDC) reports. The number of deaths from falls is increasing every year, and the CDC notes that the risk for falling rises with age.

Understanding common risk factors that contribute to falls and how to prevent falls is essential. Your organization should have clear guidance on assessing for falls risks, a falls prevention strategy, and proper training.

What Causes Falls?

Why are falls common among older adults? There is no single factor that is responsible for all falls. Older adults who have already had one fall are more likely to fall again. In fact, the best predictor for falls is a previous fall, according to Jill Jin, MD, MPH. A fear of falling is common as people get older, even for people who have never fallen. Older adults may start to limit their activities out of fear. This can lead to weak muscles and stiff joints. Both can affect how a person moves and keeps their balance.

Other reasons the CDC cites for falls in older adults are:

• Weakness
• Balance problems
• Movement issues
• Poor vision
• Blood pressure problems
• Chronic conditions such as:
  • Arthritis
  • Stroke
  • Diabetes
  • Parkinson’s disease
  • Dementia and other problems with clear thinking
  • Incontinence

Incorrect or unsafe use of a device such as a cane, walker, or wheelchair can put someone at risk for falling. Some medications have side effects that increase the risk for falls. Taking more than one medication also increases the risk for falls.

Conditions in the Home

There are also conditions in the home that increase the likelihood that an older adult may fall, including:

• No handrails on stairs
• Stairs that are steep or uneven
• No grab bars in the bathroom
• Tripping hazards, such as throw rugs, in walking pathways
• Walking surfaces that are slippery or uneven

Lighting is another environmental factor that can cause falls. Poor lighting or a strong glare from overhead lighting can be a problem. Some individuals have cataracts or glaucoma and may be sensitive to very bright light. Notice how individuals react when in different types of lighting.

It is also important to pay attention to the floor. Polished or wet floors and throw rugs, particularly those without non-slip backing, can lead to falls. Carpeting that is thick-pile, wrinkled, curled-up, or worn can be very hazardous, especially if the person uses a walker or a cane.

Addressing Risks

The keys to fall prevention are screening for fall risk and taking action in ways that address the risk factors that can be changed. Initiatives such as the CDC’s STEADI, which stands for Stopping Elderly Accidents, Deaths, and Injuries, can help with assessing fall risk, educating individuals, and selecting interventions.

A fall prevention program can be implemented after an individual is identified as being at risk. The success of a fall prevention program depends on you, the agency team, and the individual. The program should include exercise, medication reviews, vision checks, and an inspection of the home.

If the person’s home doesn’t accommodate their safety needs, they may need recommendations for changes. Your best approach is a sensitive, compassionate one, as items in the home may have great sentimental value.

Educating Yourself

Your role in fall prevention is to know why older adults fall, recognize hazards in the home that may cause a fall, support the fall prevention program, and know how to respond to a fall and report it.

Your agency policies and procedures will guide you in your role as you participate in a fall prevention program. It will outline:

• How and when risk assessment will be performed and by whom.
• Measures that should be taken for each individual.
• What to watch for.
• How to report your observations and concerns and to whom.

You can encourage each individual to take some responsibility for fall prevention by asking clients to stay active, use their prescribed assistive devices, use caution, and make choices that maintain or improve their health.

Responding to Falls

It is important to remember that despite a home health agency team’s best efforts, intentions, and interventions, some falls are unavoidable.

Your agency has its own system and structure for reporting falls. If you are ever in doubt about whether you should report a fall or how to document it appropriately, consult your supervisor for guidance.

Keeping the number of falls to a minimum is important for client safety but also for your organization’s quality measures and compliance record. With proper guidance and training, you and the rest of your team will be prepared to respond appropriately to falls risks and make each individual’s safety a priority in the home.

The post Assess for Risks to Avoid Falls in the Home appeared first on Relias.

Bethesda Lutheran Communities is a service provider for individuals with intellectual and developmental disabilities. The organization is based in Wisconsin but has programs in 13 states, serving more than 1,800 people.

In 2017, Bethesda launched its DSP Leadership Team to engage and empower its direct support professionals. DSPs who have been with Bethesda for at least a year can apply to join and must submit letters of support from their supervisor and a colleague. The team has one member from each of Bethesda’s nine regions. Team members receive a yearly stipend of $500 and are paid their hourly wage when attending or participating in team activities.

The stated purpose of the DSP Leadership Team is to “create transparent and constructive engagement between direct support professionals and regional/corporate leadership at Bethesda.” Its goals are to:

• Promote a collaborative relationship among DSPs and all corporate and regional staff
• Establish greater understanding and appreciation of different perspectives and to address employee concerns and issues
• Encourage, celebrate and recognize DSPs and provide an organization-wide network for DSP support
• Actively solicit employee feedback; evaluate and recommend strategies for improving employee engagement

We interviewed Mark Hagen, Bethesda’s Corporate Director of Public Policy, about the program.

Q: What was Bethesda’s thought process and goal when setting up the DSP Leadership Team?

A: We had been toying with the idea for a long time of how to better engage DSPs. We’re in 13 states, and one of the problems we have is that some of the DSPs who aren’t in the home state of Wisconsin where we’re headquartered feel alienated. We felt that selecting certain DSPs to come to Watertown, to meet with leadership, to have leadership talk to them, to see if there are problems unique to certain regions that maybe we’re not hearing about… Those are some of the concerns we were trying to address.

That was the genesis of the program. It was started by our CEO Mike Thirtle and our then-COO Lori Anderson. They thought this would be a good model to pursue, so we fine-tuned their ideas and rolled it out about two years ago.

Q: What have you been able to learn about the work and lives of DSPs through the Leadership Team?

A: Leadership, legislators, elected officials—as much as they say they understand what’s happening in the field, they don’t get it. They don’t understand the day-to-day challenges. They don’t know what it’s like to miss your child’s soccer game because the person who was supposed to relieve you at the group home not only didn’t show up but just quit. They’ve got these challenges in their personal lives that are exacerbated by worker shortages and staff vacancies in addition to the pressures of supporting the lives of human beings.

They said, “We know within five minutes if someone will be around in two weeks or not.” They feel like that’s always hanging over their heads because they’ll look at the schedule and say, “Well, that person’s scheduled and I bet they’re not even going to be here.” It’s surprising how really tuned in they are to who’s going to stay and who’s not because of their experience.

After talking with our HR department about what they think is important in a DSP—what attributes, what characteristics, what experiences—I think the Leadership Team feels like HR has a better idea of the type of candidate we’re looking for.

Q: What did the DSPs learn about the management and operations of Bethesda Lutheran?

A: For all of them, this is really the first time they’ve been immersed in the decision-making process—why decisions are made, how they’re made, and that programs aren’t rolled out just because we’re looking for ways to make DSPs lives more complicated, but that we’re trying to meet a government mandate or new reporting or auditing procedures. I think they have a better appreciation of Bethesda.

Before the first face-to-face meeting, I asked them to read the white paper on the DSP workforce crisis that ANCOR did. They were shocked. The comments, almost unanimously, were, “We just thought Bethesda didn’t know what it was doing. We didn’t know this was a national problem. We didn’t know all other providers were going through it.” While it didn’t make their lives providing supports any easier, it did change their perception of the organization.

As their understanding of the rationale that goes behind the processes and the policies increased, their eagerness to adapt to it and embrace it increased as well.

As a result of the conversations I had with the DSP Leadership Team, I decided to do a weekly newsletter that goes to all staff. It’s a public policy advocacy newsletter, where we talk about what’s working, how different states fund services differently. We’re really trying to do a better job of educating DSPs on how the system works, what it means to them, and better engage them in the process so they know what’s at stake. Our DSP Leadership Team is really driving some of our DSP advocacy efforts on the state level.

I developed an advocacy module that we use in DSP training in our Relias platform. As we look to our first transition to new DSP Leadership Team members (terms are two years staggered) we are looking at developing an onboarding and training module incorporating feedback from outgoing and existing team members.

Q: What kind of feedback have you received from the DSPs on the Leadership Team?

A: This will be the third November now they’ve come into town, to Watertown. Our CEO always makes sure he takes time to sit down and talk to them and let them know how much he appreciates the time and effort they’ve been putting into it. They have lunch with our board of directors who give them that same message.

They feel like it not only honors them but it honors their colleagues. I know they’re telling people about this team and really encouraging people to apply for a position on it. All of the members so far have found great value in it and feel much more valued as a member of the team.

The post How Bethesda Lutheran Turned DSPs into Leaders appeared first on Relias.

Infection prevention and control in post-acute care is an everyday job, but the potential negative outcomes are far from mundane. Paying vigilant attention to infection prevention is important if you don’t want to end up making the news for outbreaks like these:

• In a Vermont retirement community, Shigella sonnei caused an outbreak of diarrhea among residents, staff, and visitors in 2018, according to the Centers for Disease Control (CDC). Investigative information supported foodborne transmission, CDC noted, with cases identified among a staff member and visitors. Analysis predicted that the isolates were multidrug resistant. Of the 75 cases identified, two patients with serious comorbidities died, and six patients were hospitalized.
• A Nebraska long-term care facility experienced an outbreak of respiratory illness with cough and fever in 2014. Before it was over, 55 people became sick with symptoms matching the respiratory illness, 12 were hospitalized, and seven died, the CDC reported. Testing found Mycoplasma pneumoniae in 40% of specimens, and the illness affected residents, staff, and community members.
• In Colorado in 2012, an assisted-living facility had an outbreak of severe respiratory illness that led to three resident deaths. During the outbreak, CDC and health department investigations found two confirmed and five probable cases of pneumococcal disease in six patients and one staff member. Three of the resident patients died.

These are just a few snapshots of tragic outcomes that can occur when infection outbreaks hit residents of post-acute care facilities and the people who care for them and visit them.

Besides these devastating outcomes, the incentive to monitor safety practices and prevent infections comes in the form of federal rules as well. The Centers for Medicare and Medicaid Services (CMS) requires that long-term care facilities have an infection prevention and control program and an antibiotic stewardship program to comply with the Requirements of Participation (ROP). Starting in November, Phase 3 of the ROP as proposed requires facilities to have an Infection Prevention and Control Officer on staff who is designated to lead the infection prevention and control program and serve on the quality assessment and assurance committee.

Infection prevention and control is every team member’s job; yet Infection Preventionists (IPs) have specialized skills to lead the charge. As Amanda Thornton, RN, MSN, CIC, noted in a Relias webinar on the role of IPs in long-term care, they are trained to monitor the environment and people’s behavior, spot the risk factors, analyze data, and take steps to limit the spread of infection.

Eight Areas of Focus to Keep Your Patients and Staff Safe

Providing training can help increase awareness among all staff and increase your facility’s or home care setting’s defenses against healthcare-associated infections. These specific areas of training as they relate to infection prevention and control are of significant importance:

1. Infectious disease processes
2. Antibiotic stewardship
3. Healthcare-associated infections
4. Isolating precautions
5. Bloodborne pathogens
6. Multidrug-resistant pathogens
7. Hand hygiene
8. Safe food handling

As noted, the ROP requires skilled nursing facilities to have antibiotic stewardship programs, which are a key tool in the fight against infections. The CDC has identified seven core elements crucial to antibiotic stewardship:

• Leadership commitment to appropriate antibiotic use.
• Accountability among physicians, nurses, and pharmacy leads.
• Drug expertise gained by consulting with pharmacists or other experts.
• Actions to improve antibiotic policies and practices.
• Tracking antibiotic use and outcomes.
• Reporting to keep the team informed about antibiotic use and resistance.
• Education about antibiotic resistance for clinicians, nursing staff, residents, and families.

Strategies for Providing Care in the Home

Looking at post-acute settings outside skilled nursing facilities and assisted living communities, home health nurses also have infection prevention and control responsibilities. Similarly, home health agencies are subject to the Conditions of Participation (CoPs), which CMS updated in 2018 to require that an agency establish, document, and maintain an infection prevention and control program—as a component of its QAPI program—to prevent the transmission of infections and control communicable diseases.

Because home settings are less controlled environments and cultures and lab tests are not routine as in acute care, the infection risks are complicated by different factors. The CDC suggests home health infection strategies should focus on identifying patients at risk during wound care, respiratory care, infusion therapy, enteral therapy, and urinary tract care. Nurse education is key.

CMS and the CDC identify six standard precautions during patient care in the home:

• Hand hygiene.
• Environmental cleaning and disinfection.
• Injection and medication safety.
• Appropriate use of personal protective equipment.
• Minimizing potential exposures.
• Reprocessing of reusable medical equipment between each patient and when soiled.

Compliance depends on education about infectious diseases as well as on clinical skills. A study published in December in the American Journal of Infection Control found that home healthcare workers’ beliefs about infection risk were more important than knowledge about how to comply with infection prevention protocols in terms of their actions. The authors concluded that more efforts to educate nurses about infection risk would aid compliance in home health settings.

The study notes the importance of educating home health nurses about the efficacy of the influenza vaccine, hand hygiene protocols with nursing bags, and wearing personal protective equipment when anticipating contact with bodily fluids or blood products.

The charge to improve education, policies, procedural skills, tracking of compliance, and reporting on improvements is crucial to improving infection prevention and control efforts in post-acute care and keeping residents and clients infection-free and out of the hospital.

You can strengthen your team’s approach by assessing competence and providing training to keep everyone at their best. You want to ensure that your organization gets attention for infection prevention improvements, not tragic outbreaks.

The post Infection Prevention: Keep Your Organization Out of the News appeared first on Relias.

For many of us, our jobs give us a sense of purpose and an opportunity to contribute to our communities. The same is true for adults with intellectual and developmental disabilities.

Supported employment has helped countless adults with IDD and other disabilities work in their communities alongside peers without disabilities. Thanks to this important service, many people have been able to earn money and avoid or get out of poverty, which traps millions of people with disabilities who rely solely on government benefits for their income.

However, the astronomically high unemployment rate for people with disabilities persists, in part because supported employment does not work for all individuals. In the supported employment model, the individual must be able to do the job as outlined in the job description, with assistance from a job coach or support worker if needed, and must compete with other applicants for the position. This model leaves out many people who have a lot to offer an employer but who may not be able to meet all of a job’s qualifications or who may excel at some parts of a job but struggle with others.

Increasing Employment Opportunities

Customized employment takes the supported employment model and adds new tools and practices to increase employment opportunities. According to the US Department of Labor’s Office of Disability Employment website, customized employment is “an employment strategy which matches the skills and preferences of the individual with the specific business needs of the employer.”

The process begins with an in-depth examination of the job seeker’s skills, talents and interests. Our partner, Griffin-Hammis Associates, the leader in employment supports education and training, calls this process Discovering Personal Genius. After getting to know the job seeker, the employment support team determines the vocational themes, ecological fit and ideal conditions for employment, and they identify the contributions the job seeker could bring to a business.

Then the team looks for an employer who could benefit from the individual’s skills. Griffin-Hammis recommends that support agencies focus on building employment partnerships with local businesses, as opposed to national chains. Small, privately owned businesses often have the ability to craft a specific job for a specific individual without having to deal with a legal team and human resources department.

This is not a charity-based model; it is built around what most businesses focus on—making a profit. The team is looking to craft a position that allows the job seeker to use their talents to help the company make money.

A Negotiated, Noncompetitive Job

Using the information about the job seeker’s skills and interests, the job developer works with a local employer to negotiate a noncompetitive job. Let’s take an example from the Griffin-Hammis publication, Customized Employment: Stories and Lessons from the Field.

Customized employment enabled Albert, a man with autism, to get a job with a janitorial contracting company. He was assigned to do cleaning work in a department store after hours. The typical job description required workers to do multiple tasks throughout the store, including “completing floor maintenance, vacuuming, window cleaning, trash disposal and dressing room maintenance.”

Because Albert required consistency in his work and needed time to adjust to his surroundings, his job developer negotiated a modified job description for Albert. He worked on only one floor and had specific tasks on that floor. He also was responsible for cleaning the mops, buckets, vacuum cleaners and brooms that the rest of the crew had used.

The customized employment model allowed Albert’s team to create a position that put his strengths to work and benefited his employer. Because of his preference for doing solitary tasks, Albert didn’t mind cleaning his coworkers’ mops and other supplies, and doing so freed up his coworkers to do other tasks. Having Albert on the team was a win all around.

There are several ways to make a living in the world. Therefore, thinking in terms of job descriptions and job openings can be limiting. Customized employment starts with a wide open view of job creation and restructuring. Try to negotiate with employers while highlighting skills that match their customers’ needs, instead of looking at the same job openings everyone else is pursuing.

The post Creating Employment Opportunities for Adults With IDD appeared first on Relias.

World Mental Health Day is October 10 and this year the theme is suicide prevention.

World Mental Health Day may seem more like a public awareness holiday, but health care professionals play a large role in how we (the public) discuss mental and behavioral health issues. By raising awareness and reducing stigma, we make it easier for individuals to receive support and accept treatment.

This goes for all mental health issues, especially suicide, which is often a difficult subject to talk about.

World Mental Health Day 2019: Working Together to Prevent Suicide

This year, World Mental Health Day (October 10) is focused on suicide prevention. Suicide is a leading cause of death in the United States (second leading cause of death among individuals between the ages of 10 and 34) and is considered a global public health issue.

By bringing attention to suicide and suicide prevention, the World Federation for Mental Health (founder of World Mental Health Day) aims to dispel mistaken and prejudiced ideas about suicide and help our communities learn about risk factors and prevention tactics.

3 Ways to Bring Awareness to Suicide Prevention

Everyone can bring awareness to suicide prevention. No matter your role (doctor, nurse, clinician, social worker, HR manager, etc.), your efforts make a difference in reducing the stigma surrounding mental health and suicide. Here’s how you can get involved on October 10:

1. Take “40 Seconds of Action”

According to the World Health Organization, one person dies by suicide every 40 seconds. Below are ways you can turn 40 seconds into hope and awareness:

• If you’re having suicidal thoughts, take 40 seconds to talk to someone you trust about how you’re feeling
• If you’re taking a break at work, take 40 seconds to promote a mental health story on social media using the hashtag #40seconds
• If you’re a manager or leader of a team, take 40 seconds to let your staff and employees know about available mental health resources, either in your workplace or community
• If you know someone who has lost a family member or friend to suicide, take 40 seconds to ask how they’re doing
• If you’re a clinician or health care professional, take 40 seconds to review the risk and protective factors associated with suicide

Learn more about “40 seconds of action” and what you can do here.

2. Know the Suicide Risk and Protective Factors

Foundational knowledge on suicide prevention is important for all your staff. One of the most important things to know are the risk and protective factors for suicide.

Risk Factors for Suicide

• Family history of suicide
• Previous suicide attempt(s)
• History of mental disorders, alcohol, or substance abuse
• Feelings of hopelessness
• Isolation, feeling cut off from other people

Protective Factors for Suicide

• Easy access to various clinical interventions and support
• Family and community support
• Effective clinical care for mental, physical, and substance use disorders
• Having nonviolent problem-solving skills

Knowing suicide and protective risk factors helps your entire healthcare organization be more prepared in identifying, assessing, and managing risk effectively. You can read the full list of risk and protective factors here.

3. Implement Suicide Prevention Training

In addition to knowing the risk and protective factors for suicide, suicide prevention training should also be part of your staff’s onboarding and ongoing professional development. As new research develops, treatment models and assessments change, making continual training essential.

If you’re a manager or leader in a healthcare organization, check your existing training plans to see what is included related to suicide prevention.

If you’re a health care practitioner, there are a variety of online resources to help you learn more about suicide prevention. A few are: Mental Health First Aid, Zero Suicide, and the American Foundation for Suicide Prevention.

Work Together to Prevent Suicide

Suicide prevention doesn’t end on October 10—it’s only the beginning. Working together, we can make it easier for people to talk openly about mental health and suicide and accept support and treatment.

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741.

The post World Mental Health Day 2019: Working Together to Prevent Suicide appeared first on Relias.

Nurses make up the largest segment of the healthcare workforce—and while most nurses approach their careers with patient care in mind, many will unexpectedly transition into leadership roles. Unfortunately, it’s all too common for this “promotion” to arrive without adequate training, development opportunities, or sufficient support/mentorship.

The role of a nurse manager is undoubtedly one of the most challenging positions in healthcare today. With countless demands and new challenges, new nursing managers are rarely prepared for what lies ahead.

My Nurse Manager Journey

As a former nurse manager, I can honestly say that my time in that role taught me some of the biggest lessons I’ve learned so far in my career. I went to nursing school to start a second career after many years of education and experience in client service and business management. After additional education and clinical training, I was ready (or as ready as I could be) to hit the floor and care for patients. Still overwhelmed and learning new skills every day, I was grateful for the years of training preparing me for life as a nurse, and even more appreciative of the guidance and comradery from fellow nurses.

After two years as a critical care nurse in the ICU, I started a new role as a nursing recruitment and retention coordinator, focusing on coordinating efforts between nursing staff, administration, HR, learning and development, system leadership, and nursing schools to hire and retain top nursing talent for the hospital.

Less than a year later, I was approached with a nurse manager opportunity for float pool and central staffing. What seemed like the next logical step in advancing my nursing career led me to learn some of nursing’s toughest lessons.

Throughout my career, I’ve witnessed a distinct difference in management styles—those that are more institutional and high-level focused, and those that are more in-tuned with their frontline staff and day-to-day operations. I set out to blend both styles as a nurse manager.

Institutional Nurse Manager

Strengths

These nurse managers have a strong understanding of the big picture and focus on organizational goals (mostly likely set by the C-suite) and how they translate into their department. They have a knack for reporting and are skilled at keeping their unit/department within labor budget, while ensuring that supplies and equipment are ordered/maintained sufficiently. These leaders also make sure that staff compliance/education requirements are kept on schedule and use well-defined reporting processes to monitor the quality and satisfaction scorecards.

You may see these leaders spending much of their time on organizational teams and committees. They may also find themselves called upon for multidisciplinary taskforces to help lead health system initiatives above the scope of their specific unit. This type of leader’s visibility and ability to share their message at the highest levels of the organization are of great benefit to their unit.

Challenges

While the C-suite may recognize that an institutional focused manager is “checking all the boxes,” the nurses being managed by this type of leader might feel less support or appreciation due to the lack of manager visibility. Oftentimes, this organizational/high-level focused manager will focus too heavily on hitting budgets or deadlines via reports, without fully gathering concerns or feedback from the nurses in their unit.

These nurse managers may find that their engagement and satisfaction surveys are less positive, not because of unit performance or gaps, but merely from the disconnect that comes from spending less time with their staff.

Frontline Nurse Manager

Strengths

This type of “hands on” management approach isn’t afraid to step in and care for patients when the unit is short staffed, which doesn’t go unnoticed by their team. A frontline-focused manager is attuned to what’s concerning their staff and actively works to address those issues as soon as possible.

Nurses under this type of manager appreciate the dedication they see firsthand from this management style. Oftentimes, this manager was promoted from within their team and is considered a subject matter expert for all things in that unit. Managers of this type are often widely valued by staff and patients because they “know what it’s like” and “have been there.”

Challenges

With such a strong focus on the frontline needs of their unit, other goals or requirements of this style of nurse manager can suffer. These leaders perhaps haven’t built the relationships and connections with other leaders or departments to facilitate big picture change even when they recognize the need for a change.

Similarly, organization/system initiatives may be perceived as a burden as they are sometimes out of line with the challenges of their own unit. In a worst-case scenario, this manager may be underperforming in areas they (and especially their staff) are unaware of.

For example, a frontline-focused manager might concentrate on frustrations from nurses for being short staffed and bring in agency nurses to alleviate tension, only to go over budget for a temporary solution to a bigger problem. By building a strong connection with their hiring and continuing education departments, these leaders might instead fill their needs with longer term and stronger staff.

3 New Lessons to Meet in the Middle

After having experienced both institutional and frontline managers, I developed a strategy for success by implementing aspects of both. With that came lessons that I realized would need to be self-taught—and quickly.

1. Reports tell part of the story, people tell the rest:

Understanding the effects of being under or over budget and how both affect patients, staff, and the organization is invaluable. Nurses are not always prepared for managing budgets, utilization goals, quality metrics, and so on. This is a critical component to a successful nurse manager. You must learn to gather the story from the people and the paper for the full picture.

2. Communication with C-suite leaders and frontline staff:

An effective nurse manager needs buy-in from their staff and their leaders. Your unit’s goals and expectations need to be clearly outlined for all stakeholders in the organization in a clear, concise format.

3. Collaboration is key:

Learning how to partner with other units/departments to help solve your problems is an example of working smarter not harder. From the sharing of staffing resources, supplies, and tools, to driving organizational change for better patient flow and safety—collaboration will only help strengthen your unit and the organization.

How Relias Can Help

As the national leader in holistic healthcare assessments, Relias Assessments empowers nurse managers to leverage assessments to make informed hiring and placement decisions thereby helping them achieve better long-term nurse success, satisfaction, and retention. Assessment data helps nurse managers identify developmental areas, continuously measure competencies, and cultivate future leaders.

Additionally, CE Direct (known for its reputation as the leading provider in continuing education) offers a wealth of knowledge to nurse managers on management and leadership education, including:

• 100+ courses specific to management and leadership training for nurses, such as Developing Your Leadership Potential and Coaching: An Essential Skill for Nurses.
• Certification Review courses on nursing’s most popular topics to help nurse managers self-prepare for certification exams, prepare for recertification, and earn CE hours while improving knowledge.
• Focused CE Series on Nursing Preceptor Specialty Practice to maximize nurses’ knowledge in preceptoring. Topics include boundaries between preceptor and preceptee, critical thinking, time management, evaluation of competency, goal-writing, constructive feedback, patient/family engagement, HCAHPS, NDNQI, and more.

For more information on developing your team’s leaders, download the white paper below.

The post The Two Types of Nurse Managers and the One to Strive For appeared first on Relias.

Have you ever tried something new against the advice of your parents or other family members? How did it work out? Maybe the experience revealed new opportunities to you and changed the course of your life. Maybe it was a disaster, and you had to deal with the consequences.

That’s self-determination—the right to make decisions about your life (even if, in retrospect, they were bad ones). Many individuals with intellectual and developmental disabilities (IDD) don’t get the chance to make such decisions. Often, their parents, support workers or case managers make decisions about fundamental parts of their day-to-day lives, like where they live, what they do and who they spend time with.

IDD service providers have a responsibility to promote self-determination, support choice-making and empower the people they support. Direct support professionals (DSPs) should provide the appropriate support and education so people can safely and successfully make choices in their lives.

Empowerment Matters

In order to empower the individual served, a DSP should actively listen to and honor the individual’s choices—even if they feel the individual is making the “wrong” choice.

The process of empowering another person is like building a strong tower of bricks. As more bricks are put in place, the more empowered the person becomes. Here are the six building blocks for creating a strong foundation for empowerment.

1. Increase Life Experiences

The amount and variety of direct experience a person has affects that person’s ability to make decisions. Not allowing an individual with IDD to have a range of life experiences diminishes their ability to make well-informed decisions.

A DSP should help to expose the individual they support to a variety of activities, places and people to build their range of experiences. Then the DSP can help the individual translate those experiences into knowledge that will create confidence and thoughtfulness in decision-making.

2. Build Self-Esteem

Many people with disabilities experience low self-esteem, which can prevent them from asserting their needs and wants. Here are some ways DSPs can help the people they support build their self-esteem:

• Promote self-care, like eating healthy foods, drinking enough water and getting exercise. These activities can boost an individual’s mood and help them feel empowered to do more.
• If the person you support says negative things about themselves, like “I’m stupid” or “I can’t do anything,” help them replace these thoughts with more positive or constructive messages, such as “I’m learning” or “I need help.”
• Make sure they are participating in activities they are talented in and enjoy. Expose them to new activities where they might be able to build a new talent or skill.
• For people with IDD who receive services, it can be empowering to serve others. Volunteer activities, such as delivering Meals on Wheels, picking up litter or spending time at an animal shelter, can boost self-esteem.

3. Develop Assertiveness

Assertive communication means a person is able to stand up for their own desires and rights and can express themselves honestly without hurting others. People using assertive communication are honest about their feelings and use direct statements to express what they mean.

The person being supported needs to know they have the right to say “no” or “I don’t know,” express their opinions and feelings, change their mind, and make decisions and deal with the consequences. Most people who are learning to use assertive communication skills benefit from role-playing where they can practice the skills in a safe environment with a safe person.

4. Enhance Capabilities

Focus on nurturing the natural abilities, gifts, strengths and unique characteristics of the person being supported. Doing so can maximize their capacity and potential.

5. Provide Choices

True empowerment can only be achieved when people have real choices and options that are consistently available to them. The greater the number and variety of options, the more empowered a person can become.

6. Maximize Support

This doesn’t mean providing the maximum level of support! Rather, DSPs should gauge the level of support they provide to maximize empowerment. Levels of support range from direct and immediate intervention to guided facilitation to no intervention at all.

An Evolving Empowerment Process

When creating supports for people, it is important to understand that it can be a “trial and error” type of process. If one type of support does not work, then it is up to the individual and their support team to work together to create or find another one.

In order to help the person to achieve the greatest amount of control, DSPs will need to be flexible and willing to accommodate a much larger degree of uncertainty than would exist if the DSPs were deciding the routines, activities and schedule for people they support. They will also need to be creative in the ways they help, support and empower these individuals.

The post The 6 Building Blocks of Empowerment in IDD appeared first on Relias.

Marijuana has been used for thousands of years for both medicinal and religious purposes by cultures all over the world. Medical marijuana, also known as medical cannabis (MC), has been legalized in a growing number of states and is useful for many symptoms experienced at the end of life, such as pain, muscle spasms, anorexia and nausea/vomiting.  Despite widespread use, MC is not legal at the federal level. Hospices, through the Hospice Medicare Benefit, are largely funded with federal dollars, creating uncertainty and variability in how requests for MC are handled among hospice professionals.

“A Survey of Hospice Professionals Regarding Medical Cannabis Practices,” co-conducted by clinicians at Enclara Pharmacia and the University of Maryland, Baltimore, and recently published in the online Journal of Palliative Medicine, set out to uncover attitudes on this subject among hospice professionals across the country.

Gathering Data

Designed to determine respondents’ comfort level with MC use in hospice, the survey examines what processes and logistics hospice programs are employing when dealing with MC, and determines what, if any, education hospice programs are providing to their staff.

At the time that this survey was conducted, plant-based cannabis was legal for medical use in 33 of 50 U.S. states and the District of Columbia. The research team tested the survey for errors and made revisions through a collaborative process. The instrument consisted of a series of multiple-choice questions with opportunities for free text commentary.

Overwhelming Results

According to respondents, 91 percent support MC use for hospice patients. However, those same respondents reported that it is rare for hospice physicians to register as an MC practitioner in their practice state to issue certifications to patients and provide recommendations.

Eighty-four percent of respondents believed health care professionals would benefit from standardized protocols to better manage MC in their organizations, especially because it is common for patients or family members to inquire about MC, with 90 percent saying they have fielded questions from patients.

According to respondents, MC is mostly successful in reducing nausea/vomiting, pain, and anxiety. Despite these benefits, for now, barriers to MC use in hospice care include discordant legal status between state and federal governments, questions about clinical efficacy and safety, lack of access, regulatory concerns, misinformation, and other societal factors.

Nevertheless, hospice staff overwhelmingly support patient access to MC. Furthermore, those who practice in states where MC is not yet legal wish that it was. In order to better understand how MC could one day be commonly used in hospice, additional policies, regulations, education, and resources are needed.

Learn More

If you are interested in learning more about medical marijuana and its use in hospice, view our educational webinar.

Additionally, you can view the full Journal of Palliative Medicine article, “A Survey of Hospice Professionals Regarding Medical Cannabis Practices,” authored by Ryan C. Costantino, Natalee Felten, Marisa Todd, Terri Maxwell and Mary Lynn McPherson, here.

Special Thanks to These Authors For Contributing to This Post

Ryan Constantino, PharmD, BCPS, BCGP
Director of Pharmacy Clinical Decision Support, Defense Health Agency

Terri Maxwell Ph.D, APRN
Chief Clinical Officer, Turn-Key Health

Mary Lynn McPherson, PharmD, MA, MDE, BCPS, CPE
Professor and Executive Director, Advanced Post-Graduate Education in Palliative Care in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy in Baltimore

Natalee Felten, PharmD, BCPS
Managed Care Clinical Pharmacist, PerformRx

The post Medical Cannabis (Marijuana) Significantly Backed by Hospice Professionals in Survey appeared first on Relias.

Most of us have a love-hate relationship with change.

We hate monotony. We become bored with the same old, same old.

We love the excitement of something fresh. We revel in new accomplishments.

Yet change is scary.

When faced with an overhaul in our professional or personal lives, we become anxious about the new expectations. We fear the unknown.

Shifting Landscape

Expectations are surely shifting in the healthcare environment. Home health agencies are gearing up for the Patient Driven Groupings Model (PDGM). Skilled nursing facilities are adjusting to the Patient Driven Payment Model (PDPM) and Phase 3 of the Requirements of Participation (ROP). And hospice organizations are facing increased scrutiny on care and billing.

The recent PDPM, ROP, and PDGM regulatory updates may mean changes in procedures, billing, staff and clinician teams, patient acuity levels, and clinician skills—all of which can all add up to a culture shift.

In an industry forecast, 2019 Global Health Care Outlook, the management consulting firm Deloitte notes that this year’s challenges have included ensuring regulatory compliance; recruiting, developing, and retaining talented clinicians; and maintaining financial strength amid an uncertain health economy.

As shifting expectations continue in 2020, leaders and clinicians alike will need courage to break out of familiar patterns and view these changes in a positive light. They will need to work collaboratively to succeed in meeting evolving client needs, reduce risk, and remain competitive.

Choosing Your Response

You might not have a choice about adapting to new regulatory requirements. You must conform.

But you do have a choice about how you view those new expectations and what you do because of them. Instead of staying as close as you can to your professional comfort zone, you can choose to transform.

In her Netflix documentary, “The Call to Courage,” Brené Brown talks about the challenge of choosing courage over comfort when faced with difficult situations. In a blog post adapted from her book, Dare to Lead, she explains: “Courage and fear are not mutually exclusive. Most of us feel brave and afraid at the exact same time.”

Culture shifts in post-acute care organizations can inspire the same feelings. Often, we know some good will come from the changes, and that we need to be brave as we face up to them. But it’s not easy.

As Brown acknowledges, it’s human nature to pull back into self-protection mode when faced with challenging situations. Instead, she advocates staying curious, keeping an open mind, and seeking understanding.

If you view the change as something being done to you, you’re more likely to resist and complain. That’s self-protection; that’s opting for comfort.

Instead, get curious about how these new expectations will help you grow as a professional and provide better care. Try focusing on the good that will come from this change—for you, your patients or clients, and your organization. Find a way to truly transform.

An Optimistic Viewpoint

In “The Power of Positivity,” Nina M. Flanagan, a professor and geriatric nurse practitioner, notes that recent healthcare industry developments are giving rise to negative emotions.

“The outside influences—changes in ownership, reimbursement, and regulations—have been profound and continue to rapidly shift. Our workplace environment feels unstable, and instability can invoke fear and anxiety,” she says.

In this environment, cultivating a positive outlook can create powerful ripples. “Being positive and reframing these situations can help to decrease some of the fear and anxiety,” Flanagan asserts.

It starts at the top, with leadership setting the tone. “Positive energy attracts,” she asserts, and the multiplying energy will create productivity.

When you approach a change as something you’re empowered to do to make your life and your patients’ lives better, you’ll feel excited. Think about ways you can help your team members feel empowered by the change as well.

That’s the high-level way of looking at change. But you still need to map out practical steps to achieve a successful transformation.

Strategies for Wrangling Change

In order to shape the required changes into desired goals, you’ll need to focus on six key steps:

1. Sharing the change vision.
2. Planning for implementation.
3. Communicating plans and progress.
4. Connecting to meaningful outcomes.
5. Nurturing a positive culture.
6. Celebrating successes.

How do you execute on each of these six steps? Let’s take a deeper dive and find out:

1. Sharing the Vision

At the start, you’ll need to craft a clear vision.

• Identify what the end result will be and what success will look like.
• When introducing the change, share the Ws—why you’re making the change, what initiated it, and where it will lead your organization.

2. Planning for Implementation

You need a detailed and coherent plan for implementing the change.

• Break it down into task assignments.
• Appoint task owners and implementation teams.
• Set deadlines and reinforce them.
• Schedule stakeholder meetings to report on progress.

3. Communicating Plans and Progress

Communication should reinforce leadership and organizational commitment to the change.

• Meet in large and small groups, by teams and by job roles to support a shared vision.
• In meetings and one on one, discuss potential pitfalls and solicit solutions.
• Note accomplishments at each step along the way.
• Keep emphasizing what the team is doing right.

4. Connecting to Meaningful Outcomes

To enhance buy-in, connect the vision to values and purpose at the individual level.

• Explain how the change will help staff members do their jobs better.
• Share authentic anecdotes of similar challenges, achievements, and insights.
• Emphasize how the shift will improve patient and client outcomes.

5. Nurturing a Positive Culture

Amid the shifting landscape, you will encounter peaks and valleys. Engage all levels of the organization to nurture a positive culture.

• Model and emphasize kindness amid uncertainty and stress.
• Coach employees through the low points, emphasizing what they’re reaching for.
• Keep an eye on workloads and adjust as necessary.
• Help alleviate change anxiety through staff-initiated social activities.
• Reiterate your confidence in the team to achieve the goals.

6. Celebrating Successes

Along the way, find public and private ways to recognize individual contributions and team progress.

• Share success stories, and encourage colleagues to congratulate one another.
• Regularly express appreciation to individuals for the extra effort involved in implementing new practices.
• Provide regular updates on progress, using data and positive client feedback.
• Applaud the accomplishment of milestones with authentic praise and team rewards.

The post Courageous Change: Don’t Just Conform, Transform appeared first on Relias.

On October 10, (World Mental Health Day), Dr. Christine Moutier, Chief Medical Officer at the American Foundation for Suicide Prevention and Dr. Christopher Reist, Professor in Residence at the Department of Psychiatry and Human Behavior at the University of California at Irvine, shared an overview on the current state of suicide in the United States.

They covered topics like:

• Current trends and advocacy efforts in the United States.
• Evidence-based best treatment practices in suicide prevention and treatment.
• Gaps in suicide prevention and treatment as well as potential solutions.

With over 500 attendees across a variety of health care settings, we received several thoughtful questions about how practitioners can implement suicide training, policies, procedures, and more at their organizations. Below are the top questions we received, answered by Dr. Moutier and Dr. Reist.

If you missed the webinar, you can watch it on-demand here.

14 Questions and Answers from the Suicide Prevention: Science and Trends Webinar

1. What does suicide exposure mean?

Suicide exposure refers to the situation when a particularly vulnerable individual with pre-existing suicide risk factors experiences the suicidal behavior or suicide death of a peer, like in the case of a youth in school or of a celebrity through stories in the media. The research is very clear about the elevated suicide risk this can introduce for vulnerable individuals.

We also think about portrayals of suicide and mental health struggles in fictional entertainment and how positive messages of seeking help and mental health treatment can lead to a positive outcome, but contagion is also a potential concern with highly graphic or glamorized portrayals of suicide.

2. What is the best universal screener for suicide?

This depends on the setting and patient population. Please see The Joint Commission’s Suicide Prevention Portal for recommended instruments and screening tools.

• For pediatric settings, an evidence based screening instrument is the ASQ.
• For adult patient populations in emergency medicine, the Patient Safety Screener (PSS-3) is a screening instrument used in the ED-SAFE study with positive feasibility and effectiveness.
• In general medical or primary care, PHQ2+item 9 or the PHQ9 are appropriate screening instruments. The problem with the PHQ2 alone is that while it may be reasonable for detecting likely major depressive disorder (MDD), suicidal ideation can be missed. Not all patients who are suicidal are suffering from MDD.

3. Can you talk about the role of schools?

Schools play a critically important role in the community “safety net for suicide prevention,” since school personnel, including teachers and other staff, have eyes on our youth for many hours of the day during the school week. Plus, they are communities and have a structure where teachers, administration, counseling offices and school psychologists can all serve in a coordinated fashion to detect risk and provide a way for students to receive support within and outside the school.

Please see the Model School District Policy on Suicide Prevention for more details and please provide it to any school leaders you know. It is considered the gold standard for helping schools develop their suicide prevention policies and procedures.

4. You mentioned the role of technology in treatment. Can you give some examples?

Technology is being used in numerous, promising ways related to suicide prevention. Some examples include:

1. Telepsychiatry and telehealth to provide CBT and other MH treatments to people who may not otherwise be able to access mental health care.
2. Online therapy programs, like Mood Gym, that provide CBT and other forms of risk-reducing therapy. Example: Srijan Sen’s group found suicide ideation risk reduced by 40% in a medical intern cohort with exposure to four sessions of online CBT prior to the start of internship.
3. Smartphone apps, like MY3 and notOK, have safety planning built into the app.

5. Can you speak a little more on antidepressants and the increase in suicide?

After the FDA issued the “black box” warning in 2003 and especially in the lead-up to that period, there was a media frenzy which appears to have led to an unintended consequence of less diagnoses of MDD, less treatment of MDD with medications and without commensurate spillover to increased therapy referrals, and an increase in suicide attempts for the youth and young adult age populations in the U.S. Lu et al. BMJ 2014

6. What are some resources that school counselors could access?

The American School Counselor Association (ASCA) is a colleague organization of the American Foundation for Suicide Prevention (AFSP). A good resource is the Model School Policy for Suicide Prevention, which we worked on with ASCA, NASP and the Trevor Project. It includes template language for school policies on suicide prevention. There’s also this set of school suicide prevention resources.

7. Have you considered housing authorities as another viable location or source for identifying suicide since they have large consolidated populations?

Absolutely. There are many well-poised roles to help identify individuals who are struggling or suicidal.  Some examples include educating gun retailers, staff in animal shelters, and financial counselors. These were also considered as part of the analysis for Project 2025, which aims to bend the curve and reduce the national rate of suicide by 20% by 2025. But, to make the cut for inclusion in Project 2025, there needed to be at least some amount of research data that showed suicide risk reduction of a particular intervention that could be utilized in each setting.

8. When you use the term “lethal means removal,” are you mostly referring to firearms or are there other lethal means that come to mind?

Lethal-means restriction or counseling refers to making the home or workplace safe from all available lethal means. In a gun owning home, that definitely includes firearms storage outside the home or at least locking unloaded guns with ammunition either out of the home or in a secured, separate location from the guns. Guns can also be dismantled temporarily and locked up that way.

It also includes removing or locking up medications and other toxic substances, like bleach and others. Here is a training for clinicians called Counseling on Access to Lethal Means (CALM) that can provide more insight and information.

9. What can law enforcement agencies do to start an effective intervention program that will be accepted by police officers who tend to not want to deal appropriately with this issue?

There are numerous trainings and education resources available for law enforcement. One example is Talk Saves Lives, which is a in person one-hour suicide prevention education program that you can request from an AFSP chapter to deliver to a law enforcement organization. At AFSP, our chapters are delivering this to many law enforcement groups around the U.S. To find the nearest AFSP chapter, visit https://afsp.org/our-work/chapters/find-your-chapter/

There are also other models too, such as embedding a mental health clinician within the police unit.

10. What are your thoughts on educating high school students on suicide prevention?

High school students are now considered old enough to learn about suicide prevention when the curriculum content is designed by experts with safe language and messages for youth. It is also recommended to teach youth about depression and mental health.

11. What is a good way for a peer recovery specialist to promote suicide awareness and prevention?

They could start by inviting their local AFSP chapter to provide community education on suicide prevention and to request a Talk Saves Lives presentation.

12. Are corrections facilities more susceptible to having suicides?

Yes, suicide is a leading cause of death in jails and prisons. You can learn more about efforts in correctional settings to prevent suicide as part of AFSP’s Project 2025.

13. Where can I get more information on the other health factors that are part of the “perfect storm?”

If you bring AFSP’s one-hour education program to your site, the first half of the program focuses on this topic. The second half is on understanding the risk factors of suicide and what you can do if you’re worried about someone who may be showing signs.

14. It is well known that medication has serious adverse effects, including antidepressants, antipsychotics, etc., that are prescribed to patients who have attempted suicide. Some side effects of these medications include a more depressed mood and other mental illnesses. How do you reconcile prescribing medicine to patients who have attempted suicide, considering these adverse effects?

When used appropriately, medications can improve not only the primary psychiatric condition, but the suicide risk of patients as well. That said, some patients may have side effects in the early phases of treatment that should be closely monitored, like sleep disruption or agitation. It’s highly important to closely monitor and encourage communication with patients’ families, with you, or with the treatment team, particularly during initiation and changing doses. Primary care can also treat depression and anxiety very appropriately in most instances, if they use a model of seeing the patient back and evaluating the both the therapeutic and side effects, as they would when treating any health condition.

Additional Resources on Suicide Prevention and Training

• American Foundation for Suicide Prevention
• Suicide Prevention Resource Page
• [Sample Course] In Session: Suicide Assessment and Intervention for Adults

The post 14 Questions and Answers From the Suicide Prevention: Science and Trends Webinar appeared first on Relias.

The opioid epidemic has received a lot of national attention in recent years between the deaths of high-profile celebrities and the lawsuits against pharmaceutical companies. And while progress has been made in legislation and funding initiatives to help health care providers address the opioid epidemic in their communities, opioid-related deaths have increased steadily every year since 1999.

A 2018 study by the National Center for Health Statistics showed that there were over 47,600 deaths related to opioid overdose in 2017, which is six times higher than it was in 1999. It was also in 2017 when the Department of Health and Human Services (DHHS) declared the opioid epidemic a public health emergency. One thing learned for certain over the past two decades is that medication-assisted treatment programs work in helping patients struggling with opioid addiction. MAT is a lifesaving option for the over 2 million people in the U.S. who have an opioid use disorder.

But First: What Are Opioids, Anyway?

With all the talk about opioids and their effects, many people still do not know which types of drugs would be classified as an opioid. Common opioid prescriptions include fentanyl, codeine, morphine, oxymorphone, hydrocodone, and oxycodone. These are still being used by patients across the U.S. every day for issues ranging from chronic pain and cancer treatment to post-surgical recovery. Heroin is never used as a medicine in the U.S. and is considered one of the most dangerous opioids.

Methadone and Buprenorphine, which are commonly used in medication-assisted treatment (MAT), are classified as opioid agonists, meaning they stimulate the same opioid receptors in the brain. While it may seem counterintuitive to use opioids as part of a MAT program, these medications can actually help prevent withdrawal symptoms from and cravings for other opioids because they have to be taken using a strict regimen, they typically work slower than other opioids like heroin, and they do not produce the same sense of euphoria.

Why Medication-Assisted Treatment?

For individuals struggling with opioid dependence, MAT can provide relief from withdrawal symptoms, opioid cravings, and in many cases, can treat and prevent opioid overdose. MAT has also been shown to help many of these individuals lead healthier, more productive lives. The four types of medications approved for use in MAT programs are:

Methadone

The most widely known MAT medication, methadone has been used for decades to treat opioid addiction, particularly heroin. It is almost always administered in a controlled clinic setting under the supervision of a prescribing provider. Methadone can be addictive and must be taken as prescribed to prevent overdose or misuse.

Buprenorphine

Approved by the Food and Drug Administration in 2002, buprenorphine can be prescribed to a patient by a qualified physician or prescribing practitioner in a variety of treatment settings, which has significantly expanded access to treatment. Buprenorphine has a “ceiling effect,” meaning that beyond a moderate dose, the effects of the medication do not increase, which minimizes the risk of misuse or dependence.

Naltrexone

Unlike methadone and buprenorphine, naltrexone does not activate opioid receptors in the brain, rather it reduces opioid cravings by blocking the experiences of euphoria or sedation—essentially preventing the feeling of getting high. Naltrexone also has no potential for abuse, but for it to work patients must be opioid-free for at least seven to 10 days.

Naloxone

More popularly known as Narcan, naloxone is used in emergency situations for an opioid overdose. It can be prescribed by a provider and is commonly carried by first responders. Naloxone can be a lifesaving intervention by reversing the effects of an opioid overdose. Naloxone is only effective if there are opioids present in the patient’s system but is not effective for non-opioid overdoses.

Importance of Whole-Person Care

As the name implies, medication intervention should only be one component of MAT. It is widely accepted in the healthcare community that attending counseling and community support groups along with medication is the gold standard for treatment, and this is strongly advocated for by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Under federal law, MAT patients must also receive other medical, counseling, and social support services including educational and vocational support. This combination of services helps give patients the best chance at full recovery and a meaningful life. An integrated care approach is the best way to promote the whole-person treatment needed to help patients stay in recovery. There is a growing trend across the country of delivering these services in the same clinic using a comprehensive treatment team including physicians, therapists, social workers, nurses, and peer support specialists.

Outcomes and Effectiveness

Studies show that for many patients MAT programs can help them stay in recovery longer and have better health and quality of life outcomes. While relapse is always a risk for patients with opioid dependence, MAT intervention substantially decreases this risk. And at the forefront of the fight against the opioid epidemic, MAT intervention can even be lifesaving.

Advocacy groups, professional mental health organizations, and even state and federal legislation have all continued to push for more access to and funds for MAT programs, resulting in an increase in MAT services across the U.S. However, there are still gaps between the treatment needed and the capacity to provide treatment.

Access Challenges

There is a large gap in the U.S. between the number of individuals who meet the clinical criteria for opioid addiction and those who receive MAT due to challenges that prevent access to care. These challenges include stigma and insurance coverage, but also training and coordinated care:

• Restrictions on who and where MAT can be administered may result in a treatment center’s inability to accept new patients.
• Some treatment centers do not carry all MAT medications, which limits options.
• Some patients are refused administration of MAT medication, particularly in rural communities, due to a lack of coordinated care with mental health professionals.

The Need for Competent Care

The complicated nature of opioid addiction means that individuals struggling with opioid dependence are often the most vulnerable and most in need of care. These individuals need competent, compassionate health care providers and communities who are equipped with the knowledge to support them throughout the treatment process and connect them to resources needed for the best possible outcomes.

If you have provider staff who address, prescribe or treat clients who use and/or misuse opioids and you’d like to improve their competence in these areas, read the fact sheet below.

The post The Value of Medication-Assisted Treatment in the Fight Against the Opioid Epidemic appeared first on Relias.

While awaiting final guidance from the Centers for Medicare and Medicaid Services (CMS) on Phase 3 of the Requirements of Participation (ROP), skilled nursing facilities (SNFs) can still move forward with efforts to ensure that they have qualified staff leading and working in food and nutrition services at their facilities.

Although CMS has not issued final guidance on designating a director of food and nutrition services and the qualifications required for that role as we publish this post, the intent of the Phase 3 guidance is clear. CMS wants to ensure that food service programs at SNFs are led by qualified individuals who can give nutrition and food safety appropriate attention to protect the well-being of SNF residents.

Credentials and Training

The current situation is that CMS in July proposed altering Phase 3 of the ROP in some aspects, including easing the credential requirements for food service directors. The original Phase 3 wording, issued in 2016, requires SNFs to have a designated director of food and nutrition service with appropriate credentials and ensure that food service staff have adequate training and guidance in meeting food safety and dietary needs of residents.

In the proposed Phase 3 alteration, CMS notes:

Specifically, regulations at § 483.60(a)(2)(i) state that if a qualified dietitian or other clinically qualified nutrition professional is not employed full-time, the facility must designate a person to serve as the director of food and nutrition services. Under the existing regulations, the director of food and nutrition services must be a certified dietary manager; a certified food service manager; have similar national certification for food service management and safety from a national certifying body; or have an associate’s or higher degree in food service management or in hospitality (if the course study includes food service or restaurant management).

The original Phase 3 guidance says a person who was designated as a director of food and nutrition services before November 28, 2016, will have five years to obtain those specific credentials, and someone appointed to that role after that 2016 date and before the November 28, 2019, implementation date will have one year to obtain the credentials.

The rule change CMS proposed in July adds more flexibility on the director’s credentials, requiring that the person have a minimum of two years of experience in a director of food and nutrition services role or have “completed a minimum course of study in food safety that includes topics integral to managing dietary operations such as, but not limited to, foodborne illness, sanitation procedures, and food purchasing/receiving.”

According to CMS, the proposed change recognizes that the earlier education and credential requirements “may have subjected facilities to unnecessary burden and increased costs.” CMS also noted, “We understand that facilities are concerned about a workforce shortage of certified dietary managers and the financial costs imposed on existing experienced staff to obtain specialized training.”

Person-Centered Care

Regardless of how the rule finally shakes out, it is in the best interest of SNF leaders to ensure food service teams have proper training in these areas and more.

Aligned with the ROP’s focus on person-centered care, nutrition needs and preferences vary for each resident. In general, caloric intake recommendations shift with age and physical activity levels, as noted in the 2015-2020 Dietary Guidelines for Americans.

Nutrition considerations are part of the care plan developed by the comprehensive care team, which under the ROP explicitly must include a member of the food and nutrition services staff, a nurse aide, and a social worker in addition to the attending physician and a registered nurse responsible for the resident’s care.

Aligned with person-centered care, menu plans should consider specific cultural, religious, and ethnic needs and preferences of residents, as Jayne Warwick, RN, HBScN, of PointClickCare notes in a Relias webinar on Phase 3. Food and beverage options should consider residents’ needs related to allergies and intolerances, and staff should ensure that residents have adequate hydration.

Food choices are vital to managing comorbidities such as diabetes and Parkinson’s disease, and nutritional interventions should be considered when caring for people with Alzheimer’s disease and other conditions frequently encountered with elderly patients. Researchers also note that nutritional deficits and insufficient dietary intake can increase the risk of developing pressure injuries.

Foodborne Illnesses

Beyond what is served, the way it is served also requires staff training. Food safety education is crucial, as foodborne illnesses are dangerous to older people, who may have multiple comorbidities and lowered immunities. Foodborne illnesses circulating in a nursing facility can pose risks not only to residents, but also to visitors, staff, and others in the community with whom they interact.

About 48 million people a year become ill from foodborne illnesses, according to food safety information from the CDC on foodborne illnesses and germs. Of those, about 128,000 may be hospitalized and 3,000 may die.

Older adults and people with weakened immune systems are more likely to develop foodborne illnesses, CDC notes. Medical conditions such as diabetes, liver disease, kidney disease, organ transplants, HIV/AIDS, and receiving chemotherapy or radiation treatment are factors contributing to weakened immune systems.

To prevent foodborne illnesses, the director of food and nutrition service also will need to work collaboratively with the facility’s infection preventionist to ensure that proper infection prevention and control protocols are followed by food service staff.

According to the CDC, the top five germs that cause foodborne illness in the United States are:

• Norovirus
• Salmonella
• Clostridium perfringens
• Campylobacter
• Staphylococcus aureus

Competency Assessments

With so many aspects of food service and nutrition affecting the health of SNF residents, providing targeted education and competency assessments can protect SNF businesses, residents, staff, and visitors.

Regardless of the CMS final decision on Phase 3 requirements, it pays to prepare your staff by assessing competency and providing learning to fill any gaps in knowledge about nutrition and food safety. It reduces risk to all.

The post Hurry Up and Wait? Train Now for Nutrition and Food Safety appeared first on Relias.

Giving attentive care day in and day out can sap the energy of even the most dedicated caregivers. These unlicensed professionals provide support to clients in multiple ways. To fuel motivation, caregivers need to know they are supported by their care coordinators and organizational leaders in turn.

Recognizing and addressing the challenges faced by unlicensed professional caregivers can mean the difference between engaging those staff members and allowing them to drift out the door to another job.

Whether they are called home care aides, certified nursing assistants, unlicensed assistive personnel, homemakers, personal care assistants, or personal care aides, unlicensed caregivers provide unskilled services that address the needs of clients who are unable to take care of their own hygiene, nutrition, or living space without help. They also provide companionship.

Their role and typical duties may vary in different settings, all guided by a plan for care. Never forget how important they are in helping your clients live as independently as possible.

Supporting Professional Caregivers

Stress on professional and family caregivers can be intense. November is designated as National Family Caregivers Month, to honor those who support aging parents, ill spouses, and other loved ones with disabilities.

The professional caregiver’s role includes providing respite and support to family caregivers. Keep in mind, though, that the professional caregiver needs support too, and can benefit from stress relief strategies.

Effective leaders and high-performing organizations will find ways to refuel their caregivers by showing them they care. Consider these five strategies for fueling caregiver engagement:

1. Ask for feedback.

Use informal or formal surveys to find out what resources caregivers believe will help them improve the care they provide, their motivation, and their job satisfaction. You’ll find different ideas about what benefits or supports are desired. That can help you determine an appropriate array of strategies to keep caregivers engaged in their work and your organization.

2. Provide effective onboarding.

Provide welcoming and informative orientations, conduct insightful prehire assessments, and assign targeted education so you can build competence and confidence from the start.

3. Offer professional development.

By including continual online education and skills training opportunities as part of the total employment package, you can build a better and brighter team and combat turnover, as Relias client American Health Partners notes. If caregivers are interested in gaining certifications, you can support their future career paths via online learning.

4. Actively promote staff well-being.

Institute a wellness and fitness program, offering information, training, and incentives for caregivers to participate.

5. Encourage a positive work culture.

Because caregivers work in isolation from one another most of the time, consider creative strategies for helping them feel part of a team. That might include video team meetings, informal social gatherings for sporting or music events, and peer messaging systems for asking questions and offering tips.

Promoting Engagement, Reducing Turnover

Because the number of caregivers available to fill open positions is often inadequate, finding ways to show appreciation and offer growth opportunities is a crucial responsibility.

When turnover is high, new staff cannot be hired quickly enough to fulfill demand. As noted in our whitepaper on employee engagement, this staffing gap and the new employee learning curve can start a downward spiral that involves a temporary dip in productivity, a higher workload on existing employees, lower staff morale, inconsistent care quality, and reduced patient and family satisfaction.

If you provide proper training from the start and ongoing development opportunities, you can educate caregivers about paying attention to the whole person’s needs and listening to client and family concerns. High-quality care reduces complaints, increases positive interactions, and eases caregiver stress.

The burden of care can become heavy at times. Some options for relieving stress are mentioned in the Relias course “Survival Skills for Professional Caregivers.” For example, coach caregivers to:

• Find ways to organize work tasks that are efficient and effective.
• Balance their work and personal lives.
• Ask for assistance when they need it.
• Talk to someone who is a reliable ally and will listen and understand.
• Engage in after-work activities that bring personal joy.

Structuring Your Organization for Success

At the organizational level, leaders should consider whether changes in roles and reporting would maintain or improve morale and efficiency.

Just as you expect caregivers to consider the individual client, you can also expect supervisors to consider the individual caregiver. As a start, review how many caregivers report to each care coordinator in your organization.

In a July 2019 survey by Home Care Pulse, respondents revealed that the median care coordinator to caregiver ratio was 1-to-27. Consider whether it might work for your organization to increase the number of care coordinators so that fewer caregivers report to one supervisor.

Based on feedback from caregivers, consider which benefit options might help you retain more staff members longer. Most commonly offered are:

• Travel reimbursement.
• Health care plans.
• Paid time off and sick leave.
• Matching a portion of retirement contributions.

Explore how you might institute or improve an employee recognition and rewards system. As our whitepaper on the topic notes, options may include public and private praise, token rewards, and monetary rewards, and they may be initiated by leaders and peers.

Within Relias, an internal recognition program allows colleagues to thank and praise one another and to celebrate when team members demonstrate the company values. Sometimes a word of appreciation can go a long way on a challenging day.

Developing Caregiver and Coordinator Competence

Consider developing a program dedicated to coaching and mentoring caregivers who are new to your organization. Employees are more likely to thrive when given one-on-one support and encouragement as they build relationships with their clients and families. Connections matter.

To ensure good support for caregivers, provide care coordinators with education in communication, management and leadership, quality improvement, cultural competence, and more.

Likewise, educate caregivers about communication, basic care, boundary setting, safety, documentation and reporting, infection control, working with families, and other appropriate skills.

When you tune in to caregiver needs, you may be pleased to see how well those efforts translate to better care for your clients.

The post Refuel Your Caregivers With These Engaging, Re-Energizing Strategies appeared first on Relias.

Healthcare, medicine and nursing are industries that are always in flux. For the professionals in these industries, the base of evidence they draw from is constantly shifting and adapting with regard to the way they diagnose, treat and manage symptoms of various common and not so common diseases and disorders. And just when they think they have a firm grasp on one aspect of any disease or disorder, new evidence develops, calling their previous assumptions into question.

In a community health care setting, the same rings true. How can these physicians and nurses ever keep up and regularly acquire the knowledge they need to provide care when the core of their life’s work is based on the ever-changing needs and treatment of the human body?

There is always something new for community health care professionals to learn, or some new evidence or research study to keep in mind. This is especially the case with the increase in integrated care settings, where clinicians need to treat a variety of people—including the underserved, underinsured and uninsured—with a variety of treatment needs, from cancer, influenza and diabetes to opioid use disorders and serious mental illness.

Of course, it’s important to note that not only do healthcare professionals want continuing education (CE) and continuing medical education (CME) because of certification requirements and to maintain licensure—there are always those who enjoy learning simply to accumulate new knowledge and skills in the interest of staying current in their field and practice.

The Evolution of Continuing Education

The need for continuing education has been well-established and documented for decades. Boards of nursing, medicine and other complex disciplines generally require professionals to complete a certain number of continuing education credits, or hours, for each multi-year certification or licensure cycle. The exact number of hours required varies in the U.S. by state and by profession, whether for physicians or nurses. Gaining knowledge through CE and CME is the norm across healthcare professions and usually a career-long practice.

While live conferences and seminars are common ways for physicians and nurses to earn CE and CME credits and acquire new information, the travel-related expenses can easily become a burden, not to mention the entry fees for some of the larger, more well-known events for nurses and other healthcare professionals. This is where online learning comes in.

The Breadth and Depth of Online Continuing Education

With the arrival of e-learning, learning management systems and mobile apps, receiving continuing education credits no longer requires paper brochures and tests to be sent by mail. The introduction of online learning made it possible for learners to complete their continuing education courses without having them tied to a time or place. A vast number of CE and CME credits are now earned online due to the benefits it affords healthcare organizations, including:

• 24/7 access
• Travel-related cost savings
• Less time away from work
• Countless administrative hours saved

It is important for physicians and nurses in a community-based or integrated care setting to have access to CE and CME that has both a depth and breadth of options. Keep in mind, however, that having several courses to choose from is great, but making sure they are current, relevant and include multiple topics and depths of learning for different types of care.

Take pediatric care, for example. Course options could vary from a basic overview of clinical pediatric nutrition to a course on reducing pain during minor procedures or an advanced course on technical skills in pediatric emergency nursing. CE and CME courses can involve new clinical information about disease processes and syndromes that physicians and nurses see on a regular basis, and they can also offer opportunities to learn about new or rare conditions and how to approach them.

In community and integrated health care, apart from physical diseases and how to treat them, CE and CME courses can also provide information on behavioral and mental health care topics like suicide, motivational interviewing techniques, trauma-informed care, substance misuse and other psychosocial issues.

An Abundance of Knowledge

Online continuing education and continuing medical education represents a wealth of collective knowledge and learning opportunities for community health care professionals. It is the retention, practice and sharing of that knowledge that can make a lasting difference in the ever-changing healthcare industry.

The value of continuing education cannot be emphasized enough. A commitment to ongoing education to broaden one’s knowledge and expertise ultimately improves the quality of care and health outcomes of the diverse populations served in community-based care settings.

Do the clinical staff at your community or integrated care center have access to CE and CME? Read the fact sheet below to learn about the CE and CME courses Relias provides to help your staff maintain licensure and stay informed on the changes and practices in their field. Our courses are developed and regularly updated in-house by an interdisciplinary team of experts in your field. Even better? Our comprehensive learning management system includes a full library of CE and CME that you can offer to your clinical staff at no cost to them.

The post The Value of Continuing Education in Community Health Care appeared first on Relias.

When dealing with serious illness and death, patients who are immigrants to the U.S. may face cultural and logistical challenges involving language differences, health literacy deficiencies, variations in family decision-making and role responsibilities, insurance barriers, and lack of financial or social resources.

For some immigrants, acculturation may decrease variations in ritual and practice preferences. For many nearing the end of life, their ethnic, cultural, and spiritual selves may still align more closely with their place of origin rather than the country they reside in, even if they have lived in that country for a longer time period.

Unauthorized immigrants face an additional set of challenges and usually do not receive quality health care. They are not eligible for insurance coverage under the Affordable Care Act, Medicare, or Medicaid services. Because they usually have no health care coverage, they typically come to the local emergency room with the most advanced or terminal stage of their illness and receive emergency medical treatment through the Emergency Medical Treatment and Labor Act (EMTALA) and safety net clinics.

Research has shown that these patients tend to suffer from high symptom burden, receive aggressive end-of-life care, including prolonged hospitalizations and intensive-care unit admissions, and are likely to have hospital deaths, regardless of their preferences for care. It is not unusual for unauthorized immigrants to have limited or no social or financial support, a mistrust of the U.S. health care system, and fear of deportation.

Yearning for Family and Home

When unauthorized immigrants are nearing the end of life, they often request to return to their country of origin or desire to see their family one last time. Many of these patients are too ill to travel far and do not have the financial resources to return home. The situation can be complicated when their family members are also unauthorized immigrants who may be hesitant to come forward for fear of deportation.

It is not unusual for patients who are unauthorized immigrants to die in the hospital, alone, and without family or friends. If next of kin is unknown, the local coroner’s office is notified, and the patient’s physical remains would likely be cremated and may be sent to an undisclosed location. This undignified death and burial is often in direct conflict with culturally appropriate death rituals and patient wishes.

How can we as professionals, working within complex healthcare systems, provide culturally appropriate care to authorized and unauthorized immigrants facing serious illness and at end of life?

Culturally Appropriate Care

Like all person-centered care, culturally appropriate care involves paying attention to the individual’s needs and preferences.

In order to provide quality care for authorized and unauthorized immigrants, the health care team should use a cultural assessment instrument to identify cultural values, practices, and important rituals when the person enters the health care system. This may require the use of a professional medical language interpreter.

Keep in mind there may be very little time to put the appropriate interventions in place, so seeking the assistance of a palliative care team or accessing team members such as a social worker and a chaplain are essential at the time of diagnosis. Every effort should be made to identify and honor the patient’s preferences for care throughout the illness trajectory, during the dying process, and at the time of death.

Strategies to Bring Comfort

Whenever possible, it is critical to honor the patient’s cultural values regarding treatment options and end-of-life care. If the ill person wishes to return to the country of origin and that is impossible, consider some interventions that may bring comfort to the immigrant and the family. For example, you might:

• Identify others in the community from the immigrant’s country of origin who are familiar with cultural traditions and practices at end of life and can bring the essential rituals to the dying individual.
• Create a sacred space in the patient’s acute care or skilled nursing facility room to honor the immigrant’s memories of the country of origin.
• Work with the immigrant and the family to make arrangements for the immigrant’s body or ashes to be returned to the country of origin for burial.

When culturally sensitive palliative care is provided, it not only relieves symptoms, pain, and stress to improve the patient experience, it also brings another level of comfort and quality of care to patients and their families.

The post Providing Culturally Sensitive Care to Immigrants Struggling With Serious Illness appeared first on Relias.

Although the media pays close attention to workplace homicides, many violent incidents in the workplace involve nonfatal but serious injuries. According to the most recent statistics available from The National Crime Victimization Survey (NCVS) and Bureau of Labor Statistics (BLS) between 2011 and 2013, most workplace assaults occurred in social service and health care settings.

Additionally, there were many more days away from work in 2013 for staff in healthcare and social assistance facilities due to their assault-related injuries compared to employees in the private sector, as shown below.

The assault risks that healthcare and social service workers face mainly stem from violent behavior demonstrated by their patients, clients or residents. Studies have shown that the following healthcare settings consistently present the most risk:

• Inpatient and acute psychiatric services
• Geriatric long term care settings
• High volume urban emergency departments
• Residential and day social services

As such, the Occupational Safety and Health Association (OSHA) created workplace violence prevention guidelines designed specifically for staff who work in these settings.

OSHA Guidelines for Healthcare and Social Service Settings

1. Track client behavior.

It may be difficult to gather information related to the behavioral history of new clients; however, any violent behaviors of current clients must be tracked and documented to reduce the likelihood of future events.

Establish a system.

A good system utilizes log books, census reports, and chart tags to recognize clients who have a history of violence. Logbook documentation should include potential triggers (e.g., dates, visitors or television programs, etc.), previous violent act information that includes the severity, type, pattern, and client’s intended purpose. A successful system requires ensuring that employees know the protocol for updating a client’s behavioral history.

Examine each client’s behavioral history.

By creating a system that identifies clients who have a history of violence and informing service providers of their triggers, the employee can be prepared to provide the best response to de-escalate the situation.

Design individualized plans.

The information collected can be used to create an individualized plan for each client to begin to identify and prevent any future acts of violence.

2. Create home visit contracts.

Construct a clear, easy to read contract that outlines which services will be provided during a home visit and what issues can lead to an employee’s refusal to provide services.

3. Incorporate engineering controls for social service and home health workers.

Every violent incident or threat must be reported to management. It is essential that employees know the procedures to follow in the event of a violent incident or threatening situation.

• Incorporate regular use of cell phones with GPS tracking capability. Most cell phones have a ‘help’ function that can easily be accessed in the event of an emergency.
• Service providers should take note of the exit routes within each home.
• A de-escalation area for the patient/client should be established somewhere within the home.
• All portable equipment must be locked when not in use.
• Medicine or any other valuables must be secured in a locked container.
• Ensuring reliable transportation requires following the vehicle manufacturer’s maintenance schedule.
• Develop and distribute emergency action plans so employees know what to do when they need assistance.

4. Incorporate administrative and work practice controls for home health and social service workers.

Every violent incident or threat must be reported to management.

Create an Acts of Violence response policy.

In the policy clearly state that acts of violence are not permitted and are considered intolerable. By establishing this up front with clients and staff members, all parties involved know that violent behavior will not go unnoticed.

Keep track of service providers.

Require employees to contact their manager following each home health service visit. Managers must establish a set of procedures to follow in case an employee fails to check in.

Allow employees to decide if they want to begin or continue working with a patient if they feel unsafe or threatened.

Technology has provided an array of valuable tools, including mobile apps with GPS tracking and employee login and logoff capabilities. This blog post offers information related to the best—and free—time-clock software systems.

5. Create and implement login and logoff procedures.

Detailed instruction on tracking client or patient visits is also critical to workplace violence prevention. Your procedure for this should include:

• The client’s name and address.
• A contact number.
• The scheduled time of the visit.
• Expected length of visit.
• A natural-sounding code word to use in the event of an incident or threat; for example, the worker may say, “I think I forgot to lock my desk, can you check it for me?” The code word could be ‘forgot.’
• Detailed information must be documented and given to the supervisor or manager if the employee will be traveling with a client, including the departure time, planned route, destination(s), expected arrival times, etc.
• Each service provider’s license plate number and vehicle description must be documented and then placed in his or her file.
• Employees should contact their supervisor if any changes to the planned appointment or journey arise.

6. Establish an employee dress code.

Dress code tips include:

• Staff members should have an identification badge with their first name on it: Avoid including the employee’s last name as this could be used to gather personal information.
• Encourage workers to keep items that could be used as weapons on his or her person (e.g., keys).
• In the event of a confrontation, a staff member’s hair may be pulled or grabbed; therefore, encourage those with long hair to wear it up, use head netting and/or wear a cap.
• Discourage employees from carrying money, wearing chains or necklaces, long earrings, or expensive jewelry while they are working. Chains and necklaces can be used to grab on to and choke an individual.

7. Always follow up after an incident.

Gaining support from management is essential to post-incident follow up.

• Provide employees with an outline of company procedures to follow and assist them when necessary (i.e., requesting assistance from the police, filing charges against the perpetrator, etc.).
• All complaints must be addressed promptly.
• Contingency plans should be in place for providing services to clients who tend to act out with verbal threats or physical attacks.

8. Investigate every incident.

To have an effective prevention program, responding to and evaluating each incident is mandatory. The goal of each investigation is to identify the root cause of the violent act. If the root cause of an incident is not discovered and addressed, the chance of another violent act occurring for the same reason increases. By investigating these incidents, a roadmap designed to assist in the prevention of injuries and/or fatalities related to future incidents is created.

Make a report.

Notify the appropriate individuals within the organization that an incident occurred. When necessary, notify outside sources (e.g., the police).

Speak with other employees.

Speaking with the victim is one of the first steps in starting an investigation. However, other employees working in home health services may have useful insight to share.

Review information related to the employee involved in the incident.

Take the time to review records related to past incidents and training that the employee received.

9. Investigate near misses: situations that could have led to an illness, injury, or fatality.

A violent outburst or situation ending with no one being physically harmed still needs to be investigated. A one-time near miss can turn into a violent act at some point in the future. Consider a near miss a sign that some of the potential hazards are not being controlled adequately or that there are still some unidentified hazards that need to be addressed.

10. Provide ongoing workplace violence awareness and prevention training to protect employees.

Once staff members are aware of the potential hazards they face and learn how to protect themselves using established policies and procedures, violent acts and threats may be reduced or avoided altogether.

Leaders and managers at healthcare and social service facilities are responsible for enforcing a culture of safety, not only for staff but also to protect clients and patients.

Do your employees have clear guidance on how to respond to and prevent workplace violence? Take a look at one of our course demonstrations below to experience firsthand how interactive training can better prepare your staff to respond to a high-stakes situation by helping them remember what they learn through active participation.

The post Ways to Prevent Workplace Violence in Social Service and Healthcare appeared first on Relias.

As regulatory changes and government oversight push changes in the healthcare market overall, hospice agencies must pay attention in 2020 to shifting expectations amid evolving service demand.

With baby boomers aging, preferences leaning toward providing senior care in the home, and regulations aiming to deter avoidable hospitalizations, hospice agencies may see increased demand.

In 2017, Medicare paid $17.8 billion in hospice care benefits for nearly 1.5 million patients, according to the Health and Human Services (HHS) Department. Care settings for hospice services include hospitals, skilled nursing facilities, hospice facilities, and private homes.

As hospice leaders plan strategically for the coming year, these key issues should capture some focused attention:

• Tightening compliance in the aftermath of critical findings by the HHS Office of Inspector General (OIG). The OIG found that 80% of hospices had one or more deficiencies between 2012 and 2016.
• Managing the work of physician assistants (PAs) to comply with new responsibilities allowed and those still restricted.
• Identifying patients eligible for the Seriously Ill Population (SIP) payment model under the Primary Care First initiative.
• Exploring avenues for facilitating services using telehealth connections in the future.
• Monitoring quality rating factors and protecting the organization’s reputation.

Let’s delve into these shifting conditions in a bit more detail.

Monitoring Policies and Procedures

To avoid negative hits in surveys and quality ratings, hospice organizations will need to give concerted attention to following care plans and monitoring patient and family complaints.

In a 2019 HHS report, the OIG identified areas of concern after analyzing deficiency and complaint data from the Centers for Medicare and Medicaid Services (CMS).

To avoid the types of problems noted in the OIG report, hospice leaders can put these top takeaways on their 2020 to-do list:

• Use checklists to ensure that all procedures are followed and documented appropriately, including admission, recertification, revocation, transfer, and death of the patient.
• Conduct prebilling technical audits to ensure that the required documents for these aspects of hospice care are compliant with regulations. Partner with community providers that may serve your hospice patients to obtain copies of records and communicate about what services are related to hospice and covered by hospice, and what is billable under Medicare Part B.
• Routinely conduct a hospice eligibility audit to ensure all patients admitted are eligible for hospice care. Create an eligibility audit tool using Local Coverage Determination guidelines and conduct the audit before billing.
• Make sure the hospice election statement is compliant. Educate the patient about what hospice covers and any planned care outside hospice that would not be covered. Document the patient’s understanding and agreement. By October 1, 2020, hospices must comply with new regulations for the hospice election statement, including making patients aware that they have the right to an election statement addendum. As the National Hospice and Palliative Care Organization (NHPCO) notes, the addendum will be a patient-specific list of what hospices will not cover for that individual.
• Supervise care teams to ensure that they follow the plan of care and stay compliant. All services identified in the care plan should be provided at the appropriate time. The plan of care should be a living document and evolving as the patient’s condition changes. Use interdisciplinary group meetings to update the plan of care systematically and consistently with the patient’s change in condition. Visits and interventions must mirror what is detailed in the plan of care.
• Follow up to be sure clinicians and caregivers document care accurately as they provide it. When documentation is missed, altering or backdating records is off limits. Hospice professionals should document the patient’s condition, the hospice’s interventions, and the patient’s response, with time frames. The patient’s decline should be captured in every piece of documentation. Each entry should support “Why hospice, why now?” and what the hospice is providing to support the patient’s goals.
• Provide continual training options to promote high-quality hospice and palliative care.

Using PAs in Allowable Ways

As federal laws and regulations ease restrictions on the ways PAs can work with patients, hospice organizations will need to examine their policies and consider expanding the use of PAs in hospice as allowed in individual states.

Starting in January 2019, Medicare policy began allowing PAs to act as attending physicians in providing care related to a hospice patient’s terminal illness, including establishing and updating the hospice plan of care. The change, codified under the Bipartisan Budget Act of 2018, is designed to expand the pool of providers who can care for hospice patients and to ensure continuity of care if a PA is a patient’s primary provider before admission to hospice.

CMS this month issued a final rule on the Medicare physician fee schedule for 2020 that allows a stronger role for PAs in hospice by easing physician supervision requirements. A CMS press release notes that the change is designed “to give PAs greater flexibility to practice more broadly in the current health care system in accordance with state law and state scope of practice.”

The American Academy of PAs (AAPA) in March explained the ins and outs of the relevant federal law and regulations, noting that limitations on PAs still existed. The issuance of the Nov. 1 CMS final rule allows PAs more leeway. As AAPA notes, in addition to managing the hospice plan of care in the attending physician role, granted in January 2020, a PA may order medication if the PA is not employed by the hospice organization and if state law allows it. The face-to-face encounter that is required for hospice recertifications is not yet open to PAs; currently, an NP or physician must complete this task.

Considering the Primary Care First Payment Model

CMS is implementing the Primary Care First initiative, which bases payments on patient needs and outcomes, not services provided. The initiative asks participating clinical practices to assume financial risk based on patient outcomes in return for a reduced administrative burden.

The Primary Care First program includes the Seriously Ill Population (SIP) payment option, which is designed to improve SIP coordination for patients across the continuum of care, including transitions to hospice and palliative care services.

Primary Care First goals for SIP are to coordinate previously fragmented care, reduce avoidable hospitalizations, and control costs for these patients. Applications from stakeholder organizations are due in January, and the program’s launch is set for 2021.

As hospice organizations consider ways to diversify their services, adding home health primary care as a business line could provide a way to serve seriously ill populations before they need hospice care services. Some hospices are already piloting programs to provide palliative care services to home care patients.

As the January application deadline looms, hospice leaders have expressed concerns about unanswered questions, as noted in Hospice News, such as who will contact patients to educate them about opting in. The NHPCO outlines key factors of the initiative for its members to consider as the launch approaches.

Planning for Telehealth Options

A bill introduced in the U.S. Senate in October would allow expanded use of telehealth services starting Jan. 1, 2021. The bill’s Senate sponsors note that the provisions of the bill are designed to improve access to healthcare—especially in rural areas—and drive down costs.

The legislation, titled Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, or CONNECT for Health Act of 2019, could open up hospice use of telehealth, according to Hospice News. The National Partnership for Hospice Innovation advocates using telehealth and other options to modernize the requirements for face-to-face encounters for recertifying a terminal illness for hospice.

Monitoring Quality Ratings and Reviews

Paying attention to outcomes measured by the CMS Hospice Quality Reporting Program (HQRP) is vital to an agency’s reputation and business standing.

As part of the HQRP, CMS is developing a patient assessment tool to inform the care plan, guide patient and family choice, and provide meaningful outcome-based measurements.

CMS is seeking stakeholder engagement and planning for initial testing of the Hospice Outcomes and Patient Evaluation (HOPE) tool in the coming months. Hospice organizations will need to stay tuned into the HOPE effort and offer comments when CMS solicits feedback.

Hospice leaders naturally need to monitor their agency’s reputation. This means not only HQRP data and official complaints, but also online reviews from patients and family members.

Taking corrective action is vital to protecting future patients, encouraging referrals, and hiring and retaining the best team of clinicians and caregivers available.

Consider how you can ensure the best in hospice and palliative care by monitoring clinical skills and continually enhancing your team’s learning. Quality outcomes require quality clinicians and caregivers.

The post Stay on Top of Evolving Hospice Expectations for a Strong 2020 appeared first on Relias.

Highlights

• Personalized nurse remediation plans dramatically decrease the time needed to get a nurse back to safe independent practice compared to traditional remediation.
• Personalized assessments identified 26% of nurses who met all core competencies and were able to complete the remediation without an individualized education plan.
• No nurses who completed the personalized nurse remediation had another nursing practice violation within 2 years, similar to the standard approach to remediation.

Introduction

How can we improve nursing practice breakdown remediation, and get safe, well trained nurses back into the workforce? Recently published in the Journal of Nursing Regulation, the Addressing Nursing Practice Breakdown: An Alternative Approach to Remediation article aims to examine the effectiveness of an alternative approach to traditional nursing practice breakdown remediation.

The article presents the results of a pilot study assessing the Knowledge, Skills, Training, Assessment, and Research (KSTAR) program, as well as two case studies of nurses who successfully completed the program. Although this pilot study is the first presentation of such a remediation program for nurses, preliminary results suggest that it is equally as effective at preventing repeated practice breakdowns as the traditional method and leads to quicker returns to independent practice.

Summary of Findings

1. Nursing practice breakdowns pose a serious threat to safe healthcare delivery. In order to retain licensure after a violation occurs, nurses are required to take remedial education and supervised practice before return to independent work. The Texas Board of Nursing partnered with Texas A&M Rural and Community Health Institute and College of Nursing to create an alternative approach to nurse remediation known as KSTAR. KSTAR provides an individualized approach for nursing remediation for nurses who have had a nursing practice breakdown. It is different from traditional remediation programs in that it contains a personalized assessment in order to identify gaps in knowledge and develop a specific remediation plan.
2. The article clearly defines each of the components of the program which includes: a 6-hour nursing jurisprudence and ethics course, an initial assessment of the nurses’ knowledge and skills, an individualized education plan (IEP), a final assessment, and focused remediation. The article also reports case studies for two individual nurses to demonstrate how each component of the program was implemented in practice to create a personalized and effective approach to nurse remediation. The article also reports the overall results of the 53 nurses who chose to participate in the KSTAR program.
3. Results from the pilot show that 92% of the nurses who participated in the pilot KSTAR program successfully completed it. After the initial assessment 26% of nurses demonstrated competency and did not require an IEP (Individualized Education Plan). A key indicator of the effectiveness of a program is the number of nurses who have a subsequent nursing practice breakdown after completing the program. The 49 nurses who completed the KSTAR program were compared to 82 nurses who completed the traditional remediation. There were no significant differences found between the groups after two years of follow up. No nurses from the KSTAR group had a subsequent nursing practice breakdown and only 1 of the 82 nurses who completed the traditional remediation had a subsequent nursing practice breakdown.

Review

The KSTAR program is innovative in that is uses a personalized approach to remediation compared to traditional approaches. While traditional approaches base each nurse’s remediation on the type of practice breakdown that occurred, the KSTAR program uses assessments to identify gaps in knowledge and skills that may have led to the practice breakdown. This ensures that each nurse’s remediation is specific to the knowledge and skills needed for that individual.

Limitations of the study include a small sample size and lack of randomization, which are common for pilot studies. However, despite these limitations the preliminary results are quite encouraging, and it will be interesting to see if the similarities in recidivism rates between the KSTAR and control group are maintained 5 years later. While this is the first program of its kind in nurses, assessment driven remediation has also been studied in doctors with similar positive effects.¹ In combination, these studies suggest that personalized assessment driven remediation is a valid alternative to traditional remediation approaches.

This article advances knowledge in the field in several ways. This pilot program provides evidence that an alternative nurse remediation program is as effective in preventing recidivism as the traditional approach. Further, it suggests that personalized assessments as a part of nurse remediation can dramatically reduce the time needed for a nurse to return to safe independent practice. Finally, personalized assessments can help identify nurses who may not need an individualized education plan, highlighting which nurses may be ready to go back to independent practice sooner than others.

Read the full article here

Role of Relias

Relias Assessments played a vital role in both the initial and final assessment of the nurses’ knowledge and skills. The assessment is assigned based on the nurse’s area of practice and was used to identify competency gaps using benchmarks from national data and provide insight into knowledge gaps and personalize curriculum for each nurse.

Learn more about how Relias Assessments assists healthcare organizations in assessing competencies and personalizing learning.

References

1. Lillis S, Takai N, Francis S. Long-term outcomes of a remedial education program for doctors with clinical performance deficits. J Contin Educ Health Prof. 2014;34(2):96-101.

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Job seekers with intellectual and developmental disabilities (IDD) are an overlooked and underappreciated talent pool. For organizations hoping to develop employment opportunities for the people they serve, one of the biggest hurdles is building partnerships with businesses.

Stephane Leblois, program manager at The Arc@Work, did a webinar with us to educate IDD service providers about the program’s approach to supporting corporations to develop, implement and maintain neurodiversity hiring initiatives. Stephane provided useful information and actionable steps for providers interested in improving their employment programs.

The audience had great questions, and Stephane offered insightful answers. Here’s some of that Q&A.

Q: What are some nontraditional job development partnerships?

A: I would recommend looking at Rotary International, the local Chamber of Commerce or other large networks of businesses. Also, look for fraternal organizations in your area whose members may be comprised of business leaders and other folks you can network with. The key is to get on the docket to speak at a meeting about what you’re doing. Use that elevator pitch we talked about developing at the beginning of the webinar. Talk about who your organization is and the value and services you provide. That is exactly the type of presentation people want to hear.

Q: Can you speak on how to engage specifically with smaller, locally owned businesses? Do you do much job carving or customized employment?

A: The first thing is to identify their need—what are they struggling with staffing-wise—and figure out, on your terms, a way to solve that problem. For example, if they’re looking for one or two full-time positions to fill immediately, but they’re having trouble filling those positions, go to them and say, “Hey look, we can do this, but some of the individuals that we support may not be able to work full-time jobs for benefits reasons or as an accommodation. I would recommend we do job carving or splitting one position across two or three people if need be.” Employers are responsive to thinking creatively about those things.

Q: If you don’t have any applicable candidates for the position that this business is looking to fill, would you reach out to other agencies that are supporting job seekers with disabilities?

A: As far as I’m concerned, yes. I think that we shouldn’t lose sight of our mission, which is ultimately to get people with disabilities into jobs. So, if you don’t have a job candidate who is a fit for a job with a certain employer, I would 1) reach out to another agency because you want to fulfill that mission, and 2) know that the employer will thank you and remember you. They will gain trust in your ability to get their needs filled no matter what, whether that’s you doing it or somebody else.

Q: Are there any assessment tools you would recommend that would be used to find the type of businesses or industries that fit best as places of employment for your participant workforce?

A: Not that I can think of. Ultimately, it’s important to reach out to all kinds of businesses in your area, especially if you live in an area with few employer options. But you want to focus your fire on employers that have the types of jobs that may fit the skill sets and preferences of the individuals you serve. The way you assess that is up to you, but I think it starts with a person-centered plan and figuring out what the individual wants to do with their career.

One way to assess the best kinds of jobs or employers to reach out to in your area is by creating realistic job previews or walk-throughs of different employers—working with employers to create a “day in the life of” or an opportunity to shadow a current employee so that folks understand and see if they are interested in that type of work. I would use whatever free means you can for getting folks into workplaces and familiar with work processes so they can make an educated decision down the road.

Q: Have you had luck with offering some type of trial work experience to the employer and then transitioning into an actual hire?

A: One of the great programs that does this is Project SEARCH, and we’ve worked with a number of sites. Project SEARCH is a little bit different because it’s a longer internship program.

It’s not unusual for employers to allow for a bit of a trial period with an individual where they can come in and either shadow an employee or maybe even work a shift, depending on the relationship that you’ve established with that employer. That shift and the liability are often covered by vocational rehabilitation as on-the-job training, so that’s able to be funded most of the time.

To answer the question—yes, we’ve had success in doing job trials not only for the job discovery process but also as a means to build confidence on the employer side that the job seeker can work effectively.

Q: How do you feel about disclosing the fact that your company works with people with disabilities? Some pundits think we should not disclose this key piece of information.

A: The Arc is one of the nation’s largest and oldest non-profits serving people with intellectual and developmental disabilities, so I think that working for and with people with disabilities is a fundamental aspect of who we are as an organization. Secondly, I would say that working with people with disabilities is a strength and asset—not something to either be ashamed of or hide away.

At the same time, it is important for any organization that either employs people with disabilities or works with people with disabilities to not use disability as a mascot. People with disabilities are people, and true inclusion happens when disability no longer becomes a defining characteristic in the workplace or a condition for employment. Celebrating diversity and diverse abilities in your workplace is important, but not exploiting that in external communications is key.

Q: Do you recommend hosting a business partner appreciation event, or is that too much time and money?

A: Yes! In fact, one of the slides in my presentation mentions that an alternative method to traditional job development is to host events at your agency or “play a home game.” This serves to not only establish needed partnerships with local employers but also shows the community other ways that your agency achieves positive impact (e.g., daily living skills training, social events and community volunteerism). It is also important to recognize businesses in your area that are doing great things in the realm of inclusion, so I think it’s a great idea to host an appreciation event! To your point, though, don’t go overboard on expenses.

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