Embracing INTERACT® for Change of Condition!

An evidence-based system for early identification and management of early changes of condition is essential for three vital reasons: quality of resident care, regulatory compliance, and a reduction of unnecessary hospital readmissions. The INTERACT™ Quality Improvement Program is the excellent choice for facilities to implement!

When all staff in all departments are trained and able to identify even subtle changes in resident condition, using a process to identify, communicate, and then evaluate the change, the nurse can then review decision-making tools and contact the clinician in an organized and concise manner. By providing the clinician with comprehensive information about the resident, the clinician can make sound and informed decision-making for next steps for resident care.
Regulatory compliance is always in the minds of healthcare providers today.

Below are a few references from the State Operations Manual for Long Term Care Facilities:

• F726: §483.35 Nursing Services, addresses staff competencies in identification of changes in condition. This F-tag addresses the requirements of the facility to promptly identify the change, and demonstration of effective actions that address the change of condition in order for interventions to be implemented to prevent decline or a condition becoming acute. CMS does indicate that, “Interventions to Reduce Acute Care Transfers (INTERACT™) is a program with several resources aimed at improving staff competencies in this area”.1
• F726 also indicates “Staff may inform surveyors of the tools they use to help show evidence of the required competencies. However, merely stating or referencing the tools is not enough on its own to verify compliance. Staff must also demonstrate that they possess the competency to use the tools in a manner that accomplishes their purpose, of aiding to effectively identify and address resident changes in condition.” 1
• F726 outlines that change of condition is a mandatory competency “competency and skills to identify and address a change in condition” “Staff Competencies in Identifying Changes in Condition – A key component of competency is a nurse’s (CNA, LPN, RN) ability to identify and address a resident’s change in condition. Facility staff should be aware of each resident’s current health status and regular activity and be able to promptly identify changes that may indicate a change in health status. Once identified, staff should demonstrate effective actions to address a change in condition, which may vary depending on the staff who is involved. For example, a CNA who identifies a change in condition may document the change on a short form and report it to the RN manager. Whereas an RN who is informed of a change in condition may conduct an in-depth assessment, and then call the attending practitioner. These competencies are critical in order to identify potential issues early, so interventions can be applied to prevent a condition from worsening or becoming acute. Without these competencies, residents may experience a decline in health status, function, or need to be transferred to a hospital. Not all conditions, declines of health status, or hospitalizations are preventable.” 1

Reduction of unnecessary hospitalizations is also another key component. “The overall goal of the INTERACT® program is to reduce the frequency of transfers to the acute hospital.” And “By improving the identification, evaluation, and communication about changes in resident status, some, but not all acute care transfers can be avoided.”2 The INTERACT™ Quality Improvement Program can also be a great choice to implement for facilities to assist with Value Based Purchasing and the readmission measure.

Leadership Considerations

Implement a best practice approach for identifying resident change of condition by considering the following:

• Determine Change of Condition identification system for all staff to use. INTERACT™ Quality Improvement Program is a dynamic evidenced based program for your immediate use.
• Develop your change of condition system including updated policies and procedures, implementation processes for all departments and education programs with competency verification.
• Educate all staff on their role and responsibility for identifying and notifying nursing of any resident change of condition.
• Document education and evidence of all staff competency related to change of condition identification and notification.
• Monitor implementation and education outcomes.

Learn more about the entire INTERACT™ Quality Improvement Program, tools and resources, background and educational opportunities at: www.pathway-interact.com.

References:
1Centers for Medicare & Medicaid Services State Operations Manual, Appendix PP – Guidance to Surveyors for Long Term Care Facilities (Rev. 173, 11-22-17): https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

2 INTERACT®: https://pathway-interact.com/about-interact/what-is-interact/”

---