One Long-Term Care Facility’s Journey
Cedar Creek Nursing Center operates under the belief that there is always room for improvement.
When the Centers for Medicare & Medicaid Services (CMS) announced an opportunity to participate in a national program to improve dementia care in nursing homes during, Cedar Creek Nursing Center signed up as a pilot facility for the Oklahoma Challenge Grant. The program’s goal focused on reducing the use of antipsychotic drugs in nursing home residents with dementia by 15 percent.
“We were excited to learn about this unique opportunity,” stated Kelly Bowers, RN, director of nursing at Cedar Creek Nursing Center. “It was as a chance to provide better healthcare to our patients by improving in the areas of medication management, coordination of care, and behavioral management.”
Bowers explained further that taking an active role in this important national objective helped their facility create an effective and dynamic meaningful workflow that integrated the utilization of CareTracker – an electronic health record (EHR) system powered by Cerner Corporation.
A Positive Change in Workflow
Since the implementation of CareTracker, Cedar Creek Nursing Center has gone almost fully electronic. Its certified nursing assistants (CNAs) have been more successful and accurate at documenting resident’s activities of daily living (ADLs) and behaviors. In addition, the facility’s charge nurses have stayed more engaged – familiarizing them with the residents compared to the previously used paper process.
With the increase in quality and quantity of information in using an EHR, Bowers felt better equipped to take the lead on all clinical decisions. Access to the EHR gave her and the assistant director of nursing, Twyla Davis, LPN, the ability to accurately monitor all behaviors by running a behaviors detailed report from the EHR system to compare it to the resident medication list located on the resident’s chart. As a result, both facility leaders had the required tools they needed for creating a strong clinical case to present to physicians or Health Care Providers (HCP) to suggest either a decrease in the administered dose of antipsychotics or a total interruption of the drug.
Once the physician or HCP communicated their decision, Bowers introduced the appropriate non-pharmacological intervention in case of treatment interruption or dose adjustment. All non-pharmacological interventions were then entered in the EHR system and displayed on all halls through the CareTracker kiosks, a key resource allowing all clinical staff members to be informed of residents current behavioral status and intervention processes in real-time.
Another Positive Impact
In addition to workflow improvements, the Center implemented a training plan for all nurses and CNAs on non-pharmacological interventions to ensure successful patient engagement. Residents became more involved in activities. For example, a morning walk was implemented Monday through Friday, where all department heads, housekeeping, laundry and dietary staff took a resident on a walk.
“This activity has really improved our interaction with our residents. We’d walk and stop at the flag pole, say the pledge of allegiance, then proceed down to a local dentist office and read current events or sing songs for a total of 30 minutes,” said Bowers. “Then, we’d proceed back to the facility. We’ve seen an increase in liveliness from our residents since we’ve started this activity. She continued explaining that the atmosphere at Cedar Creek Nursing Center is quieter and their residents are happier. It has also increased job satisfaction for their staff members.
With improvements to workflow and patient engagement activities, Cedar Creek Nursing Center exceeded the national goal. The Center has seen a 28 percent reduction in antipsychotic medication administration, from 45 percent in August 2012 to 16.8 percent in July 2013.
While the adoption of health information technology in long-term care can be a challenging task, Cedar Creek Nursing Center realized that the process required strong leadership and monitoring of data to achieve meaningful and measurable results. The reduction of medications, engaging residents in activities and communication to staff about the progress of the improvements were crucial to staff members’ reception of change, level of involvement and success.
Overall, the implementation of electronic systems allowed the Center to have accurate documentation of behaviors and ADLs, which was shared with providers to help create an effective, decision support workflow that ultimately benefits its residents.
And the Biggest Challenge?
Cedar Creek Nursing Center’s biggest challenge was achieving the correct utilization of electronic health records and overcoming the stereotypical workflows.
“We overcame this barrier by implementing a program with our nurse educator to promote the correct approach and meaningful utilization of electronic systems in long-term care,” Bowers reflected. “ This paired with effective monitoring by supervision to ensure positive outcomes has solidified the decrease in behaviors and the positive increase in resident outcomes.”