Welcome ladies and gentlemen to the cute API continuing the journey conference call.
Good afternoon and thank you for joining us today for this webinar. While we are waiting for the rest of the people to get locked in. I wanted to get to all familiar with the chat box.
It is located on the bottom right hand side of your screen. If you are not in full screen mode, but if you are in full-screen mode it is located at the top it says chat and you can click on that and see what is happening on the chat box.
This is where you can ask questions during the presentation. Someone will be monitoring the chat box. They will be able to tell us what you are saying and we can answer your questions right then and there. Our focus today is to make this a very interactive presentation. It is all about making this journey that are for you.
Please take a moment while we are waiting and respond in the chat rocks and tell us that one thing that you are excited about that is happening in your facility right now.
I emceeing a few things in the chat box. Excited about our new tranquility suite. Jessica Ruiz thank you. Melody says what is a tranquility suite? Okay so I guess we will have to ask Jessica what is a tranquility suite. It is a newsroom.
That is prequel. There are many out there familiar with the snooze one-room? A snooze one-room where you have people who are very excited with dementia and they get real agitated. You can take them in their, there are a lot of things that are sensory stimulation for smell, touch, just different life and different things and it helps them calm down. They are amazing.
A.B. we can get desk to talk about that at another time.
It looks like we have about 41 people that have signed in. And I have 2 min. after one o'clock. So we will go ahead and get started.
Thank you for putting information into the chat.
The feeding program from The ball.
Thank you. Let me move on to start this webinar.
Okay QAPI the journey continues.
Thank you for joining us today hopefully we will have some information that you will be able to use in your facility. Like I said earlier please make sure you put questions in the chat and thank you for joining us. My name is Debi Majo and I am your moderator today.
Are objective or today, we are going to learn about root cause analysis sometimes called RCA. At the end of this presentation we hope you will be able to verbalize how you will use root cause analysis as your first steps in solving problems or issues in your facility.
Before we move on me introduce our team. Susan Purcell is our fearless leader and director. Frank is the quality improvement consultant. Cayce Brewster keeps us sane. Tiffany myself and Melody are all polity improvement consultants. Minnie Malone manages all of our data and make sure we stay on track with all of our CMS contracts and Carla is also a quality improvement consultants.
To begin with, we will start with one facilities journey to reduce antipsychotic drugs.
This facility started working on antipsychotic drug reduction back in August and it made dramatic reduction in the use of these drugs. They are going to tell us how they did it. While we get to know Miller -- one method we all know it may not work for everyone. But this facility it worked wonderfully and how do we know what will work for us if we do not try different methods. So I want to tell you thank you so much for you guys to join us.
The home is granite may set a beautiful marble Falls Texas. This photograph is in old barn with bluebonnets it was taken as you come from the South on 281 into marble Falls. If you are out and about this is a beautiful time of year. And marble Falls is a beautiful community.
Today I will introduce you to Chris Behrmann the administrator and Tabitha Ball the DOM. They will give us a little background starting with Chris about their facility.'s
Thank you Chris.
You are quite welcome can you hear me okay?
I hear you beautifully.
Okay. Reading everybody on behalf of administrator in the hard-working deal and to have the toughest job in the house. I walked down this long-term care journey for quite a while and recognize the constraints that many of us have to work with.
I want to talk about our facility here. I came here in 2009, was hired to open up a new facility. It was and is a rather unique experience because right from the get-go we were defined as a medical model. Delivering high quality of services by a professional team committed to resident focused improvement. My background I came from the hospital world environment of therapist and was accustomed to the fast pace, the patient focused approach in the -- and the necessity of adaptation and adjustment in real time. [Indiscernible] need real-time adjustment or house -- irreversible conditions that place.
It was rather interesting running myself in a. Model environment as competent, healthcare background from the hospital world.
We are part of the assistant Corporation that for more than a dozen years has worked steadily to build an organization based on the principle that change, innovation and providing good care are vital to the success of our healthcare client.
Great healthcare is made available to all of our residents here. With the assistance of board-certified physicians who are geriatric specialist. Doctors are in house 1 to 2 days a week full days. Nurse practitioner is here five days a week. And of course we have ancillary doctors that come in, [Indiscernible] care podiatry, psychologist about two days a week -- excuse me quest --?
Site -- psychiatric nurse as well.
We have been through an interdisciplinary team approach, discuss and review on a weekly basis each and every resident in our environment. As well as on a daily basis with the docs, nurse practitioner that is in-house, as the director of nurses and her team identify that problems in real time we are looking reviewing and adjusting accordingly.
All of this provides certain outcomes that are a bit more predictable and certainly far more favorable. The pace of course is a pretty quick pace and thus are outcomes I think have greatly appreciative by the community and most people that live in our environment.
We also look at a variety of approaches of how we can zero in and have done this with a paid feeding assistant program, with CQI meetings that we have regularly as far as seeing what the rates are, and we use the action plan problem probes, goals, interventions, timeframe and then a review again.
Again this is done through a disciplinary team approach so a few people doing it, everybody is on board and committed top-down, bottom-up in recognizing how valuable they are and that we are all focused on outcomes.
The outcomes should be predictable outcomes. Of course events occur that we did not predict, but for the most part we should have a sense top, bottom down what is going on with these people and everybody is involved in the problem-solving approach or else it default a few people then you have a system that does not work.
Our goal and I think the directive nurse and especially the DOM's work very hard, our goal and we are constantly looking at and improving on is the self radiating system. I see this working more at granite Mesa in marble Falls than I have experienced elsewhere. I have been to San Antonio, Dallas, Austin and other parts in between. And this is a very unique approach. It works. It is evident in the outcomes that we get.
Furthermore I would like to add we have in-house therapist as well. We have gone different ways with out of house in-house and again as part of that in-house team that we are all focused and we are doing what we are expected to do. Again, the residents benefit from this.
I am going to -- I am happy, any questions you might have I am happy to take any questions. If I do not get any questions I will give this to Tabitha Ball, my DON Thank you Chris. Okay Tabatha just let me know when you need me to change the slides.
Okay. Like Chris said this has been a group effort all the way down to my lead [Indiscernible] she is looking at this as not really a game but a goal she is always working on. When someone has not needed a medication for so long some kind of psychotropic she will come to my office and say she -- they have and use this for so long why don't we talk to the nurse practitioner about it. So all the way from the med aid up we have been working together trying to get things CCed as we can. I think are antipsychotics are as low as they can go.
Everybody who is on it definitely needs them.
Why don't you go ahead and go to the next slide.
Okay. Let me do that.
We have what we normally call a problem statement we switched it to a goal statement. Our goal statement is to do mental health grounds monthly and discuss resident on psychotropic drugs with the interdisciplinary team. And we have our psychologist are psychiatric nurse and of course well pretty much everybody in the management team that doesn't make care for the resident so we can get input from everybody. We do the IDT, -- sorry about that -- we do this to adjust the psychotropic meds so we can reach an optimal level. There are times that we will try to [Indiscernible] down which to certain [Indiscernible] we have to [Indiscernible] down and we say all that's not cannot work so we had to put them back up. But that is just the way it is. Some people just cannot function without these medications.
The next one says why and it is to identify other causes or problems that the patient may be experiencing such as pain, dehydration, UTI and that is where other team care members, we have other people involved in it. Different people see different things with these resident at different times. We have really learned a lot in these meetings we have.
The next one is why so patients are not getting over under medicated and aren't getting the correct medication for their particular need. Before we have our IDT each week we go around and talk one-on-one with the aides, nurses just to make sure there is nothing they have been seeing that they have not let management know about so we can bring that to the IDT meeting and make everybody aware. When the physicians come in they only see a snapshot and I am sure all of you know that during the night the resident are totally different. Our world changes at about 6 PM every day. Those doctors never see any of that because they are not here.
Anyway we are trying to facilitate patient independence and improve the quality of life for everybody. Then this is also so families can be reassured and have peace of mind that their loved ones are receiving the best level of care.
If you want to switch to the next slide. You will have to enlarge it on your own screen. It is a sample of our IDT sheet that we do monthly. This was produced by our geriatric specialist which is the group are medical director [Indiscernible] and over on the far left that has the patient name and in diagnosis and I go in and look on the problem list in the chart and write down any kind of psychiatric diagnoses they may have and then the next column are clinicians better treating and it will either be are psychiatric nurse or a psychologist. Those people are very very important. If you are not happy with your psychiatric specialist you are using then go shopping Secom find somebody else. The team that we have they are very very open and very willing to hear our input and it is made for a wonderful team.
The next column has that baseline sign and symptoms. Normally what we see from these resident. The next column is what they are doing currently. So we can let them know if there has been some kind of change in behavior or if it is the same, or continuing the same behavior.
By the way the way I get the names of these people we addressed as we look at the [Indiscernible] window and see who is coming up and anyone that is on antipsychotic medication are used then. That is the names we draw from.
Or the people who have have episodic events we will throw those people in as well.
The nonpharmacological intervention, Chris's talk about the psychology team that we have we have a group of around 8 to 10 counselors that come in weekly, a few times a week so counseling has been a wonderful nonpharmacological intervention that has not really affected the antipsychotics, but I have noticed it has decreased our antidepressant use. Which has been nice and it has made for a happier environment for the staff and the other residents with certain people that have just been suffering from depression.
We also -- that is where we also address activities or other things that we are trying to get people involved in.
As well as these things I just talked about we also have created a volunteer program that resident that can function pretty well are involved in. They have been given assignments in the facility and that seems to be working very well. It is giving a lot of people a purpose.
The next column is the non-formal logical intervention proposed and that is when I can jot in something and we can discuss it in the meeting and see what everyone thinks about it.
The next column are the current medications they are on and then if there's anything we want to recommend, that is the next column, and then while I am doing this I have each resident chart in front of me as I am preparing a. I also go through and check the Bismarck and make sure we have the right diagnoses with these medications that correspond with what is in the chart on the problem list. We want everything to coincide.
When we first started this there was not a whole lot of matching up. At this point we have now gone through everybody on psychotropic medications and I think we are pretty much matched up. But if you sit down and look at your facility you will probably be surprised at the [Indiscernible] matched up.
On the far right just to make sure we do have the right diagnoses with the medication the resident are on. And I have put a little bit of a question on one of them. So that is where we address that. I take the chart into the meeting with me so we can whip them out, sit in front of the doctor, they change whenever some the list that need to be changed or make whatever changes we need to make so everything is FDA approved.
That is about it for me.
Thank you Tabatha. That is excellent. We are going to move on and see if there are questions for you guys. Don can you tell everyone how they can get into the queue to ask questions?
I see a few questions here.
Okay do you want to enter these. Like Christina Crom asks how many beds business facility run.
We are 124 bed facility and we have been running around 105.
Are typical breakdown when you look at the demographic is what 5% skilled, 25% private and 50% Medicaid.
We typically run at 105.
Great.
Per day.
Okay. Don can people ask questions?
Yes ma'am. It is and him and if you like to ask a question please press the number one key on your phone.
Frank was asking about the population am a mental health versus elderly with dementia.
I think that we recently discussed this and I believe we probably have a diagnosis of dementia in some form or another I think it is as high as 60, 65% of our population. So we have a typical population. We are geriatric specialist, we do not have a lockdown unit, we do not manage major behavioral related issues, so we manage those we are able to manage and if not we discussed alternative approaches.
Fantastic. I also share one of the questions with your percentage in antipsychotic drug use and I share what we talked about yesterday that you guys are under the 45th what we talked about yesterday that you guys are under the 45th percentile for long stay residents on antipsychotic meds and short stay is zero.
Right. I think we are at 22%.
That is fantastic.
Plus everybody really needs to be touring through your pharmacy reports. That is the first thing I grab when the pharmacist since being report each month is all part antipsychotic list. I ask a guy through and make sure she does not have somebody on the list that should not be. That will make our numbers look a little bit better.
It is a good thing that I can grab throughout the month when we are having issues with somebody, it is quick and easy to look at. As soon as we get that list I also make a copy for our medical director because she is interested in going through them as well.
Think you. Don do we have anybody thank you?
No ma'am no questions thank you.
I might also like to add that our psych round sheet that Tabatha had displayed, this is a product of Austin geriatric specialist, our medical director Dr. Peggy Russell was the author of this. I thought I just might add that.
Thank you Chris. Maybe at some point in time we can get a copy of that and of course credit Dr. Russell who is excellent, I have met her in the past. And credit her with that and shared on our website. We will talk about that in the future.
Let's do a polling question if we well. If we can put up a polling question I want you to think about this. Are you actively working on a quality improvement process in your facility?
If you will give me -- we have 20 seconds left so a few quick yes or no. Then we will look at our outcome.
Okay. I think everybody has had a chance. Do we have a result?
I do not see result it. -- Yet.
Okay. It looks like 65% are actually working and that is fantastic. One of the big things for me for this webinar before we move onto root cause analysis, one of the big things for me is if you can learn one little thing that you can take back to your facility and try. You know that PSA cycle we try. If it doesn't work we try again, if it does not work that is fantastic.
Let's move onto root cause analysis. Our presenter is Melody Malone. As far as I am concerned she is an expert on root cause analysis. Thank you Melody.
Okay. Thank you be so much. I am hoping at this point all of you are engaged so feel free to keep the chat going we will try to keep up with that.
Have you ever looked at a graph or data and said what is going on? I am trying to be the top 10 in Texas I am trying to be as good as I can be but how come I can't whatever that data with thank you, how come I cannot get to where I want to be and really I think ultimately for all of us why can't I get my facility where I wanted to be and sustain us improvement.
I am sure you asters of some of those questions. Then you look at another graphically why can't I get here, how come I can't have this wonderful sustainable long-term improvement. This might be a benchmark, and actually this is. This is the restoring data for Texas when we started way back in 2002 restoring data for Texas when we started way back in 2002 All the Way up until they turned off the old 2.0 quality measures. So you can see Texas had this great improvement and actually became a benchmark or the country.
When you look at your data and say why can't I get here, why can't I sustain this.
The problem really is we have to cause -- find the real root cause. This is where you need to put on your thinking cap on as your mom used to say, and use your best critical in clinical thinking skills.
I want you to be really open to what is the real cause of the problem. Oftentimes I think we prejudge. So to get to the root cause, to find that fundamental reason why a problem has occurred, why we did not meet expectations, is to really utilize a deep clinical process. I want you to think about this like a CSI or a crime scene investigator. I am not trying to say that every event in your facility is a crime, I don't mean not, but most of us has seen one of those television shows. When it got to the end of the show it did not turn out like you thought. The whodunit, was a shock. That is sort of like root cause analysis.
What is challenging in him that the gating is we cannot give you one specific form or tool that you can use in always get to the end result. You are going to have to really do it like a crime scene investigator and think about this sort of along the clinical process that most clinicians follow. Where they do a full assessment or evaluation of the residents first. Once they have done that then they identify all the problems they have to address.
That full assessment that is what the root cause analysis is. If we do not do a full root cause analysis that we can't really get to the true reason why we had the problem, therefore we don't really fix it with sustainable changes.
The goal of the root cause analysis is to help us find out what really happened, and all the what really happened. There may be multiple reasons. Why did it happen that way? And what do we do to keep it from happening again? Those are the real goals of the root cause analysis. So in order to make this really work it has got to be interdisciplinary. Dislike you heard Tabatha and Chris talk about their interdisciplinary process, it has got to be where you are involving those experts on the front line. Your staff that are right there at the bedside with the resident all the time, they are the experts, they know those resident so well.
A lot of times I think we think an outside person is going to see something with fresh eyes and we forget to involve those experts on the front line in our quality improvement opportunities. But when we involve those experts, they know exactly how things get done. And how they work around what the policy or procedure might say. And you all know exactly what I mean. There are lots of work around. We need to figure out how the experts are actually doing their job and what do we need to do to design it in a new way that will eliminate that opportunity for error.
So in the root cause analysis we are constantly asking ourselves why, why, why. When we do that we have to ask these questions in a way that it is a no blame exercise. We are not trying to do a finger-pointing here. We are not wanting to assume that one individual is responsible for the error or problem. We want to find the true root cause.
Do not be surprised if you uncover multiple aspects that have played into it. Oftentimes there is not only one root cause of multiple root causes.
That is the goal of root cause. But I am going to show you a few tools that are available on our website. [Indiscernible] resource section.
The first one is the five wise tool. This if you think about why, why, why. As you saw granted Mason use this strategy different with their ideas of goal. But when you look at it as a root cause analysis tool your interdisciplinary team will start off with their problem statement. Like we have inappropriate antipsychotics. What ever the problem is. Then you start asking why. Why do we have inappropriate antipsychotics and you worked all the way down. It may take more than five wise, it may only take five wise it may only take 30. When you get to that real root cause when you ask yourself if we remove this root cause, would it keep this happening. Then you found that real root cause.
I'm going to share one that I have completed. So why is there no changes in the resident condition. Well because we have poor staff communication. Why is that? Because they are not using the proper tools, the 24 report and handouts. Well why not? Say they don't have time.
Well why not? Because they're not efficiently care and documentation. Life that?
Lack of planning and training. So this team decided that lack of training on the 24 report, lack of training on the handoffs, and lack of interlinking the handoffs with their root cause. When they work on those changes it solved their problem. So they five wise tool is one thing you can use the help Junior root cause analysis. Another tool is called brainstorming. Many of us have probably done brainstorming in a lot of different ways. There are two types I called the first one brainstorming with my out loud voice. This is a way for us to create or to generate creative solutions or problems.
It is spontaneous. Contributed by all of the members that are on that team. But there are a few rules about this. Because if we are all sitting in a room together and we brainstorm ideas, if someone says that was a really great idea, it may make somebody else feel like my idea doesn't seem that great. I don't think I will set.
That could be the idea that is the solution. So we want to withhold any kind of comment, great or what's that all about? Because the whole idea in brainstorming is to generate as many ideas as possible, the wilder the better. Not put any kind of judgment on them because every person has an idea. Every person idea if equal and had equal worth.
By the end of that you should have a list of opportunities. In such a deal I have for you guys. We are going to do a brainstorming exercise right now. I have for wonderful tran7's are going to help me out. I have Marcia Riley who is it DON at [Indiscernible] home. I have [Indiscernible] who is the DON at Texas State veterans home, I have Julie will be the DON at the, manner, and I have just reread who is the DON at Westminster Manor healthcare. I would like to invite these ladies to brainstorm with me. What alternatives all their to antipsychotic use.
So Marsha why don't we start with you. Give me an idea.
One of the first things we did we quit accepting any orders for PR and antipsychotic drug that includes our new admission and current resident.
Okay. That sounds great.
Course we had to train are admitting physician but they are all on board with us now.
All right. Erlang.
Yes Melody one of the things we have done is what you said the brainstorming are entered disciplinary team has gotten together one of the great alternative interventions we have come up with here is a sensory intervention looking at individual resident and what works for them. A weighted blanket, we have had wonderful, wonderful results in using a weighted blanket that calms the resident, cuts down on the behaviors, the yelling. It was really great.
Thank you.
Kind of along the same line this is Julie, with the Sentry interventions we looked at what was going on in the environment, the stimuli, the visitors, the bed alarms, the wheelchair a Lawrence to see what was going on and maybe we could eliminate and use other items to format the alarms [Indiscernible] the bed alarms to calm our environment down.
Thank you. Jessica.
That is a good point Julie. Actually thinking of that you remind me of some the things we have done. We have gotten a system to where it goes to pagers on the employees that keep on vibrate that there is no audible alarm in the resident room. That has been helpful to keep the noise level down. On our demented therapy area.
We also use my favorite tool is the reminiscent therapy that we help facilitate that with memory boxes. So we have a big meeting with all the families and admission and help develop this memory box back goes to our staff whenever our resident is having a difficult time that day. That box has different thing that remind them of previous memories whether it is a candle with that Eber fragrance are pictures of their trip to London or whatever and we can take those things out in utilizing to start a conversation with that resident and hopefully de-escalate the situation and change the tone for the day.
Thank you so much Jessica.
Not just give me some more ideas ladies.
What's the weighted blanket?
The weighted blanket is what we ordered from a catalog and we received here. We have a memory wean, a secure memory wing that we were looking at interventions in this weighted blanket has been in it and also has lavender for the sensory. You can put in a microwave and warm it. It is just a lavender and warmth has created a security for this resident that it has really worked.
Actually this is just again, we have one of those in our tranquility room or tranquility suite which I mentioned earlier. We just got that started this past month. Each resident has a sensory profile of different things that they liked. Whether it sounds or different stimulation whether it is light or textures or touching something. We have a weighted blanket in there to for residents to enjoy that security. They can sit in a chair with another CNA there and implement different sensory items for them. It is a private room for them to experience that. It has been very tranquil and very good for a lot of our residents.
Thank you Jessica. Marcy.
Another thing we have done is vamped up, revamped, redone our pain assessment program. We have all the CNA's, the med aid, the housekeepers everybody on board to monitor for pain. We adapted all of our pain pills. We really go out there and take is this -- how is this resident behaving because of the pain problem. Our whole staff is on board to look for and monitor for pain.
Okay.
Along the same line this is Julie again, we were [Indiscernible] lab work looking to see if there was undiagnosed type attics looking at thank you OC and seeing if maybe they have a urinary tract infection running you aid on them. Because those can have a large impact on psychotic behaviors.
Okay. Anybody else?
Melody, this is [Indiscernible] again another thing we have done that seem to work for a specific resident and Mike said all of this is individualized, a resident that was chanting and would get louder and louder and louder with her chanting therapy got brainstorming with this and came up with the idea for earmuffs. We put earmuffs on this resident and she could hear herself chanting and it quite to her. And not work for her.
I have not heard about one.
Anyone have a great idea that they want to add?
This is Marsha again. I have recently implemented a vitamin E therapy program. I noticed a lot of my people with behavior had low vitamin D levels and now we are 2 to 3 times a week take them outside [Indiscernible] ones that don't go outside and that in the sun. We also check love levels and from one of your other one I talk to like the idea of having that as an admission process to check vitamin D level in a comment.
Okay.
We utilize that as well. We do that on admit the vitamin D and have them either on the deed to or D3. The D2 is really good because you can do it on a weekly medication. About 50. About 50,000 units I think is what we are using here. Been the D3 anywhere from 2 to 5000 units whatever the doctor orders for the vitamin deficiency supplement.'s
Okay. Ladies let me thank you so much I think you have added a lot of our discussion today. I hope for all of our [Indiscernible] you can see how brainstorming can work.
I appreciate Julie Jessica [Indiscernible] Marsha for helping us. Thank you. What would be nice is if we do all this right all of these lists are going to stay in the webinar so you will be able to have them.
This is how you could use brainstorming with in your team. Generate a whole list of ideas. Whether or not this is for a root cause analysis or any reason you want to work on any issue, brainstorming can be quite effective.
There is another tool that you can use with rain storming as well and it is called brainstorming silently. Or I call it silently. What you do with this rain storming system is basically on a flip chart dislike those would have been on a flip chart, use sticky notes and you give the keynote everybody in the room, and this is a great opportunity to really ask controversial questions. A lot of times in your root cause analysis there will be people who have an idea but they do not do comfortable speaking up. They are not going to say that with their out loud voice, but they may write it down.
What you will do is collect all of the ideas for one question. So just like that same question what alternatives do you have for antipsychotics? We could had each one of those ideas written down. Then as a team go back and process those ideas. So even without our brainstorming or silent rain storming you are going to go back and process those ideas so you can identify what the root causes or what some improvement opportunities might be.
The Fishbone diagram is an opportunity for you to see what I mean by processing. So you can either brainstorm right into the Fishbone or you can take your items and see where they are grouped together.
So a problem statement is like the head of the fish and you can group your issues or ideas by different headers. So I have staff materials, equipment, education here. You might end up with different kind of topics such as methods or machines or measurement or environment.
Let me show you an example of what I mean by one completed. So in this case the problem is that the resident are having facility acquired pressure ulcers. So this team with looking at how can we prevent this.
They identified in the staff that there was an issues. Nourse's don't know how to do skin assessment. Resident risk factors were not documented or acted upon. So they grouped these items under staff issues. Were asked under processes there was no head to toe skin assessment on admission. So you can see whether you brainstorm with you out loud bubbles or you are thinking about brainstorming or even the [Indiscernible] you might end up grouping your issues under this Fishbone example to give you an idea of general areas that you may need to work.
So Fishbone is an opportunity for you to either brainstorm right into the Fishbone example or to use it as an egg -- a way to organize your thoughts.
One last thing I want you to think about before we close today if have you considered the human factors?
We are all human and we all make mistakes. We are in the process now of creating a video series and one will be on human factors and I hope when that series is available you will watch it. Keep in mind that if a plan is not sufficient, then it is going to happen. The problem is going to happen. If the staff cannot execute it then there is going to be in error. There are times when the staff choose to not do something but it may be because we make system so hard. They may violate the policy, but maybe we make the system so hard.
All of those are human factors that we have to take into account when we look at our root cause analysis.
The question comes down to now that we have our root cause, so we have gone through this analysis, we have utilized our critical thinking skills, we have analyzed our problem, we have taken into account human factors, now we get down to the real root cause and we say okay what do we do now? Now we know what our problem is. This is when you go into the model for improvement. I think at this point most of you are familiar with this but just as a week reminders so what are we trying to accomplish today seems to be a lot of antipsychotics to decrease antipsychotics. How do we know the change is an improvement because of the webinar look at the data. And what change can we make that were result the improvement. Well for all of the ideas you heard today, from what Granit Mesa had to say from our brainstorming team, you may come up with a change I did that you want to implement but you want to test that change and work out the bugs. We do not want to rollout something out of the hole facility and not make sure that it will really work well.
Then we want to come up with a sufficient plan, test it, evaluate those results and then decide how we are going to move on to a larger testing change or rollout an idea that might be more sustainable than what we are doing right now.
A way to do that is looking at the worksheet were testing change. Many of you have seen this as well. This is a model for improvement pushed out onto a piece of paper. As you work for your quality improvement process this is the way you document your quality improvement testing efforts.
Your root cause analysis will be in all the other work you have done prior to getting to your worksheet for testing change.
I am going to turn this back over to Debbie. Thank you so much.
Thank you Melody. Now we have another polling question for you. Again select your answers on the right-hand side. Have you started using root cause analysis to identify changes that you can test in your facility? And you have 30 seconds to answer that and get that turned in.
While we are answering that there are a couple of things I want to remind you. When we look at root cause analysis, we are looking at system and we are not pointing fingers at people. If people are not doing things correctly, the question is have we provided the training to help them do things correctly.
I don't personally believe anybody get up in the morning and comes to work in a nursing home with the idea today I am going to hurt somebody or cause harm. Because people who work in a nursing home do so because they love resident and they love the elderly. That if my 28 year experience of long-term care. Now that I get off my little soap box. We have our result.
It looks like it is kind of mixed. Some people have started using root cause analysis. For those of you who have not, I hope that this presentation will help you get into using root cause analysis to determine what you need to start to make changes in your facility.
Okay. I would like to open it up not to questions. If you have questions, Don can you reminder they had to get into the cube?
Absolutely. It is and gentlemen if you would like to ask a question press the number one key on your phone. Again if you want to ask a question press the number one key on your phone.
Also the Is available. If you have questions in the chat.
There are currently no questions Inc. you.
Okay. There is a little poll at the end over on the right-hand side. If you would please fill that out. And let me also give you a little information about us as your feeling that out.
We are the quality improvement organization for the state of Texas. We focus on improving lives by improving the quality of healthcare through our contracts with multiple organizations including state, federal and local governments. And for over 40 years we have helped providers and Precht dismissed in many settings improve care for their patients and residents.
I remind you again please fill out the little questionnaire on the side and I thank you very much for your participation today.