No. 12 – Summer 2016
  In This Issue   New Clinical Director Joins NY-RAH

The GNYHA Foundation and Icahn School of Medicine have selected a new clinical director to replace Inna Popil, RN, DNP, who left the NY–RAH project in August for a new opportunity in nurse education.

Avril Robinson, RN, MHA, has been named NY–RAH's Clinical Director. Ms. Robinson has decades of experience in long term care and in educating, managing, and building relationships across care teams and will begin on October 3rd. Most recently, she served as Director of Nursing at The New Jewish Home in Manhattan.

As Clinical Director, Ms. Robinson will work closely with the NY–RAH Clinical Nurse Managers and the RN Care Coordinators as the project shifts focus to Phase Two to implement educational materials for nursing facility staff on the six clinical conditions. She will make site visits to meet with nursing directors over the next few months to get to know the facilities and familiarize herself with all aspects of NY–RAH, especially the Deep Dive process and use of Quality Improvement Tools to drive change.

The Project Management Team looks forward to working with Ms. Robinson in her new role as the project enters Phase Two.
  Phase One Culminating Event Registration  
NY–RAH is holding a Phase One culminating event for all participating nursing facilities. At the event, RN Care Coordinators will hold a poster session to highlight each facility's accomplishments over the past four years. Also, the project management team will provide an overview of the overall progress to date to close out Phase One and provide information on the plans for Phase Two.

Date: Thursday, September 29, 2016
Time: 1:00 p.m.–3:00 p.m.
Location: GNYHA Conference Center, 555 West 57th Street, 15th Floor, New York, NY 10019

NY–RAH encourages facilities to invite staff that has championed the NY–RAH project, including Administrators, Medical Directors, Directors of Nursing, Directors of Social Work, Nurse Supervisors and Managers, Quality Improvement Managers, INTERACT Champions, and Palliative Care Champions.

Please register here.
  NY-RAH Participates in CMS Regional Webinar

On August 9, Joseph Sacco, MD, NY–RAH Medical and Palliative Care Director, and Ashley Hammarth, NY–RAH Deputy Project Director, presented on the Centers for Medicare & Medicaid Services (CMS) Webinar Series for Long Term Care (LTC) and Sepsis Prevention. Due to the success of the NY–RAH project to date, the team was invited by CMS to present on the first webinar in a series to assist LTC providers in the challenges associated with managing an effective infection control program. The webinar series is a collaborative quality effort between three of the 10 geographic regions that CMS has organized across the United States. Nursing facilities in 19 states were invited to attend. More than 400 callers joined the event.

The presentation consisted of an overview of the CMS Nursing Facility Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents and of the NY–RAH project. Special attention was placed on the work the project has done with early recognition of acute changes of condition and materials from the American Medical Directors Association, as well as the use of the INTERACT curriculum. Dr. Sacco linked the project's efforts with early recognition as the key to preventing conditions from escalating to sepsis and provided an in-depth discussion of what has been learned from the completion of NY–RAH Quality Improvement Tools in the NY–RAH facilities. He described what NY–RAH hopes to see in Phase Two, such as more frequent in-person visits from practitioners early in the acute change, and more serious efforts to manage conditions appropriately in the facility, both of which are supported by CMS payment incentives.

Future webinars in the series will include strategies for early identification of conditions that lead to sepsis, how to combat deadly health care-associated infections, and how to develop and implement updated LTC regulations. For more information, please contact Ashley Hammarth.
  NY-RAH Rate of Advance Directive Discussions Improves  
Over the past four years, NY–RAH emphasized improving palliative care and the importance of quarterly advance directive discussions. Joseph Sacco, MD, Medical and Palliative Care Director, has given numerous facility trainings on the use of the MOLST form, and in summer 2015 the Institute for Healthcare Improvement provided trainings on The Conversation Project Starter Kit, which is a tool to assist residents and families in discussing their end-of-life wishes.

NY–RAH identified holding advance directives discussion with residents and families on a quarterly basis as a best practice and began reporting this measure in the first Palliative Care Report in Quarter 3 of 2014. In Quarter 2 of 2016, NY–RAH set its highest mark for the percent of eligible residents with a quarterly advance directive discussion at 74%, up from only 27% in Quarter 3 of 2014. Over the last two years, NY–RAH facilities have improved on this measure each quarter and the most recent data reflects nearly a 50% increase since NY–RAH first reported this measure in Quarter 3 of 2014. This percent increase represents tremendous progress over the last two years, and the emphasis on these important conversations should position facilities well for the Phase Two implementation of the payment incentive for care coordination conferences. Care conferences must be interdisciplinary and be a minimum of 25 minutes in length, and can be conducted on an annual basis for eligible residents who have stable health and after a significant acute change or hospitalization for residents whose health may be declining.

If you have any questions or would like assistance interpreting your facility's specific reports, please contact Scott Gaffney.
  ECCPs Around the Nation

NY–RAH is one of seven Enhanced Care Coordination Providers (ECCPs) that received the Phase One award for the CMS Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. The ECCPs across the initiative meet annually and speak monthly to learn best practices from each other. Six of the seven ECCPs will continue onto Phase Two and will work together to develop educational and promotional materials for facilities and practitioners. NY–RAH will highlight an ECCP each quarter and describe its unique features and best practices.

US Map

Indiana University, the Regenstrief Institute, and the University of Indianapolis are together known as OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care). Its staffing model is similar to NY–RAH in that it has 19 specially trained registered nurses (RNs) stationed at 19 central Indiana nursing facilities. The OPTIMISTIC model differs from the NY–RAH model in that these RNs provide direct clinical support. In addition to education, they:
  • Recognize early warning signs of changes in condition so that treatment can begin before the problem escalates
  • Educate the resident and family on the transfer process and ensure that the patient's care wishes go with them to the hospital
  • Engage in advance care planning discussions with residents and families to help make decisions about treatment goals
These RNs are supported by a team of nurse practitioners who cover three to four facilities each, coordinate with primary care providers by completing in-person evaluations and management of residents with acute changes, and coordinate with the RNs. When necessary, project geriatricians are conferred to make recommendations.

For more information on the OPTIMISTIC ECCP, please go to the OPTIMISTIC website
CMS Outstanding Nursing Facility Recognition
Summer 2016: Modupe Fajobi, RN, Director of Nursing, Trump Pavilion for Nursing and Rehabilitation
CMS Outstanding ECCP Staff Recognition
Summer 2016: Pamela Charles, RN Care Coordinator Coach, Icahn School of Medicine at Mount Sinai
  The project described was supported by Funding Opportunity Number CMS-1E1-12-002 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.  
  Greater New York Hospital Association
555 West 57th Street, 15th Floor New York, NY, 10019, United States