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INTERACT® as ONE: A Collaborative Approach to Impact Hospital Readmissions Using High Fidelity Simulation

Carolinas Simulation Center (CSC)

Carolinas Simulation Center (CSC) has partnered with Carolinas HealthCare System’s (CHS) post-acute care division to bring mobile simulation to skilled nursing facilities (SNF). The original purpose of the project was to decrease hospital readmission through validation of project INTERACT—Interventions to Reduce Acute Care Transfers. INTERACT is described as a quality improvement program that helps to improve the identification, evaluation, and communication regarding changes in resident status.
System leadership, facility directors of nursing, and educators, in conjunction with CSC team members, developed a plan to utilize simulation with the ultimate goal of reinforcing the process of using INTERACT. It was also decided to include an annual review of skills for the staff of the SNFs. Carolinas Simulation Center would bring a high-fidelity Human Patient Simulator, along with available task trainers, to meet the goals of the curriculum.
The stations focused on frequently used skills that require a higher level of accuracy, such as urinary catheter insertion and care, wound care, tracheostomy care, PleurX drain, tube feedings, and ostomy care. The skills sessions, facilitated by CSC teammates, product vendors, and facility educators, offered a hands on approach to practicing patient care.
Due to the positive feedback that was received, CSC has continued providing this education to the SNFs for the last four years. The information gained during this education has been used to standardize and develop policies for the SNFs across the system and to standardize the equipment and products that are used on our patients.
Sessions have focused on heightening the assessment skills of the nursing staff and empowering the nurses to communicate with physicians using the SBAR (Situation, Background, Assessment, Recommendations) guide, as well as to advocate for patient care. With these additions, we incorporated the use of standardized patients, providing valuable opportunities for participants to practice clinical skills in an environment that is both safe and supportive to the learning process. By practicing their skills with standardized patients, participants could develop and refine their interpersonal skills and professionalism without putting actual patients at risk. The standardized patients would allow participants to practice early sepsis identification and to increase the comfort levels of Certified Nursing Assistants (CNA) using the STOP and WATCH early warning tool.
More than 80 percent of the nurses reported improvement of their assessment and communication skills. Comparing the pre-quiz to the post-quiz results showed an overall 30 percent improvement in knowledge after the simulation sessions. Of the CNAs who participated, 98.5 percent either strongly agreed or agreed that the scenario-based session helped them better understand the STOP and WATCH tool, and 100 percent either strongly agreed or agreed that the scenario-based session would help them recognize potential problems with their residents. We also identified trends, areas of potential growth, and future areas of education focus and shared these with leadership of the Post-Acute Care Service line.
The SNF environment offers an excellent opportunity for education with our healthcare providers who serve one of our most vulnerable patient populations. During this year’s session, an added focus was enhancing knowledge on the Urinary Tract Infection (UTI) protocol used in the SNFs. Although there is not data available yet, we expect that this education will decrease hospital readmissions from the SNFs related to UTIs.