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Step Two: Clinical Applications


This section explains how to strengthen the foundational practices by applying them to three priority clinical areas:

1. Promoting mobility, reducing falls and alarms

2. A good welcome: the first 24 hours

3. Reducing off-label use of antipsychotic medications by engaging staff in individualizing care to alleviate resident distress

Incubator homes accelerated their improvement in each of these clinical areas by tapping into consistently assigned staff's deep knowledge of residents through huddles and QI closest to the resident. Staff can identify ways to individualize their approach as they know better what works best for the people they care for every day. Customary routines hold the answer for how to meet clinical goals.

The nursing home reform law requires nursing homes to provide care and services to "attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident." The term "highest practicable" means that there is no decline unless a decline is unavoidable, and that an unavoidable decline is one that is a natural progression of an illness or condition.

An avoidable decline is actually "iatrogenic" – caused by the treatment, not by the disease. Iatrogenesis is a medical term derived from Greek meaning "inadvertent harm caused by the treatment." Alarms that immobilize and antipsychotic medications that sedate have iatrogenic effects.

When staff know residents well and are supported by the rest of the team to follow residents' customary routines, they are able to shift from iatrogenic institutional care to individualized care that promotes residents' highest practicable well-being.

Promoting Mobility, Reducing Falls and Alarms

Promoting Mobility Tip Sheet

Promoting Mobility Reducing Falls and Alarms Starter Exercise

Promoting Mobility, Reducing Falls and Alarms Video Clip - Hear from a Massachusetts Director of Nursing how her team reduced falls by eliminating alarms and individualizing care. 

A Good Welcome – The First 24 Hours

First 24 Hours Tip Sheet

A Good Welcome - The First 24 Hours Starter Exercise

A Good Welcome - The First 24 Hours Video Clip - Hear from the administrator of Loomis House in Holyoke, MA how her team learns residents' rhythms of life as soon as they come in so that they can help residents be comfortable from day one.

Reducing Off-label Use of Antipsychotic Medications by Engaging Staff in Individualizing Care to Alleviate Resident Distress

Reducing Antipsychotic Medications by Individualizing Care Tip Sheet

Reducing Antipsychotic Medications by Individualizing Care Starter Exercise

Reducing Antipsychotic Medications Video Clip - Hear from geriatric psychiatrist Susan Wehry, MD, how to understand what residents are communicating by agitated and aggressive behavior and how to respond in ways that best meet residents' needs.

Download Step Two: Clinical Applications Introduction (PDF)

Starter Toolkit Home          Step One          Step Two          Step Three          Self-Assessment
Prepared by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS as the Engine for High Quality Individualized Care. Funded by The Retirement Research Foundation.