Creating an Integrated Care Plan for Nursing Home Residents Receiving Dialysis Treatment
The Dialysis and Nursing Home Integrated Care plan provides a framework for a discussion to evaluate a resident’s response to dialysis and develop or revise person-centered care plans as needed.
Adopt Project Firstline
Project Firstline helps healthcare workers understand, think critically, and apply infection control actions.
Project Firstline offers easy-to-use, accurate, and free infection control training resources in multiple formats to align with healthcare workers’ learning needs and preferences. This tool can help you achieve success in providing staff with consistent and effective education related to infection prevention and control, which was developed by the Centers for Disease Control (CDC).
IPRO QIN QIO nursing home team recommends that you consider using these resources in a structured way or as a “just in time” learning opportunity.
This Substance Use Disorder (SUD) Treatment and Access Policy and Procedure Toolkit for Nursing Homes and Adult Care Facilities is intended to provide easy-to-adapt policies and procedures for facilities that wish to implement or improve their care for residents with SUD, which includes access to behavioral health resources, medications, telehealth, and referral networks. Most of the policies deal with opioid use disorder treatment, as this was the overarching need identified by nursing homes and adult care facilities; however, this toolkit was designed to be modified, and future updates will include additional substance use disorder policies.
Person Centered Care Plan Development Guide
Use this guide, with focus areas and examples, to assist in developing a person-centered care plan.
Person Centered Comprehensive Care Plan Audit Guide
Use this care plan guide to audit baseline and comprehensive care plans in the long-term care setting to ensure each care plan is person-centered and individualized.
The IPRO QIN-QIO has prepared educational materials to help spread awareness about health topics relevant to your community members and to support population health. Each LINKS portfolio introduces a health-related topic and resources for more information. This is the cover for the LINKS Advance Care Planning portfolio.
Advance Care Planning Fact Sheet
This fact sheet provides data about Advance Care Planning, including the importance, resources that help support the discussion, and links to state-specific requirements.
Advance Care Planning: Tools and Resources to Help You Get Started
This PowerPoint presentation is about Advance Care Planning and can be adapted to fit the needs of your specific audience or community.
Advance Care Planning: Conversation Posters
Posters that can be displayed in consumer or patient-facing areas to encourage discussions about Advance Care Planning. Select the one that best suits your needs, 3 are in English, and 1 in Spanish.
Advance Care Planning: Resources for Patients and Families
A guide that provides a curated list of tools and resources to support patients and providers through the Advance Care Planning process, and serious illness or end-of-life care conversations.
Posters that can be displayed in consumer or patient-facing areas to encourage discussions about Advance Care Planning. Select the one that best suits your needs, 3 are in English, and 1 in Spanish.
Advance Care Conversation Poster #1
Advance Care Conversation Poster (Spanish) #2
Advance Care Conversation Poster #3
Advance Care Conversation Poster #4
“One of the most important steps in providing quality dementia care is to know
the person with dementia.
This resource can provide insight into the resident to avoid triggers that could
result in disruptions due to changes in the environment and care providers.
The form has fillable fields and should be printed and sent with the resident/patient when they will be in an unfamiliar environment. “
This toolkit provides steps your organization can take to integrate a social needs screening and referral process into its clinical workflow. These steps are general recommendations that an organization can consider and adapt for its specific needs. The recommendations are general by design, to ensure they are useful for the diverse organizations that will be using this toolkit and their unique patient populations, workflow, and available resources.
Clear communication between nursing home and dialysis provider interdisciplinary teams (IDTs) is essential for successful transitions in care when nursing home residents receive dialysis. This integrated care plan highlights the importance of ongoing communication, collaborative care planning and delineated division of responsibilities as critical elements for the successful implementation of a plan of care for nursing home residents who leave their facility for dialysis treatments.
Certified Nursing Assistants (CNAs) can play an important role in pressure injury prevention planning and education.
“More than one in four older adults (>65 years of
age) are diagnosed with diabetes and half of the
older adult population are prediabetic.
As the prevalence of diabetes increases in older
adults living in long term care facilities, it’s
important to minimize adverse drug events for
those who take diabetic medications.1
Unfortunately, even with the advancements of insulin delivery
and new medications, older adults still experience higher rates of
functional disability, increased risk of falls, accelerated muscle loss,
coexisting illness, and premature death.2 To address these concerns,
IPRO has created this list of tips to decrease the number of adverse
drug events related to diabetes management in long term care
facilities.”
Common screening tools (DAST-10, SBIRT, TAPS) and Medicare and Medicaid Reimbursement guidance.
