Congratulations, Alta Vista Rehabilitation and Healthcare Center, on recently being published in the Winter 2012–13 • Vol. 36 .No. 4 issue of Journal of the American Society on Aging!
The article highlights the Alta Project at Alta Vista’s facility in Brownsville, Texas. Led by Medical Director Dr. Lorenzo Pelly, the project focuses on patient accountability and delivering the highest-quality care before, during and after a patient’s admission. Dr. Pelly continually works with and trains staff to enable them to exceed standard care practices, using the following program goals as a guide toward delivering exceptional care:
- Improve resident care
- Reduce the number of rehospitalizations related to errors by 20 percent in less than two years
- Reduce miscommunication at all levels of the care process
- Improve healthcare professionals’ decision making through staff education and checklists
- Increase understanding of criteria for admissions to the nursing home from the hospital
- Avoid futile care (that which does not improve the illness or quality of life)
- Promote awareness of highly detailed screening and the cross-referencing network for each resident
With the introduction of the new tools and processes below, the Alta Project offers an industry benchmark through which facilities nationwide can enhance their patients’ care.
Resident Admission Checklist
This checklist, completed by two nurses, reminds the nursing staff to place the new resident close to the nurse’s station and ensures the complete transfer of vital clinical information for each resident. The extra checks and balances enable staff members to obtain all of the information required to prevent rehospitalizations, while also allowing for a seamless transition for the patient from acute care into the facility.
Alta Individual Care Plan
This plan, tailored for each resident, offers complete instructions on the short- and long-term needs of residents, including a detailed analysis of medications, special needs, and timelines for treatment and improvement.
Alta Prevention Cart
This mobile cart is stocked with all of the essential medications and equipment needed to intervene in the event of a medical crisis, such as C-paps, B-pap technology, emergency box with IVs, antibiotics and fluids. By facilitating treatment at the Alta Vista facility, the cart helps to prevent patient rehospitalizations.
The Hospital Re-Admission Log
With this tool, the nursing staff and medical director can instantly identify residents who are most at risk for returning to the hospital in 30 days. It incorporates a tracking log spreadsheet that charts patients from high-risk to manageable status within 30 days.
The Resident Discharge Checklist
This innovative checklist includes a traditional medication reconciliation list and “tracker” designed to assist residents and their families in understanding the care requirements upon patient discharge. The document describes the patient’s common clinical conditions, symptoms and signs to watch for as well as special medical equipment in use. In addition, it provides caregivers with pre- and post-tests that enable caregivers to understand fully the expected level of care for their loved ones.
Alta DOT System
As a complement to the other systems, the DOT System consists of large colored dots placed outside a resident’s room that visually define his or her condition or need for special observation.
Through the Alta Project, residents are offered uninterrupted care as they move from one institution to another — whether from acute care into Alta Vista or from Alta Vista to home or hospice care. All staff members, including certified nursing assistants, nurses, dieticians and pharmacists, are equipped with the education and resources they need to provide seamless transitions — as well ongoing quality care throughout each resident’s stay.