SaralinTiedemanExpanding INTERACT Program Implementation

By Saralin Tiedeman, MS, OTR/L, Post-Acute Project Manager

The Post-Acute sector has been extremely busy this quarter expanding the INTERACT program implementation to 32 Skilled Nursing Facilities and three Certified Home Health Agencies within the Millennium Collaborative Care network. As of this quarter, over 140 Leadership staff, 800 Direct Care Staff, and 400 RN’s and LPN’s have been trained in the core INTERACT principles and care.


The INTERACT Program seeks to decrease rates of hospitalization among Post-Acute patients by operating the following strategies:

  1. Prevent conditions from becoming severe enough to require hospitalization through early identification and evaluation of changes in resident condition.
  2. Manage some conditions without transfer when this is feasible and safe.
  3. Improve advance care planning and the use of palliative care plans and facilitated end of life conversation with patients and family to anticipate needs and desires of the individuals within the facility.
  4. Improve communication and documentation within LTC facilities and programs, and between LTC and acute care.
  5. Integrate into ongoing QI initiatives (e.g. QAPI).
  6. Embed in Health Information Technology across care settings.

Many of our participating providers have made the transition from paper-based to an electronic medical record, several of which integrate the INTERACT program into the daily work flow of direct care staff.

In addition, an Advanced Care Planning and Palliative Care committee has been formulated.

The objective of this group is to identify the issues of End-of-Life planning, patient and provider engagement at the end of life, and Advanced Directive completion for the patients of our community.

Increasing staff, patient, and family knowledge about End-of-Life and normalizing these conversations to coordinate better plans of care for each and every individual is our goal.

We have also developed a sub-group of this committee, looking specifically at these same issues for the population of individuals with Developmental Disabilities, as there are greater legal regulations and barriers at the end of life for this group of individuals.


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