Approach: Process—Information—Decision Making

| Process |
Decision Making |
| Screening & Assessing |
- Establish indicators of high risk
- Standardize assessment process to categorize and prioritize patient needs
|
| Care Planning |
- Establish forum for proactive care planning
- Maximize collaborative working session and team problem-solving
|
| Team Communication |
- Increase RN role facilitating and coordination activities of multi-disciplinary team (versus doing it themselves)
|
| Resident/Family Communication |
- Increase early interaction with patient/family
|
| Monitoring/Evaluation |
- Information feedback on process and outcomes measures
|
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