CMS strives to provide nursing home providers with access to resources (materials or websites) to support QAPI implementation. Use of these resources is not mandated by CMS for regulatory compliance nor will their use ensure regulatory compliance.
Guides to Quality
Getting Better All the Time: Working Together for Continuous Improvement
The Isabella Geriatric Center and Cobble Hill Health Center has developed a web manual on quality improvement approaches as a guide for nursing home caregivers. This is a particularly practical and lively resource that explains and illustrates performance monitoring and improvement approaches in ways that are understandable to most nursing home caregivers. Getting Better All the Time was written by Ann Wyatt, a social worker and nursing home administrator; it aims to present a model of quality improvement that integrates quality of care and quality life. Click here to access Getting Better All the Time.
Implementing Change in Long-Term Care: A Practical Guide to Transformation
This resource was prepared by Barbara Bowers and others with a grant from the Commonwealth Fund to the Pioneer Network. Although it deals with implementing culture change (not QAPI), it is a good resource on the change process. Click here to access Implementing Change in Long Term Care.
National Nursing Home Quality Care Collaborative Change Package
The National Nursing Home Quality Care Collaborative (NNHQCC) Change Package is a menu of strategies, change concepts, and specific actionable items that nursing homes can choose from to begin testing for purposes of improving residents’ quality of life and care. The Change Package was originally intended for nursing homes participating in the National Nursing Home Quality Care Collaborative led by CMS and the Medicare Quality Improvement Organizations (QIOs), to improve care for the millions of nursing home residents across the country. The Change Package was developed from a series of ten site visits to nursing homes across the country, and the themes that emerged regarding how they approached quality and carried out their work. It focuses on the successful practices of high performing nursing homes. Click here to access The NNHQCC Change Package.
QAPI at a Glance
QAPI will take many nursing homes into a new realm in quality - a systematic, comprehensive, data-driven, proactive approach to performance management and improvement. This guide provides detailed information about the “nuts and bolts” of QAPI. We hope that QAPI at a Glance conveys a true sense of QAPI’s exciting possibilities. Your QAPI results are generated from your own experiences, priority-setting, and team spirit. Click here to access QAPI at a Glance.
Advancing Excellence in America’s Nursing Homes
Supported by CMS, the Commonwealth Fund, and others, The Advancing Excellence Campaign provides tools and resources to improve nursing home care in clinical and organizational areas. Click here to access the Advancing Excellence Campaign website.
Agency for Healthcare Research and Quality
The Department of Defense and the Agency for Healthcare Research and Quality developed the TeamSTEPPS program to optimize performance among teams of healthcare professionals and improve collaboration and communication. The Long-Term Care version addresses issues specific to nursing homes. Click here to access TeamSTEPPS Tools.
Department of Veterans Affairs
The National Center for Patient Safety supports and leads the patient safety activities for all VA medical centers and has developed tools including Root Cause Analysis investigations. Click here to access Patient Safety Tools.
Donna’s Diary is an interactive website for nursing homes to support learning about quality improvement and to enhance the quality of life for nursing home residents and staff. The entries in this fictitious diary of a director of nursing (DON) represent realistic case studies about the challenges nursing homes face. The solutions posed are based on best practices using QAPI principles. The website was created and is operated by Stratis Health. Click here to access Donna’s Diary.
Lean Goddess Video Series
This series of videos teaches quality improvement by applying quality strategies to everyday situations. This material was prepared by The Colorado Foundation for Medical Care (CFMC), the Learning and Action Network National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services (CMS). Click here to access the Lean Goddess Video Series.
Model for Improvement
The Institute for Health Care Improvement uses the Model for Improvement as the framework to guide improvement work. This model, developed by Associates in Process Improvement, is a simple, yet powerful tool for accelerating improvement. Learn about the fundamentals of the Model for Improvement and testing changes on a small scale using Plan-Do-Study-Act (PDSA). Click here for to access the IHI website.
Quality Improvement Organizations
Each state is served by a Quality Improvement Organization that offers resources and tools for nursing homes. Click here to find your Quality Improvement Organization.
Adverse Drug Event Trigger Tool
In response to the Office of Inspector General (OIG) report Adverse Events in SNFs: National Incidence among Medicare Beneficiaries, CMS has developed, and is making available in draft form, a resource document that may be helpful in evaluating systems of care around high risk medications. This document was designed to be a crosswalk that lists:
- common potentially preventable adverse drug events,
- risk factors related to those events,
- triggers – signs, symptoms, or clinical interventions which could indicate that the adverse drug event has occurred, and
- probes which would assist surveyors in evaluating systems around high risk medications.
Change in Condition
An example of a more extensive set of tools, INTERACT II is a system of tools to improve how nursing home caregivers communicate around change in resident condition. This comprehensive set of tools could be considered a QAPI process toolkit as well. Click here to access INTERACT II.
The Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network:
The CDC’s National Healthcare Safety Network (NHSN) provides nursing homes and other long term care facilities with a customized system to track infections in a streamlined and standardized way. When facilities track infections, they can identify opportunities for prevention and monitor progress toward stopping infections. On the national level, data entered into NHSN by long term care facilities will help define the burden of infections in this setting and gauge progress toward national infection prevention goals. Click here for more information on tracking infections using NHSN.
Person Centered Care
Picker Institute Publications
These publications include a Long-Term Care Improvement Guide, commissioned in 2010 and a Patient-Centered Care Improvement Guide, commissioned in 2008, both by Susan Frampton and others. The website also carries information on current books related to person centered care that the Picker Institute recommends. Click here to access Picker Institute Publications.
Agency for Healthcare Research and Quality (AHRQ)
AHRQ developed On-Time Pressure Ulcer Prevention (OTPP) to be an evidence-based program for nursing homes who currently use electronic medical records (EMRs). This program shows how to use reports generated from a nursing home’s own EMR to help identify residents who are at risk for pressure ulcers. Nursing homes can choose the reports they want to implement into day-to-day practice. The program provides a self-assessment of current practices, a menu of implementation strategies, and facilitator training materials. The program’s tools encourage multi-disciplinary communication to assess a resident’s changing risk factors, modify care plan interventions, and engage in root cause analysis when a pressure ulcer occurs or worsens. OTPP is a data-driven, proactive approach to improving the quality of life, care, and services in nursing homes. Click here to access the On-Time Pressure Ulcer Prevention program.
Note: References to non-CMS sources or sites on the Internet are provided as a service and do not constitute or imply endorsement of these organizations or their programs by CMS or the U.S. Department of Health and Human Services. CMS is not responsible for the content or accessibility of pages found at these sites. URL addresses were current as of the date of this publication.
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