Nursing home resident safety and quality initiatives

Improving Individual Patient Care

Acumentra Health’s Medicare-sponsored assistance to Oregon nursing homes has two phases: technical assistance for nursing facilities in need of performance improvement support in key clinical areas, and a learning and action network (LAN) that will engage facilities and stakeholders around the state in improving resident care.

Pressure Ulcer & Restraint Reduction Project

This project (August 2011 through January 2013) brought technical assistance to nursing homes identified by CMS as needing to reduce the proportion of their residents who have pressure ulcers or are physically restrained.

Why focus on pressure ulcers and restraints?

Research identifies adverse physiological and psychological effects associated with use of restraints. Our assistance focuses on process issues to help nursing homes break down the barriers to safe, efficient, individualized care without using restraints. Participating nursing homes receive assessments of their systems and care practices related to use of physical restraints, then develop and implement improvement projects.. Through education and peer sharing, the facilities work to improve the quality of care and residents’ quality of life.

Oregon Resident Safety & Quality Collaborative

The Oregon Resident Safety & Quality Collaborative is a LAN convened by Acumentra Health from February 2013 through January 2014. The LAN will support nursing home teams regional groups around the state as they address a range of safety, quality, and quality-of-life issues, through a collaborative process of learning sessions and action periods. Topics and other assistance will be informed by an advisory faculty of stakeholders.

Tools and resources

Advancing Excellence in America’s Nursing Homes

The national Advancing Excellence campaign aims at accelerated improvement in multiple areas, including improved staff retention and consistent assignment as well as key clinical topics (pressure ulcers, mobility/restraints, and pain).

Visit the campaign website to register or reenroll: www.nhqualitycampaign.org

Quality Assurance & Performance Improvement (QAPI)

• Five Elements of QAPI (overview, PDF)
• CMS program web page

Root Cause Analysis (RCA)

• Root Cause Analysis Process (5 Steps handout, PDF)
• PDSA Worksheet (with form fields, Word)
• PDSA Worksheet (no fields, Word)

Pressure ulcers

Positioning and pressure points materials for caregivers

• Pocket card (PDF)
• Wall poster (8.5 x 11, PDF)

Tip Sheet

• Skin Condition Coding Tip Sheet for MDS 3.0 (PDF)

Skin Care Toolkit

• Standalone toolkit coming soon!

Advancing Excellence campaign

• AE pressure ulcer materials

Transitional Care & Pressure Ulcers Project Toolkit

In 2007, the Oregon IHI Network and the Oregon leaders of Advancing Excellence in America’s Nursing Homes formed a Joint Committee to plan and develop cross-setting interventions for transitional care, with an initial focus on pressure ulcers.

The Joint Committee assembled a cross-setting, multidisciplinary Advisory Panel to identify Oregon Best Practices for preventing or minimizing pressure ulcers in hospitals, nursing homes, community-based long-term care, and home health agencies. The Panel also developed a handoff dataset of pressure ulcer-related information that would accompany residents/patients in transition between settings. These materials were pilot-tested in several Oregon communities.

• Go to toolkit page

Physical restraints

Tip sheets

MDS 3.0 Restraint Coding Tip Sheet (PDF)
A summary of RAI guidance for coding physical restraints on the Minimum Data Set (MDS)

Physical Restraint Physician Order Tip Sheet (PDF)
A summary of the guidance for physician orders for physical restraints, including the components of an order, supporting documentation, and examples.

Physical Restraint Care Planning Tip Sheet (PDF)
A summary of State Operations Manual guidance and a tool to walk you through the physical restraint care planning process.

Advancing Excellence campaign

• AE restraints reduction materials

Related resources

CMS Survey & Certification Memo 07-22 (PDF)
This CMS Memorandum to state survey agency directors clarifies terms used in the definition of physical restraints as applied to the requirements for long-term care facilities.

Rethinking the Use of Position Change Alarms (PDF)
Joanne Rader, Barbara Frank, Cathie Brady, January 2007
Position change alarms are considered restraints if they have the effect of keeping a person from moving. This article encourages nursing homes to rethink the practice, focusing instead on understanding the underlying causes of falls and instability and on developing individualized approaches that take into account the resident’s strengths, wishes, and needs.

Individualized Wheelchair Seating: For Older Adults—Part I: A Guide for Caregivers
Individualized Wheelchair Seating: For Older Adults—Part II: A Guide for Professionals
Joanne Rader, Debbie Jones, Lois Miller (Benedictine Institute for Long-Term Care, Mt. Angel, Oregon, February 1998)
Growing numbers of elderly spend much of their day in chairs that do not fit them or allow them the independence they could have. These guides were created to help caregivers and professionals recognize problems and modify seating or ask for professional help, if needed, to individualize and improve the seating for frail elderly people.

Falls

Tip Sheet

• Falls Coding Tip Sheet for MDS 3.0 (PDF)

FallsInvestigation Toolkit

A Nursing Home Expert Panel convened by the Oregon Patient Safety Commission developed a toolkit to assist facilities in learning from falls and planning person-centered approaches to avoid harm.

• Download toolkit from OPSC website

Pain management resources

• Pain screening and assessment form
• Instructions for pain screening and assessment form
• Pain assessment of cognitively impaired residents (Geriatric Pain website)