VIEWS: 3 PAGES: 4 POSTED ON: 12/25/2011
Spring 2004 Volume 2, Issue 2 Quality Focus Enhanced Quality Measures Websites worth Since November 2002 when the The enhanced post-acute care surfing national Nursing Home Quality measures posted are: Initiative (NHQI) was launched, we South Dakota Foundation ♦ Percent of short stay residents for Medical Care at have said that quality measures are who had moderate to severe pain dynamic and will continue to be www.sdfmc.org ♦ Percent of short stay residents refined as part of CMS’s ongoing You will find: with delirium commitment to quality. In January • Quality Measures Resource 2004, CMS began reporting an ♦ Percent of short stay residents Manual enhanced set of quality measures. with pressure sores • Resources on pain, pressure ulcers, and ADLs These enhanced measures were Of the 11 chronic care measures endorsed by the National Quality listed above, four of the measures Forum, a voluntary standard setting, are clinically related. These four Medicare Quality consensus-building organization measures have been grouped into Improvement Community at representing providers, consumers, two pairs. If one of the measures in and researchers. a pair is selected, the other measure www.medqic.org will also be displayed on the Nursing You will find: Enhanced chronic care measures • Facility Checklists posted on Nursing Home Compare: Home Compare website. The first set • Quality Improvement of paired measures is percent of low Worksheets ♦ Percent of residents whose need risk residents who have pressure • Resources on all 14 for help with daily activities has sores and percent of high risk quality measures increased residents who have pressure sores. ♦ Percent of residents who have The second set of paired measures is moderate to severe pain percent of low risk residents who lose The John A. Hartford ♦ Percent of residents who were control of their bowels or bladders Foundation Institute for physically restrained and percent of residents who have/ Geriatric Nursing at ♦ Percent of residents who spent had a catheter inserted and left in www.hartfordign.org most of their time in bed or in a their bladders. You will find: chair • Katz Index (ADL) We encourage you to download the ♦ Percent of residents whose • Fall Risk Assessment revised Quality Measures Resource • Nutrition and Hydration ability to move about in and Manual (Version 4.0) which is Assessment around their room got worse available through www.sdfmc.org. • Urinary Incontinence ♦ Percent of residents with a Assessment urinary tract infection We also encourage you to visit www. • Beers’ Criteria Medicare.gov/nhcompare/home.asp • Many more resources ♦ Percent of residents who have and view your facility’s current become more depressed or quality measure scores. Please note anxious that the quality measure scores for National Guideline ♦ Percent of high risk residents all facilities are refreshed every Clearinghouse who have pressure sores quarter. We hope that you visit the ♦ Percent of low risk residents www.guideline.gov site regularly and track your quality who have pressure sores You will find: measures over time. • Evidence-based clinical ♦ Percent of low risk residents practice guidelines who lose control of their bowels For more information contact or bladder Bernadette Nelson or Rhonda Streff ♦ Percent of residents who have/ at 605-336-3505 or send an email to: had a catheter inserted and left Bernadette: email@example.com in their bladder Rhonda: firstname.lastname@example.org. QM FOCUS: ADLs Percent of residents whose need for help with daily activities has increased QM Description falls, contractures, and muscle wasting can be This measure reflects the percent of residents who expected. Lack of attention to range of motion, experienced a decline in their ability to perform at activities, and restorative care can lead to more least one of four late-loss activities of daily living rapid decline in ADL function. Additional clinical (ADLs). Activities of daily living are the activities information regarding decline in ADLs, as well as people must perform daily to function at their quality improvement strategies for prevention of highest level of independence. The ADLs measured decline, can be found on CMS’s website at in this QM are level of independence in eating, www.MedQIC.org. ability to move in bed, ability to move from one MDS Assessments Used chair to another, and ability to go to the bathroom • Target assessment: OBRA Full (AA8a = 01, independently. 02, 03, or 04) or Quarterly Assessment Rationale for ADL QM (AA8a = 05 or 10). Latest assessment with Personal mastery of activities of daily living and assessment reference date (A3a) within the mobility are as crucial to functional independence 3-month target period. in the nursing home as they are in the community. • Prior assessment: AA8a = 01, 02, 03, 04, 05, The nursing home is unique only in that most or 10. Assessment reference date (A3a) must residents require help with self-care functions. ADL be in the window of 46 days to 165 days dependence can lead to intense personal distress preceding the target assessment reference such as invalidism, isolation, diminished self-worth, date. and a loss of control over one's destiny. As inactivity increases, complications such as pressure ulcers, MDS ADL Definitions ADL Item ADL Definition How a resident moves to and from a lying position, turns Bed Mobility - G1a side to side, and positions body while in bed. How the resident moves between surfaces, i.e., to/from bed, chair, wheelchair, standing position. Exclude from this Transfer – G1b definition movement to/from bath or toilet, which is covered under Toilet Use and Bathing. How the resident eats and drinks, regardless of skill. Eating – G1h Includes intake of nourishment by other means (e.g., tube feeding, total parental nutrition). How the resident uses the toilet room, commode, bedpan, Toilet Use – G1i or urinal, transfers on/off toilet, cleanses, changes pad, manages ostomy or catheter, and adjusts clothes. Walk in Room – G1c How resident walks between locations in his/her room. Walk in Corridor – G1d How resident walks in corridor on unit. Page 2 Quality Focus Team Building RESOURCES for LTC The Adult Services and Aging's Ombudsman Program is The formation of effective teams is imperative to the a valuable resource for your facility as well as your quality improvement process. It is important to residents. Their most often requested inservices are recognize that all teams go through a series of Sexuality in the Long Term Care Setting, Competence stages. These stages are forming, storming, With Compassion (regarding abuse prevention), and norming, and performing. Team leaders need to be Resident Rights. able to recognize these phases, understand that The Ombudsman Program also has videos available on they are normal, and use that understanding to topics such as restraints, Alzheimer's disease, dementia, relate them to the team process. sundowning, confidentiality, resident rights, Parkinson's disease, Eden Alternative, conflict resolution, depression Stage 1 – Forming in the elderly, abuse, neglect, and care of the dying. Team members are excited and have high If you would like more information, or a listing of all expectations about the prospects of the project. available video resources for your use in staff/resident/ They are also a little anxious about how they might family education, phone (605) 773-3656 or e-mail fit in, and what will be expected of them. Many will Jeff Askew at Jeff.Askew@state.sd.us or write to sit back and size up the situation. Very few will take Adult Services and Aging's Ombudsman Program the initiative to jump right in. They will depend on Dept of Social Services the team leader for direction and structure. Team 701 Governors Drive leaders need to provide members with a good Pierre, SD 57501-2291 orientation and a clear framework for the team to operate. Team leaders should help the team define their goals, and clarify roles so the team has a clear At this stage, the team leader needs to help understanding of their mission. This is a stage members develop new skills and support where individuals start to become team members. improvements. The leader encourages members to Stage 2 – Storming take on more power, gradually shifting leadership to Storming, the most difficult stage, begins after the the team. team members realize that teamwork is not as easy Stage 4 – Performing as it seems. Disappointment and disillusionment The team is ready to focus on its mission. The team set in, they argue with each other, and they members start to solve problems and implement become testy or overzealous. Cliques can form, changes, which is exciting and energizing. The team power struggles ensue, and anger can be directed is working interdependently. There is satisfaction in at the team leader. Often there is the feeling that their progress. Team members recognize each the team may dissolve. Productivity stalls. The others’ strengths and weaknesses. There is team becomes distracted because of its internal constructive self-change. The team leader must problems. Members are expressing resistance to avoid trying to exert control at this stage when the working collaboratively with each other, but they team is building openness to change. By updating are also beginning to understand each other. methods and procedures to support cooperation, The role of the leader is to allow team members to the leader will assist the team to understand and discuss issues, work through differing opinions, and manage change and will display the success of the resolve conflict. The leader helps the team to use team to senior management, other teams, and feedback and problem solving techniques to resolve coworkers. With the right tools, the team will be issues. This really is a productive stage. When the able to monitor progress and thus to celebrate its team works through these tough times, they develop achievements. self-esteem and confidence in their ability to work Teams move through these stages at different together and share control. The worst thing the speeds. A team could go through the stages several team leader can do at this stage is to jump in and times, especially if membership changes. Team solve the problems for the team. leaders must be patient and supportive of the team Stage 3 – Norming as it moves through the stages. All teams have high During this stage, the members are becoming a and low cycles. No matter how well the team works team, accepting the ground rules, and together, progress is never smooth. It’s the leader’s understanding their roles and those of other responsibility to provide the direction and support members. They experience team cohesion, and to develop a high performance team. their level of satisfaction increases as they begin to This material was adapted from solve problems and work toward a common goal. Quality Insights of Pennsylvania – Nursing Home Insights – May 2003 Spring 2004 Page 3 NHQI Advisory Committee Jeff Askew SD Ombudsman Program Tony Berg, MD Winner Regional Healthcare Center - Long Term Care David Brechtelsbauer, MD SD Medical Directors Assn. Mark Deak Executive Director, SDHCA Loren Diekman CEO, Jenkins Living Center Jane R. Mort, Pharm.D. Professor of Clinical Pharmacy SDSU, College of Pharmacy Cynthia Riddle State Program Coordinator CMS, Denver Regional Office Ken Senger Senior Vice President, SDAHO Dan Thayer SD Department of Health Health Care Facilities Pharmacist’s Corner Licensure and Certification Pharmacist’s Corner will be a regular feature in the Quality Focus. The complete article can be found on Sam Wilson Associate Director for SDFMC’s website at www.sdfmc.org/NursingHomes/ Advocacy, AARP PharmacistsCorner/Index.cfm Mark Hoven CEO, SDFMC Depression and Activities Jay Lewis of Daily Living Jane Mort, Pharm.D. authors the Vice President, SDFMC Pharmacist’s Corner. Dr. Mort Jane Mort, Pharm.D. has ten years experience as a Bernadette Nelson long term care consultant NHQI Project Manager, SDFMC Is there a relationship between ADLs pharmacist. For the past six and depression? How are facilities years she has worked with the Rhonda Streff Geriatric Assessment Team at NHQI Assistant Project following up on depression management? Even if a resident is on Rapid City Regional Hospital. Manager, SDFMC Currently she teaches the antidepressant therapy, can you be geriatrics component of the Gerald Tracy, MD sure that his/her ADLs are not affected pharmacy curriculum at SDSU Medical Director, SDFMC by depression? Without you having to College of Pharmacy in Vicki Wheeler collect any additional information, Brookings, South Dakota. Communications Director, what useful piece of information can Dr. Mort has been at SDSU for 18 SDFMC you learn about depression years, published over 40 articles, management in your facility? and given 70 presentations in the United States. Dr. Mort is the Find the answers to these questions in current Chair-elect of the This material was prepared by SDFMC under the article Depression and Activities of American Association of Colleges a contract with the Centers for Medicare & Medicaid Services (CMS). The contents pre- Daily Living in the Pharmacist’s of Pharmacy, Geriatric Pharmacy sented do not necessarily reflect CMS policy. Corner under Nursing Homes on Special Interest Group. Item 7SOW-SD-04-18 April 2004 SDFMC’s website (www.sdfmc.org).
Pages to are hidden for
"Spring Quality Focus pub"Please download to view full document