PLAN OF ACTION FOR CONTINUOUS QUALITY IMPROVEMENT
Agency: Provider Number: QUALITY IMPROVEMENT TEAM MEMBERS
(Team Member), title/discipline 1. 2. 3. Outcome Report Time Frame: 4. 5. 6. 7. 8. 9. Plan of Action Date:
1. Target Outcome Addressed by Plan of Action: Acute Care Hospitalization 2. Action Plan for (circle one): a. Remediation 3. Identified Problem or Strength: (Pending) b. Reinforcement
4. Care Behaviors or Processes Selected as Best Practices (Prioritized): a. The SOC nurse/PT will teach the patient and caregiver(s) about the indications for contacting the HHA (versus contacting EMS) by utilizing the [name of the teaching aid/tool that they are either 1) already using, or 2) going to develop or procure for use via an agency intervention action]. b. The SOC nurse/PT will teach the patient and caregiver(s) on how to contact the HHA by utilizing the [name of the teaching aid/tool that they are either 1) already using, or 2) going to develop or procure for use via an agency intervention action]. c. The SOC nurse/PT will teach the patient and caregivers(s) about the indications for contacting EMS (versus contacting the HHA) by utilizing the [name of the teaching aid/tool that they are either 1) already using, or 2) going to develop or procure for use via an agency intervention action].
d. The SOC nurse/PT will teach the patient and caregiver(s) on how to contact EMS by utilizing the [name of the teaching aid/tool that they are either 1) already using, or 2) going to develop or procure for use via an agency intervention action]. e. The SOC nurse/PT will conduct a safety assessment of the patient’s home and surroundings by utilizing the [name of the assessment tool that they are either 1) already using, or 2) going to develop or procure for use via an agency intervention action]. f. If the SOC nurse/PT notes safety issues, he/she will teach the patient/caregiver(s) on home safety by utilizing the [name of the safety teaching tool that they are either 1) already using, or 2) going to develop or procure for use via an agency intervention action].
5. Agency Intervention Actions (Prioritized): Time Frame Action a. Conduct Inservice regarding OBQI, POA, best practices, and expectations of staff in carrying out OBQI/POA activities b. Develop/Procure (specify which) a Start Finish Responsible Person(s) Proof/Evidence of Action All appropriate staff members are educated, as evidenced by their signatures on the Inservice sign-in sheet. Teaching tool is
This material, provided and modified by Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for the state of Oklahoma, under contract number 500-02-OK-03 with the Centers for Medicare & Medicaid Services, Department of Health and Human Services, was developed by Carolina Medical Review in support of the national home health initiative.1B-HH-ACHPOA-OK-0805.
teaching tool for teaching 1) the indications for the patient to contact the HHA (versus EMS), and 2) how to contact the HHA.
developed/procured (specify which), approved for use by [the name of whomever approves such things for the agency], and its whereabouts is made known to the clinicians who will be using it. Teaching tool is developed/procured (specify which), approved for use by [the name of whomever approves such things for the agency], and its whereabouts is made known to the clinicians who will be using it. Assessment tool is developed/procured (specify which), approved for use by [the name of whomever approves such things for the agency], and its whereabouts is made known to the clinicians who will be using it. Teaching tool is developed/procured (specify which), approved for use by [the name of whomever approves such things for the agency], and its whereabouts is made known to the clinicians who will be using it. All appropriate staff members are educated, as evidenced by their signatures on the Inservice sign-in sheet.
c. Develop/Procure (specify which) a teaching tool for teaching 1) the indications for the patient to contact EMS (versus the HHA), and 2) how to contact EMS.
d. Develop/Procure (specify which) a safety assessment for use in assessing the safety of the patient’s home/surroundings.
e. Develop/Procure (specify which) a safety teaching tool for use if safety issues are identified in the patient’s home and surroundings.
f. Conduct an inservice to educate clinical staff on all new teaching and assessment tools. (If they already have such tools in place, they might consider an intervention action of providing a refresher inservice on their proper use.) 6. Evaluation: a. Review of Plan: Date: Responsible Person(s): Results: b. Next Outcome Report: Date: Result: Next Step(s):
This material, provided and modified by Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for the state of Oklahoma, under contract number 500-02-OK-03 with the Centers for Medicare & Medicaid Services, Department of Health and Human Services, was developed by Carolina Medical Review in support of the national home health initiative.1B-HH-ACHPOA-OK-0805.
c.
Monitoring Activities (periodic chart audits for the performance of the best practices): (1) Activity: Did the SOC nurse/PT teach the patient and caregiver(s) about the indications for contacting the HHA (versus contacting EMS) by utilizing the [name of the teaching aid/tool that they are either 1) already using, or 2) going to develop or procure for use via an agency intervention action]? Date Chart Audit Completed: Finding: In of charts audited ( %), this best practice was carried out as specified. Response:
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
2) Activity: Did the SOC nurse/PT teach the patient and caregiver(s) how to contact the HHA by utilizing the [name of the teaching aid/tool that they are either1) already using, or 2) going to develop or procure for use via an agency intervention action]? Date Chart Audit Completed: Finding: In of charts audited ( Response: Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
This material, provided and modified by Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for the state of Oklahoma, under contract number 500-02-OK-03 with the Centers for Medicare & Medicaid Services, Department of Health and Human Services, was developed by Carolina Medical Review in support of the national home health initiative.1B-HH-ACHPOA-OK-0805.
3) Activity: Did the SOC nurse/PT teach the patient and caregiver(s) about the indications for contacting EMS (versus contacting the HHA) by utilizing the [name of the teaching aid/tool that they are either 1) already using, or 2) going to develop or procure for use via an agency intervention action]? Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
4) Activity: Did the SOC nurse/PT teach the patient and caregivers(s) how to contact EMS by utilizing the [name of the teaching aid/tool that they are either1) already using, or 2) going to develop or procure for use via an agency intervention action]? Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
This material, provided and modified by Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for the state of Oklahoma, under contract number 500-02-OK-03 with the Centers for Medicare & Medicaid Services, Department of Health and Human Services, was developed by Carolina Medical Review in support of the national home health initiative.1B-HH-ACHPOA-OK-0805.
5) Activity: Did the SOC nurse/PT conduct a safety assessment of the patient’s home and surroundings by utilizing the [name of the assessment tool that they are either 1) already using, or 2) going to develop or procure for use via an agency intervention action]? Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
6) Activity: If the SOC nurse/PT noted safety issues, did he/she teach the patient/caregivers on home safety by utilizing the [name of the safety teaching tool that they are either 1) already using, or 2) going to develop or procure for use via an agency intervention action]? Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
Date Chart Audit Completed: Finding: In of charts audited ( Response:
%), this best practice was carried out as specified.
This material, provided and modified by Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for the state of Oklahoma, under contract number 500-02-OK-03 with the Centers for Medicare & Medicaid Services, Department of Health and Human Services, was developed by Carolina Medical Review in support of the national home health initiative.1B-HH-ACHPOA-OK-0805.