Fixing Broken Facilities – Case Studies in QAPI

Fixing Broken Facilities – Case Studies in QAPI

Strong Quality Assurance Performance Improvement (QAPI) programs lead long term care facilities to positive outcomes. QAPI also helps to foster an engaged culture due to its emphasis on improving systems to affect quality of care and improve staff satisfaction. Regardless of specific areas of concern, using QAPI principles to identify the issue, conduct root cause analysis, set realistic goals and measurable outcomes is a proven framework for fixing broken processes and systems.

Case Study Example 1 – Hospital Rehospitalization Rate Reduction

Problem: Increase in rehospitalization rates over the last 2 quarters

Goal: Reduce 30-day rehospitalization rates by 15% in 90 days

Root Cause: Lack of early identification of health status changes and barriers in nurse training related to acute care management, specifically related to CHF exacerbation and sepsis

Action steps:

• • Implement early warning tools – EMR dashboard alerts and “Stop-and-watch”
  • Focus training on CHF and sepsis
  • Partner with local hospital system to cross-train nurses and provide additional education, as well as specialist oversight
  • Daily huddles with clinical staff to discuss changes in status and potential concerns
  • Review of all rehospitalizations on a case-by-case basis to determine root cause of hospitalization and potential preventative actions
  • Trending and tracking of rehospitalization data and root causes included in QAPI to monitor progress

Outcome: 24% reduction in 30-day rehospitalization rate over 1 quarter

Case Study Example 2 – Fall Reduction

Problem: Fall rate of 31%

Goal: Reduce fall rate to 22% over 1000 patient days

Root Cause: Lack of consistent IDT review process related to falls

Action steps:

• • Educate nurses on need for immediate intervention and provide tools to use post-fall for root cause determination and appropriate intervention
  • Nurse aides educated on fall prevention and encouraged to assist with root cause and intervention suggestions
  • Review of all falls by IDT including environmental observations of location of fall
  • Implemented daily huddles with frontline staff with focused discussion on falls and implemented interventions
  • Trending and tracking of falls to determine potential consistency in time, shift, and location of falls
  • Audit of IDT documentation weekly x4 weeks to determine gaps in process and documentation
  • Review of trends and audit results in QAPI to monitor outcomes and need for adjustments in action steps

Outcome: 17% fall rate in 90 days

Integrating QAPI into everyday practice and communicating goals and outcomes with staff fosters an environment of quality and safety. Additionally, a strong QAPI program offers structure to tackle issues with a systematic and organized process.

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