QAPI Expectations in Skilled Nursing Facilities

Quality Assurance and Performance Improvement (QAPI) is a vital component of maintaining and enhancing the quality of care in Skilled Nursing Facilities (SNFs). How can you move QAPI programming in your facility to the next level?

QAPI is a comprehensive approach that integrates two crucial aspects of quality management: Quality Assurance (QA) and Performance Improvement (PI), to ensure safety and quality in nursing homes.

Background of QAPI

The QAPI framework builds on the existing Quality Assessment and Assurance (QAA) provision at 42 CFR, Part 483.75(o), which outlines the composition and meeting frequency of QAA committees in nursing facilities. This provision emphasizes the importance of facilities establishing accountability for QAPI processes to sustain quality care and life for residents.

The Affordable Care Act of March 2010 includes Section 6102 (c), allowing CMS to develop QAPI standards and provide technical assistance for best practices. This provision significantly expands the level and scope of required QAPI activities, facilitating the continuous identification and correction of quality deficiencies and, when effective, sustaining performance improvement.

In September 2011, CMS launched a prototype QAPI program in a small number of homes. The demonstration provided best practices for upgrading current quality programs, combining results with feedback from consumers, providers, and stakeholders to establish QAPI tools and resources.

What is QAPI?

QAPI is a coordinated application of Quality Assurance (QA) and Performance Improvement (PI). QA involves setting and maintaining standards for the quality of services and outcomes, ensuring that care meets these standards through ongoing efforts. PI focuses on continuously improving processes to enhance services or outcomes, addressing persistent problems by identifying opportunities and testing new approaches.

Together, QA and PI create an ongoing, organized method of achieving optimal results, involving all levels of an organization. This comprehensive, data-driven approach emphasizes the participation of all nursing home caregivers in practical and creative problem-solving.

The Five Elements of QAPI

To effectively implement QAPI, a framework based on five key elements is essential:

1. Design and Scope:

• • • QAPI programs must be ongoing and comprehensive, covering all services and departments within the facility.
    • They should address all systems of care and management practices, including clinical care, quality of life, and resident choice.
    • The program aims for high-quality clinical interventions while emphasizing autonomy and choice in residents’ daily lives.
    • Utilizing the best available evidence, the program defines and measures goals, with a written QAPI plan adhering to these principles.

2. Governance and Leadership:

• • • The governing body and administration play a critical role in developing a culture that values input from staff, residents, and their families.
    • Adequate resources must be ensured for QAPI efforts, including designated accountable persons, leadership development, and facility-wide training.
    • Policies should sustain QAPI efforts despite changes in personnel, emphasizing safety, quality, rights, choice, and respect.
    • Staff accountability and a supportive atmosphere for identifying and reporting quality problems are essential.

3. Feedback, Data Systems, and Monitoring:

• • • Effective systems must monitor care and services, drawing data from multiple sources.
    • Feedback from staff, residents, families, and others should be actively incorporated.
    • This includes using Performance Indicators to monitor care processes and outcomes, reviewing findings against benchmarks or targets, and tracking, investigating, and monitoring adverse events with action plans to prevent recurrences.

4. Performance Improvement Projects (PIPs):

• • • PIPs focus on specific problems within one area of the facility or facility wide.
    • These projects involve systematic information gathering to clarify issues and intervene for improvements.
    • PIPs address areas needing attention, which vary depending on the facility’s type and services provided.

5. Systematic Analysis and Systemic Action:

• • • A systematic approach is used to determine when in-depth analysis is needed to understand problems, their causes, and implications of changes.
    • A thorough and structured approach identifies if problems are caused or exacerbated by the organization or delivery of care and services.
    • Facilities are expected to develop policies and procedures, demonstrate proficiency in Root Cause Analysis, and focus on preventing future events.
    • Continual learning and continuous improvement are key components.

Here’s an example of a PIP that addresses Reduction of Resident Falls:

Background: Falls are a common issue in skilled nursing facilities, leading to injuries and reduced quality of life. A PIP aimed to reduce falls by 25% over six months.

Objective: Decrease the number of falls by 25% in six months.

Steps Involved:

1. Team Formation: A multidisciplinary team of nurses, therapists, and a quality improvement coordinator was assembled.
2. Data Collection: Baseline fall data and resident assessments identified high-risk individuals.
3. Interventions:
   • • Environmental Modifications: Improved lighting, installed handrails, and reduced clutter.
     • Staff Training: Educated staff on fall prevention and response techniques.
     • Resident Education: Informed residents and families about fall risks.
     • Exercise Programs: Implemented balance and strength exercises for high-risk residents.
     • Monitoring: Regular tracking of fall incidents and weekly team meetings to review progress.
     • Sustainability: Ongoing staff training, resident education, and environmental audits.

Results: Achieved a 30% reduction in falls, surpassing the goal.

Summary: A systematic, multidisciplinary approach effectively reduced falls, improving resident safety and quality of life.

Implementing a robust QAPI program in Skilled Nursing Facilities is essential for ensuring the highest standards of care and quality of life for residents. By integrating Quality Assurance and Performance Improvement, SNFs can create a systematic, comprehensive approach to maintaining and improving care, fostering a culture of safety, accountability, and continuous improvement. With the support of effective governance, data systems, and ongoing projects, QAPI becomes more than a regulatory requirement; it offers a framework for success and represents a commitment to excellence in every aspect of care.

Join us for the Developing & Implementing a QAPI Program webinar series starting August 15th!