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Providers may soon have a little more room to maneuver in their Quality Assurance and Performance Improvement (QAPI) programs thanks to the recently published Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency Proposed Rule. However, the Centers for Medicare & Medicaid Services (CMS) doesn’t seek to change the core regulations that lay out required performance improvement activities, including performance improvement projects (PIPs). The bottom line: PIPs are here to stay, and directors of nursing services (DNSs) need to make sure their teams optimize them, says Linda Winston, RN, MSN, BS, QCP-MT, DNS-MT, RAC-CT, a nurse consultant based in Norwich, NY.
What CMS wants to change
CMS proposes to again revise the Medicare/Medicaid conditions of participation (CoPs) by removing a significant chunk of the prescriptive requirements (i.e., the subparts) in the Phase 3 QAPI regulations that the agency originally designated for implementation this November 28.
As recently as the February 14 Skilled Nursing Facility/Long-term Care Open Door Forum, officials with the Centers for Medicare & Medicaid Services (CMS) indicated that providers could have to wait several months for the release of version 12 (v12) of the MDS 3.0 Quality Measures User’s Manual. However, in a surprise move on February 21, CMS released the updated manual, as well as the Quality Measure Identification Number by CMS Reporting Module Table V1.7, on its Quality Measures (QM) page.
The most significant revisions focused on these key areas:
The short-stay and long-stay pressure ulcer QMs;
The long-stay weight loss QM;
The short-stay improvements in function QM;
The long-stay and short-stay influenza vaccination QMs.
Here are the highlights:
Clinical staff are incredibly busy completing the tasks that are expected of them every day. It seems there is never enough time to get everything done. As the demand for high-quality care continues to rise, nurse leaders will need to look to the research to identify evidence-based approaches to improving clinical outcomes, increasing customer satisfaction, and maximizing staff efficiency. These best practices are often generated in acute care settings but can be used in long-term care with great success.
One evidence-based approach that offers value for long-term care settings is hourly rounding. Hourly rounding is the process of ensuring that a resident is checked each hour by a member of staff to ensure he or she is safe, well positioned, and needs are met. Since the first study on hourly rounding was done, the practice has been implemented in numerous clinical settings, including long-term care, in the new-admission process and in programs for preventing falls, reducing call light use, and monitoring residents with changes in condition.
Have you ever thought of quality assessment and assurance as a ticker tape of data that is routinely collected and reported but that goes nowhere, leading to little or no action? Or is your facility’s usual action plan for survey deficiencies the never-ending education of staff and then an audit of all the deficient processes that continues until the end of time, never stopping because another deficiency may occur, which will only add another layer of data collection when a new problem is found? We have made our data go wild and it is now time to make data collection a useful exercise that drives quality improvement. A well-designed quality assurance and performance improvement (QAPI) plan can guide you through the data-collection process, assist in identifying problems, and provide an escape route from repetitive audits and data that add no value to the quality of your residents’ lives.
Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) can serve as key partners for directors of nursing services (DNSs) in their efforts for quality improvement. With all that DNSs are responsible for, every DNS should be aware of the resources that QIN-QIOs offer.
On April 13, 2016, the National Pressure Ulcer Advisory Panel (NPUAP) announced a number of changes, including changing the term pressure ulcer to pressure injury and modifying stage definitions. Other changes include those of verbiage—changing stage numbering from Roman numerals (I, II, III, IV) to Arabic (1, 2, 3, 4) and removing the word suspected from deep tissue injury; and two additions—Medical Device Related Pressure Injury and Mucosal Membrane Pressure Injury. NPUAP also announced that they will be updating their illustrations. Although CMS has not adopted the verbiage changes to date, providers need to consider the impact of this possibility...
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