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QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT (QAPI) FOR WOUND CARE Anne Scheurich, BS, RN, CWOCNWoundRounds
BACKGROUNDQuality Assurance and Performance Improvement (QAPI) Programs will soon be required for long term care (LTC) providers by CMS.2 Complying with emerging QAPI requirements provides an opportunity to engage workers and enhance resident outcomes and quality of life.
This case study explores pressure ulcer prevention in a LTC setting and presents a Performance Improvement Plan (PIP) as part of QAPI.
QAPI METHODSCMS Plan-Do-Study-Act Model for Problem Solving3
CONCLUSIONAs a result of this Performance Improvement Plan, the facility reduced its facility acquired pressure ulcers and continued use of its electronic wound management system.1
Poster Presentation at Wound Ostomy Continence Nurses Society Annual Conference, June 2014
SELECT REFERENCES:1. WoundRounds, www.woundrounds.com, 847-519-35002. Medicare and Medicaid Requirements for Long-Term Care Facilities. Regulations: 42 CFR Part 483 (o), subpart B, F520.3. QAPI at a Glance: A Step by Step Guide to Implementing Quality Assurance and Performance Improvement (QAPI) in Your Nursing Home”, go.cms.gov/Nhqapi4. QAPI Insights form the Experts, http://www.providermagazine.com/columns/Pages/QAPI-Insights-From-The-Experts.aspx
CASE STUDYFacility acquired pressure ulcer Performance Improvement PlanA long term care facility implemented a PIP surrounding facility acquired pressure ulcers (FA PrU) as part of their QAPI initiative.
• PIP team developed the Fish-Bone Diagram below to identify factors contributing to acquired pressure ulcers based on internal discussion and a literature search on the topic.
• The Fish-Bone was shared with employees. Asking for feedback from the organization, can help drive QAPI engagement and better outcomes within the facility.
• The PIP team identified lack of communication as a major contributing factor to acquiring pressure ulcers. Not all CNAs knew which residents had wounds.
• The facility implemented a wound management system1 that automates the wound care process and shares patient wound information with all members of the care team.
RESULTSAfter 3-4 weeks, the facility had zero FA PrUs, The PIP was completed, and the facility continued its use of the wound management solution.
PLAN• Objective• Predictions• Plan to carry out the cycle (who, what, where, when)• Plan for data collection
DO• Carry out the plan• Document observations• Record data
ACT• What changes are to be made?• Next Cycle?
STUDY• Analyze data• Compare results to predictions• Summarize what was learned
Environment
Incontinence
Dryness
Head of Bed Elevated
Contaminants on Skin
Patient/Family Education
PUPP Program
Supplies Available
Exposure to Cold
Exposure to Wetness
OrientationCall Light Response
Residents Not Educated
Education and Training
Consistent Staffing
Families Not Educated
Not Oriented Shower Sheets Treatments Complete
Policy Followed
PIC Meetings
Discussed at Stand Up
CARES Program
Acknowledgement FormsAppropriate Cushions
Mattresses and Heel Lifts
Barrier Cream Available
RW for Acquired Wounds
Wound Documentation in Place
Unable to LiftStand Up
PIC
QAPI
Process
End of Life Care
Management
EquipmentProcessPeople
Turnover
Materials/Supplies
Problem
AcquiredPressure Ulcers