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Elements for Framing QAPI in Nursing Homes Cheat Sheet (DRAFT) by [deleted]

Framing QAPI for Nursing Homes

This is a draft cheat sheet. It is a work in progress and is not finished yet.


The 5 elements are your strategic framework for develo­ping, implem­enting, and sustaining QAPI. In doing so, keep the following in mind:
Your QAPI plan should address all five elements;
The elements are all closely related. You are likely to be working on them all at once—they may all need attention at the same time because they will all apply to the improv­ement initia­tives you choose; and
Your plan is based on your own center’s programs and services, the needs of your particular residents, and your assessment of your current quality challenges and opport­unities

Element 1: Design and Scope

A QAPI program must be ongoing and compre­hen­sive, dealing with the full range of services offered by the facility, including the full range of depart­ments. When fully implem­ented, the program should address all systems of care and management practices, and should always include clinical care, quality of life, and resident choice. It aims for safety and high quality with all clinical interv­entions while emphas­izing autonomy and choice in daily life for residents (or resident’s agents­). It utilizes the best available evidence to define and measure goals. ­Nu­rsing homes will have in place a written QAPI plan adhering to these princi­ples.

Element 2: Governance and Leadership

The governing body and/or admini­str­ation of the nursing home develops and leads a QAPI program that involves leadership working with input from facility staff, as well as from residents and their families and/ or repres­ent­atives. The governing body assures the QAPI program is adequately resourced to conduct its work. This includes design­ating one or more persons to be accoun­table for QAPI; developing leadership and facili­ty-wide training on QAPI; and ensuring staff time, equipment, and technical training as needed for QAPI. They are respon­sible for establ­ishing policies to sustain the QAPI program despite changes in personnel and turnover. The governing body and executive leadership are also respon­sible for setting priorities for the QAPI program and building on the principles identified in the design and scope. The governing body and executive leadership are also respon­sible for setting expect­ations around safety, quality, rights, choice, and respect by balancing both a culture of safety and a culture of reside­nt-­cen­tered rights and choice. The governing body ensures that while staff are held accoun­table, there exists an atmosphere in which staff are encouraged to identify and report quality problems as well as opport­unities for improv­ement.

Five Element of QAPI

Element 3: Feedback, Data Systems & Monitoring

The facility puts in place systems to monitor care and services, drawing data from multiple sources. Feedback systems actively incorp­orate input from staff, residents, families, and others as approp­riate. This element includes using Perfor­mance Indicators to monitor a wide range of care processes and outcomes, and reviewing findings against benchmarks and/or targets the facility has establ­ished for perfor­mance. It also includes tracking, invest­iga­ting, and monitoring Adverse Events that must be invest­igated every time they occur, and action plans implem­ented to prevent recurr­ences.

Element 4: Perfor­mance Improv­ement Projects (PIPs)

The facility conducts Perfor­mance Improv­ement Projects (PIPs) to examine and improve care or services in areas that are identified as needing attention. A PIP project typically is a concen­trated effort on a particular problem in one area of the facility or facility wide; it involves gathering inform­ation system­ati­cally to clarify issues or problems, and interv­ening for improv­ements. PIPs are selected in areas important and meaningful for the specific type and scope of services unique to each facility.

Element 5: Systematic analysis & Systemic action

The facility uses a systematic approach to determine when in-depth analysis is needed to fully understand the problem, its causes, and implic­ations of a change. The facility uses a thorough and highly organized/ structured approach to determine whether and how identified problems may be caused or exacer­bated by the way care and services are organized or delivered. Additi­onally, facilities will be expected to develop policies and procedures and demons­trate profic­iency in the use of Root Cause Analysis. Systemic Actions look compre­hen­sively across all involved systems to prevent future events and promote sustained improv­ement. This element includes a focus on continual learning and continuous improv­ement.

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