Quality Improvement in the field of health care has continued to be a priority for the Centers for Medicare & Medicaid Services (CMS). Priority requirements in the Affordable Care Act, in the Section 3011 of the National Strategy for Quality Improvement in Health Care have a number of goals. These include improved outcomes, patient-centeredness, and efficiency for all populations, identification of potential areas for rapid improvements areas, and a keen assessment on the gaps in comparative effectiveness, quality, and efficiency.
Nursing Homes is pursuing the development of a quality improvement plan to address the issue of patient falls. The objective of the quality improvement (QI plan is to examine its implementation in nursing homes together with its association with the organizational culture and its effects on reducing patient falls. It also aims to test the extent of improvements from outcomes that are explained by changes in the health care processes.
Some of the project settings and data sources will include primary data collected from the different staff within the Nursing Home organization on the measures related to the organizational structure and implementation of the QI. These data will then be combined with the information obtained from analyses of existing databases and abstractions of medical records. The design of the project will essentially be a cross-sectional analysis of the relationship and association among the different measures.
Changes and reductions in patient falls are often driven by a number of factors, which include changes in the care processes in Nursing Homes. It is therefore, necessary to understand the processes that lead to successful quality improvements in the reduction of patient falls. This will consequently create a stronger case for continued use of outcome measures in the report cards of Nursing Homes.
Nursing Homes is a chartered corporation with the goal of providing respectful and holistic skilled nursing home care and assisted living for elderly citizens. What makes Nursing Homes unique is its provision of a good quality of life for its residents. Although most of the hospital models of care practice provide valid results for Medicaid and Medicare billing, they fail to address the significant issue of good living conditions. The organization is committed to service and assists the elderly members to adapt to their new home. Service delivery is through the establishment of a facility that meets both the physical and medical needs of its clients as well as a nourishment of their individual dignity, social connections, and personal preferences. The organization aims to work with its prospective residents to identify their areas of interest and community involvement methods that appeal to them.
The goals and objectives of Nursing Home are to create an emphasis on satisfaction and quality in healthcare through a continuous program of measuring performance. It aspires to provide senior care leaders with evidence-based management tools that will help to better achieve their organization's goals. It similarly has a mission to improve the health of the population, reduce the cost per capita of healthcare services through improvement of the health care experience. The corporation aims to heighten its handling of the industry’s effectiveness than any other entity. Workforce satisfaction is similarly part of the goals of Nursing Homes through reporting and measuring the level of the workforce and consumer satisfaction. In brief, the organization hopes to record a continuous increase in the level of satisfaction in the country’s nursing homes.
The Falls Management Program is an interdisciplinary initiative for quality improvement designed to assist Nursing Homes in the provision of person-centered individualized care. It also aims to enhance its fall care outcomes and processes through quality improvement and educational tools. Patient falls management is important because falls are common in Nursing Homes and have severe consequences when not effectively managed. According to data from CDC, fall-related injuries also decrease the quality of life of residents and are furthermore being a major safety concern in the facility. It is significant to have a systematic process of intervention, assessment, and monitoring of results to minimize the risks of patients falling (Becker et al., 2003). As a result, some of the Nursing Home departments that will be affected by the QI plan include the nursing coordination team, nursing assistants, therapy section, and the engineering department as well. The program will include two primary approaches to the management of injuries and falls, which are the immediate response, and long-term management (Capezuti & Talerico 1999). In both of the approaches, a comprehensive assessment of the falls situation will be utilized to develop individualized care plans.
Data collection and extraction methods will involve completed surveys. These will contain information on QI implementation, employee satisfaction, organizational culture and the perceived adoption of guidelines from the nursing home staff. There will be a strict adherence to the best practices related fall reduction. The fall management self-assessment tool will assist the staff to identify weaknesses and strengths in key areas and will be completed before the commencement of the program. This will be in order to develop a specific- plan for the facility for the implementation of the program. The tool will be completed after the implementation of the program for progress evaluation and the identification of further needs for process improvement. Completion of the chart audit section of the self-assessment quarterly will be effective in the detection of care processes like care planning, assessment, screening, and monitoring (Becker et al., 2003). These processes are essential because they are documented and performed adequately and therefore, need improvement.
The QI methodology and process implementation will involve the fall response program. The past fall history records predict the future falls and statistics state that almost 30–40% of those who fall do so again. A quick response is therefore, important for effective fall reduction. The Fall Response is a cohesive and comprehensive approach forming the backbone of the Falls Management Program. Implementation will include a sequence of eight steps. Evaluation of fall patients 72 hours after their fall is one of the most critical steps. This will be followed by the investigation and recording of the circumstances that led to the fall, staff response and resident outcome. Alerts to the primary health care providers are similarly significant as an implementation of the immediate intervention. A complete fall assessment, development of care plans and monitoring of resident response and staff compliance will be some of the final measures of implementation. The staff will be expected to manage and monitor resident response and make revisions for care plans as needed. The facilities responsible for mastering the fall response process will consequently shift to proactive reduction of fall risks and its related injuries from crisis management (Becker et al., 2003). Implementation includes major areas of documentation that are necessary for best practices and the promotion of positive results during survey.
An accurate measurement and comparison system is an important constituent of the QI process of fall management. It will allow the staff to determine whether or not the care plan changes led to improvement and progress. One of the key tools for measurement of the fall management program will be the tracking record for improving patient safety tool. This will replace the old reporting tools technique. Some of the key indicators for the outcome of the QI process will include outcome measures for falls statistics on the number of falls and related injuries. These key indicators are one of the best markers proven for improvement evaluation. Other important markers like resident satisfaction, survey tags, lawsuits and changes in staff awareness and organization will also available for consideration by the staff members and the administration (Capezuti et al., 1999). A comparison between a reduction of lawsuits and survey tags related to falls before and after implementation will help provide important information for leadership. Opinion based views from the staff will be valid for a comparison on the changes in the organization and awareness of the staff. The feedback will be useful in program revisions. Other important indicators of satisfaction include the perceptions of the residents and members of the family. In order to target the specific measures of the process, the identification of chart audits during the self-assessment will be of significance.
Training and information administration for the primary care providers, facility staff, licensed nursing staff, residents, and their families will be of crucial significance for communicating of outcomes and progress evaluation. The necessary information will be provided by the staff development coordinator and the nurse coordinator. Communication will involve awareness on the factors that cause falls, their related injuries, measures of reductions, outcomes, and the consequent evaluation measures (Capezuti et al., 1999).
References
Becker, C., Kron, M., Lindemann, U., Sturm, E., Eichner, B., Walter-Jung, B., & Nikolaus, T.
2003. Effectiveness of a multifaceted intervention on falls in nursing home patients. JAGS, 51, 306-313.
Capezuti, E. & Talerico, K.A. 1999. Review article: Physical restraint removal, falls and
Injuries. Research and Practice in Alzheimer’s disease, 2, 338-355.
Capezuti, E., Talerico, K.A., Cochran, I., Becker, H., Strumpf, N., & Evans, L. 1999.
Individualized interventions to prevent bed-related falls and reduce side rail use. Journal of Gerontological Nursing, 25(11), 26-34.
Centers for Disease Control (CDC) National Center for Injury Prevention and Control (NCIPC).
Falls in Nursing Homes. Retrieved, from the World Wide Web: http://www.cdc.gov/ncipc/factsheets/nursing.htm
