Florida Nursing Home Quality Care Connection

The Florida Nursing Home Quality Care Connection

Encourage Resident Mobility

Mobility is a term that includes physical strength, flexibility, balance, and endurance, according to Advancing Excellence in America's Nursing Homes. It includes important activities that require movement, such as turning over in bed, getting up, standing, walking, or using a device. Not all residents are equally mobile; however, being able to move helps improve physical function and psychological well-being. For example, improved mobility can improve sleep, appetite, and greater independence during activities of daily living.

To help nursing homes encourage resident mobility, the National Nursing Home Quality Care Collaborative Change Package includes a six-point change bundle to help the multi-disciplinary quality improvement team support function and well-being of residents. The six-points are as follows.

Define mobility for each unique individual
Provide a place or space to move
Provide supportive equipment
Train staff and residents
Support and encourage
Address physical and psychological needs that inhibit mobility

You can find specific action items for each of these six points in Attachment 3 of the NNHQCC Change Package.

Quality Measure Tips: Activities of Daily Living (ADL)

The ADL quality measure reports the percentage of residents whose need for help with ADLs has increased when compared with the prior assessment. The seven-day look-back measure involved four late-loss ADLs: bed mobility, transferring, eating, and toileting.

When you are working with your staff members, you may want to consider the following questions.

Is the staff member's coding documentation accurate?
Has the root cause for the decline been determined and treated?
Is pain/depression managed?
Is the resident receiving appropriate assistance from staff members?

If you would like more improvement tips and MDS coding insight, you can download the HSAG ADL quality measure tip sheet by clicking here.

Please contact [email protected] if you have any questions.

Do You Know Your Nursing Home's Current Quality Measure (QM) Composite Score?

The Quality Measure Composite Score, developed by the Centers for Medicare & Medicaid Services (CMS), comprises 13 long-stay measures and is an excellent "barometer" of your facility's implementation of Quality Assurance & Performance Improvement (QAPI). Your Florida National Nursing Home Quality Care Collaborative (NNHQCC) team provides this data to you.

QAPI Corner

STEP 12: Take Systemic Action

Systemic Action is often the most challenging step in improving performance. After identifying root causes to an issue, it is important to implement changes or corrective action that can improve or reduce the chance of an event happening again. These actions should be tightly linked to the root causes in order to have a higher likelihood of being effective. It is vital to avoid quick fixes. The goal is to make strong changes that will result in lasting improvement. Actions can be defined in the following ways.

Weak: Actions that depend on staff to remember training or policies. These actions enhance or enforce existing processes.
Intermediate: Staff must remember to do the right thing, but these actions provide tools. These modify existing processes.
Strong: Actions that do not depend on staff to remember to do the right thing. Strong action redesign the process.

Pilot testing is one tactic nursing homes can use to carry out to test systemic change ideas. Think about testing or "piloting" changes in one area of your facility before launching something facility wide. Sometimes, changes can have unintended consequences.

For more information on the different types of actions and examples for each, read page 19 of QAPI at a glance.

HSAG Resource Spotlight

Guidance for Performing Root Cause Analysis

Use this guide to walk through an RCA to investigate events in your facility. Learn more.

Five Whys Tool for Root Cause Analysis

The Five Whys is a simple problem-solving technique that helps get to the root of the problem quickly. Learn more.

QAPI Plan Template

The QAPI Plan Template can help guide nursing home staff members as they develop specific quality improvement plans for their organizations. Learn more.

This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Florida, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. FL-11SOW-C.2-05272016-01