Senior contributing writer Joanne Kaldy is a freelance writer in Hagerstown, Md., and a communications consultant for AMDA and other organizations.
A growing number of medical directors are leading quality initiatives in their facilities using the tools from the Advancing Excellence (AE) in America's Nursing Homes campaign, which has compiled tools from facilities and organizations such as AMDA.
Gaining on Goals in Georgia
R. Elliott Jackson, MD, of Georgia's Golden Living Centers sets an example. “The Advancing Excellence campaign promotes quality and the many proven tools that the team can use to improve processes,” he said. For example, “we use tools such as the SBAR [the Situation, Background, Assessment, and Recommendation technique] and AMDA clinical practice guidelines to develop and implement processes that work for our staff and help us reach results and measurable outcomes.”
Quality improvement tools have enabled Dr. Jackson and his team to identify and address problems—such as pain—early. “We've made this a priority, and the nurses know that when they call, I want to know the pain's location, intensity, and history. They're comfortable with the tools because … they know they work.”
The AE campaign inspired Dr. Jackson's team to focus on reducing urinary incontinence problems. “We discussed all of our patients and carefully considered who would be an appropriate candidate for a prompted voiding program. So far, the results are positive—we're seeing fewer skin problems and falls,” he said. He emphasized that not every quality improvement goal is appropriate for every patient. “For those patients who aren't right for one initiative, we'll focus on another area of care that would improve their clinical outcomes and/or quality of life.”
Dr. Jackson stressed that his executive director and director of nursing have made such positive changes possible. “We are fortunate to have visionary team leaders who are champions of Advancing Excellence,” he said. “It helps to have proven tools, such as those promoted by Advancing Excellence.”
Showing Them in Missouri
Jeffery Kerr, DO, CMD, a multifacility medical director in Missouri and a member of the AE Steering Committee, also has had positive results. “The Advancing Excellence tools not only help improve quality, but they make life easier. If the facility has policies and procedures and processes in place, the number of calls to the physician plummets,” he said.
“Our administrators love these tools because they're free, and education pieces such as a Webinar on pressure ulcers can be downloaded and viewed at leisure,” said Dr. Kerr. He added that as a physician, he feels the tools represent evidence-based best practices: “For example, it's great to have evidence-based medicine documenting that we can reduce restraints and [have the] tools to educate staff about restraint reduction.”
As a result of this education, “More people realize that rails actually put people at greater risk of injury; and more facilities are utilizing alternatives such as high-low beds to reduce falls and injuries,” said Dr. Kerr., “The number of hip fractures has plummeted since we implemented the restraint reduction program.”
Dr. Kerr likes that AE has shaken things up a bit. “For years, facilities often just followed regulations and did what surveys mandated.” He noted that AE encourages team leaders to think in novel ways. “In facilities where the medical director works with the team in a collaborative way, staff embrace change and make positive things happen. Tools such as those available through Advancing Excellence not only improve quality and outcomes, but they make people's jobs easier. Nurses and others become part of the process, and they embrace the change.”
Also, staff love tools that are easy to implement, said Dr. Kerr. “When something comes to the facility to use, staff want it to be ready to roll. We don't have time to try things that are speculative.”
Dr. Kerr noted that the tools work only if the facility provides a positive culture for change. Part of this is consistent staff. “In my homes that have this, residents and staff are happier and there are fewer problems and complaints.”
Dr. Kerr explained how the Centers for Medicare & Medicaid is involved in Advancing Excellence and why that matters. “Advancing Excellence dovetails into compliance issues, and F-tags now have an educational component. As a result of this collaboration, interdisciplinary team members can do their jobs, use the tools, and feel confident that they won't be cited for something unfairly,” said Dr. Kerr.
“Advancing Excellence is still a young organization, but already it has become a key clearinghouse for best practices and a free resource,” said Dr. Kerr. He urged medical directors to take the lead on implementing these tools and processes in their facilities and to be champions of quality improvement by their interdisciplinary teams. AE's Web site is www.nhqualitycampaign.org.
Advancing Excellence in America's Nursing Homes campaign has released second-year data showing continuing improvement in care quality. Specifically, the campaign estimated that from its inception in 2006 through the third quarter of 2008, there were 1.8 million fewer days during which high-risk residents suffering pressure ulcers and 8.5 million fewer days of residents using physical restraints.
Advancing Excellence (AE) also reported improved pain management for both long-term and short-term nursing home residents. “To our coalition members, the data indicate that Advancing Excellence is making a difference in the lives of thousands of nursing home residents,” Mary Jane Koren, MD, chair of AE and assistant vice president of The Commonwealth Fund, said in a statement. A major focus of the campaign is to encourage nursing homes to set quality targets as a way to monitor quality-improvement efforts. Nursing homes that set targets outperformed those that didn't, AE reported.
Since its inception, nearly 7,400 nursing homes have signed on to AE, the campaign reported. Each participating nursing home works on at least three of eight measurable goals:
▸ Reducing high-risk pressure ulcers.
▸ Reducing use of physical restraints.
▸ Improving pain management for longer term nursing home residents.
▸ Improving pain management for short-stay, postacute nursing home residents.
▸ Establishing individual targets for improving quality.
▸ Assessing resident and family satisfaction with the quality of care.
▸ Increasing staff retention.
▸ Improving consistent assignment of nursing home staff, so that residents regularly receive care from the same caregivers.
The organization's goals, downloadable information, and other tools are available at www.nhqualitycampaign.org.
FULL TEXT
