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