Process Improvement Discussion Guide
This Guide
provides assessment questions and process improvement considerations. The On-Time program is funded by the Agency for Healthcare Research and Quality (AHRQ), with support from the California Healthcare Foundation, to improve long-term care by turning daily documentation into useful information that enhances clinical care planning.
Select for print version (PDF File, 40
KB). PDF help.
I. Completeness
Report
Current Process: Assessment Questions |
Process Improvement Considerations |
- Who is responsible for monitoring certified nurse assistant (CNA) documentation?
- What is the followup to form incompletion?
- What processes are in place to determine if a chart is incomplete? What is measured/audited?
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1. Use for Documentation Audits:
- Schedule routine chart review: weekly/bi-weekly.
- Assign responsibility for specific sections: e.g., MDS RN review Behaviors, Dietary review Meal Intake.
- Establish routine followup with CNA staff and determine topics for in-service schedule, for example, how to document behaviors or how to document skin observations section.
- Staff to review post-trended completeness rates on units.
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II. Nutrition
Report
Current Process: Assessment Questions |
Process Improvement Considerations |
- How are residents at nutritional risk identified? What are the criteria?
- What information is communicated? To whom is information communicated? When is it communicated? How is it communicated?
- What is dietician role in this process? Nursing?
- Are there standard interventions for followup for residents with low meal intake? Are interventions standardized across facility?
- Are CNAs aware at the beginning of their shift of residents who have:
- Not been eating well?
- Lost weight?
- New pressure ulcer?
- Worsening pressure ulcer?
How is information communicated? What is the CNA responsibility? -
What processes are in place to associate meal intake trends and worsening pressure ulcer status?
|
1. Weekly 5-Minute Stand-Up Meeting
- Schedule brief weekly team (CNA, Dietary, Nursing) review of Nutrition Report, e.g., 5-Minute Stand-Up Meeting to review medium risk residents.
- Does report information match clinical picture?
- Do residents have tube feedings? Supplements?
- When was the last dietary consult?
- Does resident also have a pressure ulcer (PU)?
- Establish standard protocols/interventions:
- Clear action steps post meeting, i.e., if meal intake decreased and weight loss in past week, dietary notified and CNA offer snacks throughout day.
- Followup on CNA action items before shift ends.
2. Integrate
report findings into Care Planning meetings.
- Assign
responsibility to print and discuss Nutrition Report as part of care plan
meeting.
- Confirm
that resident care plans address identified risk indicators like decreased
meal intake, etc.
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III. Trigger
Summary Report
Current Process: Assessment Questions |
Process Improvement Considerations |
- Who
is responsible for monitoring unit trends? What criteria are evaluated?
What is the process?
- How are new program
opportunities identified? Prioritized?
|
1. Integrate report findings into weekly high-risk
Interdisciplinary Team meetings and/or Care Planning
meetings.
- Review
trigger totals by resident each week.
- Identify residents with change in triggers by 2 or more.
- Confirm report results are consistent with clinical picture.
- Establish standard action plan/protocol for risk indicators.
- Confirm PU prevention practices are in place for high-risk residents.
- Confirm communication plan.
- Confirm that care plans are developed based on resident needs—PU Trigger report.
2. Consider
using report during Quality Improvement (QI) Team meetings
- Assign responsibility for evaluating/monitoring
unit trends; establish standard action plan/protocols
(e.g., IF # residents with foley catheter =>20% unit
census THEN.)
|
Current as of June 2007
Internet Citation:
On-Time Quality Improvement for Long-term Care: Process Improvement Study Guide. June 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/ltc/puprocessimpr.htm