How to know when you have acheived quality

AAHASA has put together a series of questions that are asked in order to determine how focused a nursing facility is on quality. Although designed for consumers, it is also a useful tool for using internally. Take a look sometime.

Are you a nursing home nazi?

I read an interesting discussion on the allnurses.com forums called "Rounds, Falls, and Skin issues". What caught my eye is this:

"On another note, this same study revealed another "secret." In war days in the concentration camps the prisoners were subjected to various types of torture. Among these was that they were awakened every 2 hours during the night and forced to stay awake for about 10 minutes and then allowed to go back to sleep. This severely disturbed their sleep patterns and thus, made them clumsy and confused during the day due to lack of proper REM sleep. Hmmm, is this what we are doing to our elderly? Is this part of the reason for so many falls and inappropriate behaviors?"

Does the way your facility take care of residents actually cause more harm than good? This is something to really think about.

A most powerful excerpt from "Everything I Learned in Life...I Learned in Long Term Care" by Lori Porter

"At that minute, I knew there was nowhere else a high school dropout could go and have that much power and influence...You see, we have the power to make an old person feel special, beautiful, worthwhile, needed, wanted, respected, revered, admired, and productive, but we also have the power to strip them of their every dignity. That power should come with a warning, and we should all be reminded of it everyday. None of us fully appreciate or comprehend the power of our own influence."
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Although this book has been out for some time, I just got the chance to read it last night and I was really touched by it. I especially appreciate the above-mentioned quote so much that I plan on printing up a copy and sticking it in front of my desk just to remind me how much power I really do have working in long term care. I think you should print off a copy too, and make sure that no one in your nursing home forgets that power either.

2 things to think about doing

(1) Require all employees to initiate a conversation before touching a resident or doing something clinical to them
(2) Recruit volunteers to come in and write down the stories of resident's lives that they dictate to the volunteers. Share these stories with staff so they realize that the resident is a person with a rich, vibrant history and not just some inanimate object to feed, change, and bathe.

Occupational Hazards in LTC

OSHA has an interactive nursing home set up at http://www.osha.gov/SLTC/etools/nursinghome/index.html where you can learn pretty much everything there is to know about occupational hazards in the long term care setting.

An interesting nursing home blog

Barbara Mitenberger has created an excellent blog at http://www.longtermhealthlaw.com. It focuses on the legal aspects of nursing home administration and is highly informative. Thanks Barbara!

F371

Depending on who you ask, anywhere from 1/3 to 1/2 of nursing homes are cited with a F371 tag in a year. F371 requires that kitchens be clean and sanitary. One way to verify that the conditions of F371 are being met is to have the dietary manager to conduct a weekly audit. The easiest way to do this is to make a list of all potential violations and have the manager to circle them as they occur. The possible violations are:

ANYTHING STORED ON FLOOR

DENTED OR SWOLLEN CANS NOT STORED SEPERATELY

INSECTS OR DROPPINGS

STREAKS ON WALLS ALONG SHELVES

LACK OF FIRST IN, FIRST OUT ROTATION

OPENED FOOD THAT IS UNSEALED AND/OR UNDATED

BULK FOODS IN CRACKED OR PEST-VULNERABLE CONTAINERS

UNUSUALLY HIGH OR LOW TEMPERATURE IN FOOD STORAGE AREA

REFRIGERATOR TEMPERATURE >41 DEGREES FAREINHEIT

HIGHLY PERISHABLE FOODS USED AFTER THREE DAYS OF BEING OPENED

(This means foods that are animal derived and/or high in protein)

EGGS IN UNBROKEN SHELL USED 4-5 WEEKS AFTER PACK DATE

RAW ANIMAL FOODS LOCATED NEAR OTHER ITEMS

FREEZER TEMPERATURE >0 DEGREES FAREINHEIT

FROST BUILDUP IN FREEZER OR EVIDENCE OF THAWING

SPILLS IN THE DAIRY CASE

DIRTY SHELVES, FLOORS, OR WALLS

CROWDED STORAGE SPACE

HOT FOOD HELD FOR MORE THAN 30 MINUTES BEFORE SERVING

ICE IN CONTACT WITH FOOD

HOT FOODS HELD <135>180 DEGREES

COLD FOODS HELD >41 DEGREES

LACK OF HAND WASHING/SANITIZATION

IMPROPER UTENSIL USE OR LACK OF CLEANING

IMPROPER OR LACK OF CLEANING OF EQUIPMENT AFTER USE

LACK OF COVER DURING TRANSPORTATION

FOODS TRANSPORTED NEAR SHOES OR FLOOR

Lectures on Pain Management

IPro has a set of 6 mp3 files on pain management in nursing homes at http://www.providers.ipro.org/index/nhqi-conferences-pain-management. It's a good resource for audio learners.

SPIRIT: A rapid QI program that stays on the floor

Beth Israel Deaconess Medical Center in Boston has recently launched a new semi-informal QI initiative called SPIRIT: Solutions Promoting Improvement Respect Integrity & Teamwork. I'm feeling a bit lazy right now so I'm just going to link to its description on their CEO's blog here. Nursing homes seem to never do anything innovative, so the next best thing is to steal ideas (steal? I really mean borrow ideas) and adapt them to the long term setting. One thing that really impresses me about the SPIRIT initiative is that it strives to empower employees to answer these 3 questions with a "resounding YES!":

"Am I treated with dignity and respect by everyone I encounter, regardless of role or rank in the organization?

Am I given the knowledge, tools and support that I need in order to make a contribution to my organization and that adds meaning to my life?

Did somebody notice I did it, i.e., am I recognized for my contribution?"

Can every single employee in your nursing home, administrator on down to the lowliest part-time laundry aide, answer these questions in the affirmative?

Quality Indicator Surveys

The surveyor's manual for the quality indicator survey program can be found at http://www.uchsc.edu/hcpr/qis_manual.php. Under "Tab 9", you can find the phase II critical elements. These forms serve as a sort of "how to survey nursing homes for dummies". They tell exactly what to ask residents and staff, exactly what type of documentation needs to found in the chart, what needs to be observed, and which F tags should be cited and under which conditions. It seems that this could be a great tool for your facility's QA committee, as they would be able to take care of quality issues while preparing for surveys at the same time.