Do you know your P's and Q's of QAPI?

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Shelly Mesure, MS, OTR/L
Shelly Mesure, MS, OTR/L
The Quality Assurance and Performance Improvement system from CMS is on our doorsteps. As facilities have been training and educating themselves, the new QIS (Quality Indicator Surveys) are ready to roll. So, while the entire nursing facility department heads gear up for this new survey process, where does this leave therapy?

Therapy is often left in the dark when it comes to expectations of quality assurance. Rehab managers may participate in the monthly QA meetings, but are they truly participating in the quality assurance and performance improvement process? Many years ago, I was often asked to provide reports on the number of patients on caseload by insurance type for each month. This was my QA report that was requested by the nursing home administrator. While this is a helpful report, it does not fit into the QA definitions, and should have been separated as a management report.

Quality assurance is defined as an approach to organizational management that emphasizes meeting and exceeding consumer needs and expectations. Scientific methods are used to continually improve work processes, and to empower all employees to engage in continuous improvement of their work. Isn't that a mouthful?! Well, let's break down this definition. In simpler terms, the expectation of quality assurance is to use an organized approach (systematic review, in some cases) to better examine our work processes. Upon examination, we then analyze the process, possibly use statistics to determine compliance, and conclude if further action is required.

Still sound very technical? Well, let's look at a realistic example:

Happy Valley Nursing Home has a policy that expects every time a resident has a fall reported, a referral is sent to rehab, and the patient is screen by PT, OT and/or SLP. This policy (work process) is the focus of our monthly QA audit. While auditing, the reviewer determines 20 patients had reported falls during the previous month. Of those 20 falls, 10 were referred to rehab and screened. The reviewer then determines that only 50% compliance is occurring with following the facility's policy to refer to rehab.

Upon further review, the reviewer determines 10 falls occurred on Unit A, and 10 falls occurred on Unit B. Unit A referred 10 out of 10 patients to therapy, while Unit B referred 0 out of 10. Now the reviewer is able to determine Unit B is 0% compliant with the facility's policy, and has now identified the problem.

Now that the problem has been determined, the reviewer and facility staff must determine an effective plan of correction (or action plan) to improve this problem and set new goals for compliance. A follow-up audit may be recommended for the following month, but the audit results and action plan should be reported during the monthly QA meetings. This is a good example of QA involving policies and procedures that relate directly to rehab.

Don't leave rehab in the dark. A strong QA model is required to ensure better compliance with all policy and procedures, and ultimately improve the quality of care provided to our residents.

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Rehab Realities

Rehab Realities is written by Shelly Mesure, MS, OTR/L. She is the senior vice president of Orchestrall Rehab Solutions and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide.

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