QAPI success requires nurse leadership, expert says

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Former CMS official Alice Bonner says the change is good news.
Former CMS official Alice Bonner says the change is good news.

The most important leadership decision in a Quality Assurance/Performance Improvement plan is not what, but who, to include, a former Centers for Medicare & Medicaid Services official said Tuesday.

“You need team building for person-centered care,” said Alice Bonner, Ph.D., RN, the former director of the skilled nursing division at CMS and a current professor at Northeastern University. Her presentation, “QAPI and the CMS National Partnership to Improve Dementia Care: A Time for Leadership,” was held during the National Association Directors of Nursing Administration in Long Term Care conference in Anaheim, CA.

Finding the staff you need “involves teaching people how to hire,” or saying, “we are going to grow our own people,” she said.

CMS has said QAPI is a foundation for person-centered care, for defining quality and for systems thinking, Bonner noted. The five elements are Design & Scope; Governance & Leadership; Feedback, Data Systems & Monitoring; Performance Improvement Projects (PIPs) and Systematic Analysis & Systemic Action.

One area of quality improvement for many facilities is alarm reduction, she said.

“CMS is working with associations on updating a memo in order to help surveyors look at alarms differently,” Bonner said. “Surveyors have been known to say, ‘Why didn't that resident alarm?'” While it's not recommend to get rid of all alarms at once, “research shows they don't work,” she said.

Another quality improvement area for facilities may be dementia residents and recurrent falls. Many residents do not respond to being told to sit down multiple times a day, Bonner and other experts have said. By talking to the family, staff can figure out what is causing the resident agitation and ask questions such as “Does she like to go outside?” Incidents with dementia residents often need a root cause analysis, with family involvement, to determine the reasons for underlying behaviors.

Directors of nursing should work on making sure leadership and direct care staff “speak a common language,” that performance is monitored, and that priorities are identified based on core values of compassion, relationships and human connection, Bonner said.

Around 300 nurses are attending the conference. NADONA concludes Wednesday at the Disneyland Hotel Convention Center.