Nursing Home Quality Initiative Newsletter-Winter 2005/06

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Vision...

Imagine a nursing home where every person receives the right care every time. Where there is relatively low turnover among staff. Where residents are smiling, and actively engaging staff and others in their social and cultural activities. Imagine a nursing home where residents live their lives in a private and dignified manner - and feel a greater respect for the staff as a result. The Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, is helping to realize this vision through IPRO, the Medicare Quality Improvement Organization (QIO) for New York State, through the Nursing Home Quality Initiative.

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IPRO: Your Quality Partner

Like most health care facilities around the country, long-term care facilities experience cycles of staff turnover and stretched resources. Nursing facilities do their best to provide quality care, yet often there is little time for activities beyond basic resident care.

The members of the IPRO nursing home team understand the challenges you're facing and would like to help you identify improvement opportunities and solutions, enhance existing systems and adopt alternatives to create a nursing home that is more like a home.

Over the next three years, in a major effort to transform the quality of nursing home care, IPRO will work with a select group of motivated nursing homes across New York State. These are the facilities that will lead the way for others to follow. We will assist this identified participant group (IPG) of nursing homes survey resident and staff satisfaction, and staff turnover. We will help them redesign systems of care to be more integrated and collaborative, leading to person-centered or more individualized care. In addition, members of the IPG group will receive coaching and consultation from IPRO that will facilitate improvement of care in the areas of physical restraints, pressure ulcers among high-risk residents, and management of pain and depression.

IPRO will assist New York State's nursing homes in setting improvement targets and improving their performance on publicly reported quality measures for high-risk pressure ulcers and physical restraints. All nursing homes in the United States may set targets and track their progress on quality measures, including physical restraints and pressure ulcers, at any time by going to www.nhqi-star.org.

For more information on IPRO's efforts throughout the Medicare 8th Scope of Work, please visit our Web site at www.ipro.org/nhqi or contact Pauline Kinney, Director of the Nursing Home Quality Initiative via e-mail at pkinney@nyqio.sdps.org.

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Meet the IPRO Nursing Home Quality Improvement (NHQI) Team

Throughout the past three years, our NHQI team has worked with nursing homes throughout the state to help improve the quality of care for nursing home residents. We have provided facilities with complimentary clinical resources, quality improvement materials and, where indicated or requested, 1:1 technical support.

Many New York facilities have made significant improvements in the care being provided to residents by working with our team and taking advantage of the materials and the support of IPRO's NHQI staff. We are pleased to report that New York ranked among the most successful states during this period. We will continue to support New York's nursing homes as we enter the expanded Medicare 8th Scope of Work nursing home initiative.

Our team will be working to improve performance on the following clinical topics:

and will support nursing homes as they set improvement targets.

We have resources to help you on your quality improvement journey. Our NHQI team continues its commitment to provide nursing homes with the tools, materials and skills necessary to develop and implement successful quality improvement projects. To assist with these projects, we will be introducing additional quality improvement tools for use in your facility:
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NICK the Flu - National Improvement Collaborative to Kick the Flu

Influenza and invasive pneumococcal disease kill more people in the United States each year than all other vaccine-preventable deaths combined, according to the Centers for Disease Control and Prevention (CDC). To help prevent flu-related deaths, IPRO, the Medicare Quality Improvement Organization (QIO) for New York State, supports flu shots for seniors residing in long-term care facilities, and for the staff who care for them.

Recommendations for flu immunization coincide with an October 7, 2005 announcement from the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, which set new rules for the conditions of participation in Medicare for long-term care facilities.

"As a QIO, we strive to help ensure that the right care is delivered to every person, every time in New York State. We have resources for nursing homes to help educate residents and their families about the importance of immunization. Flu is among the unnecessary killers of the elderly and increasing immunization rates in nursing homes will help to keep more of our seniors healthy during this flu season," said Dr. Patricia Gagliano, Clinical Director, NHQI at IPRO.

The new rule (CMS-3198-F) requires long-term care facilities to have policies and procedures in place to ensure that, before being offered influenza or pneumococcal immunization, each resident or the resident's legal representative is informed about the benefits and potential side effects of these immunizations. It also requires that all residents be offered immunizations unless medically contraindicated or already immunized during the time period identified, which is between October 1st and March 31st, annually for influenza, and (without a specified time frame) usually once in a lifetime for the pneumococcal vaccine. A second pneumococcal immunization may be given under certain circumstances. (For more details, see Federal Register/ Vol. 70, No. 194/Friday, October 7, 2005/Rules and Regulations.) The resident or resident's legal representative must also have the opportunity to refuse immunization. Finally, the resident's medical record must include documentation that indicates each of the above-mentioned requirements has been met.

In New York State, most nursing homes have strong programs supporting the administration of pneumonia and flu vaccine to their residents. Immunization of health care staff can limit the severity and spread of influenza in long-term care settings. However, rates of immunization among health care providers has been too low to keep staff from spreading the disease. NICK the Flu is the National Improvement Collaborative to Kick the Flu.

Research shows that among older persons who reside in nursing homes, the flu vaccine has been reported to be 50 to 60 percent effective in preventing influenza-related hospitalization or pneumonia, and 80 percent effective in preventing influenza-related death.

"As the QIO for New York, we at IPRO are a resource for long-term care facilities in interpreting and understanding the application of the new immunization rule. We believe that these immunization practices can make a real difference in the health of New York State's long-term care facility residents and we will do everything we can to assist in implementing them" said Pauline Kinney, Director of NHQI.

For more information about the NICK the Flu Collaborative, contact Kinney at pkinney@nyqio.sdps.org

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We Like Sharing!

Share your quality improvement experiences. Take a moment to think about the QI initiatives implemented in your facility - how you began, the obstacles you met and overcame, the successes you've achieved - and send them to the NHQI team at IPRO. The team will review submissions and share stories in future issues of this newsletter. Please submit articles to pkinney@nyqio.sdps.org.

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Visit Us on the Web

nhqi web page

We are proud of our NHQI Web site, a valuable resource for all to share. Please visit our site at www.ipro.org/nhqi. We continue to update content on the Web site with information about Quality Measures, Quality Improvement, Target Setting, Process Improvement, and Culture Change. Another Web site feature of interest is "JENY" (Joint Effort New York), an online community of practice for health care professionals. Facilities like yours across New York State use JENY to join discussion groups, ask questions, and share information and ideas. Participation is free, but you will need to register to join. http://jeny.ipro.org

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