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What long term care facilities should know about performance improvement for CMS surveys & beyond

As the healthcare industry endured the siege of COVID-19, long term care (LTC) facilities were on the front lines. Serving the country's most at-risk demographic, they quickly pivoted to launch initiatives to ensure their residents and staff were as safe as possible.

While complying with national safety standards is their top priority, inspectors nevertheless needed to pause visits to conduct Centers for Medicare and Medicaid Services (CMS) surveys to:

  • Protect residents and staff from additional visitors
  • Allow LTC facilities to contend with extra obligations amid a profusion of new sanitation protocols, explains Patti Baicy, director of McKesson Medical-Surgical's clinical resource team

"The focus was on ensuring they were instituting ample infection control processes, including quarantining, deploying adequate personal protective equipment (PPE) and conducting testing; then administering vaccines as they became available," Baicy says.

However, as the immediate danger from the pandemic waned and vaccines became widespread, Baicy confirms that LTC surveys resumed in August 2021 to ensure LTC quality assurance and performance improvement.

As part of LTC facilities' ongoing efforts to identify and overcome deficiencies, they identify the most pressing quality assurance performance improvement (QAPI) metrics for resident safety.

Here are three key elements that have become more crucial since the pandemic and can help bolster LTC quality assurance and performance improvement.

1 | Keep infection control top of mind

Though this was a priority before the pandemic, infection mitigation is paramount today. During the height of COVID, most LTC facilities experienced shortfalls in PPE, as demand far exceeded supply and was complicated by well-known supply chain issues.

Fortunately, facilities are in solid shape again regarding the supply of PPE products such as gowns and masks, says Baicy.

"It's one of the main questions we get as facilities aim to confirm they have the right PPE products and proper disinfectants to make sure their facilities can meet guidelines, both for CMS compliance and general safety," she says.

During the CMS survey, inspectors assess compliance for several "F-Tags," a federal tag number corresponding to a specific regulation in the Code of Federal Regulations. One commonly given F-Tag citation relates to F880, which states that "the facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and help prevent the development and transmission of communicable diseases and infections."1

As part of fulfilling this F-Tag, LTC facilities need an infection preventionist, notes Lisa Thomson, chief strategy and marketing officer for Pathway Health, offering expert consulting services, strategic technology implementation and education solutions for post-acute care continuum.

To aid compliance, Pathway offers an Infection Preventionist Basic Bootcamp for LTC providers, a 20-hour course that covers all relevant topics.2

Similarly, McKesson offers a variety of resources as part of our recently relaunched UPrevent® infection prevention program, which serves as a single source for building and enhancing an infection prevention program.

"COVID is still COVID," says Baicy. "It's still there, and it is real. We still see outbreaks in buildings, and LTC facilities cannot let their guard down."

2 | Prioritize staff development

It's no secret that most sectors, especially in the healthcare industry, are struggling with staffing, but the issue is particularly intense in the long term and post-acute care markets.

One of the upcoming changes CMS has developed to help consumers and families compare nursing homes on the Nursing Home Care Compare website is the need to report nursing home staff turnover and weekend staffing levels.3, 4

According to Baicy, retaining sufficient staff is a tall order for any LTC facility, as boosting numbers remains the "$100,000 question." Finding adequate staff continues to pose a problem, but facilities can use existing staff strategically to help address shortfalls.

With high turnover, there's even more of a need for employee education to make sure they understand and implement policies and procedures, including how to use products properly.

"Facilities have excellent plans and programs for CMS compliance, but the workforce has to understand them," Thomson says. "Leaders must be vigilant in making it a priority to work with their clinical staff to adequately train them on risk mitigation strategies."

One solution is to deploy virtual learning, given that tight staffing can make it challenging to pull personnel off the floor to attend live presentations.

"E-learning solutions allow staff to take courses when convenient and in a relaxed environment," Baicy says.

It's also important to engage staff, notes Thomson.

"Facilities should take advantage of their bright and dynamic team to tap different departments with their own skills and talent," Thomson says.

"When you've identified a hurdle, there's an opportunity for improvement and finding innovative solutions by creating a cross-functional team across disciplines, departments and shifts.

Determine your focus and gather team members based on their roles and responsibilities because everyone comes at these issues from a fresh perspective."

She concludes that when leaders engage staff at all levels, they not only receive creative solutions to potential obstacles, this collaboration fosters buy-in from the staff. Allowing facilities to reap the benefits of a more engaged team can also improve retention.

Get the clinical education and training you need with McKesson Academy™, our no-cost online portal featuring over 270 resources.

3 | Optimize technology

As LTC facilities aim to use their staff more strategically, they need to deploy solutions that promote efficiency and take work off the frontline caregiver while giving them more time to provide patient care and work side by side with the residents.

"We've learned a lot through COVID about the importance of identifying essential and nonessential functions of clinical staff," says Thomson. "This is the opportune time to consider how to redeploy resources."

Suggested options include:

Electronic health records (EHRs)

EHRs allow facilities to streamline documentation and reduce redundancy while improving patient care with a clear picture of your residents' status, notes Baicy. She adds that dashboards can bring together information to simplify reporting and provide enhanced data and tracking to allow facilities to identify QAPIs they could improve.

"They provide a great opportunity to observe trends and pinpoint specific data that can help you with quality improvement while also adhering to the standards of practice for your state," Thomson says.

Connected vital signs monitors

Connecting these tools to your EHR allows you to avoid transcribing metrics for blood pressure, temperature, oxygen saturation and other vital signs. That removes workload from clinical staff and prevents potential errors when team members multitask with competing priorities.

Improved wound care

Many elderly residents struggle with repercussions from wounds, and it can prove challenging to document issues without an experienced wound nurse.

A solution like Swift Medical's skin and wound care smartphone app equips frontline staff with best practices and tools to treat wounds and monitor a patient's skin for prevention. 

Get advanced wound care, skin care and nutrition products, support and resources all in one comprehensive program, with McKesson WoundCare Companion™.

Data analytics

Data analytics companies like PointRight can enhance care management and quality programs and allow facilities to make data-driven decisions to help improve outcomes.

Using COVID as a catalyst for LTC quality assurance & performance improvement

The pandemic fundamentally changed how healthcare delivers, especially in LTC facilities. And as they strive to continuously improve patient care and other measures for CMS surveys, they can take many of the lessons learned to heart.

"Through COVID, we've seen a lot of collaboration across all departments, which truly has been a testament to the strength of long term care facilities and how they respond to situations in front of them. Historically, everybody comes together to work on solutions, and now we can take the lessons learned from COVID-19 and focus on the wellbeing of our patients and staff alike," says Thomson. 

"Your team wants to be engaged and involved, and this crisis has allowed us to identify emerging leaders within organizations and give them an opportunity for growth and development."

In addition, it's the right time to review operations and eliminate redundant processes and documentation. Making changes, large or small, can become a win for LTC facilities aiming to improve their quality and better prepare for CMS surveys, and the effect is even greater when teams work together.

"I always recommend LTC facilities work with their vendor partners to identify ways to reduce the load," says Thomson. "Companies like McKesson have great solutions that can help."

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