Repertoire Magazine (US) explains how nursing homes can use the help of distributor representatives in adhering to regulations and providing better patient care.

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Republished from Repertoire Magazine
Edition: August 2008 - Vol 16 Number 08

Article#: 2993
. Author: Repertoire

Your nursing home customers can't get patient safety out of their minds. Nor should they. Whether it's a matter of preventing falls, elopement or medication errors, protecting residents against pressure ulcers or ensuring they attend activities and remain emotionally healthy, nursing home administrators have a full plate to address. But, providing quality care to their residents is the main point of their job. And, to ensure nursing homes do that job well, the Centers for Medicare and Medicaid Services (CMS) has begun posting a special focus facility (SFF) list on its Web site, citing homes with "a history of poor performance on repeated violations of state and federal health and safety rules.”

In the past, facilities that failed their state inspections often addressed violations in order to pass their next inspection, only to backslide and fail the following year. Under the new system, the names of such facilities will remain on the SFF list for a minimum of 18 months, according to Lyn Bentley, director of regulatory services, American Health Care Association (AHCA).

Still, "if nursing homes meet individual patients' needs on a regular basis, they should remain in compliance with [state and federal] regulations," says Bentley.

Enough staff, enough attention

One way directors of nursing and their staff can provide better care is by knowing their patients, according to experts. "Nothing about this [environment permits] a cookie cutter approach," says Liz Weingast, director of clinical excellence, Jewish Home Lifecare (NYC, N.Y.). "Patient safety is all about communication and understanding who each patient is and what puts [him or her] at risk for certain [problems]." There are a lot of details to consider about each resident, she adds. For instance, why is a particular individual on a certain medication? Has the medication been changed recently? If so, why? Is the patient at risk for elopement? And, if his or her medication has been changed, how will that affect his tendency to wander? "We need to know what is going on with each resident at any particular moment," she says. "All of this impacts patient safety."

However, all too frequent budget cuts often lead to staff cuts, which limit nurses' and staff's ability to give residents adequate time and attention. "It's much less stressful for the nursing home staff when they know whom they're caring for and can notice small changes in behavior," says Weingast. But that can be difficult if staff turnover is high. She has addressed staff shortages by partnering with her facility's unions to try to minimize turnover rates. Nevertheless, when staff shortages do occur, she finds it helpful to assign temporary fill-ins to one area, so they get to know their patients better. She also suggests cross-training social workers and therapeutic rehabilitation staff to help feed residents. "Many individuals can help support the quality of patient care at a nursing home, not just the nursing staff," she says.

Bentley agrees that when staff is in place for a long time, they come to know individual patients and are more sensitive to minor changes in patients. That said, nurse shortages are expected to continue, she points out. What's worse, nurses are often tied up with paperwork. Regulations require that this work be completed by an RN. Keeping up with paperwork is essential, but "by focusing too much on regulations, it's easy to lose sight of the fact that we are supposed to be providing hands-on care to residents."

How reps can help

A stressed-out nursing staff is probably more likely to overlook errors or gaps in caring for patients. But distributor reps can help. Armed with an objective perspective, they can offer customers sources for checking their performance and staying on track for upcoming surveys.

For example, nursing homes need effective Quality Assessment and Assurance (QAA) committees to identify problem areas and develop plans for improvement, says Bentley. The extent to which the QAA is effective largely determines a nursing home's ability to improve the quality of care for its residents, she adds. In addition, CMS offers the Quality Indicator Survey (QIS), which aids facilities in evaluating how well they are performing and complying with regulations.

Another resource available to nursing homes is their state quality improvement organization, says Bentley. "The organization's staff goes into a nursing home and helps it identify weaknesses and processes for change," she explains. "Every state offers this."

Indeed, Jewish Home Lifecare subscribes to state-run online services, which "provide us with a picture of how we're doing," says Weingast. "For instance, are more of our residents falling? If so, where is this occurring and why?

"Nursing homes need systems in place on a daily basis that benefit both patients and staff," says Weingast. "They must keep up with changing guidelines and, too, they are required to have performance improvement programs." Facilities that stay on target do so by identifying their weaknesses, establishing a plan of change and ensuring that everyone works together to mobilize this change, she adds. "Then, whether the state comes to inspect your facility tomorrow or in six months, you are prepared."

"It's easy to ignore data," she adds. But, nursing homes must believe the data and share it with their staffs in order to repair shortcomings and comply with regulations.