In today’s healthcare climate, patient safety and quality of care is not only expected but demanded. Long-term care providers who wish to remain competitive in the market and desirable among prospective patients, residents and employees must prioritize quality improvement initiatives. A thorough and regular assessment of the provider’s clinical practices offers valuable insight into the effectiveness and consistency of quality care. When issues can be identified proactively, providers can work more strategically and cost-efficiently towards solutions that best meet their resident’s physical, mental and emotional needs.

Conducted at the facility level, a clinical process review should involve key individuals including the director of nursing, nursing administrators and direct care staff. Having worked within the facility, these professionals may already be aware of certain conditions in need of attention. It is also helpful to solicit input from residents and their families, as well as an unbiased third-party industry expert such as Richter. The clinical process review begins with information gathering to better understand the condition of the facilities, then findings are compiled and reported before quality improvement initiatives are formed.

The Review: Conducting a Facility Assessment

A clinical process review begins with a facility assessment, which is a tool initiated and required by the Centers for Medicare & Medicaid Services (CMS). Long-term care facilities have been required to conduct the annual assessment since it became effective in 2018, however the requirements have since been modified to account for the new minimum staffing mandates. As of August 8, 2024, the facility assessment must include an evaluation of diseases, conditions, physical or cognitive limitations of the resident population, acuity (the level of severity of residents’ illnesses, physical, mental, and cognitive limitations, and conditions) and any other pertinent information about the resident population that may affect the services the facility must provide.

Although clinical in nature, the facility assessment is intended to serve as a strategic planning tool to aid in budgeting, decision-making and resource allocation. At a high level, providers can identify whether they are sufficiently meeting their resident’s needs. Information collected for the evaluation may include but is not limited to the following:

• Service offerings
• Staffing levels
• Staff skills and competencies
• Space utilization
• Equipment (medical and non-medical)
• Technology
• Communication methods

The Redesign: Incorporating Solutions to Reduce Deficiencies

Once the facility assessment is complete, the findings must be reviewed and discussed by the leadership team before any decisions regarding resources should be made. Using the data to drive your decisions, providers should choose 2-3 key areas to focus their quality assurance and process improvement (QAPI) efforts. Though it may be tempting to take on all your improvement ideas at once, limiting your scope of work will keep you from becoming too overwhelmed.

You may find it beneficial to constrict your QAPI efforts to a specific area within the building or to a specific problem trending throughout the facility. You will likely need to assess whether issues were caused by human error or a result of faulty equipment, and whether they were isolated incidents or widespread problems. Some issues may be more urgent than others, some may require significant investments to fix, and some may cause temporary interruptions to system operations. It is important to take all these factors into consideration as you set your QAPI plans. Examples of QAPI focus areas include:

• Infection prevention
• Patterns with accidents
• Dietary/food service
• Inventory and supplies
• Equipment malfunctions

Update Best Practices to Reflect Quality Improvements

Now that you have gotten to the root of the problem and prioritized what you will work to improve, the final step is to incorporate best practices to maintain your new quality care standards. Best practices provide structure and promote an organizational culture that embraces change, growth and collaboration. Effective best practices should offer long-term solutions to the problem, while eliminating vulnerabilities and the need for intervention. When creating best practices for your facility, focus on corrective actions that will lead to lasting improvements.

• Document changes to any existing processes or workflows
• Provide timely communication and education on new policies
• Re-train all staff when incidents occur
• Maintain employee training records
• Establish a time frame for completing project milestones

Enhance Outcomes with Richter

Quality of care is critical for providers and residents alike, yet positioning your facility as a credible, safe and efficient organization is an ongoing challenge. Mastering the clinical review process requires attention to detail and a commitment to continuous improvement. Richter understands your passion for delivering quality care and your need to accurately plan for future expenditures while preserving existing revenue streams. Our clinical consulting team of experts can help you prioritize facility needs, develop a QAPI plan and implement sustainable best practices. To learn more about our comprehensive solutions, contact us here or call us at 866.806.0799.