provider training long term care agenda ltc provider training handouts.pdf1:15 p.m. – 2:00 p.m....
TRANSCRIPT
7:30 a.m. – 8:15 a.m. Registration 8:15 a.m. – 8:30 a.m. Welcome 8:30 a.m. – 9:30 a.m. Decision Making: Fire or Strategy? Dr. Mac McCrory 9:30 a.m. – 9:45 a.m. Break 9:45 a.m. – 10:15 a.m. LTC Updates Mike Cook 10:15 a.m. – 10:45 a.m. Incident Reports – Changes and Updates Glenn Box 10:45 a.m. – 11:00 a.m. Emergency Preparedness Brent Maroney 11:00 a.m. – 12:00 p.m. Disaster Preparedness and Response : Kari Beggs A Guide for Planning 12:00 p.m. – 1:15 p.m. Lunch
1:15 p.m. – 2:00 p.m. LTCSP & Regulatory Overview Beverly Clark Susan Hays
2:00 p.m. – 2:20 p.m. QM/Composite Score Report Mike Cook 2:20 p.m. – 2:40 p.m. The National Partnership to Improve Paula Terrel Dementia Care 2:40 p.m. – 3:00 p.m. Elevate Care: Protecting Resident and Julie Myers Empowering Staff 3:00 p.m. – 3:15 p.m. Break 3:15 p.m. – 3:35 p.m. TMF Health Quality Institute - Sandy Terry Quality Programs for Long Term Care 3:35 p.m. – 3:55 p.m. Destroying Drugs: The Proper Way Lisa McAlister 3:55 p.m. – 4:25 p.m. Q&A OSDH Panel 4:25 p.m. – 4:30 p.m. Wrap up
Provider Training
Long Term Care
Agenda June 28th - Oklahoma City, August 30th - Tulsa
1
SLIDE 1
Decision Making:
Fire or Strategy?
Dr. Mac McCrory
Oklahoma State Department of
Health
Long Term Care
OSU Center for Executive and
Professional Development
June 2018
SLIDE 2
Why
What
How
SLIDE 3
How do we make decisions?
• History (the way we’ve always done it)
• Fire ( Sudden, without thought)
• Unilaterally (some one higher up says so)
• Policy, procedure (are they effective, updated)
• Purposeful
• Inclusive, collaborative, all stakeholders represented
• All of the above (% effort)
2
SLIDE 4
Our decision??? Or
• Our interpretation of decision from above
• Implementation of existing policy, procedure
• Application of our practices to past decisions
• Interpretation of laws, rules, regulations
• Creation of process or procedure to deal with
existing problem, situation, or dilemma
SLIDE 5
ACE: formula for decision making
• Assessment
• Calibration
• Evaluation
• “Ready Break” the action
SLIDE 6
Assessment
• Assimilation of data, facts, background, history
• Acquiring input
• Inclusive communication
• What challenges need to be met (collaborative)
• Cost benefit analysis
• Predictable outcomes
• Unbounded Creativity
3
SLIDE 7
Calibration
• Versus known “exacts”
• Laws, rules, regulations
• Policies & procedures
• Done it before (status quo)
• What worked, what didn’t
• Can (or how) we pay for it
• Collaboration =?? friendly
SLIDE 8
Evaluation
• As applied to this situation, personalities,
shared goals,
• Plan
• Output
• Outcomes
• Measurement tools
• How do we know when we get there?
• Next time?
SLIDE 9
Ready Break
• Execute the plan
• Tactical adjustments
• Formative evaluation
• Information for next time
• Dealing with the glitches….
4
SLIDE 10
Glitches
-a Techno Term
• A sudden, brief surge of energy
• Usually disruptive
• Minor malfunction
• Any problem
– a wrench in the gears
– a fly in the ointment
– a burr in our saddle
– a wedgey in our wear
SLIDE 11
Solutions to Glitches uses:
• Conflict Resolution
• Inclusive, collaborative communication
• Problem Solving
• Decision making
• Assertiveness
• Time Care
• Stress Ease
SLIDE 12
Critical thinking??
• See above
• “we” may not always like the answer
06/19/2018
1
CMSCMSCMSCMS
Emergency Preparedness Rule:Emergency Preparedness Rule:Emergency Preparedness Rule:Emergency Preparedness Rule:Oklahoma Health and Medical SystemOklahoma Health and Medical SystemOklahoma Health and Medical SystemOklahoma Health and Medical System
Oklahoma Health and Medical System Oklahoma Health and Medical System Oklahoma Health and Medical System Oklahoma Health and Medical System
• Assistant Secretary for Preparedness and Response (ASPR)
• Oklahoma State Statute
• Healthcare Coalition
• Funding
06/19/2018
2
Region 5 Healthcare CoalitionRegion 5 Healthcare CoalitionRegion 5 Healthcare CoalitionRegion 5 Healthcare CoalitionMedical Planning Group (RMPG)Medical Planning Group (RMPG)Medical Planning Group (RMPG)Medical Planning Group (RMPG)
Emergency Preparedness Program: Emergency Preparedness Program: Emergency Preparedness Program: Emergency Preparedness Program: 4 Core Elements4 Core Elements4 Core Elements4 Core Elements
• Risk Assessment and Planning
• Policies and Procedures
• Communication Plan
• Training and Testing Program
Risk Assessment and PlansRisk Assessment and PlansRisk Assessment and PlansRisk Assessment and Plans
• Hazard Vulnerability Analysis (HVA)• Agency/Facility Specific
• County Emergency Operations Plan (EOP)
• Regional Health and Medical
• Emergency Preparedness Plan
• Based on Risk Assessment (HVA)
• Update annually
06/19/2018
3
HVAHVAHVAHVA
Policies and ProceduresPolicies and ProceduresPolicies and ProceduresPolicies and Procedures
• Based on Plan • How
• Specifics
• Staff/Patient tracking
• Evacuation• Shelter In Place
• Update annually
Communication Plan Communication Plan Communication Plan Communication Plan
• Develop a Plan
• Coordinate with external partners
• Local • Regional
• State
• Update annually
06/19/2018
4
Training and TestingTraining and TestingTraining and TestingTraining and Testing• Develop a training and testing program
• Ensure staff can demonstrate knowledge
• Conduct 2 drills annually • Full Scale or Real World
• Community OR Facility Based • Full Scale, Table top, or Real World
• Facility Based
***After Action Reports (AAR)
QuestionsQuestionsQuestionsQuestionsKari Beggs RN, BSN
Region 5 Medical Response System Director
Medical Emergency Response Center
Coordinator
Phone: 405-226-5329
Fax: 918-423-7691
Long‐Term Care Rule | F‐Tag: Job Aid
* Substandard quality of care = one or more deficiencies with s/s levels of F, H, I, J, K, or L in RedFederal Regulatory Groups for Long Term Care Facilities
F540 Definitions
483.10 Resident RightsF550 *Resident Rights/Exercise of RightsF551 Rights Exercised by RepresentativeF552 Right to be Informed/Make Treatment DecisionsF553 Right to Participate in Planning CareF554 Resident Self‐Admin Meds‐Clinically AppropriateF555 Right to Choose/Be Informed of Attending PhysicianF557 Respect, Dignity/Right to have Personal PropertyF558 *Reasonable Accommodations of Needs/PreferencesF559 *Choose/Be Notified of Room/Roommate ChangeF560 Right to Refuse Certain TransfersF561 *Self DeterminationF562 Immediate Access to ResidentF563 Right to Receive/Deny VisitorsF564 Inform of Visitation Rights/Equal Visitation PrivilegesF565 *Resident/Family Group and ResponseF566 Right to Perform Facility Services or RefuseF567 Protection/Management of Personal FundsF568 Accounting and Records of Personal FundsF569 Notice and Conveyance of Personal FundsF570 Surety Bond ‐ Security of Personal FundsF571 Limitations on Charges to Personal FundsF572 Notice of Rights and RulesF573 Right to Access/Purchase Copies of RecordsF574 Required Notices and Contact InformationF575 Required PostingsF576 Right to Forms of Communication with PrivacyF577 Right to Survey Results/Advocate Agency InfoF578 Request/Refuse/Discontinue Treatment;Formulate Adv DiF579 Posting/Notice of Medicare/Medicaid on AdmissionF580 Notify of Changes (Injury/Decline/Room, Etc.)F582 Medicaid/Medicare Coverage/Liability NoticeF583 Personal Privacy/Confidentiality of RecordsF584 *Safe/Clean/Comfortable/ Homelike EnvironmentF585 GrievancesF586 Resident Contact with External Entities
483.12 Freedom from Abuse, Neglect, and ExploitationF600 *Free from Abuse and NeglectF602 *Free from Misappropriation/ExploitationF603 *Free from Involuntary SeclusionF604 *Right to be Free from Physical RestraintsF605 *Right to be Free from Chemical RestraintsF606 *Not Employ/Engage Staff with Adverse ActionsF607 *Develop/Implement Abuse/Neglect, etc. PoliciesF608 *Reporting of Reasonable Suspicion of a CrimeF609 *Reporting of Alleged ViolationsF610 *Investigate/Prevent/Correct Alleged Violation
483.15 Admission, Transfer, and DischargeF620 Admissions PolicyF621 Equal Practices Regardless of Payment SourceF622 Transfer and Discharge RequirementsF623 Notice Requirements Before Transfer/DischargeF624 Preparation for Safe/Orderly Transfer/DischargeF625 Notice of Bed Hold Policy Before/Upon TransferF626 Permi ng Residents to Return to Facility
483.20 Resident AssessmentsF635 Admission Physician Orders for Immediate CareF636 Comprehensive Assessments & TimingF637 Comprehensive Assmt A er Significant ChangeF638 Quarterly Assessment At Least Every 3 MonthsF639 Maintain 15 Months of Resident AssessmentsF640 Encoding/Transmi ng Resident AssessmentF641 Accuracy of AssessmentsF642 Coordina on/Cer fica on of AssessmentF644 Coordina on of PASARR and AssessmentsF645 PASARR Screening for MD & IDF646 MD/ID Significant Change Notification
483.21 Comprehensive Resident Centered Care PlansF655 Baseline Care PlanF656 Develop/Implement Comprehensive Care PlanF657 Care Plan Timing and RevisionF658 Services Provided Meet Professional StandardsF659 Qualified PersonsF660 Discharge Planning ProcessF661 Discharge Summary
483.24 Quality of LifeF675 *Quality of LifeF676 *Ac vi es of Daily Living (ADLs)/ Maintain Abili esF677 *ADL Care Provided for Dependent ResidentsF678 *Cardio‐Pulmonary Resuscita on (CPR)F679 *Ac vi es Meet Interest/Needs of Each ResidentF680 *Qualifica ons of Ac vity Professional
483.25 Quality of CareF684 *Quality of CareF685 *Treatment/Devices to Maintain Hearing/VisionF686 *Treatment/Svcs to Prevent/Heal Pressure UlcersF687 *Foot CareF688 *Increase/Prevent Decrease in ROM/MobilityF689 *Free of Accident Hazards/Supervision/DevicesF690 *Bowel/Bladder Incon nence, Catheter, UTIF691 *Colostomy, Urostomy, or Ileostomy CareF692 *Nutri on/Hydra on Status MaintenanceF693 *Tube Feeding Management/Restore Ea ng SkillsF694 *Parenteral/IV FluidsF695 *Respiratory/Tracheostomy care and Suc oningF696 *ProsthesesF697 *Pain ManagementF698 *DialysisF699 *{PHASE‐3} Trauma Informed Care F700 *Bedrails
483.30 Physician ServicesF710 Resident's Care Supervised by a PhysicianF711 Physician Visits ‐ Review Care/Notes/OrderF712 Physician Visits ‐Frequency/Timeliness/Alternate NPPsF713 Physician for Emergency Care, Available 24 HoursF714 Physician Delega on of Tasks to NPPF715 Physician Delega on to Die an/Therapist
483.35 Nursing ServicesF725 Sufficient Nursing StaffF726 Competent Nursing StaffF727 RN 8 Hrs/7 days/Wk, Full Time DONF728 Facility Hiring and Use of Nurse F729 Nurse Aide Registry Verifica on, Retraining
Friday, July 14, 2017Page 1 of 2Report‐30: LTC‐Rule Job Aid
* Substandard quality of care = one or more deficiencies with s/s levels of F, H, I, J, K, or L in RedFederal Regulatory Groups for Long Term Care Facilities
F730 Nurse Aide Perform Review – 12Hr/Year In‐ serviceF731 Waiver ‐Licensed Nurses 24Hr/Day and RN CoverageF732 Posted Nurse Staffing Informa on
483.40 Behavioral Health ServicesF740 Behavioral Health ServicesF741 Sufficient/Competent Staff‐Behav Health NeedsF742 *Treatment/Svc for Mental/Psychosocial ConcernsF743 *No Pattern of Behavioral Difficulties Unless UnavoidableF744 *Treatment /Service for DementiaF745 *Provision of Medically Related Social Services
483.45 Pharmacy ServicesF755 Pharmacy Svcs/Procedures/Pharmacist/RecordsF756 Drug Regimen Review, Report Irregular, Act OnF757 *Drug Regimen is Free From Unnecessary DrugsF758 *Free from Unnec Psychotropic Meds/PRN UseF759 *Free of Medica on Error Rate sof 5% or MoreF760 *Residents Are Free of Significant Med ErrorsF761 Label/Store Drugs & Biologicals
483.50 Laboratory, Radiology, and Other Diagnostic SeF770 Laboratory ServicesF771 Blood Blank and Transfusion ServicesF772 Lab Services Not Provided On ‐SiteF773 Lab Svs Physician Order/No fy of ResultsF774 Assist with Transport Arrangements to Lab SvcsF775 Lab Reports in Record ‐LabName/AddressF776 Radiology/Other Diagnostic ServicesF777 Radiology/Diag. Svcs Ordered/No fy ResultsF778 Assist with Transport Arrangements to RadiologyF779 X ‐Ray/Diagnos c Report in Record‐Sign/Dated
483.55 Dental ServicesF790 Rou ne/Emergency Dental Services in SNFsF791 Rou ne/Emergency Dental Services in NFs
483.60 Food and Nutrition ServicesF800 Provided Diet Meets Needs of Each ResidentF801 Qualified Dietary StaffF802 Sufficient Dietary Support PersonnelF803 Menus Meet Res Needs/Prep in Advance/FollowedF804 Nutri ve Value/Appear ,Palatable/Prefer TempF805 Food in Form to Meet Individual Needs
F806 Resident Allergies, Preferences and Subs tutesF807 Drinks Avail to Meet Needs/Preferences/ Hydra onF808 Therapeu c Diet Prescribed by PhysicianF809 Frequency of Meals/Snacks at Bed meF810 Assistive Devices ‐ Ea ng Equipment/UtensilsF811 Feeding Asst ‐Training/Supervision/ResidentF812 Food Procurement, Store/Prepare/Serve ‐ SanitaryF813 Personal Food PolicyF814 Dispose Garbage & Refuse Properly
483.65 Specialized Rehabilitative ServicesF825 Provide/Obtain Specialized Rehab ServicesF826 Rehab Services ‐ Physician Order/Qualified Person
483.70 AdministrationF835 AdministrationF836 License/Comply w/Fed/State/Local Law/Prof StdF837 Governing BodyF838 Facility AssessmentF839 Staff QualificationsF840 Use of Outside ResourcesF841 Responsibili es of Medical DirectorF842 Resident Records ‐ Identifiable InformationF843 Transfer Agreement F844 Disclosure of Ownership RequirementsF845 Facility closure‐AdministratorF846 Facility closureF849 Hospice ServicesF850 *Qualifications of Social Worker >120 BedsF851 Payroll Based Journal
483.75 Quality Assurance and Performance ImprovemF865 QAPI Program/Plan, Disclosure/Good Faith AttemptF866 {PHASE‐3} QAPI/QAA Data Collec on and MonitoringF867 QAPI/QAA Improvement Ac vi esF868 QAA Committee
483.80 Infection ControlF880 Infection Prevention & ControlF881 Antibiotic Stewardship ProgramF882 {PHASE‐3} Infec on Preven onist Qualifica ons/RoleF883 *Influenza and Pneumococcal Immuniza ons
483.85 {PHASE‐3} Compliance and Ethics ProgramF895 {PHASE-3} Compliance and Ethics Program
483.90 Physical Environment
F907 Space and EquipmentF908 Essen al Equipment, Safe Opera ng Condi onF909 Resident BedF910 Resident RoomF911 Bedroom Number of ResidentsF912 Bedrooms Measure at Least 80 Square Ft/ResidentF913 Bedrooms Have Direct Access to Exit CorridorF914 Bedrooms Assure Full Visual PrivacyF915 Resident Room WindowF916 Resident Room Floor Above GradeF917 Resident Room Bed/Furniture/ClosetF918 Bedrooms Equipped/Near Lavatory/ToiletF919 Resident Call SystemF920 Requirements for Dining and Activity RoomsF921 Safe/Func onal/Sanitary/ Comfortable EnvironmentF922 Procedures to Ensure Water AvailabilityF923 VentilationF924 Corridors Have Firmly Secured HandrailsF925 Maintains Effec ve Pest Control ProgramF926 Smoking Policies
483.95 Training RequirementsF940 {PHASE‐3} Training Requirements ‐ GeneralF941 {PHASE‐3} Communication TrainingF942 {PHASE-3} Resident’s Rights TrainingF943 Abuse, Neglect, and Exploitation TrainingF944 {PHASE‐3} QAPI TrainingF945 {PHASE‐3} Infection Control TrainingF946 {PHASE-3} Compliance and Ethics TrainingF947 Required In‐Service Training for Nurse AidesF948 Training for Feeding AssistantsF949 {PHASE-3} Behavioral Health Training
Friday, July 14, 2017Page 2 of 2Report‐30: LTC‐Rule Job Aid
F906 Emergency Electrical Power System
CMS Training Resources
Nursing Homes (Google: CMS Nursing Home LTCSP)
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html
This website has links to several resources including:
• Appendix PP
• Revised list of the new Ftags
• LTC Survey Pathways (41 pathways)
• Entrance Conference Form – Matrix with instructions
• And more…
The Medicare Learning Network (Google: CMS Medicare Learning Network)
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.html
This website has links to:
• Medicare Learning Network (MLN) Newsletter
• Electronic Mailing Lists
• MLN Calls & Webcast training (upcoming and past)
MLN Calls & Webcast Training Example: Nursing Home Facility Assessment Tool
To locate training follow the steps below:
1. Click on Events & Training/Calls & Webcasts link
2. Type the topic of interest in the search field next to Filter On (see screen shot below, in this example
the search is for Facility Assessment Tool)
3. Click the date of the program for a link to the training information. (See screen shot above.)
Integrated Surveyor Training Website (Google: CMS ISTW)
https://surveyortraining.cms.hhs.gov/pubs/ProviderWelcome.aspx
This website offers 24/7 training on Federal regulations and survey process for both providers and
surveyors.
To access the training follow the steps below:
1. Click the link I AM A PROVIDER (see the screen shot below)
2. Click Course Catalog
3. Select the course you would like to view. You may use the Filter By: Type or Search Courses. See search
examples below.
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES
ENTRANCE CONFERENCE WORKSHEET
1/2018 1
INFORMATION NEEDED FROM THE FACILITY IMMEDIATELY UPON ENTRANCE
1. Census number 2. Complete matrix for new admissions in the last 30 days who are still residing in the facility. 3. An alphabetical list of all residents (note any resident out of the facility). 4. A list of residents who smoke, designated smoking times, and locations.
ENTRANCE CONFERENCE 5. Conduct a brief Entrance Conference with the Administrator. 6. Information regarding full time DON coverage (verbal confirmation is acceptable). 7. Information about the facility’s emergency water source (verbal confirmation is acceptable). 8. Signs announcing the survey that are posted in high-visibility areas. 9. A copy of an updated facility floor plan, if changes have been made. 10. Name of Resident Council President. 11. Provide the facility with a copy of the CASPER 3.
INFORMATION NEEDED FROM FACILITY WITHIN ONE HOUR OF ENTRANCE
12. Schedule of meal times, locations of dining rooms, copies of all current menus including therapeutic menus that will be served for the duration of the survey and the policy for food brought in from visitors.
13. Schedule of Medication Administration times. 14. Number and location of med storage rooms and med carts. 15. The actual working schedules for licensed and registered nursing staff for the survey time period. 16. List of key personnel, location, and phone numbers. Note contract staff (e.g., rehab services). 17. If the facility employs paid feeding assistants, provide the following information:
a) Whether the paid feeding assistant training was provided through a State-approved training program by qualified professionals as defined by State law, with a minimum of 8 hours of training;
b) The names of staff (including agency staff) who have successfully completed training for paid feeding assistants, and who are currently assisting selected residents with eating meals and/or snacks;
c) A list of residents who are eligible for assistance and who are currently receiving assistance from paid feeding assistants.
INFORMATION NEEDED FROM FACILITY WITHIN FOUR HOURS OF ENTRANCE
18. Complete the matrix for all other residents. The TC confirms the matrix was completed accurately. 19. Admission packet. 20. Dialysis Contract(s), Agreement(s), Arrangement(s), and Policy and Procedures, if applicable. 21. List of qualified staff providing hemodialysis or assistance for peritoneal dialysis treatments, if
applicable. 22. Agreement(s) or Policies and Procedures for transport to and from dialysis treatments, if applicable. 23. Does the facility have an onsite separately certified ESRD unit? 24. Hospice Agreement, and Policies and Procedures for each hospice used (name of facility designee(s)
who coordinate(s) services with hospice providers).
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES
ENTRANCE CONFERENCE WORKSHEET
1/2018 2
25. Infection Prevention and Control Program Standards, Policies and Procedures, and Antibiotic Stewardship Program.
26. Influenza / Pneumococcal Immunization Policy & Procedures. 27. QAA committee information (name of contact, names of members and frequency of meetings). 28. QAPI Plan. 29. Abuse Prohibition Policy and Procedures. 30. Description of any experimental research occurring in the facility. 31. Facility assessment. 32. Nurse staffing waivers. 33. List of rooms meeting any one of the following conditions that require a variance:
• Less than the required square footage • More than four residents
INFORMATION NEEDED BY THE END OF THE FIRST DAY OF SURVEY
34. Provide each surveyor with access to all resident electronic health records – do not exclude any information that should be a part of the resident’s medical record. Provide specific information on how surveyors can access the EHRs outside of the conference room. Please complete the attached form on page 4 which is titled “Electronic Health Record Information.”
INFORMATION NEEDED FROM FACILITY WITHIN 24 HOURS OF ENTRANCE
35. Completed Medicare/Medicaid Application (CMS-671). 36. Completed Census and Condition Information (CMS-672). 37. Please complete the attached form on page 3 which is titled “Beneficiary Notice - Residents
Discharged Within the Last Six Months”.
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES
ENTRANCE CONFERENCE WORKSHEET
1/2018 3
Beneficiary Notice - Residents Discharged Within the Last Six Months
Please complete and return this worksheet to the survey team within 24 hours. Please provide a list of residents who were discharged from a Medicare covered Part A stay with benefit days remaining in the past 6 months. Please indicate if the resident was discharged home or remained in the facility. (Note: Exclude beneficiaries who received Medicare Part B benefits only, were covered under Medicare Advantage insurance, expired, or were transferred to an acute care facility or another SNF during the sample date range).
Resident Name Discharge Date
Discharged to: Home/Lesser Care Remained in facility
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES
ENTRANCE CONFERENCE WORKSHEET
1/2018 4
ELECTRONIC HEALTH RECORD (EHR) INFORMATIONPlease provide the following information to the survey team before the end of the first day of survey.
Provide specific instructions on where and how surveyors can access the following information in the EHR (or in the hard copy if using split EHR and hard copy system) for the initial pool record review process. Surveyors require the same access staff members have to residents’ EHRs in a read-only format.
Example: Medications EHR: Orders – Reports – Administration Record – eMAR – Confirm date range – Run Report
Example: Hospitalization EHR: Census (will show in/out of facility)
MDS (will show discharge MDS)
Prog Note – View All - Custom – Created Date Range - Enter time period leading up to hospitalization – Save (will show where and why resident was sent)
1. Pressure ulcers
2. Dialysis
3. Infections
4. Nutrition
5. Falls
6. ADL status
7. Bowel and bladder
8. Hospitalization
9. Elopement
10. Change of condition
11. Medications
12. Diagnoses
13. PASARR
14. Advance directives
15. Hospice
Please provide name and contact information for IT and back-up IT for questions: IT Name and Contact Info: ______________________________________________________________
Back-up IT Name and Contact Info: _______________________________________________________
______________________________________________________________________________
MATRIX INSTRUCTIONS FOR PROVIDERS _____________________________________________________________________________
1/2018
The Matrix is used to identify pertinent care categories for: 1) newly admitted residents in the last 30 days
who are still residing in the facility, and 2) all other residents.
The facility completes the resident name, resident room number and columns 1-20, which are described in
detail below. Blank columns are for Surveyor Use Only.
All information entered into the form should be verified by a staff member knowledgeable about
the resident population. Information must be reflective of all residents as of the day of survey.
Unless stated otherwise, for each resident mark an X for all columns that are pertinent.
1. Residents Admitted within the Past 30 days: Resident(s) who were admitted to the facility
within the past 30 days and currently residing in the facility.
2. Alzheimer’s/Dementia: Resident(s) who have a
diagnosis of Alzheimer’s disease or dementia of
any type.
3. MD, ID or RC & No PASARR Level II: Resident(s) who have a serious mental disorder,
intellectual disability or a related condition but does not have a PASARR level II evaluation and
determination.
4. Medications: Resident(s) receiving any of the
following medications: (I) = Insulin, (AC) =
Anticoagulant (e.g. Direct thrombin inhibitors
and low weight molecular weight heparin [e.g.,
Pradaxa, Xarelto, Coumadin, Fragmin]. Do not
include Aspirin or Plavix), (ABX) = Antibiotic,
(D) = Diuretic, (O) = Opioid, (H) = Hypnotic,
(AA) = Antianxiety, (AP) = Antipsychotic, (AD) = Antidepressant, (RESP) = Respiratory (e.g.,
inhaler, nebulizer).
NOTE: Record meds according to a drug’s
pharmacological classification, not how it is
used.
5. Facility Acquired Pressure Ulcer(s) (any stage): Resident(s) who have a pressure ulcer at any
stage, including suspected deep tissue injury
(mark I, II, III, IV, U for unstageable, S for
sDTI)
6. Worsened Pressure Ulcer(s) at any stage: Resident(s) with a pressure ulcer at any stage
that have worsened.
7. Excessive Weight Loss without Prescribed
Weight Loss program: Resident(s) with an
unintended (not on a prescribed weight loss
program) weight loss > 5% within the past 30
days or >10% within the past 180 days. Exclude
residents receiving hospice services.
8. Tube Feeding: Resident(s) who receive enteral
(E) or parenteral feedings (P).
9. Dehydration: Resident(s) identified with actual
hydration concerns takes in less than the
recommended 1,500 ml of fluids daily (water or
liquids in beverages and water in foods with high
fluid content, such as gelatin and soups).
10. Physical Restraints: Resident(s) who have a
physical restraint in use. A restraint is defined as
the use of any manual method, physical or
mechanical device, material or equipment
attached or adjacent to the resident’s body that
the individual cannot remove easily which
restricts freedom of movement or normal access
to one’s body (e.g., bed rail, trunk restraint, limb restraint, chair prevents rising, mitts on hands,
confined to room, etc.). Do not code wander
guards as a restraint.
11. Fall(s), Fall(s) with Injury, Fall(s) with Major
Injury: Resident(s) who have fallen in the
facility in the past 90 days or since admission
and have incurred an injury or not. A major
injury includes bone fractures, joint dislocation,
closed head injury with altered consciousness,
subdural hematoma.
Use (F) to identify residents with a fall(s), (FI)
to identify a resident who has sustained an injury
excluding major injury, and (FMI) to identify a
resident who has sustained a fall(s) with Major
Injury.
12. Indwelling Urinary Catheter: Resident(s) with
an indwelling catheter (including suprapubic
catheter and nephrostomy tube).
______________________________________________________________________________
MATRIX INSTRUCTIONS FOR PROVIDERS _____________________________________________________________________________
1/2018
13. Dialysis: Resident(s) who are receiving (H)
hemodialysis or (P) peritoneal dialysis either
within the facility (F) or offsite (O).
14. Hospice: Resident(s) who have elected or are currently receiving hospice services.
15. End of Life/Comfort Care/Palliative Care:
Resident(s) who are receiving end of life or
palliative care (not including Hospice).
16. Tracheostomy: Resident(s) who have a
tracheostomy.
17. Ventilator: Resident(s) who are receiving
invasive mechanical ventilation.
18. Transmission-Based Precautions: Resident(s)
who are currently on Transmission-based
Precautions.
19. Intravenous therapy: Resident(s) who are
receiving intravenous therapy through a central line, peripherally inserted central catheter, or
other intravenous catheter.
20. Infections: Residents(s) who has a
communicable disease/contagious infection. For
example, (M) MDRO, (P) pneumonia, (TB)
tuberculosis, (VH) viral hepatitis, or (C) c-diff
OR has a healthcare-associated infection (e.g.,
(WI) wound infection or (UTI) Urinary Tract Infection).
Resident Name Res
iden
t Roo
m N
umbe
r
1
Dat
e of
Adm
issi
on if
Adm
itted
with
in th
e Pa
st 3
0 D
ays
2
Alz
heim
er’s
/ D
emen
tia
3
MD
, ID
or
RC
& N
o PA
SAR
R L
evel
II
4 M
edic
atio
ns: I
nsul
in (I
), A
ntic
oagu
lant
(AC
), A
ntib
iotic
(A
BX
), D
iure
tic (D
), O
pioi
d (O
), H
ypno
tic (H
), A
ntia
nxie
ty
(AA
), A
ntip
sych
otic
(AP)
, Ant
idep
ress
ant (
AD
), R
espi
rato
ry
(RE
SP)
5
Faci
lity
Acq
uire
d Pr
essu
re U
lcer
(s) (
any
stag
e)
6
Wor
sene
d Pr
essu
re U
lcer
(s) (
any
stag
e)
7
Exc
essi
ve W
eigh
t Los
s w
/out
Pre
scri
bed
Wei
ght L
oss P
rogr
am
8
Tub
e Fe
edin
g
9
Deh
ydra
tion
10
Phys
ical
Res
trai
nts
11
Fall
(F),
Fall
with
Inj
ury
(FI)
, or
Fall
w/M
ajor
Inju
ry (F
MI)
12
Indw
ellin
g C
athe
ter
13
Dia
lysi
s: P
erito
neal
(P),
Hem
o (H
), in
faci
lity
(F) o
r of
fsite
(O)
14
Hos
pice
15
End
of L
ife C
are
/Com
fort
Car
e/Pa
lliat
ive
Car
e
16
Tra
cheo
stom
y
17
Ven
tilat
or
18
Tra
nsm
issi
on-B
ased
Pre
caut
ions
19
Intr
aven
ous t
hera
py
20
Infe
ctio
ns (M
,WI,
P, T
B, V
H, C
, UT
I)
21
Oth
er
MATRIX FOR PROVIDERS
1/2018
06/19/2018
1
National Partnership to Improve Dementia Care in Nursing Homes
National Partnership to Improve Dementia Care in Nursing Homes
� CMS launched the Partnership to Improve Dementia Care in Nursing Homes on May 30, 2012.
� An initiative to ensure appropriate care and use of antipsychotic medications for nursing home residents.
� The government partnered with national organizations, providers, caregivers, and advocacy groups.
National Partnership to Improve Dementia Care in Nursing Homes
� The partnership was to promote comprehensive dementia care and therapeutic interventions for nursing home residents with dementia related behaviors.
� The goals were to improve person centered care and reduce the use of unnecessary antipsychotic medications.
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2
National Partnership to Improve Dementia Care in Nursing Homes
� The partnership is committed to improving the quality of care for individuals with dementia living in nursing homes.
� The partnership has a mission to deliver health care that is person centered with a focus on protecting residents from being prescribed antipsychotic medications unless there is a valid, clinical indication and a systematic process to evaluate each individual’s needs.
Why Antipsychotic Medications
� Antipsychotic drugs, when administered to residents with dementia, can cause:
� over-sedation,
� make the residents more prone to falls,
� compromise overall well-being, and
� increase the risk of death.
Why Antipsychotic Medications
� Both first and second generation antipsychotic medications have serious side effects and can be especially dangerous for elderly residents. When used without an adequate rationale, or for the purpose of limiting or controlling expressions or indications of distress without first identifying a cause, there is little chance that they will be effective, and they commonly cause complications such as movement disorders, falls with injury, cerebrovascular adverse events (CVA’s and TIA’s) and increased risk of death.
� The FDA Boxed Warning which accompanies second generation antipsychotic medications states, “Elderly patients with dementia-related psychosis treated with atypical anti-psychotic drugs are at an increased risk of death.” There are similar boxed warnings for first generation anti-psychotic medications.
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3
National Partnership to Improve Dementia Care in Nursing Homes
� The official measure is the percentage of long - stay residents who are receiving an antipsychotic medication.
� This excludes residents diagnosed with Schizophrenia, Huntington’s Disease, or Tourette’s Syndrome.
National Data
� Baseline data, obtained from 2011 Quarter 4, documented 23.9% of long-stay nursing home residents were receiving an antipsychotic medication.
� CMS challenged states to reduce unnecessary antipsychotic medications in nursing home residents by 15% before June 2013.
Oklahoma Data
� Oklahoma started with 27.3% of our long-stay nursing home residents receiving an antipsychotic medication.
� 5,100 of 19,300 residents in nursing homes were being administered antipsychotic medications.
� Oklahoma was ranked 48th highest in use of antipsychotic medications.
� More than 100 Oklahoma homes had over 30% of residents on antipsychotic medications.
06/19/2018
4
Oklahoma Partnership to Improve Dementia Care in Nursing Homes
� In June and July 2012, Oklahoma Partners and Stakeholders reached a consensus regarding dynamic activities to educate prescribing physicians, pharmacists and nurse managers regarding antipsychotic medications.
� The partnership’s improvement theory was that equipped with best practice standards, nursing facility leaders (administrators, nurses, pharmacists, and physicians) could reduce unnecessary antipsychotic medications for long- stay residents with dementia.
� Our goal was to reduce the prevalence of unnecessary antipsychotic medications used to treat behaviors for residents with dementia by 15% by June 2013.
Oklahoma Partnership to Improve Dementia Care in Nursing Homes
� The Oklahoma State Department of Health
� The Oklahoma Foundation for Medical Quality
� The Alzheimer’s Association, Oklahoma Chapter
� The Oklahoma Culture Change Coalition
� The University of Oklahoma College of Pharmacy
� The OUHSC Department of Geriatric Medicine
� Leading Age Oklahoma
� The Oklahoma Association of Health Care Providers
� Representatives From Oklahoma Nursing Homes
� Many Others
Oklahoma Partnership to Improve Dementia Care in Nursing Homes
� Throughout the next year the Oklahoma Partnership provided many educational opportunities through seminars, one on one visits with facility staff, on line training, workshops, webinars, guest speakers and you tube trainings.
� Results were better than the targeted 15% reduction.
� Actual improvement was 18% by June 2013.
� This was one of the top ten results in the U.S.
� Oklahoma’s ranking on antipsychotic drug use improved from 48th to 39th.
06/19/2018
5
Cost Savings
� Cost savings were estimated at $4.8 million annually based on reduced use of medications.
� There were 944 fewer residents receiving antipsychotic medications.
Continued Progress
� The Partnership continued it’s efforts through July 2014, when Oklahoma reached a 24% reduction in antipsychotic drug use.
� Affecting 1059 residents
� With Drug cost savings estimated at $8 million annually.
All Time Low Prevalence of Use
� Oklahoma reached a low of 19.4% prevalence of antipsychotic use in September of 2015, down from a high of 27.5% in December 2011.
06/19/2018
6
STAR- OKLTC Network
� To ensure continued improvement in quality of care for individuals living with dementia, Long Term Care Stakeholders reconvened in 2017. The group has agreed to reinvigorate efforts to improve dementia care, with an emphasis on sustainability of the antipsychotic drug reductions achieved through the Partnership.
Current Data
� The most current data for the prevalence of antipsychotic medication use for Long-Stay residents is from September 2017.
� There has been a decrease of 36.6% to a national prevalence of 15.1%.
� Oklahoma has a 19.5% prevalence of antipsychotic medication use in long-stay residents.
� This represented a 28.5% decrease in the use of antipsychotic medications for long-stay residents from 2011Q4 to 2017Q4 in Oklahoma.
Oklahoma Ranking
�Oklahoma ranks 51st highest in the use of antipsychotic medications in the nation!
�19.5% is the highest prevalence of antipsychotic use in the nation!
06/19/2018
7
New Goals
� The National Partnership to Improve Dementia Care recently announced a new goal:
� Nursing Homes with low rates of antipsychotic medication use are encouraged to continue their efforts and maintain their success.
� Late Adopters, facilities with high rates of antipsychotic medication use, are to work to decrease antipsychotic medication use by 15% by the end of 2019.
LATE ADOPTERS
� These Nursing Homes have made little to no progress in decreasing their antipsychotic medication use or have actually increased their use of antipsychotic medications since the start of the National Partnership.
Criteria Used to Determine Homes Deemed as Late Adopters
� Facilities were included that were in both of the following categories:
� Nursing Homes in the lowest 25% of the long-stay antipsychotic medication quality measure in 2017Q1 (a value > 20.29%)
� Nursing Homes in the lowest 25% of change in the long-stay antipsychotic medication QM from 2011Q4 to 2017Q1 (with an increase in value or a decrease of less than 6.7%)
06/19/2018
8
Criteria Used to Determine Homes Deemed as Late Adopters
� Of the prior list, they included only facilities that also had a long-stay antipsychotic medication QM > the national average in 2017Q1 ( a value > 15.73%)
� Additionally, they disregarded facilities that were in the top 10% of Schizophrenia prevalence in 2017Q1 (a prevalence > 18.29%)
Late Adopters
� Initially 50 homes were designated as Late Adopters in Oklahoma.
� Per request of CMS, the OSDH and TMF Health Quality Institute, the CMS designated Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Oklahoma, have reached out to 36 of these nursing homes, deemed Late Adopters in Oklahoma, to make them aware of their status and to offer assistance and a referral for a quality improvement program.
LATE ADOPTERS
� OSDH is also providing information to facilities who are Late Adopters at their recertification surveys.
06/19/2018
9
Information
� The National Partnership Resource Repository -– for information regarding The National Partnership to Improve Dementia Care.
� Https://www.nhqualitycampaign.org/dementiaCare.aspx.
Regulatory References
� F758 – Unnecessary Psychotropic Medications
� F744 – Residents with Dementia Receive Appropriate Treatment & Services to Reach Their Highest Practicable Well-Being
HELP
� CMP Funded Programs can help your facility decrease the use of antipsychotic medications and promote person centered care for residents with dementia.
� TMF Health Quality Institute, the CMS designated Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Oklahoma, will provide free consultation services to assist you.
06/19/2018
10
WE CAN DO THIS
� Let’s NOT be #51
� We Focused on the Issue in 2012 – 2014 and significantly lowered our numbers.
� OKLAHOMA was recognized by the State and Nationally for the progress we made.
� Our Residents Deserve to have the best life they can with person centered care to promote their highest practicable well-being.
� If you need help or guidance it is available.
� We Can Do This
Thank you
Paula Terrel, R.N.
Preventive Medical Consultant
Oklahoma State Department of Health
06/05/2018
1
Quality Improvement Assistance for Nursing Homes
Julie Myers, DrPH, CPHQ
Objectives• Describe the history and purpose of the CMP
Fund Program• Define eligibility of participation• Delineate current projects and services
available to eligible nursing homes
06/05/2018
2
History• Revolving Fund was established in 2013 per state
statute §63-1-107.4• In 2014, OSDH released the first RFP to fund
improvement grants• In 2015 the Program itself was funded followed
by expansion in 2016 to include education for nursing homes, needs assessment, data analysis, and quality assurance of projects
Eligibility for Assistance• Skilled nursing facilities• Nursing homes • Certified as a provider by the federal
government (Medicaid or Medicare)
06/05/2018
3
LTC Composite Score• Baseline: December 31, 2014 = 10.3
(highest – worst score on record)
• Remeasurement: April 30, 2018 = 8.7• 2.5 points in the right direction• 15.5% Relative Improvement from baseline!
CMP Fund Program Goals• Help Oklahoma become the leader of
nursing home quality in the region • Stretching toward the goal of a 6.0 or better
composite score
06/05/2018
4
VisionServe as a catalyst for
improving quality of life and quality of care in nursing homes
StrategyProvide assistance in quality improvement by
funding effective projects based on the needs of the
nursing homes in Oklahoma
06/05/2018
5
Tactics• Fund three to five projects that address focus areas annually• Fund provider and surveyor educational series• Visit up to twenty long-term care communities annually to
qualitatively assess needs, successes, and barriers• Host two to three funding information sessions annually• Facilitate four to six contractor network calls annually• Develop a network of CMP Programs across the nation
Funding Focus: Clinical Quality–Antipsychotic Use
/Dementia Care–Catheter Use–Depression–Falls/Mobility
–Medications–Pain–Pressure Ulcers–UTI–Underweight
06/05/2018
6
Funding Focus: Other• Consistent Assignment• Hospitalizations• Person-Centered Care• Staff Stability
• ADL Increased Need• Incontinence• Physical Restraints• Vaccines: Flu /Pneu
Current CMP Fund Projects• QAPI Support• Medication
Optimization • Oral Care
• Dementia Care In-Service
• Fall Prevention• New Projects Soon!
06/05/2018
7
Pop Quiz• Who is eligible?
• What is funded?
• Do we provide in-service trainings at no cost to you?
• What do you do when you come up with an idea to fund quality improvement?
Questions?
CMP Fund ProgramJulie Myers, DrPH, CPHQ
http://CMP.Health.ok.gov
06/19/2018
1
Improving Care for Oklahoma Seniors
TMF Quality Innovation Network Quality Improvement
Organization (QIN-QIO) for Oklahoma
Sandra Terry, MBA, BSN, RN
TMF QIN-QIO State Program Director for Oklahoma
Imagine If You Will…
2
Why I Do What I Do
What is your story?
3
06/19/2018
2
TMF QIN-QIO Regional PartnersTMF has subcontracted with strong, experienced quality
improvement partners to provide expert technical assistance and
quality improvement support for participating providers across
the region.
� Arkansas Foundation for Medical Care
� Primaris (Missouri)
� QIPRO and Ponce Medical School Foundation (Puerto Rico)
� TMF Health Quality Institute (Texas and Oklahoma)
4
Nursing Home Quality
Improvement Project
Goals for this five-year project
ending in 2019 include:� Achieve a score of six or less on the National Nursing
Home Quality Composite Measure Score
� Decrease antipsychotic medication use
� Decrease health care-associated infections and other
health care-acquired conditions
� Decrease potentially avoidable hospitalizations
� Track and prevent Clostridium difficile
6
06/19/2018
3
How can the TMF QIN-QIO help
you?� Assist with interpretation of data reports
and development and implementation of a
quality improvement plan.
� Provide education and resources on clinical
quality topics, with an emphasis on
reducing inappropriate antipsychotics, as
well as infection prevention and antibiotic
stewardship.
� Assist with reporting of Clostridium difficile
infection rates to the Centers for Disease
Control and Prevention’s National
Healthcare Safety Network database.
Your Nursing Home Quality
Improvement Team
8
Susan PurcellDirector
Frank Barber Quality
Improvement Consultant
Cayce BrewsterHealth Services
Consultant
Your Nursing Home Quality
Improvement Team
9
Melody Malone Quality Improvement
Consultant
Debi MajoQuality Improvement
Consultant
Tiffany LanghamQuality
Improvement Consultant
06/19/2018
4
Your Nursing Home Quality
Improvement Team
10
Cheri LipscombQuality Improvement
Consultant
Monika MaxwellQuality Improvement
Consultant
Carla SmithQuality Improvement
Consultant
Care Coordination Project:
A Community-Based Approach
Project Goals:� Reduce hospital readmission rates in the Medicare
program by 20 percent
� Reduce hospital admission rates in the Medicare
program by 20 percent
� Increase community tenure by increasing the
number of days spent at home by Medicare Fee-
for-Service (FFS) beneficiaries by 10 percent
� Reduce the prevalence of adverse drug events,
emergency department visits and observation
stays or readmissions occurring as a result of the
care transitions process
12
06/19/2018
5
Source: Medicare FFS Claims. Time Period: 08/01/2017 – 10/31/2017
Oklahoma: Discharge Disposition After Inpatient
Hospitalization and 30-Day Readmission Rates
13
Setting
Number of
Discharges
% of All
Discharges
30-day
Readmits
Rate of
30-day
Readmits
Home Health Agency 7,372 19.6% 1,241 16.8%
Home 20,725 55.2% 3,546 17.1%
Hospice 1,617 4.3% 53 3.3%
Inpatient Rehabilitation
Facility 1,620 4.3% 274 16.9%
Long-Term Acute Care 853 2.3% 119 14.0%
Nursing Home 5,386 14.3% 1,176 21.8%
All 37,573 100.0% 6,409 17.1%
Drivers for Readmissions� Lack of transfer of information between providers
and/or patients at the time of transition
� Low patient activation, which impacts a patient
and/or caregiver to self-manage their condition
� Lack of standard processes to effectively manage the
transition of the patient between settings
14
Communities for Care Coordination
Partners:
Hospitals, skilled nursing facilities, home health agencies,
physicians, patients, caregivers, payers and stakeholders
Communities:
� SE: Durant
� NW: Elk City/Weatherford area
� SW: Lawton
� NE: Miami
� Central: Norman
� Oklahoma City 15
06/19/2018
6
Medication Safety Project
� GOAL: Reduce adverse drug events by 35 percent
per 1,000 Medicare FFS beneficiaries
� Why: Older adults are seven times more likely to
be hospitalized due to an adverse drug event
� How: Monitor rates for anticoagulants, diabetic
agents and opioids by care setting, state and
region
16
Filled by long-term care (LTC) pharmacies
• 4,894 prescriptions for opioids were filled
• 6,960 unique beneficiaries residing in LTC facilities
• 70 percent of beneficiaries in a LTC facility had a prescription opioid filled.
17
Filled by community pharmacies
• 78,347 prescriptions for opioids were filled
• 123,243 unique beneficiaries not residing in LTC facilities
• 64 percent of beneficiaries had a prescription opioid filled
Opioid Prescriptions in OklahomaMedicare Fee-for-Service Beneficiaries April 1, 2016 – March 31, 2017
Percentage of Medicare Fee For Service Beneficiaries with Prescriptions for
Opioids
18
48%
64%
58%
64%
12%
NCC data 4/1/2016 through 3/31/2017 General population, non-LTC
06/19/2018
7
Percentage of Medicare Fee For Service Beneficiaries with Prescriptions for
Opioids - LTC
19
51%
70%
83%
63%
N/A
NCC data 4/1/2016 through 3/31/2017 prescriptions filled by pharmacies servicing long term care facilities
Benefits to Participating Providers
� Partner with multiple community organizations, such as
beneficiaries, practitioners and stakeholders, to address
problems across the continuum of care in communities
� Develop a project plan, with a timeline, to implement
evidence-based interventions
� Establish online data portal accounts for providers to track
and monitor readmissions data and download provider and
community-level 30-day readmission reports
� Participate in live, web-based educational forums to learn and
share best practices with other network members
20
Your Readmissions Quality
Improvement ConsultantJenny Kellbach
Phone: (405) 578-4491
21
06/19/2018
8
Oklahoma Nursing Home
Oral Care Project
Under contract with the Oklahoma State
Department of Health through the
Civil Money Penalty Funds Award
How can TMF help you?
Oral Health Care Project Participants Receive:
� Three onsite oral education trainings
› Importance of Daily Oral Care for the Elderly
› Daily Oral Care Strategies and Care Planning
› Residents Requiring Special Care and the Resistant
Resident
� Free educational toolkit that will provide staff with
resources so they feel more confident to provide oral
care and perform oral assessments on their nursing
home residents
23
Take 60 seconds each day to perform
an oral health assessment.
Oral cancer in the elderly
� Seven times more likely to be diagnosed with
oral cancer than those under age 65
� When in doubt, refer out 24
06/19/2018
9
Breathing in germs from a dirty mouth is a
significant risk factor for pneumonia
� Germs from this plaque can get into the lungs
and cause pneumonia
25Study by Quagliarello V et al. Modifiable risk factors for nursing home acquired pneumonia. Clin Infect Dis 2005;40:1-6
Your Quality Improvement Consultant
for the Oral Health Project
Shelley Mitchell, CDA, RDH, MEd
26
Join the TMF QIN-QIO Website
https://www.TMFQIN.org
� Provides targeted technical assistance and will engage
providers and stakeholders in improvement initiatives
through numerous Learning and Action Networks (LANs)
� The networks serve as information hubs to monitor data,
engage relevant organizations, facilitate learning and
sharing of best practices, reduce disparities and elevate
the voice of the patient.
27
06/19/2018
10
All Are Welcome
� Visit the Networks tab for more information.
� As you complete registration, follow the
prompts to choose the network(s) you would
like to join.
28
Questions?
Together we can make a better world for our
seniors. Won’t you join us?
29
Contact Me
Sandra Terry, MBA, BSN, RN
State Program Director for Oklahoma
TMF Quality Innovation Network
405-919-6490
www.TMFQIN.org
30
This material was prepared by TMF Health Quality Institute, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers
for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 11SOW-
QINQIO-C3-18-29