QAPI (Quality Assurance and Performance Improvement) will be a familiar acronym for anyone working in the long term care industry. Before 2010, Quality Assurance (QA) and Performance Improvement (PI) were two separate processes.
QA (Quality Assurance) is the “process of meeting quality standards and assuring that care reaches an acceptable level.” PI (Performance Improvement) identifies potential opportunities through the continuous study and improvement of processes, intending to prevent or decrease the likelihood of long term care services problems.
In March 2010, Congress first introduced the Affordable Care Act (ACA). A stipulation of the ACA was to combine QA and PI into a single, streamlined program, now known as QAPI. This has become a requirement for all nursing homes to develop and implement into their facility.
QAPI not only incorporates minimum standards, but it continually raises the bar, pushing for higher standards. This paved the way for CMS (Centers for Medicaid and Medicare Services) to standardize a set of best practice regulations to improve the quality of life and the quality of care services in nursing facilities. As new materials and resources become available, a facility’s goals and expectations must also be modified to factor in the latest additions. You can find all the latest QAPI updates on the QAPI website.
While it is not compulsory for nursing homes to use CMS’ QAPI tools and resources, it does provide a fountain of knowledge on QAPI regulations and compliance. This is particularly useful for facilities that find it challenging to keep track of the many State and Federal regulations.
The advantages of using CMS’ QAPI tools are manifold, as they guide a facility to using data-driven systems that provide real-time feedback to propel and sustain their QAPI program. There is also a practical step-by-step guide, QAPI at a Glance, where facilities can read about the intricate QAPI details that are otherwise missed.
Implemented QAPI plans are intended as a living document, so facilities and CMS alike can review and revise their QAPI plan/regulations to ensure the highest quality care is provided in nursing facilities across the country. CMS stresses that a successful QAPI plan needs input from staff, leadership, and residents, who are encouraged to voice their opinions and concerns. This provides realistic data so a facility can address negative outcomes and system failures with practical and creative problem-solving.
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What Does QAPI Stand For?
What does QAPI stand for besides the literal meaning (Quality Assurance and Performance Improvement)?
We know that QAPI governs a facility to maintain high-quality standards, thus improving residents’ level of care and quality of life. However, it is also essential for facilities to have a strong knowledge of bioethics that can assist and guide QAPI decisions.
The execution and implementation of QAPI fall on the facility’s QAPI committee to oversee the program and its activities. The committee usually consists of administrators, supervisors, and quality improvement coordinators, who determine the facility’s services and assess their quality standards.
The success of a QAPI program rests on five crucial elements that determine a facility’s ability to assess, evaluate, and improve its care and services. CMS has created a helpful framework outlining the different goals for each element with valuable tools to help the implementation. Failure to implement all five elements will impact the success of the program.
- Design and Scope: QAPI has the capacity to address all departments and services within the facility.
A successful QAPI program needs to address various issues, including “clinical care, quality of life, resident choice, and safe and effective care transitions.” Facilities also need to develop and write a comprehensible QAPI plan which adheres to CMS regulations, therefore displaying precise data results with realistic and measurable goals.
- Governance and Leadership: QAPI programs include input and participation from staff members, residents, and their families. The facility’s governing body (committee) determines the QAPI program and provides adequate resources and investment.
The governing body also develops the facility’s culture with staff meetings, CMS technical training, and contingencies for personnel and staff turnover. This minimizes quality reporting errors by safeguarding staff’s accountability in line with the facility’s culture, as outlined in their purpose.
- Feedback, Data Systems, and Monitoring: For facilities to implement improvement changes, systematic data must be recorded accurately, sourced from several avenues, and compiled into an understandable format. This also includes feedback from residents and staff who offer performance indicators on the services and processes across the facility.
When facilities emphasize a data-driven approach, it can prevent the likelihood of adverse events, further encouraging quality and safety. Therefore, the tracking, investigating, and monitoring of adverse events should be measured after every occurrence to prevent future recurrences.
- Performance Improvement Projects (PIPs): The process starts with systematically gathering information so staff can identify areas of concern before implementing meaningful improvements.
Facilities usually select PIPs according to their importance for a specific service. It is also recommended that staff participate in PIPs that interest them to pinpoint known problems that need fine-tuning.
- Systematic Analysis and Systemic Action: It is crucial to perform a root cause analysis when problems arise. This allows facilities to analyze and understand current processes that contributed to the problem.
Facilities need to find a systematic approach to identify all influencing factors, including the cause, implications for change, and solutions.
How Can You Measure QAPI Nursing Home tools?
A valuable QAPI nursing home aid is the QAPI Certification and Education for QAPI/QAA Committee Members. This program focuses on all aspects of QAPI, giving learners practical training to implement theoretical approaches into application-based strategies.
There are also numerous CMS-created QAPI templates that facilities can implement into their QAPI plan. These are performance measuring tools and guidelines, with step-by-step advice ensuring facilities can maintain high standards.
Here are some helpful QAPI templates facilities should utilize:
- QAPI Written Plan How-To Guide – This provides facilities with detailed suggestions on how to define their purpose, list of services, quality assessment, along with a framework outlining their QAPI activities.
- Guide for Developing Purpose, Guiding Principles, and Scope for QAPI – This aids the team and senior leadership in establishing a facility’s purpose, guiding principles, and scope so they can tailor their QAPI plan.
- Guide for Developing a QAPI Plan – This is a living document for facilities to meet and achieve their goals previously identified in their purpose and guiding principles. This helpful guide helps facilities to outline the roles and responsibilities of staff with clear instructions so they can carry out their tasks.
- QAPI Self-Assessment Tool – As facilities begin to implement their QAPI plan, they can use this self-assessment tool to provide honest feedback, highlighting problem areas.
- Goal Setting Worksheet – This worksheet allows facilities to measure their performance. It guides QAPI teams with realistic goals and PIPs so that they can accomplish their goals.
- For the complete list of CMS QAPI resources, visit CMS resources.
While CMS developed a usable framework to guide facilities, some may still be confused about certain things and ask: what does QAPI stand for or what is QAPI in long term care or and how does it affect long term care facilities?
The basic points outlined here will, thus, be of great value to your facility. This is because, those working within long term care—both the staff and leadership team—are required to create and implement a QAPI plan.
Additional training is needed if facilities want to implement their QAPI plan to achieve their desired results. Learners will gain hands-on training in translating real-time data into actionable plans that will minimize risk, maximize efficiencies, and improve resident outcomes, all the while improving their facility’s quality of care and performance.
QAPI Makes a Difference
While facilities must implement a QAPI plan, it is equally important for residing residents that a QAPI plan is successfully implemented. The overall goal of QAPI is to improve the quality of life and quality of care to nursing home residents, directly impacting the residents’ health and wellbeing.
Facilities that have successfully implemented a QAPI plan have reported success in the following areas:
- Improvements for quality issues with better prevention for recurrences
- Enhanced knowledge leading to more opportunities to achieve set goals
- More job satisfaction from nursing home staff, who have been given the opportunity to suggest realistic performance improvements
- Better quality of care and life for long term care residents
Yet despite a facility’s best efforts to implement a QAPI plan, there will still be occasions in which negative outcomes and system failures occur. This is all the more reason why QAPI plans are designed as living documents that can be modified as and when needed.