Soltun Nursing Home;Quality Indicators Internal Quality Control and Interventions Anna Birna Jensdóttir CEO & Director of Nursing

Transcription

1 Soltun Nursing Home;Quality Indicators Internal Quality Control and Interventions Anna Birna Jensdóttir CEO & Director of Nursing

2 % Selfcare ability among Icelandic Nursing home residents Full control and independant in personal activities of daily living (ADL): eating bowel continent continent bed mobility toilet use dressing

3 Financial planning according to needs & resources Nursing & other supplies Balanced recruitment Financial management according to plan Independence of the resident highly respected Accommodation attractive, home atmosphere & modern equipment Less absence from work Staff contracted according to the ideology Soltun Nursing Home best services & practices Resident's satisfaction Primary nursing model Staff satisfaction Well-being Social active Privacy respected Caring, qualified & experienced staff Balanced score card Maintaining Self respect and self care ability Security provided Quality improve team work Staff cooperation & flexibility Rewards Performance appraisal Training program for new staff Job descriptions Continuous Education & learning

4 The residents are highly dependent on 24 hours skilled nursing care. They have multiple diseases and polypharmacia Average lenght of stay 2,1 yrs

5 Activities of Daily Living (ADL) Self-Performance 7 ADL; personal hygiene 0-4, locomotion in and off unit 0-4, eating 0-4, toilet use 0-4, dressing 0-4, transfer 0-4 and bed mobility = totally dependent in all 7 ADLs 25,00 20, ,00 10,00 5,00 Icelandic NH Soltun NH 0= independent in all 7 ADLs 0,

6 NTSC F TNT COLOR BRIGHTNES CONTRAST SHARPNESS PAL NTSC ZMX2/K A NTSC F ZMX2/K A TNT COLOR BRIGHTNES CONTRAST SHARPNESS PAL NTSC NTSC F TNT COLOR BRIGHTNES CONTRAST SHARPNESS PAL NTSC ZMX2/K A Soltun Nursing home 92 residents 12 assisted living arrangements (households) on 3 floors Each household has 8 apartments, one has 4 apartments All the apartments are designed for individual need and good nursing environment. Each apartment is fitted with fully equipped bathroom, including WC, washbasin and shower.

7 Residents home

8 Living- and dining room

9 Smart house Security system in residents room The bell Door to the garden (sensor) Bed exit sensor Nurse call outlet Incontinence sensor Bed sensor outlet 360 Infrared motion detector Emergency call Infrared motion detectors Staff cancel switch

10 Sóltún Balanced Scorecard 4 integrated components Finance Sevice Human Resources Quality & Processes

11 Nursing homes quality indicators Good Average Poor outcome Hjaltadóttir, I. (2012). Icelandic Nursing Home residents: Their mortality, health, functional profile, and care quality, using the Minimum data set over time. University dissertation from Lund University, Faculty of Medicine Rantz, M. J., Hicks, L., Petroski, G. F., Madsen, R. W., Mehr, D. R., Conn, V., et al. (2004). Stability and sensitivity of nursing home quality indicators. Journals of Gerontology Series A: Biological and Medical Sciences 59(1),

12 Poor quality of care can shorten life Poor outcome increases cost Quality of care is highly depending of nursing care time = finance Nursing staff competance Active use of knowledge = provide best practices empowerment to improve The believe of beeing able to Bravo, G., Dubois, M. F., De Wals, P., Hebert, R., & Messier, Caring for people Nursing care time vary between 4 to 5 hrs/24 hrs. Staff cometence vary between nursing homes. Ref:, National Audit 2005 In a statewide analysis of Medicaid cost reports and quality indicators, poor resident outcomes accelerate care costs, for example when higher incidence of pressure ulcers or ADL decline occur, costs of care accelerate (Hicks et al, 2004). Hicks, L.L., Rantz, M.J., Petroski, G.F., & Mukamel, D.B. (2004). Nursing home costs and quality of care outcomes. Nursing Economics, 224, * Rantz, M., Hicks, L., Petroski, G.F., Madsen, R.W., Conn, V., Zwygart- Stauffacher, M., & Maas, M. (2003). High-quality nursing home care is more cost effective than low-quality care. Long-Term Care Interface, 4(9): * L. (2002). Relationship between regulatory status, quality of care, and three-year mortality in Canadian residential care facilities: A longitudinal study. Health Services Research, 37(5), Hjaltadóttir, I. (2012). Icelandic Nursing Home residents: Their mortality, health, functional profile, and care quality, using the Minimum data set over time. University dissertation from Lund University, Faculty of Medicine

13 The Resident Assessment Instrument (RAI) RUG MDS QI RAP { Resource Utilization Groups Time Measurement Case-Mix Index { { Minimum Data Set (394 items) Quality Indicators Resident Assessment Protocols (18 RAPs)

14 Resources Utilization Groups(case-mix) 1,35 1,3 1,25 1,2 1,15 1,1 1,05 1 0,95 0,9 RUG 34-groups RUG 34- groups Soltun is estimated to score between 1,05-1,20 Rug-34 group

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16 Multidisciplinary quality teams were established about each identified quality indicator in the RAI results over multiple years. Out of the data 21 quality indicators are calculated. The assessments are done at least 3 times yearly by registered nurses (RN) and therapists. The quality improvement work follows the methodology of Alison Kitson RN and Avedis Donabedian. Attempts are made to understand the underlying context by information gathering, the need for corrective intervention is analyzed, goals are described and processes for improvement are set in motion. Nursing interventions are based on recognized research.

17 Based on RAI-assessment from Sóltún Prevalence of falls Byggt á RAI-mötum frá Sóltúni Poor threshold Good threshold

18 Based on RAI-assessment from Sóltún Prevalence of weight loss Poor threshold Good threshold

19 Based on RAI-assessment from Sóltún Prevalence of stage 1-4 pressure ulcers Poor threshold Good threshold

20 The quality team results is that restraints are not used in Soltun, the QI indicators outcome is the use of safety belts in weel chairs, use is based on informed concent.. Prevalence of daily restraint Good threshold Good threshold Based on RAI-assessment from

21 Prevalence of little or no activity Based on RAI-assessment from Sóltún Poor threshold Good threshold

22 Standard of care The goal is: To minimize depression and anxiety among Soltun nursing homes residents as possible Upper criteria is 30%, and lower criteria is 12,5%. The aim is to score as close to the lower criteria. Caregivers will target the aim by working proactive Upper threshold (poor) is the score derived from MDS that is flagging potential problem areas in nursing homes care that needs further attention. Lower threshold (good) is the core derived from the MDS that indicates excellent performance in nursing home care. Process criteria: Use all oppertunities avilalable Beeing to-geather Outdoor activities in open air, close to nature and garden Training and exercises Spiritual care Club activities; dans, music, theather etc Continuing education Behavior program Family program Medication Entertainments The quality improvement work follows the methodology of Dr. Alison Kitson RN and Dr. Avedis Donabedian. (bottom up)

23 Prevalence of depression Based on RAI-assessment from Sóltún Poor threshold Good threshold

24 Based on RAI-assessment from Sóltún Poor threshold Good threshold

25 Outdoor activities increases well beeing Júlíana Sigurveig Guðjónsdóttir, Þuríður Björnsdóttir, Ingibjörg Steinunn Sigurðardóttir og Harpa Karlsdóttir (2010). RAI-matstækið: Útivera eykur vellíðan íbúa á hjúkrunarheimili. Tímarit hjúkrunarfræðinga, 2.tbl.86. árg. Bird, W. (2007). Natural thinking. Bretlandi: Royal Society for the Protection of Birds. Taylor, A.F., Kuo, F.E. % Sullivan, W.C. (2001). Life worth living: How someone you love can still enjoy life in a nursing home The Eden alternative in action. Massachusets: VanderWyk & Burnham Action Sacks,O (1984). A leg to stand on. New York:Harper Collins, 37(5),

26 Prevalence of depression Icelandic NH Soltun NH Soltun QI-team policy on prevalence of depression= lower threshold 12,5% & upper threshold 30%. The aim is to work towards the lower threshold

27 14= severe depression 14,00 Depression scale 12,00 10,00 8,00 6,00 4,00 2,00 3 3,11 3,24 3,24 3,54 3,4 3,07 3,03 2,98 2,66 2,53 2,2 2,1 1,88 1,46 1,61 1,41 1,07 1,09 0,84 0,97 0,83 0,75 0,63 Icelandic NH Soltun NH 0= no indication of depression 0, The scale is as valid and reliable as the Hamilton Depression rating scale and the Cornell Scale for Depression.

28 Human Resources

29 Staff turnover rate Benchmarking Magnet hospitals Sóltún

30 Structured quality improvement projects have resulted in improved well-being of the population of Soltun nursing home according to RAI outcomes. Comparisons of quality indicators have been performed between years for the past decade. Results have been positive in all quality indicators that have been worked with. In presented quality indicators all the outcomes are within the aim of the standards of care and more towards the lower threshold.

31 A variety of benefits have been gained by using the effective instruments, such as detailed information on health and nursing needs, better documentation and improved treatment. It is important to be able to demonstrate measurable results of improvement activities. Very frail elderly residents in nursing homes can experience high quality and meaning of life. Soltun is one of the most popular choice for a nursing home among the elderly, who need nursing home placement in the capital area of Reykjavik. Soltun provides an environment that focuses on quality improvement work and attracts excellent personnel, resulting in low turn over rate, that certainly improves the quality of life of the residents.