IPRO QIN-QIO Resource Library

The AC Forum, in partnership with FDA, identified seven Core Elements for improving systemic management of anticoagulants. The Playbook, developed with input from more than 30 experts, offers detailed strategies for each Core Element and is designed to be used by organizations establishing or considering Anticoagulation Stewardship programs, as well as those with existing programs in place. While all seven elements are important for implementation of a stewardship initiative, the first Core Element—securing the commitment of administrative leadership—is a foundational priority to ensure success and sustainability.

This tool was developed by CMS for use by nursing home surveyors and is a valuable resource for organizations that are focusing on preventing ADEs.

It was designed to help surveyors identify:

1. The extent to which facilities have identified resident-specific risk factors for adverse drug events

2. The extent to which facilities developed and implemented systems and processes to minimize risks associated with medications that are known to be high-risk and problem-prone

3. When a preventable adverse event has occurred, evaluate if the nursing home identified the issue and responded appropriately to mitigate harm to the individual and prevent recurrence.

A quality improvement tool for determining the reliability of a process by assessing the 5 attributes.

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“The Decision Guide tools and resources have really helped us think differently on how we can prepare our Residents and Families for changes in condition and to let them know, WE take care of them in our Nursing Facility.” NC SNF

INTERACT (Interventions to Reduce Acute Care Transfers) is a quality improvement program that focuses on the management of acute change in resident condition. It includes clinical and educational tools and strategies for use in everyday practice in long-term care centers.

INTERACT is designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents. The goal of INTERACT is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital.

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The LACE index identifies patients that are at risk for readmission or death within thirty days of discharge. It incorporates four parameters.

Safer Medication Management for Better Transition of Care
SHM recognizes the importance of equipping hospital clinicians with evidence-based strategies to prescribe, document, and reconcile medications accurately and safely at times of care transitions.

Medication reconciliation, or med rec, is the process of compiling the most accurate list of medications a patient is taking to avoid dosing or other errors.

Take responsibility for med rec with your patients by:

Leading, coordinating or participating in med rec quality improvement efforts that incorporate best practices to improve patient outcomes.
Grasping key evidence-based interventions, such as obtaining the best possible medication history and effective discharge medication counseling.
Identifying patients who are at high risk for medication discrepancies due to the number and/or types of medications they are prescribed

This manual is designed to assist organizations in identifying how a resident will “trigger” for a quality measure based on quality measure specifications and the coding of the MDS 3.0 Resident Assessment Instrument (RAI).

This website contains the MDS 3.0 RAI Manual v1.17.1 and MDS forms, effective October 1, 2019. This version of the MDS 3.0 RAI Manual incorporates clarifications to existing coding and transmission policy; it also addresses clarifications and scenarios concerning complex areas. Since the preliminary release of the manual on May 20, 2019, changes have been made to clarify which assessments swing bed providers must complete; the definition of the “interruption window” for interrupted Part A-covered stays; the coding of item I0200B; and changes related to group therapy policies, as well as other corrections. Please see the document titled “MDS 3.0 RAI Manual v1.17.1 Replacement Manual Pages and Change Tables_October 2019” posted in the Related Links section at the bottom of this page.

The National Action Plan for Adverse Drug Event Prevention (ADE Action Plan) was established to address two key objectives: (1) identify common, preventable, and measurable adverse drug events (ADEs) that may result in significant patient harm; and (2) align the efforts of Federal health agencies to reduce patient harms from these specific ADEs nationally.

On the basis of national ADE data from inpatient and outpatient settings, three types of ADEs were considered to be common, clinically significant, preventable, and measurable, and were therefore selected as the high-priority targets of the ADE Action Plan.
The three initial targets of the ADE Action Plan are:
1. Anticoagulants (primary ADE of concern: bleeding)
2. Diabetes agents (primary ADE of concern: hypoglycemia)
3. Opioids (primary ADE of concern: accidental overdoses/over sedation /respiratory depression)

The ADE Action Plan suggests a four-pronged approach to reduce patient harms from these three ADEs: Surveillance, Prevention, Incentives and Oversight, and Research.

This Staff Stability Toolkit is an Excel file that contains individual worksheets focused on selected areas related to “staff stability”.

The tool is intended to offer a “snapshot” of your current staffing situation allowing you to collect and analyze areas for detailed and focused areas such as

• Employment Status – The makeup of your current staffing situation as it relates to “full-time”, “part-time” and “per diem” employment status
• Current Staff by Length of Service – Summarizing the current staff into Length of Service classifications across several categories from “< 6 months” through “10 Years or More”
• Vacant Positions – Current vacant positions by FTEs across all departments and shifts
• Turnover Rates – The calculation of turnover rates by “Overall Facility” with the opportunity to drill down by individual departments or groups
• Cost of Turnover – The calculation of “Turnover Replacement Costs” to include recruitment, vacancy costs, and training/orientation costs based on current rate of terminations by position
• Terminations by Length of Service – Collects both the number and percentage of terminations either by “Employee Choice” or “Employer Choice” across several Length of Service categories from “< 6 months” through “10 Years or More”
• Absenteeism – The collection of Call-In Statistics by department and shift for categories to include “timely call-in”, “shift replaced”, “replaced with overtime”, “replaced with agency”, and any “incentives” that were paid for the replacement of the individual call-in. The categories are summarized and graphed by department and shift with the calculation of an overall call-in percentage related to scheduled shifts
• Financial Incentives – The collection and summary of any incentive programs currently in place with an annual cost estimate

It is believed that by collecting and analyzing these focused “costs”, a facility will be better positioned to strategize and plan their approaches to improve and maintain the staffing stability within their individual facility.

A link to the most current State Operations Manual (SOM) for Long Term Care Facilities.

This Substance Use Disorder (SUD) Treatment and Access Policy and Procedure Toolkit for Nursing Homes and Adult Care Facilities is intended to provide easy-to-adapt policies and procedures for facilities that wish to implement or improve their care for residents with SUD, which includes access to behavioral health resources, medications, telehealth, and referral networks. Most of the policies deal with opioid use disorder treatment, as this was the overarching need identified by nursing homes and adult care facilities; however, this toolkit was designed to be modified, and future updates will include additional substance use disorder policies.