QIO - HSAG logos


The Florida Nursing Home Quality Care Connection
Nursing Home Event Icons
Share Your Successes!
The National Nursing Home Quality Care Collaborative (NHQCC) Change Package is a menu of strategies, change concepts, and specific actionable tactics that any nursing home can begin testing for purposes of improving residents' quality of life and care. As you test action items from the change package, consider documenting your success stories and sharing them with your staff members, as well as with the Florida NHQCC, to help spread improvement and best practices across the state.
Developing a success story is useful for a number of reasons:
  • It provides a historical record of efforts taken to produce positive results.
  • It celebrates achievements.
  • It pinpoints messages to communicate to stakeholders.
  • It can help others emulate your success and establish your nursing home as a leader.
To help, a success story template is included as attachment 1 in the NNHQCC Change Package .
Contact us with any questions at
Ideas for Urinary Tract Infections
Urinary tract infections (UTIs) can be uncomfortable and painful and can lead to serious complications. The UTI quality measure (QM) reports the percentage of long-stay residents with a target assessment that indicates a UTI within the last 30 days. The denominator of this quality measure includes all long-stay residents with a selected target assessment, except residents whose:
  1. Target assessment is an admission assessment (A0310A = [01]) or a Prospective Payment System (PPS) 5-day or readmissions assessment (A0310B = [01, 06]).
  2. UTI value is missing (I2300 = [-]).

Learn more about the calculation of this QM on page 32 of the Minimum Data Set (MDS) 3.0 Quality Measures User's Manual (v9.0 08-15-2015).

Performance Improvement Project (PIP) teams should assess UTI risk factors for each resident at numerous points of care, including pre-admission, admission, changes in continence status or condition, and with MDS assessments. Interventions may include:
  • Proper catheter management
  • Proper UTI testing
  • Toileting programs
  • Educating staff about the signs and symptoms to report

Additionally, PIP teams must ensure their goal to prevent UTIs is clearly communicated and involves all staff members, residents, and families.


For more information, review HSAG's handout, MDS Coding Guidelines for UTIs.

Next issue: Tips and Change Ideas for Catheters
QAPI Corner
STEP 8: Identify Your Gaps and Opportunities
Quality Assurance & Performance Improvement (QAPI) is a data-driven, proactive approach to improving the quality of life, care, and services in nursing homes. Nursing homes are in the best position to assess, evaluate, and improve the care they deliver because they have first-hand knowledge of their own organizational systems, cultures, and histories.
Reviewing various sources of information can help determine if gaps or patterns exist in your systems of care that could result in quality problems. The following are some potential resources for reviewing your nursing home's data:
  • MDS
  • Nursing Home Compare
  • State survey results and plans of correction
  • Resident care plans noting progress toward goals
  • Complaint logs that show trends
  • Satisfaction reports based on resident and family feedback

These data lead to the next step of developing PIPs to deal with high-risk, high-volume, problem-prone areas. Also, don't forget to take time to notice the things that are going well, and recognize your staff members for these achievements.

For more information on this topic, read page 16 of QAPI at a Glance.

Next issue: Prioritize Quality Opportunities and Charter PIPs
HSAG Resource Spotlight
Access all of the CMS tools for QAPI from one easy-to-use electronic resource library. Learn more.
This QAPI Plan Template can help guide nursing home staff members as they develop specific quality improvement plans for their organizations. Learn more.
This guide helps walk your team through the action steps of developing your organization's QAPI plan. Learn more.
Have you completed your QAPI Self-Assessment? 
Register for these upcoming webinars!
Trends in Person and Family Engagement National LAN Call
February 2
3 to 4 p.m. (ET)
Addressing Healthcare-Associated Infections in Nursing Homes Using the QAPI Approach
February 25
2 to 3 p.m. (ET)

Subscribe to our YouTube channel

Quick Links