Content contained in this newsletter may have been previously published in prior issues of the QCC newsletter.  
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The Florida Nursing Home
Quality Care Connection
This QCC Newsletter is your monthly National Nursing Home Quality Care Collaborative (NNHQCC) in Florida member update that provides information on the latest activities. It is a quick reference for information on links to improvement tools, resources, news, best practices, and success stories. 
Long-Stay Influenza Vaccine
Quality Measure Overview
Importance of Section O (Influenza Vaccine)
Health-related quality of life and planning for care are two important rationale for coding Section O (Influenza Vaccine). When infected with influenza, older adults and persons with underlying health problems are at increased risk for complications and are more likely than the general population to require hospitalization. Influenza vaccines have been proven to be effective in preventing hospitalizations.
 
Steps for Assessment
  1. Review the resident's medical record to determine whether an influenza vaccine was received in the facility for this year's influenza vaccination season. If vaccination status is known, proceed to the next step.
  2. Ask the resident if he or she received the influenza vaccine outside of the facility for this year's influenza vaccination season. If vaccination status is still unknown, proceed to the next step.
  3. If the resident is unable to answer, then ask the same question of the responsible party/legal guardian and/or primary physician. If influenza vaccination status is still unknown, proceed to the next step.
  4. If influenza vaccination status cannot be determined, administer the influenza vaccine to the resident according to standards of clinical practice.
 
Coding Tips and Special Populations
  • Once the influenza vaccination has been administered to a resident for the current influenza season, this value is carried forward until the new influenza season begins.
  • Influenza can occur at any time, but most influenza occurs from October through May. However, residents should be immunized as soon as the vaccine becomes available and continue until influenza is no longer circulating in your geographic area.
 
More information
Contact us with any questions at FL-NNHQCC@hsag.com
QAPI Corner
STEP 11: Getting to the "Root" of the Problem

A major challenge in process improvement is getting to the root of the problem or opportunity.
 
Root cause analysis (RCA) is a term used to describe a systematic process for identifying contributing causal factors that underlie variations in performance. This structured method of analysis is designed to get to the underlying cause of a problem - which then leads to identification of effective interventions that can be implemented in order to make improvements.
 
RCA helps teams understand that the most immediate or seemingly obvious reason for the problem or an event may not be the real reason that an event occurred. The RCA process leads to digging deeper and deeper - looking for the reasons behind the reasons. This process will generally lead to the identification of more than one root cause. The root cause(s) and any contributing factors can then be sorted into categories to facilitate the identification of various actions that can be taken to make improvements.
 
RCA focuses primarily on systems and processes, not individual performance.
 
The RCA process takes practice, but can be a valuable tool for performance improvement. In order to get familiar with RCA you and your team may consider:
  • Studying case examples of RCAs.
  • Applying RCA to an adverse event and discussing this technique with the team.
  • Building RCA examples into training opportunities.

For more information on this topic, read page 18 of QAPI at a Glance .
 
Next month: Take Systemic Action
Infection Preventionist Training
We know you are hard at work ensuring your Infection Control Programs are in place for Phase 3 implementation in accordance with Regulation § 483.80 of the Final Rule for Long-Term Care Facilities. By November 28, 2019 all nursing homes are required to have an Infection Preventionist(s) (IP), who is/are responsible for the facility’s infection control program.
 
In support of your facility and this regulation, the CMS has approved this no-cost Infection Preventionist Training Course developed by the Centers for Disease Control and Prevention (CDC). This course has been developed and approved to support the specialized training indicated in the Final Rule requirement for the designation of at least one Infection Preventionist. 
The course will include information about the core activities of an effective IPC program, with a detailed explanation of recommended IPC practices to:
  • Prevent pathogen transmission
  • Reduce healthcare-associated infections
  • Decrease antibiotic resistance in nursing homes
No Cost CEs Available!
HSAG Resource Spotlight
Care coordination resources aim to improve transitions of care and lower unnecessary hospital readmissions. Learn more.
 
In addition to the NNHQCC Change Package v2.2., the Centers for Medicare & Medicaid Services (CMS) has just released an important new resource: All Cause Harm Prevention in Nursing Homes Change Package.
 
This package is a compendium of successful practices of high performing nursing homes, illustrating how they prevent harm while honoring each resident's rights and preferences.
This material was prepared by Health Services Advisory Group, the Medicare Quality Innovation Network-Quality Improvement Organization for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No.
FL-11SOW-C.2-03262019-01