Content contained in this newsletter may have been previously published in prior issues of the QCC newsletter.  
Nursing Home Icons
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. 
Construct Solid Business Practices
That Support Your Purpose
A well-run nursing home excels as a business yet feels like home. It seeks ways to effectively manage the bottom line with integrity and with the resident as the focus. It runs efficient operations, invests in equipment and supplies to provide the highest quality care, and ensures that its physical and outdoor environments are comfortable and inviting.
Change concepts for this strategy include:
  • Seek strategic and creative approaches to expand your resource base to meet your mission and serve your residents.
  • Maximize your efficiency.
  • Ensure you are making the most of your physical assets.

Contact us with any questions at
Ideas for High-Risk Residents
With Pressure Ulcers (Long-Stay)
The quality measure (QM) for pressure ulcers captures the percentage of long-stay, high-risk residents with Stage II-IV pressure ulcers. Central to this measure is identifying residents at high risk and ensuring that they are coded as such and included in the measure denominator.

Residents are defined as high-risk if they meet one or more of the following three criteria.
  • Impaired bed mobility or transfer indicated by either or both of the following:
  • 1.1. Bed mobility, self-performance (GG0110A1) = (3, 4, 7, 8)
  • 1.2. Transfer, self-performance (G0110B1) = (3, 4, 7, 8).
  • Comatose (B0100 = [1])
  • Malnutrition or at risk of malnutrition (I5600 = [1]) (checked)
Learn more about the calculation of this QM on page 23 of the Minimum Data Set (MDS) 3.0 Quality Measures User's Manual (v1.16, October 2018).
Performance Improvement Project   (PIP) teams should identify which residents have triggered high risk for pressure ulcer development, as well as residents who have documented Stage II-IV pressure ulcers, and review and revise their care plans accordingly.
Additionally, PIP teams should explore critical factors contributing to the development or worsening of pressure ulcers. They should devise strategies to improve processes related to identifying risk, prevention, assessment, and treatment.
Next month: Urinary Tract Infections Tips/Change Ideas 
QAPI Corner
Step 7: Develop a Strategy for Collecting and Using QAPI Data

Your plan will assist you in achieving what you have identified as the purpose, guiding principles and scope for QAPI. This is a living document that you may revisit as your facility evolves.
A written QAPI plan guides the nursing home’s quality efforts and serves as the main document to support implementation of QAPI.
The plan describes guiding principles that will be used in QAPI as well as the scope QAPI will have based on the unique characteristics and services of the nursing home. The QAPI plan should be something that is actually used and not viewed as a task that must be completed. You should continually review and refine your QAPI plan.
For more information on this topic, read pages 15-16 of QAPI at a Glance.
Next month: Identify your Gaps and Opportunities
Hand in Hand: A Training Series for Nursing Homes
The updated Hand in Hand: A Training Series for Nursing Homes  is now available on the Centers for Medicare & Medicaid Services’ (CMS’s) Integrated Surveyor Training Website (ISTW). Hand in Hand is available as a self-paced training as well as an instructor-led course and may be accessed using the links below. The self-paced training may take approximately 24 hours to complete.
Self-Paced Online Training
Downloadable Materials for Instructor-Led Training
Training Description
This training focuses on caring for residents with dementia and on preventing abuse. CMS, supported by a team of training developers and subject matter experts, created this training to address the need for nurse aides’ in-service training on these important topics.
The Hand in Hand: A Training Series for Nursing Homes was previously developed as an instructor-led training conducted by nursing home staff members for nurse aides. The Hand in Hand training will now be available as a self-paced, online training and available to download for use as an instructor-led course.
Target Audience
Federal law requires that nurse aides complete in-service training on dementia management and resident abuse prevention. Additionally, facilities must provide dementia management and resident abuse prevention training to all facility staff members, (direct and indirect care and auxiliary functions) contractors, and volunteers.
For help with registration and all other technical issues, please contact the ISTW Helpdesk at .
CDC Antibiotic Stewardship Training Course
Sections three and four have been added to CDC’s no-cost online antibiotic stewardship training course! The entire four-section course is now available on the CDC Train site and offers up to eight hours of continuing education (CE) credit.
The following topics are covered in the course:  
  • Section 1: Antibiotic resistance and the benefits of antibiotic stewardship.
  • Section 2: Antibiotic stewardship in outpatient settings.
  • Section 3 (New): Antibiotic stewardship considerations for the management of common outpatient conditions and dentistry.
  • Section 4 (New): Antibiotic stewardship in emergency departments, hospitals, and nursing homes.
While this course is primarily for clinicians who prescribe antibiotics, the CDC recognizes that everyone plays an important role in improving antibiotic use.
This course is open to physicians, nurse practitioners, physician assistants, certified health education specialists, nurses, pharmacists, and public health practitioners with a master’s degree in public health, and they are eligible to receive up to eight hours of no cost CE credit.
To learn more about this course, as well as other CE opportunities, visit the CDC Antibiotic Use Continuing Education page .
This course fulfills Improvement Activities (IA) Patient Safety, and Practice Assessment (PSPA)_23 and PSPA_24 under the Centers for Medicare & Medicaid Services (CMS) Merit-Based Incentive Payment System (MIPS).
Create an account and register for this course directly on CDC Train
HSAG Resource Spotlight
Refer to this toolkit as a guide to increasing flu vaccination among healthcare personnel in long-term care settings.

The CDC complied materials, resources, images, and other tools to assist providers and lay people in understanding seasonal flu and combating it. Learn more.
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.2-11282018-01