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 upcoming learning events, links to improvement tools, resources, news, best practices, and success stories. 
Reduction in Urinary Tract Infections (UTIs) and Inappropriately Prescribed Antibiotics
Urinary tract infections (UTIs) are the most commonly treated infections among nursing home residents. Even in the absence of specific (e.g., dysuria) or non-specific (e.g., fever) signs or symptoms, residents frequently receive an antibiotic for a suspected infection (Phillips et al. BMC Geriatrics, 2012, 12:73).

Read the full article here:

In 1996, Dr. Jospeh Ouslander published a study on the prevalence of pyuria and bacteriuria in the asymptomatic chronically incontinent nursing home residents ( J Am Geriatr Soc 1996; 44:420-423). Forty-five percent of residents had pyuria, defined as >10 wbc/hpf and 43 percent had bacteriuria, defined as >100K CFU's of a pathogen. These findings were in asymptomatic NH residents! 

Lesson learned: When we order urine tests, half the time we may find residents with either pyuria or bacteriuria. These findings are meaningless without other corroborating clinical findings. Otherwise, the possibility of inappropriately ordering antibiotics can occur, which can then create problems such as Clostridium difficile infections (CDIs).

Tips for Improving the 
UTI Long-Stay Quality Measure
The UTI measure reports the percentage of residents who have had a UTI within the last 30 days.
Minimum Data Set (MDS) Coding Requirements
In the MDS:
  1. Include a look-back period of 30 days.
  2. Code only if all of the following are met:
  • Physician, certified nurse practitioner, physician assistant, or clinical nurse specialist diagnosed a UTI in the last 30 days.
  • Documented signs and symptoms of a UTI, such as fever, burning, frequent urination, pain, or tenderness in the flank, confusion, mental status change, or pyuria exist.
  • Current medication or treatment of a UTI has occurred in the last 30 days.
  • Significant laboratory findings exist. (Attending physician should determine the level of significant laboratory findings and whether a culture should be obtained or not.)

This measure will not be triggered if the target assessment is an admission, a prospective payment system (PPS) 5-day assessment, or a readmission/return assessment.
Ask these questions:
  • Was the MDS coded as per the Resident Assessment Instrument requirements?
  • Does the facility have established criteria for testing (such as the McGeer Criteria, available on the Centers for Disease Control and Prevention [CDC] website), and are the nurses aware of the criteria?
  • Does the resident need to be placed on a hydration program?
  • Is water accessible at all times and offered to dementia residents?
  • Are chronic conditions treated?
  • Are staff members monitored for proficiency in perineal/catheter-care and hand washing?
  • If a catheter has been inserted, was the diagnosis appropriate?

QAPI Corner
Step 1: Leadership & Accountability

Facility leadership (e.g., medical director, administrator, director of nursing, and other key managers) is responsible for "setting the tone" to help staff identify how to meet the organization's mission, vision, guiding principles, standards, and expectations. Without strong leadership, change efforts often fail or are not sustainable. As a leadership team, consider these key questions:

  • How can we provide needed resources for QAPI?
  • Is our culture open, respecting and "just" (fair)?
  • What does our culture look like?
  • How can QAPI blend with our existing QA efforts?

Not sure where to start? Review pages 9-10 of QAPI at a Glance and page 8 of the QAPI Companion Guide to get started.

Next month: Focusing on a deliberate approach to teamwork.

  • Facility QAPI Plan
  • This document offers a template to assist your facility in creating a QAPI plan that will guide your organization's performance improvement efforts.
Have You Completed Your QAPI Self-Assessment?
Clostridium difficile Infection Prevention Cohort Members
Announcements and Information

  • CDI data for October is due November 10, 2017.
  • Login to NHSN using your SAMS grid card credentials to submit your CDI LabID events (if applicable) and summary data (total resident days for the month, resident admissions, and residents admitted on CDI treatment).
  • Do not forget to check "Report No Events" under the C. difficile row if there were no positive labs collected within your facility for the month.
  • Resolve Alerts: Review the "Alerts tab and complete missing and/or incomplete data.
Upcoming Events and Education
Tuesday, November 7, 2017
Webinar: What Does Antibiotic Stewardship Mean?
Join HSAG for an educational webinar exploring Antibiotic Stewardship in Long-Term Care Facilities (LTCFs). When you implement an antibiotic stewardship program (ASP), you can protect your patients from Clostridium difficile and adverse drug events associated with unnecessary prescribing of antibiotics. HSAG will discuss resources and programs that are available to support your efforts.
HSAG Resource Spotlight
This infographic outlines the 5 steps to prevent healthcare-associated infections in nursing homes from the National Nursing Home Quality Care Collaborative (NNHQCC) Change Package.   Learn more .

Effective November 28, 2018, the new long-term care regulations require nursing facilities to conduct, document, and annually review a facility-wide assessment, which includes both their resident population and the resources the facility needs to care for their residents (ยง483.70(e)). This is an optional template provided for nursing facilities to evaluate its resident population and identify the resources needed to provide the necessary person-centered care and services the residents require . If used, this tool may be modified. Each facility has flexibility to decide the best way to comply with this requirement. Learn more.
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Florida, 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.2-10252017-01