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. 
Register for the Joint FL-NNHQCC Learning Session 2 and AHCA Trainings for Skilled Nursing Facilities

September 6, 2017
September 12, 2017
September 14, 2017
September 18, 2017
The Centers for Medicare & Medicaid Services (CMS) recently released Interpretative Guidance update for Phase II of the Requirements of Participation . A CMS Certification and Survey Memodated June 30, 2017, outlines the Revised Interpretive Guidance for Survey Agencies, revised F-Tags, a revised survey process, training resources for surveyors and Long-Term Care (LTC) providers and enforcement, and Nursing Home Compare considerations for Phase II. Phase II requirements are scheduled to take effect November 28, 2017.
Encourage Resident Mobility
On April, 27, 2016, the Centers for Medicare & Medicaid Services (CMS) added six new quality measures to its consumer-based Nursing Home Compare website ( In July 2016, CMS incorporated all of these measures, except for the antianxiety/hypnotic medication measure, into the calculation of the Nursing Home Five-Star Quality Ratings. One of these measures, the Percentage of long-stay residents whose ability to move independently worsened (MDS-based), also referred to as the long-stay locomotion measure, evaluates the quality of nursing home care with regard to the loss of independence in locomotion among individuals who have been residents of the nursing home for more than 100 days. Loss of independence in locomotion is itself an undesirable outcome. Additionally, it increases risks of hospitalization, pressure ulcers, musculoskeletal disorders, pneumonia, circulatory problems, constipation, and reduced quality of life. Residents who have declined in independence in locomotion also require more staff time than those who are more independent. (
To help nursing homes encourage resident mobility, the National Nursing Home Quality Care Collaborative Change Package includes a six-point change bundle to help the multi-disciplinary quality improvement team support function and well-being of residents. The six-points are as follows.

  1. Define mobility for each unique individual.
  2. Provide a place or space to move.
  3. Provide supportive equipment.
  4. Train staff and residents.
  5. Support and encourage.
  6. Address physical and psychological needs that inhibit mobility.

You can find specific action items for each of these six points in Attachment 3 of the NNHQCC Change Package (April 2017 v2.2).

More mobility resources are available on the FL-NHQCC website at:
Quality Measure Tips:
Activities of Daily Living (ADL)
The ADL quality measure reports the percentage of residents whose need for help with ADLs has increased when compared with the prior assessment. The seven-day look-back measure involved four late-loss ADLs: bed mobility, transferring, eating, and toileting.
When you are working with your staff members, you may want to consider the following questions.
  • Is the staff member's coding documentation accurate?
  • Has the root cause for the decline been determined and treated?
  • Is pain/depression managed?
  • Is the resident receiving appropriate assistance from staff members?
If you would like more improvement tips and MDS coding insight, download the HSAG ADL quality measure tip sheet.
Please contact if you have any questions.
HSAG has developed an MDS ADL Coding Tip Sheet, to access click on the image below.
Do You Know Your Nursing Home's Current Quality Measure (QM) Composite Score?
The Centers for Medicare & Medicaid Services (CMS) has set a goal for all U.S. nursing homes participating in the National Nursing Home Quality Care Collaborative (NNHQCC) to achieve a Quality Measure Composite Score of 6 percent or less. The Composite Score includes the 13 long-stay quality measures publicly reported on Nursing Home Compare. As your partner in quality, Health Services Advisory Group (HSAG), the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Florida, is committed to helping you achieve your quality improvement goals.
QAPI Corner
STEP 12: Take Systemic Action

Systemic Action is often the most challenging step in improving performance. After identifying root causes to an issue, it is important to implement changes or corrective action that can improve or reduce the chance of an event happening again. These actions should be tightly linked to the root causes in order to have a higher likelihood of being effective. It is vital to avoid quick fixes. The goal is to make strong changes that will result in lasting improvement. Actions can be defined in the following ways.

  • Weak: Actions that depend on staff to remember training or policies. These actions enhance or enforce existing processes.
  • Intermediate: Staff must remember to do the right thing, but these actions provide tools. These modify existing processes.
  • Strong: Actions that do not depend on staff to remember to do the right thing. Strong action redesign the process.

Pilot testing is one tactic nursing homes can use to test systemic change ideas. Think about testing or "piloting" changes in one area of your facility before launching something facility wide. Sometimes, changes can have unintended consequences.
For more information on the different types of actions and examples for each, read page 19 of QAPI at a glance.
Have You Completed Your QAPI Self-Assessment?
Clostridium difficile Infection Prevention Cohort Members
Announcements and Information

  • CDI data for August is due September 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
Wednesday, August 30, 2017
Antibiotic Stewardship National LAN Event 
Sunrise; Wednesday, September 6, 2017
Tampa; Tuesday, September 12, 2017
Orlando; Thursday, September 14, 2017
Tallahassee; Monday, September 18, 2017
FL-NNHQCC Learning Session 2 2017 Joint Training
Skilled Nursing Facilities
Thursday September 7, 2017
Nursing Home Facility Assessment Tool and State Operations Manual Revisions Call
HSAG Resource Spotlight
Guidance for Performing Root Cause Analysis Use this guide to walk through an RCA to investigate events in your facility. Learn more.
The Five Whys is a simple problem-solving technique that helps get to the root of the problem quickly. Learn more.
The QAPI Plan Template can help guide nursing home staff members as they develop specific quality improvement plans for their organizations. 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.2-08282017-01