5 Ways to Improve Patient Outcomes at Your Facility
In the wake of more than 200,000 nursing home resident and staff deaths during the COVID-19 pandemic, the federal government renewed its mission to improve nursing home quality and patient outcomes. It aims to achieve this mission through legislation adding new compliance requirements for nursing facilities and tying quality measures to nursing facility incentives and penalties.
Leaders of nursing facilities and residences are undoubtedly facing tough challenges in providing high-quality care to residents with limited resources. In this article, we’ll review the patient measures the government evaluates and five practical ways to improve patient outcomes.
Outcomes and Quality Measures, Explained
The definition of “outcomes” is the impact your facility’s services and interventions have on the health status and quality of life of your residents or patients. The Centers for Medicare and Medicaid Services (CMS) utilizes “quality measures” to assess and quantify outcomes and demonstrate a facility’s ability to provide high-quality healthcare. As we review resident outcomes, remember that they go hand-in-hand with quality measures.
Quality measures not only directly impact your residents’ care but also your facility’s ratings, which include:
- Five-Star Quality Rating: This helps attract new residents.
- Skilled Nursing Facility Value-Based Purchasing: This increases Medicare incentive payments.
- Skilled Nursing Facility (SNF) 3-Day Rule eligibility: This increases your patient referrals from hospitals.
The CMS measures used to evaluate nursing homes are listed in the table below. The government obtains data from insurance claims and the Minimum Data Set (MDS) assessments, which are federally mandated and completed for each resident in certified nursing homes. CMS examines nursing residence measures based on length of stay.
| Short Stay (<100 days)
vs. Long Stay (>100 days) |
Nursing Resident Quality Measures |
|---|---|
| Short | Percentage of residents who improved in their ability to move around on their own |
| Short | Percentage of residents with pressure ulcers/pressure injuries that are new or worsened |
| Short | Percentage of residents who received antipsychotic medication for the first time |
| Short | Percentage of residents who were re-hospitalized after a nursing home admission |
| Short | Percentage of residents who have had an outpatient ED visit |
| Short | Rate of successful return to home and community from a SNF |
| Long | Percentage of residents whose need for help with daily activities increased |
| Long | Percentage of residents whose ability to move independently worsened |
| Long | Percentage of high-risk residents with pressure ulcers |
| Long | Percentage of residents who have or had a catheter inserted and left in their bladder |
| Long | Percentage of residents with a urinary tract infection (UTI) |
| Long | Percentage of residents who had one or more falls with major injury |
| Long | Percentage of residents who got an antipsychotic medication |
| Long | Number of hospitalizations per 1,000 long-stay resident days |
| Long | Number of outpatient emergency department (ED) visits per 1,000 long-stay resident days |
1. Utilize the MDS Assessment as a Predictive Tool
The MDS is a comprehensive evaluation of the resident’s functional abilities. It provides extensive insight to the resident’s state of health and serves as a foundation to their individualized care plan. Your facility can use this information to implement strategies to mitigate problems for the at-risk resident.
Here are some helpful tips on using the MDS to predict patient outcomes that you can use while developing a plan with your nursing management team.
- Identify the most important outcomes to your facility that will have the most significant patient impact.
- Determine the desired outcome for each clinical measure.
- Define the metrics for patient and quality outcome success or failure.
- Establish what the consequences are for not meeting the outcomes.
- Formulate how to improve the quality of care for residents already struggling with their health and functional abilities.
Example: An elderly female prone to UTIs can be placed on an automatic toileting schedule upon admission to reduce long voiding intervals and decrease infection risk.
2. Incorporate Shared Decision-Making
Shared decision-making is the process of including the resident or patient and their family as active participants in the healthcare team. Nursing assists patients by providing education and information about their health and medical conditions. This, in turn, empowers patients to become more invested in their health and make informed decisions regarding their care.
According to the Agency for Healthcare Research and Quality (AHRQ), by placing patients at the center of their own care, your facility can achieve the following benefits:
- improvements in patient outcomes
- enhancements in the patient experience of care, quality, and satisfaction
- lower costs
- eligibility to become recognized as a patient-centered medical home (PCMH) or accountable care organization (ACO)
Example: After the nurse explains to the patient and their family the importance of preventing UTI to their overall health, they can engage the patient to develop a toileting routine that works around the patient’s schedule and needs.
3. Educate Nurses
Your facility can remain current on best practices and improve quality measures and outcomes by providing nursing education. Education is an ongoing process that includes yearly reviews, competencies, and periodic in-services focusing on prevention, early identification, and nursing management for conditions commonly affecting residents.
Example: Your facility can offer annual training on the cause and prevention of UTIs, perform annual competency on sterile technique with catheter insertion, and provide quarterly in-services on early identification of infections.
4. Create Nurse Champions
In addition, you can create a staff committee dedicated to improving healthcare measures specific to your residence needs. Enlist a nurse from each unit to become their quality champion, the subject matter expert who provides updates, answers questions, offers guidance, and gathers outcome data. By engaging nursing staff through education and inviting them to be a part of the solution, your facility is leveraging your best asset to address patient outcomes.
Example: Your nursing champion for infection prevention can consult with the nursing staff caring for residents to review early UTI signs and symptoms and provide important education points for them to reinforce when providing care.
5. Increase Nurse Retention
The federal government is committed to increasing and retaining nursing staff to improve nursing home quality. It incentivizes nursing facilities to improve staffing and retention by including turnover rates for overall nursing staff, RN staff, and nurse administrators in determining your 5-Star Quality Ratings and SNF-VBP eligibility.
Adequate nurse staffing is associated with fewer pressure ulcers and urinary tract infections, decreased risk of hospitalizations, reduced mortality, and improved quality measures, including falls and pain management in nursing residents. If you’re wondering how to improve patient outcomes through staffing, take heart in knowing that there are effective ways to reduce nurse turnover and to support your nursing leadership to create a positive work environment.
Example: The resident will have more consistent care by having the same nursing staff attend to her needs. They will immediately catch subtle changes that can signal a UTI and promptly implement an action plan.
Need Help Improving Outcomes?
Assembling a top-notch nursing team is essential to providing excellent patient care. However, many staffing companies don’t focus on quality measures with their nurses. Learn more about improving patient outcomes, retaining key staff, and other important aspects of staffing a healthcare facility by signing up for our free newsletter today.