Strategy #1: Staff conducts evaluations in order to assist clients in obtaining a nursing facility level of care. 

Strategy #2: Maintaining number of client's under the CFC/COW program, to stay in the least restrictive environment, which is usually their homes.

ABOUT

Problem Statement

Aim / Overall Goal / Desired Result

To assist individuals who qualify for a Nursing Facility Level of Care to be able to stay in their own homes or in the least restrictive environment with assistance, by completing their visit/starting their assessment in the most timely manner possible. The nurses will strive to meet this goal by attempting to do 14 assessment visits and 70% of those visits be completed by the due date. The timeframe for meeting this goal will be 7/1/2021.

Change Idea

Enlist help in contacting medical providers for medical records, in order to speed up the initial visit for the evaluations.

PDSA Objective

to achieve the goal stated above

PDSA Cycle Number: 1

Estimated PDSA Implementation Timeline

From 2021-06-01 to 2021-07-01

What questions do you want answered for this change?

What is the % of assessments that were completed by the due date and how many were completed?

PLAN

Predict what will happen when this test is carried out:

Monthly goals will be met.

List the tasks needed to set-up this change: (Please include the person responsible, when the task is to be completed, and where the task is to be completed for each task.)

1. Nurses review the patient chart and notify administrative support which medical providers they need medical records requested from. 2. Administrative support contacts the providers to request records and emails/forwards them to the nurses when received. 3. When evaluation is completed and chart turned into administrative support, the reference date (date of the visit) is documented. 4. At the end of the month a report is ran and the #’s recorded, both of % of visits/assessments started by the due date, and quantity of assessments completed.

Related Improvement Measure:

No related measure has been set yet. Please connect this Quality Improvement project to a raw data measure.

DO

Describe what happened when you ran the test:

We are able to complete at least 14 assessments. However our last two months percentage of completed assessments by the due date is in the 50 % range, not our 70% goal.

STUDY

Describe the measured results, and how they compared to the predictions:

In discussion with the nurses, we find that some months are harder than others. The months of June and July (August numbers are not tallied yet), we were dealing with staff time off (scheduled vacations) and also some very difficult clients who are very hard to get in touch with to schedule. (They don’t answer their phone, don’t return calls, etc., therefore delaying when we can meet with them to start their assessment). We have also had an increased number of Nurse Monitoring clients to do during the last two months, which takes time away from being able to start the assessments. We believe that we need more than a cycle of 2 months to measure outcomes. (We used June, July )

ACT

Describe what modifications in the plan will be made for the next cycle from what you learned:

Our goal was to have 70% of assessments started by the due date.  We brainstormed and realized that we actually needed to improve our tracking method.  Our goal per the state is 15 working days.  The dates we had set up in PatTrac was 15 calendar days, because PatTrac does not have a way to count “working” days.  We just decided that a better, more accurate tracking would be to change this report and expand it to 21 calendar days, therefore more closely reflecting 15 working days.  We feel that this will allow our percentage of assessments started on time to be much closer to our goal.  We will plan to try this for about 6 months and see if it shows an increase in % of assessments completed on time.  We plan to continue the process we have implemented and give it more time to see if it is working.   Since we started this project, we also had hit a hard time period in the last few months where there were more than usual assessments due, and we have had a very hard time getting several client’s (more than usual) to call us back to schedule them.  By changing our report for the month of October, our % increased from 30% to 40%.

ABOUT

Problem Statement

We have a very small staff,  and we receive a lot of referrals.  Referrals are often not completed by the nurses by the requested due date, therefore delaying client receiving services under this program.  For many months of Qualify Improvement Project # 1, we did not meet our goals.  However, there were several things that attributed to that.  We discovered that we were not quite accurately documenting the due date.  Our computer system cannot track working days, so we changed that late in the year, from 14 working days, to 21 calendar days. In addition, one of our nurses was out for medical reasons for an extended period of time, our computers went down and we had to improvise to be able to use laptops, personal computers or tablets.  Also, we have an additional issue that will affect Project # 2, that started January 1, 2022.  At the end of January, beginning of February, one of our staff of 3 nurses transitioned to a different department, leaving us a staff of only two nurses, as opposed to normally having three.  This will last for a few months until we are able to advertise, replace, and train that nurse.  With the changes to the way we calculate days, we decided that we need more time to see if that helped us meet our goal more often, so we are continuing the same project that we did last year, with that one change.  

Aim / Overall Goal / Desired Result

To assist individuals who qualify for a Nursing Facility Level of Care to be able to stay in their own homes or in the least restrictive environment with assistance, by completing their visit/starting their assessment in the most timely manner possible. The nurses will strive to meet this goal by attempting monthly to do 14 assessment visits and 70% of all referrals be completed by the due date. The due date is 21 calendar days. The timeframe for meeting this goal will be 12/31/2022.

Change Idea

Enlist help from administrative support in contacting medical providers for medical records.  This should speed up the initial visit for the evaluations by freeing up their time and allowing nurses more time to do other things that are needed to get the evaluation started/completed.

PDSA Objective

To achieve the goal stated above

PDSA Cycle Number: 2

Estimated PDSA Implementation Timeline

From 2022-01-01 to 2022-12-31

What questions do you want answered for this change?

What is the % of assessments that were started by the requested due date and how many were completed?

PLAN

Predict what will happen when this test is carried out:

Monthly goals will be met.

List the tasks needed to set-up this change: (Please include the person responsible, when the task is to be completed, and where the task is to be completed for each task.)

1. Nurses review the patient chart and notify administrative support which medical providers they need medical records requested from. 2. Administrative support contacts the providers to request records and emails/forwards them to the nurses when received. 3. When evaluation is completed and chart turned into administrative support, the reference date (date of the visit) is documented. 4. At the end of the month a report is ran by administrative support and the #’s recorded, both of % of visits/assessments started by the due date, and quantity of assessments completed.

Related Improvement Measure:

# of Waiver/CFC Assessments Completed (New & Redets.)

DO

Describe what happened when you ran the test:

We will check to see if we met our goals after 3 months, 6 months and 9 months.

STUDY

Describe the measured results, and how they compared to the predictions:

ACT

Describe what modifications in the plan will be made for the next cycle from what you learned: