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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP) Navigating the ROP Changes: Are You in Compliance? 1 1
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“QAPI Motivate, Educate, Innovate Part MBA, BS MT(ASCP) programs/2018.03. julie k...Questions Why? Who? What? ... “QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA,

Jul 10, 2018

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Page 1: “QAPI Motivate, Educate, Innovate Part MBA, BS MT(ASCP) programs/2018.03. julie k...Questions Why? Who? What? ... “QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA,

“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 1

Page 2: “QAPI Motivate, Educate, Innovate Part MBA, BS MT(ASCP) programs/2018.03. julie k...Questions Why? Who? What? ... “QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA,

“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 2

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Jan Feb Mar Apr May Jun Jul Aug Sep

Ant

ipsy

chot

ic R

ate

Antipsychotic PIP Project

Sunshine NH Rate

National Average

Track Your Progress Over Time

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 3

Making QAPI Dynamic

QAPI

Educate

Motivate

Innovate

Motivation for Adult Learning1. Social relationships: to make new friends, to meet a need for associations and 

friendships. 2. External expectations: to comply with instructions from someone else; to fulfill 

the expectations or recommendations of someone with formal authority. 3. Social welfare: to improve ability to serve mankind, prepare for service to the 

community, and improve ability to participate in community work. 4. Personal advancement: to achieve higher status in a job, secure professional 

advancement, and stay abreast of competitors. 5. Escape/Stimulation: to relieve boredom, provide a break in the routine of home or 

work, and provide a contrast to other exacting details of life. 6. Cognitive interest: to learn for the sake of learning, seek knowledge for its own 

sake, and to satisfy an inquiring mind. 

Knowles, Malcolm. (1986) The Adult Learner: A Neglected Species. Houston: Gulf Publishing.

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 4

Motivate the Millennials• They want positive feedback

– Signed poster of appreciation– Recognition in front of their peers

• They want to feel fulfilled at their job• They are technologically savvy• They want to feel inspired

https://money.usnews.com/money/blogs/outside‐voices‐careers/articles/2017‐03‐09/3‐ways‐to‐motivate‐millennials‐at‐work

Organizational Culture• Can be defined by a company’s mission, goals, and values

• Culture is defined by those things that influence the working environment itself and the behaviors of those who work there

• Your culture has its own spoken and unspoken rules of conduct

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 5

Why is it important?• Those unwritten rules that govern the care delivered in your nursing homes

• These unwritten rules play directly into staff turnover and employee satisfaction

• Negative culture can lead to sub‐optimum care

Motivate by LeadershipConcept Leadership ManagementMotto Do the right thing Do things rightChallenge Change ContinuityFocus Purpose Procedures

Method Strategy SchedulesOutcomes Journeys DestinationPeople Potential Performance

Questions Why? Who? What? When? Where? How?

Time Frame Present to future Past to present

Page 6: “QAPI Motivate, Educate, Innovate Part MBA, BS MT(ASCP) programs/2018.03. julie k...Questions Why? Who? What? ... “QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA,

“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 6

Make the Staff Heart Connection• Walk a mile in your shoes• Staff scavenger hunt• Front line staff participate in “I” care plan meetings

• Thank you for being a “life‐saver”

• Staff become resident for a day

Team Building• Use Learning Circles for Problem Solving• Sunshine Jar to start off meetings• Red Carpet ceremonies to reward hard work• Create a group of “imagineers” – the sky is the limit

Page 7: “QAPI Motivate, Educate, Innovate Part MBA, BS MT(ASCP) programs/2018.03. julie k...Questions Why? Who? What? ... “QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA,

“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 7

Empower Resident Relationships• Let staff be “dream catchers”• Memory boards• Prom night• Fashion show• Virtual Cruise

Making QAPI Dynamic

QAPI

Educate

Motivate

Innovate

Page 8: “QAPI Motivate, Educate, Innovate Part MBA, BS MT(ASCP) programs/2018.03. julie k...Questions Why? Who? What? ... “QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA,

“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 8

Create C.S.I. Investigators

CareSceneInvestigation

• Put the participant in the driver’s seat

• Participants receive a ‘crime sheet’ that they can use during the workshop to keep track of clues

• Witness Testimony• Real Life Situations

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 9

The Case of Smiling FacesNursing Home: A Pressure Ulcer Mystery

Witness Testimony: The Wound Care Nurse

Page 10: “QAPI Motivate, Educate, Innovate Part MBA, BS MT(ASCP) programs/2018.03. julie k...Questions Why? Who? What? ... “QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA,

“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 10

Witness Interview: The CNA(currently under Federal Witness Protection) The Conclusion: We Solve the Case

• Grab your Investigation Case Sheet to crack the mystery case

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 11

Another Workshop Idea:Encourage Interaction in Workshops

What’s Wrong with this Picture?

Another Mystery• Mrs. Jones is about to develop a pressure ulcer. In our quest to prevent it, what’s wrong with the picture? 

Page 12: “QAPI Motivate, Educate, Innovate Part MBA, BS MT(ASCP) programs/2018.03. julie k...Questions Why? Who? What? ... “QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA,

“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 12

What is wrong with this picture? What else is wrong?

Page 13: “QAPI Motivate, Educate, Innovate Part MBA, BS MT(ASCP) programs/2018.03. julie k...Questions Why? Who? What? ... “QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA,

“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 13

Nutritional Clues Case Solved! It’s all in the evidence

Page 14: “QAPI Motivate, Educate, Innovate Part MBA, BS MT(ASCP) programs/2018.03. julie k...Questions Why? Who? What? ... “QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA,

“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 14

The Annual Pressure Ulcer In-service• Is your in‐service:

– The same old same old?– Scheduled on payday? – Enough notification for staff to plan to be present?

– Enough chairs to sit down comfortably and listen?

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 15

The Barrier Reef Barrier Reef ExerciseSee the water beading up on right hand?

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 16

The Daily Post• Use a moisture barrier to help protect the skin from stool and urine

• Barrier creams and ointments only work if they are applied, and applied correctly

• These creams can be the first line of defense for your elder to stop a pressure ulcer before it develops

Treasure Hunt

• The picture on the right is view from glasses with petroleum

Seeing through the resident’s eyes

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 17

The Daily Post• Assist residents to eat as necessary

• Notify the nurse if there is a decline or change in a resident’s eating habits

• In the dining room, consider using different color placements to identify those that need assistance with eating

Terrors of the Deep

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 18

Terrors of the DeepStage 1 Stage 2

Stage 3 Stage 4

The Daily Post• Stage IV pressure sores take the longest to heal

• In some residents, stage IV can develop in a matter of hours; for example, if left on the wrong surface too long

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 19

Solving the Puzzle ofThe Braden Scale*

Nutrition

Mobility

Friction and Sheer

MoistureActivity

*Refers to The Braden Scale  for Predicting Pressure Sore Risk, Barbara Braden and Nancy Bergstrom, 1988

Sensory Perception

You Just Need Prizes from a Dollar Store

• Quiz Bowl – Based on your favorite TV game show

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 20

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Prevention A & P Risk Factors Nutrition Positioning/Repositioning

The best treatment for pressure sores is________________.

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 21

Prevention What is the body’s first line of defense against infections/microorganisms?

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 22

THE SKIN

The skin needs to be intact to keep germs out.

Making QAPI Dynamic

QAPI

Educate

Motivate

Innovate

Page 23: “QAPI Motivate, Educate, Innovate Part MBA, BS MT(ASCP) programs/2018.03. julie k...Questions Why? Who? What? ... “QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA,

“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 23

Innovate with Cutting Edge Best Practices

• INTERACT• TeamSTEPPS• IA‐ADAPT• Geriatric Pain

INTERACT: http://interact2.netInterventions to Reduce Acute Care Transfers

is a quality improvement program that focuses on the management of acute change in resident condition. It includes clinical and educational tools and strategies for use in everyday practice in long term care facilities.

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 24

Quick Guide to Get Started• This is intended to help reveal opportunities for further implementation.

• Great to use in a QAPI Performance Improvement Project (PIP).

Quality Improvement Tools

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 25

“Initiative based on evidence derived from team performance…leveraging 

more than 25 years of research in military, aviation, nuclear power, business and 

industry…to acquire team competencies”

Team Strategies & Tools to Enhance Performance & Patient Safety

TeamSTEPPS Website

https://www.ahrq.gov/teamstepps/longtermcare/index.html

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 26

All Modules Can Be Downloaded For Free The Tools of TeamSTEPPSCommunica‐tion

Leadership Situation Monitoring

Mutual Support

•SBAR•Call‐Out•Check Back•Handoff•I PASS THE BATON

•Effective Team Leaders•Team Events•Brief Checklist•Debrief Checklist

•Situation Monitoring Process•STEP•Cross‐Monitoring•I'M SAFE Checklist

•Task Assistance•Feedback•Advocacy and Assertion•Two‐Challenge Rule•CUS

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 27

University of Iowa

https://igec.uiowa.edu/ia‐adapt

IA-ADAPT Resources• Training Videos

– Introduction/Overview– Assessment– Delirium– Non‐Drug Management– Shared Decision Making– Antipsychotic Selection– Antipsychotic Monitoring

• Family/Patient Information– Shared Decision Making 

Guide– Managing a crisis

• Pocket Guides– Overview of evidence‐based 

approach + evaluation of problem behaviors

– Delirium assessment and management

– Non‐drug management– Drugs that may cause 

delirium or problem behaviors

– Antipsychotics guides• Other Guides

– Algorithm for symptoms of dementia

– Managing a crisis

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 28

University of Iowa – Geriatric Pain

https://geriatricpain.org/pain‐management

More Resources to Make Things Easy

http://qioprogram.org/nursing‐home‐training‐sessions

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

Navigating the ROP Changes: Are You in Compliance? 1 29

Quality Insights Can Assist

QAPI Resources• Action Planning Worksheet• QAPI at a Glance• QAPI Toolkit• Fishbone RCA• 5‐Whys RCA• Goal Setting Worksheet• Sustainability Guide• Topic Example Documents

Examples of our Topic Resources

• Antipsychotics– Trigger Tools, Step‐by‐Step 

Guides to reduction

• Fall Management– Care Plans, Risk Assessments

• Pressure Ulcer Prevention– Skin Care Fair

• Pain Management– Audit Tools, Team Tools

Your Louisiana Quality Improvement Specialist

Julie Kueker318‐294‐[email protected]

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“QAPI Motivate, Educate, Innovate Part 2” Julie Kueker, MBA, BS MT(ASCP)

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Thank you

This material was prepared by Quality Insights, the Medicare Quality Innovation Network‐Quality Improvement Organization for West Virginia, Pennsylvania, Delaware, New Jersey and Louisiana 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 number QI‐LA‐C2‐022618