Technology helps hospices meet QAPI requirements

EMR software produces timely reports

Twenty-one months after quality assessment and performance improvement (QAPI) requirements became part of the Hospice Conditions of Participation, quality improvement managers are reporting that the transition has gone smoothly when electronic medical records (EMRs) and staff education are integrated.

"Our hospice has used electronic records for billing purposes since 1994, and our field staff began documenting electronically in 2005, so our staff was familiar with the technology," says Maria Lawson, MS, senior systems analyst for Gilchrist Hospice Care in Hunt Valley, MD. (See p. 125 for tips on implementing new technology.) Because information that is useful for quality improvement (QI) already was being collected, the agency developed protocols and tweaked the assessment forms to readily identify key areas for QAPI.

As case managers conduct the comprehensive assessment of new patients, the information is entered using a tablet PC, says Lawson. "We read the requirements for QAPI regularly as well as the other requirements for information we must collect for billing purposes and update the forms to reflect changes, but the process for nurses to enter the data remains the same," she explains.

Members of the quality improvement team, comprised of representatives from different areas of the hospice, review monthly statistics from the report generated from the electronic records system and identify areas to focus upon for improvement, says Lawson. "Members of the senior leadership team and the director of quality set specific goals for the hospice based upon team recommendations," she says. Once these goals are set, managers talk about the focus and steps to improve performance in staff meetings, Lawson explains. "Everyone in the hospice is involved in quality improvement, and it is a continuous process in our hospice," she says.

Use of electronic records to capture information is valuable because you can obtain reports in a timely manner, Lawson points out. An "outcome" report based on information on all charts can be produced quickly with electronic records, she says. "We are monitoring falls, infections, and turnaround time to see new patients," Lawson says. "Prior to use of electronic records for our field staff, we had to manually calculate results." A report from electronic records can produce the information more quickly, enabling managers and QI team members to address issues, revise QI activities, or follow up on problems more effectively, she adds.

QAPI projects do not have to be related to clinical issues, Lawson emphasizes. The use of electronic records throughout the hospice enables staff members to track information in all areas, including staff credentials, she says. "One of our goals was to have 100% of all clinical leaders certified in their hospice specialty by the end of the fiscal year," Lawson explains. This type of goal required a simple data tool that collected the information and generated a report that enabled managers to track progress of the certifications, she says. It is a straightforward, measurable goal that does improve patient care because it improves the knowledge and skills of the people overseeing the provision of care, Lawson adds.

The staff at VNA of Western Pennsylvania in Butler is looking at falls and pain for their QI initiatives. Nurses use laptops to document visits in the home, and the assessment forms have been developed to capture additional information on these two areas, says Carol Arthur, RN, CCM, QI coordinator for the agency. "We've developed specific profile forms that standardize the way information is collected," Arthur says. "We also collect information from on-call triage nurses that identify issues that show up nights and weekends."

Reports generated from the electronic records produced by field nurses and triage nurses are used to identify trends, she points out. "If it looks like we are having more calls about pain at night, or if nurses are reporting more falls, I look at specific data to see specific causes or trends," Arthur adds. "Our hospice staff started using laptops and standardized assessment forms about 10 years ago, so they were accustomed to completing an array of forms." This meant that the transition to QAPI was not a problem for the hospice, she says. Staff members just needed to make sure the forms collected data they needed to meet requirements, Arthur says.

Even though nurses had been completing standard profiles on their laptops, there was a need to update forms and re-educate nurses, she says. "We talked about QAPI and explained why we were changing some forms, but emphasized that it was a good thing for the hospice," she says.

Constant evaluation of forms, reports, and data is necessary for a good quality program in a hospice, says Arthur. "We are always looking for ways to improve the forms, not only to improve the data we collect, but also to make the forms simple and easy to complete for the nurses," she says.