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Quality Markers
Culture Change Markers of Quality | Physical Restraints | Depression and Anxiety
Pressure Ulcers | Pain Management
Nursing homes that have the following quality markers in place are more likely to successfully attain the goal of the right care for every person every time. The names of those nursing homes that have these markers in place are listed here.
Permanent Assignment:
Permanent assignment in a nursing home, also known as consistent resident assignment, is when a nursing home has its nursing staff permanently assigned to a unit, neighborhood, or household. This is an important part of the care delivery system as it helps maintain the continuity of care and allows the nursing staff to more easily and effectively identify any changes in the residents’ conditions and respond more quickly to the residents’ needs. Nursing homes that have implemented permanent assignments report higher staff and resident satisfaction, a greater sense of teamwork, and fewer clinical complications. In order for nursing home facilities to be included in this marker of quality, the nursing staff at the facility cannot be “pulled off” the unit, neighborhood, or household more than 25% of the time.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
Multi-Disciplinary Rounds:
Multi-disciplinary rounds are when a set group of staff from a variety of disciplines walks through the nursing facility to discover any issues that need quick resolution and gain situational awareness of the facility. The types of multi-disciplinary rounds this marker includes are those where a staff member conducts rounds outside of his/her discipline. For example, a housekeeping employee would conduct rounds for, or with, dietary or nursing staff. This is an important element of quality within a nursing home facility as it encourages staff to support other departments and builds teamwork among the staff. In order for nursing homes to be included in this marker of quality, the facility must conduct at least one type of multi-disciplinary round at least daily.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
Dining Experience:
HealthInsight supports the concept that resident-centered care delivery involves providing nursing home residents with a dining experience that resembles the homelike mealtime experience. This type of dining experience tends to help a resident feel more at home and draws them away from feelings of being institutionalized. Offering a homelike environment at mealtime is an important part of the care process as it helps residents feel more connected with others and helps renew their spirits. In order for a nursing home facility to be included in this marker of quality, the facility must provide buffet style, family style, or restaurant style dining for any one of the main daily meals.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
Resident Choice:
HealthInsight supports the concept that resident-centered care delivery involves providing opportunities for nursing home residents to make their own choices such as being able to decide when they would like to wake in the morning. When nursing home residents are allowed to make some of their own decisions, it helps them feel empowered to make small choices about their day. Once admitted into a nursing home facility, residents typically experience a loss of decision-making and control, which can be a difficult adjustment. Creating more opportunities for residents to make their own decisions enhances the quality of life and can make residents feel more at home. In order for a nursing home facility to be included in this marker of quality, the facility must allow all residents to go to bed and wake up when they like.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
| Physical Restraints: |
- For every resident physically restrained, there is a physician’s order and documented reasons why the restraint was ordered. This marker of quality is an important part of the restraint process, as it requires nursing staff to consult with a physician about why they believe a restraint should be utilized in addition to how the resident’s safety and/or health may be at risk if the restraint is not applied. All restraint use should be well documented to allow the nursing home facility to appropriately assess the resident’s progress (or decline), as well as help the nursing staff identify what other interventions may be more appropriate.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
- For each physical restraint used, the facility conducts an assessment to determine if the device used is the least restrictive device available. This marker of quality is also an important part of the restraint process as it requires nursing staff to accurately assess and determine which device is most appropriate for each resident. This may involve testing each device to see which is most appropriate for the event the nursing staff is trying to prevent, such as a resident fall. The least restrictive device is always preferred as it allows the resident to maintain his or her quality of life as much as possible.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
- In addition to regular care plan meetings, there are documented plans to regularly re-evaluate all residents to reduce or completely eliminate physical restraints. This marker of quality is an important part of the restraint process as it facilitates the discussion of restraint use and helps identify when the use of restraints is appropriate. This allows the nursing staff to become more acutely aware of the purpose behind each restraint so when the resident no longer requires the restraint, this is recognized and re-evaluated by staff. This also allows nursing home facilities to more appropriately assess the resident’s progress and/or decline as it relates to the type of device used and whether a different type of device (or no device at all) is needed.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
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| Depression and Anxiety: |
- All residents are screened for depression within 7 days of admission. Untreated depression can lead to functional decline and serious medical problems such as cognitive impairment, life-threatening malnutrition, weight loss and psychological distress. Screening nursing home residents within 7 days of their admission is an excellent practice in managing depression from the beginning of care delivery.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
- For those residents with depressive symptoms, a process is in place to re-evaluate the effectiveness of interventions within 2 weeks of the initial depression screening. It is important to determine whether or not a chosen treatment method has been effective so alternative approaches can be implemented.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
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| Pressure Ulcers: |
- All residents have a full skin assessment within 24 hours of their admission. This is especially critical for those residents at risk for pressure ulcers as skin can break down quickly. The level of one's risk should be determined upon admission so that interventions can be put into place immediately.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
- For residents who are admitted with a pressure ulcer, a treatment plan is developed and is consistently implemented as written. It is important to have an effective treatment plan in place for the prevention and treatment of pressure ulcers. It is equally as important that the treatment plan be consistently implemented and well documented specifically as the plan was written. The prevention of pressure ulcers involves many risk factors that need to be well managed.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
- In order to best detect new pressure ulcers, residents at risk of developing pressure ulcers have their skin inspected daily. Most pressure ulcers are preventable and so a thorough assessment every 24 hours is necessary for effective prevention. The most effective way to treat pressure ulcers is to prevent them in the first place.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
- The care plans for those residents at risk of developing pressure ulcers incorporate interventions that address each of the residents' risk factors. A thorough assessment of the risk factors associated with each resident is an effective way to prevent their occurrence. Pressure ulcers are associated with a large number of clinical factors that require the appropriate attention in the care plan.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
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| Pain Management: |
- New residents are screened for pain within 24 hours of admission. This quality marker is an important first step to manage pain from the beginning of care. Unrelieved pain has a significant negative impact on all aspects of the quality of life and contributes to decline, depression, and social isolation and can lead to significant medical problems.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
- For those residents who report pain upon admission, the facility has a plan of care to address pain within 48 hours. Effective pain assessment and management are key factors in reducing the prevalence of pain in nursing home residents and managing the complications unrelieved pain instigates such as immobility, malnutrition, and weakness that can lead to falls.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
- Does the facility have non-drug therapies available and address these options in the care plan for residents who report pain? Non-medicinal methods of pain management can be very effective and include such things as aromatherapy, massage, laughter, and memory boxes. This type of treatment should address the resident's quality of life and be well documented in the residents care plan.
For a list of Nevada and Utah nursing homes who have implemented this marker of quality click here.
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Want to add your facility’s name to the list?
In Nevada, contact: Jackie Buttaccio at nursinghomenv@healthinsight.org or 702-385-9933
In Utah, contact: Juliana Preston at nursinghomeut@healthinsight.org or 801-892-0155
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