Browsing "QAPI"

QAPI – Entry 3

Dear Diary,

I went to a conference session recently on quality assurance and performance improvement (QAPI). Other homes shared what they’re doing and I feel like we’re already doing a lot of the same things. Yes! I know we can further develop our QAPI plan too. Using the Guide for Developing a QAPI Plan, we have started writing our plan, taking one section at a time. It’s going slow, but we’re having really good discussions among our leadership team and staff.

For Step 1 QAPI Goals, we started by reviewing our vision and mission statements. Our mission: “to preserve and enhance the quality of life of those we serve by promoting individuality, independence, and choice for everyone.” Our vision: “to improve the quality of life for those we serve.” We feel it’s important to have our mission statement and values known by everyone who enters our door. We have more work to do in this area.

The next step is to describe how QAPI supports our vision and mission. We talked a lot about how QAPI can support our mission of promoting individuality and choice. We came up with:

The purpose of QAPI at Riverview Rehabilitation and Care Center is to take a proactive approach in the way we care for and engage our residents, caregivers, and other partners so that we might realize our vision of improving the lives of those we touch.”

We always must think about the residents and how everything we do should contribute to improving their lives. All of us have to participate in QAPI efforts which promote resident individuality, independence, and choice. We had a great discussion about how our quality improvement efforts should have our vision and mission in the forefront.

I’m proud of the QAPI goals we came up with. For example, we all agreed being serious about improving the lives of all we touch means QAPI must include all employees, all departments, and all services we provide. One of our goals is to hold monthly QAPI meetings that include at least one representative from each department. We also are asking for residents and family members who are interested in participating.

I think we have a great start. Developing the QAPI plan seems overwhelming, but breaking it down into steps is helping. Our next step will be to define the scope of QAPI. I am excited to see what our team members come up with for this one. I wonder what other homes are doing to implement QAPI?

Signed, Donna


  • I agree that there is always improvement to be had. We continue to struggle with using QAPI as a discussion platform, but have made small strides in that direction. What we decided recently is to review our QAPI data monthly, auditing, implementing committees, etc. with our quarterly QAPI meeting setting goals, action plan, etc. Our biggest hurdle always is time!

    • Yes, agree that time is a big factor. Everyone wears many hats now at our facilities, especially if you are in a smaller home. Also, coming up with ways to educate new staff members (as that is ongoing) on QAPI. We need to come up with a good education tool for orientation!

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QAPI – Entry 2

Dear Diary:

We talked about Quality Assurance and Performance Improvement (QAPI) at our leadership meeting today. Some of the managers seemed on board and some didn’t. I talked about quality and how it wasn’t just the nursing department’s issue. I showed the video by Alice Bonner on the CMS website and distributed copies of “QAPI at a Glance”. I asked them to review it before our next meeting. Our administrator, Dan, suggested we have a discussion at our next meeting about what quality means in our home and what we want for our residents and staff. We’re going to review our mission and values and see how QAPI fits in. We also plan on completing the QAPI Self Assessment as a team. I imagine that will help guide our next steps and lead to more discussion.

This is exciting. I hope everyone can understand the importance of quality improvement being everyone’s responsibility and get on board. It will make such a difference to our residents if we can have a united front to make improvements continuous and their lives better. I’d also like to get that five star rating back!

I wonder how other homes are incorporating QAPI into their daily work?

Signed, Donna

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QAPI – Entry 1

Dear Diary:

I’ve been to several presentations on the new QAPI changes coming to nursing homes. The information I’ve been collecting is becoming quite the pile on my desk. I recently went to one presentation that emphasized our need to start discussing and implementing QAPI concepts before the regulation is final. I’ve been looking at the CMS website and reading what I can on QAPI, including that pile on my desk. It’s finally making some sense.

I understand quality assurance, which I think we do pretty well at River View. I have to admit that sometimes we collect data and report it at our QA meetings and it doesn’t seem to mean much. We don’t do a lot of benchmarking or even identifying goals in some areas. I can see that we’ll have to look at the data we’re collecting  and if it makes sense to continue collecting it for our home.

We do problem solve as a team when issues come up, but sometimes the same issues come up every couple of months. Information from the seminar I attended tells me that an issue keeps coming up because we didn’t get to the root cause, or we didn’t develop a system to really keep it from happening again. I guess I’ve contributed to issues happening again because I’ve supported the quick fix, versus looking at everything that contributes to an issue.

This is going to take some work! “QAPI at a Glance” also talks about everyone on staff having responsibility for quality improvement and being involved. How are we going to make that happen? I wonder what other homes are doing to get ready for QAPI?

Signed, Donna


  • We are also trying to put this all together and figuring out how we are going to implement this.

  • Our facility had an inservice and we did a short presentation on
    ATTAX, QAPI, PIPP, MAPS. A poster was made and each area has a seperated colored sheet explaining what it means. A bottom poster was done which we put The Common Aim of all of the above which we put as
    (Applying systems and culture change necessary to improve Safety and Quality through TEAMWORK!). Above this poster is a umbrella which is written on with Under the umbrella of Achieving Excellance.

    We also changed the name of our QAA committee to be called QAPI and have tweaked the meeting.

    Goal: Everyone is to know, be involved and committ to Quality Care.

    Hope it works!!!

    • I have been racking my brain trying to figure out a good way to involve all staff with QAPI. Reading your comment of how you involved everyone in such a unique way was great. I now have a better understanding of how I am going to inform everyone about our current projects with QAPI, MAPS, and PIPP. Thanks!

  • We have incorporated QAPI information and our facility goals for QAPI into our new employee orientatation and our annual inservice for all staff. We have more training to do and will be discussing more at our next QA meeting.

  • We continue to work towards QAPI integration as well, I think that including the entire staff will be our major challange. We are working to educaate staff on QAPI. We are certainly in a state of continuous improvement!

  • We have been warming the soil with staff by using using QAPI and PIPP language. On a larger level we are meeting with a group of 8 homes to write QAPI metrics and policy. Individually, we have several sub committees consisting of management, front line, and residents. We are considering QAPI buttons that say, “Show me the data” Continuous process improvement.

  • Interestingly enough we have been doing QAPI for awhile so it is not a new concept but many staff think it is. It is all about educating and getting the word out. I too like the ideas presented by Shawn. We will be looking at those ideas as well. Thank you!

  • I struggle with getting front line staff members involved. They do not like to attend meetings and getting them to understand QAPI takes time. They are very involved with our PIPP grant and can understand how that is improving their work load and the residents quality of life – now I need to move forward into the other aspects of QAPI.

  • We have started re-vampingour processes into trying to look at tackling individual issues as short-term projects to work on. This will be better than just selecting areas to audit and just continually collecting data.

    I think by just doing small focus projects and fixing these issues one at a time that staff will buy into the process more and take some ownership into improving quality. Much easier to get their arms around this process with this type of approach instead of just sharing results of audits and not involving front-line people at the beginning.

  • We have had meetings with the Licensed Staff to educate them on QAPI and the areas that our facility has elected to work on. We then scheduled meetings with front line staff with our ideas and asked for their input as well. Continued education is needed with all.

  • AHC team has instituted 2 QAPI projects as our trial leading up to implementation. I will discuss one of them here. We started this about a year ago. We started small with our first performance improvement project which was Pressure Ulcer Prevention. We started on our ventilator dependent unit and selected our highest risk residents (15 of them from that unit) to be in the QAPI: Pressure Ulcer Prevention. AHC has the most at risk long term care residents in our state. Many of our residents have been here for years. We are “QAPI Squad” here at AHC because we initiated the process! We have extended the QAPI to the other nursing units at AHC. All of our RN Managers are trained & participating in QAPI. We are spreading the word! QAPI is for everyone!! When we first started, we did so by asking our RN manager on the vent unit to ask the CNA staff to select their Unit CNA QAPI leaders!! We had one CNA on each shift & rotation to “lead QAPI & our Pressure Ulcer Prevention!” They now owned this project. They made posters, trialed skin care products on this group of residents, & did an outstanding job! We have had some turnover and the staff have changed but we have to continually teach & preach prevention & rejuvinate our QAPI plan but we have had consistent RN & LPN staff which helps tremendously. Our rehab team is a huge part of our success. Our PT is a great go to resource! We have a Skin Team Nurse & CNA. They teach new CNAs in orientation about positioning & skin care. The CNAs are our front line LEADERS!! I contribute our success with QAPI to them! Most recently our QAPI Squad has started a fundraiser project (QAPI t-shirt sales). This fund will be used to reward high performing units on the QAPI projects. Additionally, we had a QAPI Fun Day to promote QAPI. We had door prizes & drawings & all of this to raise enthusiasm & promote QAPI. It was quite successful and we plan another QAPI Fun Day to catch the opposite shift rotation!
    I wanted to share! I hope this will be helpful to some of you! Please feel free to e mail me if I can answer any questions or help you in any way!

    • Hi Melba,

      If you’d be willing to share your QAPI Fun Day agenda and or resources that would be much appreciated!


Share your nursing home perspective on this quality improvement issue.