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May 2018 Excerpt

Congrats to the first facilities to earn a Diamond Quality Gem!
issaquah team
Issaquah Nursing & Rehabilitation Center's Laura Hokenson, LPN and Lisa Stubenrauch, RN-BC BSN CDONA/LTC RAC-CT NHA receive their Diamond from Qualis Health's Jeff West, MPH RN and Paula Parsons.(Enlarge photo.)
sunshine team
Several members of Sunshine Health & Rehab's team stand next to their award certificate. (Enlarge photo.)
From left to right: Jason Priebe, Therapy Director; Mena Riffle, RN MDS; Kathy Bleam, Infection Control/Staff Development; Donna Goodwin,COO; Kimberly Winkler, RN, DNS; Annette Barfield, MSW
We are proud to announce that Issaquah Nursing & Rehabilitation Center (located in Issaquah, WA) and Sunshine Health & Rehab (located in Spokane Valley, WA) are the first NHQCC teams to reach the Diamond level for Quality Gems. This award reflects several years of hard work.
When asked about their achievement, both organizations stressed:
  • The importance of ensuring that quality improvement teams are interdisciplinary
  • The value of attending the NHQCC in-person events
Kimberly Winkler, RN, the Director of Nursing at Sunshine Health & Rehab said about interdisciplinary teams: "Everyone brings their unique perspective, which can help us identify things we might otherwise miss."
For example, their activities assistant noted that she could better help prevent falls if information about each resident's ability to self-transfer was readily available in the activity room (instead of just documented in a centralized care plan). Now, that information is posted in the activity room and staff there can quickly confirm whether the resident should stand on their own, receive assistance getting out of their wheelchair, or remain seated for a particular activity.
Lisa Stubenrauch, RN-BC BSN CDONA/LTC RAC-CT NHA, the Administrator at Issaquah Nursing & Rehabilitation Center, said of the NHQCC events, "We make sure someone goes to every in-person meeting. We always get ideas and learn from others. It's a very personable way to get information."
For example, they heard about another facility that used "Food for Feedback" to generate ideas and insight. (Similar to this event.) The Issaquah team invited residents, families, and staff to a barbeque—with one catch: attendees needed to complete a falls-related survey to get their meal. "We learned about inconsistencies in rounding," Stubenrauch described, which provided insight into their knowledge that there was a trend of falls occurring at the beginning of shifts. The team worked to streamline the start-of-shift reporting and scheduling so that all the CNAs now start their rounds within 8 minutes of coming on duty.
Stubenrauch noted that they all have a competitive streak, which can help bring fun into their work. "We started a "Least Falls by Hall" competition with results posted on a big calendar," she said. At staff meetings, they award a trophy to the winning team, which they get to keep for a month.
Passion also makes a difference, explained Jenn Daley, RN CWON CDONA/LTC, Issaquah's Director of Nursing. Once she started seeing improvement in residents' quality of life when the facility started a structured effort to reduce antipsychotics use, she got excited. For example, Christin Brockway, Certfied Activity Director, runs trials of various sensory stimulation techniques (lighting, music, hand massage, etc.) with the residents. "Citrus aromatherapy is a popular one," she noted. Daley chimed in, "I wanted to see how many residents could have that awakening. How far could we go?" She is working with one resident at a time, testing the effects of taking him or her off antipsychotics. Daley continued,"If someone has a passion about something, they can be a driver. They will want to keep going, get everyone involved, and see the improvements add up."
It's not always easy to create change, of course. At Sunshine Health & Rehab, they use a fun technique to help each other. At one of their QAPI meetings, Winkler brought hard hats for everyone and "hazards of progress" cones that were labeled with phrases such as "But we've always done it this way," and "I hate change." "It's become an ongoing joke," Winkler reports. "We call each other out for getting tripped up on these now."
Winkler admits that when the QAPI team started, they really didn't understand root cause analysis and first applied "band-aid" solutions that were quick to implement but not successful over the long term. But once they really understood how to dig deeper and use the fishbone diagram, "I stopped being so stressed because it really works!" she said. "Now it's just how we do all our projects."
One new initiative at Sunshine Health & Rehab is the result of some of this root-cause thinking. Wanting to reduce their 30-day rehospitalization rate and improve satisfaction with discharge, they realized that one contributing factor was not always having a good fit with an incoming patient—which was compounded by a slow response time in getting pertinent details from the hospital. Starting this month, they will have an Outreach Coordinator going to the hospital on a regular basis and meeting with patients who are scheduled to be discharged soon. The Coordinator will speak with the patients (and their families) and discuss whether they can meet their needs. "We will be able to make faster decisions, and the whole process will be much smoother for families," Winkler said.
Clearly, both Issaquah Nursing & Rehabilitation Center and Sunshine Health & Rehab have found successful methods to identify problems, test solutions, and keep motivated along the way. How will your facility follow their lead toward a Diamond?