Abstract
Despite improvements in selected nursing facility (NF) quality measures such as reduction
in antipsychotic use; local, state, and national initiatives; and regulatory incentives,
the quality of clinical care delivered in this setting remains inconsistent. Herein,
recommendations for overcoming barriers to achieving consistent, high-quality clinical
outcomes in long-term (LTC) and post-acute care are provided to address inadequate
workforce, suboptimal culture and interprofessional teamwork, insufficiently evidence-based
processes of care, and poor adoption and fidelity of technology and integrated clinical
decision support. With high staff attrition rates in NFs, mechanisms to measure and
close knowledge gaps as well as opportunities for practice simulations should be available
to educate and ensure adoption of clinical quality standards on clinician hiring and
on an ongoing basis. Multipronged, integrated approaches are needed to further the
quest for sustainment of high clinical quality in NF care. In addition to setting
a tone for attainment of clinical quality, leadership should champion adoption of
practice standards, quality initiatives, and evidence-based guidelines. Maintaining
an optimal ratio of hours per resident per day of nurses and nurse aides can improve
quality outcomes and staff satisfaction. Clinicians must consistently and effectively
apply care processes that include recognition, problem definition, diagnosis, goal
identification, intervention, and monitoring resident progress. In order to do so
they must have rapid, easy access to necessary tools, including evidence-based standards,
algorithms, and care plans, during the care delivery process. Embedding such tools
into workflow of electronic health records has the potential to improve quality outcomes.
On a national and international level, quality standards should be developed by interprofessional
LTC experts committed to applying the highest levels of clinical evidence to improve
the care of older persons. The standards should be realistic and practical, and basic
principles of implementation science must be used to achieve the desired outcomes.
Keywords
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Article info
Footnotes
This work was supported in part by Think Research, Toronto, Ontario, Canada.
BZ and JO are consultants for Think Research, Toronto, Canada. There are no other relevant conflicts of interest.
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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
