Written by Jennifer Thew, RN
Forrest Gump was right when he said, "Life is like a box of chocolates. You never know what you're gonna get."
That was certainly my experience during my brief foray into hospice nursing. I'm not referring to the types of patients or their individual situations, but rather, the way care was delivered in different settings and organizations.
I could walk into one nursing home and it would be outfitted with electronic medical records. Two hours later, I'd be at different facility that was still using paper charts and a Kardex for medication scheduling.
In hospitals, the types of EMRs varied from facility to facility as did workflows and chains of command.
Who to page, how-to-page them, where to put the progress note, all differed. Processes and systems, at both acute and post-acute care facilities, varied so widely it was overwhelming.
This experience played through my mind as I talked with University of Missouri researchers Colleen Galambos, PhD, ACSW, LCSW, LCSWC, professor in the College of Human Environmental Sciences' School of Social Work and Gregory L. Alexander, RN, PhD, FAAN, professor in the Sinclair School of Nursing about a project they are involved with called the Missouri Quality Initiative for Nursing Homes.
MOQI, which was launched in 2012 under the leadership of the university's Marilyn Rantz, RN, PhD, FAAN, curators' professor emerita, is a partnership among MU, the Centers for Medicare & Medicaid Services, and state Medicaid programs to improve care at 16 nursing facilities in St. Louis.
As one can imagine, this no small project. Shifting the culture, processes, and systems at one facility can be a challenge. But 16 unique facilities?
"Everybody's starting in a different place," Galambos told me. "We have 16 different facilities with 16 various capabilities, and 16 cultures."
Factor in all the other stakeholders involved in nursing home resident's care—hospitals that admit and transfer residents, primary care providers, labs, hospice—and it truly becomes an enormous undertaking. But it's one that seems to be working.
Decreasing Avoidable Hospitalizations
Don't be fooled by the name of the program, the project doesn't just benefit nursing homes. It addresses issues of importance to hospitals and health systems as well.
The four main goals of MOQI, which is a four-year project slated to wrap up in September 2016, are to:
- Reduce potentially avoidable hospital transfers
- Decrease polypharmacy and antipsychotic medication use among nursing home residents
- Increase discussions on goals of care and completion of advance directives
- Introduce secure communications for electronic transfer of health information among healthcare providers, nursing homes, and hospitals
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