Louisiana success stories

LA Success Stories
Quality improvement endeavors can often feel overwhelming, but chances are, you can learn from the experiences that another physician, hospital or nursing home has had in a similar situation. Coupled with support from Quality Insights Quality Innovation Network, learning what has worked for others — and what didn't — is a valuable strategic planning component. 

We encourage you to read the success stories, contact us for more information, and also let us know if you have a Quality Insights' success story to share.

The Olive Branch Senior Care Center Unties Restraints

The leadership at The Olive Branch Senior Care Center in Tallulah, Louisiana has always been proactive to improve the lives of their residents.  They have embraced culture change, increasing the choice of dining and waking for the elders they serve.  However, The Olive Branch is also acutely aware that improvement must encompass all areas, including their public reported measure on Nursing Home Compare.  A quick glance showed them that their restraint rate was higher than the state and national average, and the decision was an easy one to initiate the hard work of improvement.
Linda Frith, the administrator of The Olive Branch, had attended eQHealth Solutions’, the Quality Improvement Organization (QIO) for Louisiana, Regional Workshop held on October 9, 2013. Once she realized her restraint rate numbers had lost the improvement they had enjoyed for months, she knew immediately the tools she would depend on to guide her through the improvement process once again.  At that regional workshop, the QIO had provided Linda a Quality Assurance/Performance Improvement (QAPI) toolkit that was a step-by-step guide for performance improvement projects (PIP).  Linda realized she had all the tools at her disposal to start improving, and that she needed to begin quickly. 

Linda reached out to her Quality Improvement Specialist (QIS), Julie Kueker to help with that first PIP meeting. Julie met with the entire team in December 2013, to start work on their QAPI plan and projects.  At that first meeting, the team realized sadly, that their restraint rate was 6.6%.  They had enjoyed a restraint rate for so many years that was at or near 3%, and they assumed the project was on auto-pilot. They also assumed they no longer needed to monitor those rates.  At the first meeting, Julie explained that once they reached their goals, that a sustainability plan was a must.  If they follow that plan, their project’s improvement would make it easier to sustain the gains.

The first meeting was a long one.  The multi-disciplinary team of 11 came eager to learn and they were full of questions. Since not all members of the team were at the regional workshop, we began a ground floor review of the quality principles that would be necessary to achieve a fast-track to improvements.  The PDSA cycle was emphasized, as were the techniques to perform a good Root Cause Analysis (RCA).  Julie taught the fishbone technique and the possible contributing factors behind the high restraint rate were explored and captured for future use. Julie also taught them how to develop their goal statement, how to write their business problem, and what data sources are best to track improvement to their desired process/outcome measures. 

The team took all-hands on deck approach, which incorporated representatives from CNA supervisors, environmental staff, MDS coordinators, social work, physical therapy, and leadership including the DON and administrator. They recognized that restraint reduction would mean that their focus would be studying the resident from all angles to be able to develop a plan for a restraint alternative. They wanted all staff who have the opportunity to interact with the resident at any part of the day to participate in this project.  Through the course of this first meeting, the team studied a resource provided by Julie, entitled “Seating Ideas for Nursing Home Residents”.  This booklet provided a variety of solutions for proper seating in wheelchairs using devices when necessary, and adjusting the wheelchair for appropriate heights. 

The first meeting was buzzing with new ideas to try, many coming from this resource. A second meeting in January showed several pilot trials on devices and ideas which were discovered in the wheelchair seating booklet. Though some of these devices did not provide the results they were looking for, they recognized the need for piloting on a small scale first. The second meeting also established that three of the eight restraints had already been removed – they were on their way!

By the start of April 2014, the team had reported amazing results. They had reduced their restraint to 0% in four months! The team attributed this rapid success to the tools that encompass the PDSA process. Linda reports that, “we see the value of the QAPI approach, and we use the QIO PDSA tools and resources in all of our meetings now.” Julie returned in late April to educate the team on sustainability, and how to sustain their gains and not lose any ground on their hard work.  eQHealth Solutions stands proudly with The Olive Branch Senior Center in their complete adoption of a quality framework that is effective. 

The future is bright for Olive Branch as they now have the confidence to initiate new projects and know that with hard work, they can achieve their quality goals.  Their next PIP is on the reduction of the unnecessary use of antipsychotics.  Linda states that “we are working collaboratively with our pharmacy consultant and Nurse Practitioner who are both pleased with their quality progress”.  Given the fact of The Olive Branch’s adoption of the QAPI process, this is not surprising at all.