west virginia success stories

WV Local 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 storyto share.

Quality Insights Affecting Positive Change in West Virginia Nursing Home Health Care

Quality Insights Quality Innovation Network, of which the West Virginia Medical Institute (WVMI) is a member, is leading the charge of affecting positive change in nursing home health care in West Virginia. Collaborations have been a key in finding success.
Historically, Quality Insights has seen success through its partnerships with local providers. Pam Meador and Sherry Foltz, both RN Project Coordinators, have helped numerous nursing homes meet health care quality improvement goals that include reducing the use of physical restraints and incidence of pressure ulcers, adverse drug events, and healthcare-acquired infections in patients. For example, more than half (62 out of 132) of the nursing homes in the state participated in the West Virginia Nursing Home Quality Care Collaborative (WVNHQCC) and actively worked to reduce healthcare-acquired conditions from 2011 through 2014.  Additionally, through the Nursing Home Collaborative Learning and Action Network (LAN) for high risk pressure ulcers and physical restraint reduction, staff and participating nursing homes decreased incidence of high-risk pressure ulcers in the long term care setting by 33.5 percent.
Nursing homes in West Virginia have been working to expand their Person-Centered Care approach for their residents, especially those individuals that have dementia.
As a result, Quality Insights teamed up with a host of other partners, including the West Virginia Alzheimer’s Association, to form the West Virginia Dementia Care Coalition (WVDCC) to decrease the inappropriate use of antipsychotics in the long term care setting.  The Coalition meets on a quarterly basis and is spearheaded by Quality Insights. Stakeholders include the West Virginia Healthcare Association, West Virginia Geriatric Education Center, the Ombudsman from the Legal Aide department of the West Virginia Bureau of Senior Services, the Alzheimer’s Association – West Virginia Chapter, and the West Virginia Office of Health Facility Licensure and Certification.   
“Our facilities are shifting their focus to person-centered care by utilizing the Quality Assurance Performance Improvement (QAPI) process,” Pam Meador, project coordinator for Quality Insights, said. “They’re in the beginning stages of using Root Cause Analysis and the Plan-Do-Study-Act cycle but are seeing the benefits of using these foundations.”
Meador and Foltz have conducted numerous provider visits, meeting with multidisciplinary teams and encouraging interventions with a proven record of success. These interventions included Root Cause Analysis (RCA), Plan-Do-Study-Act (PDSA), and Quality Assurance Performance Improvement (QAPI). They have also supplied partnering facilities with brochures aimed at educating families about the potential risks of giving antipsychotic medication to the elderly and have completed the “Hand-in-Hand” training series. Meador and Foltz also provided toolkits to facilities in three areas of the state, which were met with positive feedback, participation and interest for the future.  
As a result of Coalition efforts, West Virginia was able to reduce inappropriate use by 21.5 percent and improved its rank from 19th to 12th in the nation regarding the reduction of antipsychotic medication use for nursing home residents with dementia.  Quality insights also partnered with the Kendal Corporation to host dementia care workshops in Morgantown, Charleston and Beckley in 2014 as part of Coalition efforts.
Coalition members are also seeing many creative non-pharmacological approaches to care from nursing homes throughout the state.
“Pam and I have 20 years each in long-term care and some of the interventions we used came from this experience,” Foltz said. “We also use ideas and interventions from other facilities that have been successful in this reduction, as well as other Quality Improvement Organizations (QIOs.)  These interventions are shared with all of our providers and stakeholders.”
“We discussed the different levels of dementia, person-centered care, quality and quantity of staff, critical thinking, and the engagement of the resident or their representative,” Meador explained. “We also encouraged providers and their staff to assess for unmet needs of the dementia resident using the driven compromised model. We have been extremely impressed and inspired by some of the fantastic interventions our facilities are providing for our residents.” 
Meador explained how one facility had tried multiple interventions for a resident that was wandering at night. The facility discussed the situation with the resident’s family and realized she had slept in the same bed with her husband, who had recently passed away, for more than 50 years. Together, the family and staff decided to try using a body pillow sprayed with his cologne to place in the bed with her. The solution proved successful. 
Another innovative intervention occurred after a resident became extremely upset when family would leave after a visit. 
“The resident’s behavior became so upsetting that the family would often try to slip out while the resident was sleeping,” Meador explained. “After many other less successful intervention attempts, the facility purchased a photo album that included voice recordings. Staff placed some of the resident’s cherished photos in the album and had family members record a message after each photo. The result was overwhelmingly positive. Now, when the resident’s family leaves from a visit, a staff member will look through the album with the resident, talking and laughing while the resident enjoys the album and hearing loved ones’ voices.”

To learn more about the West Virginia Dementia Care Coalition or other nursing home quality improvement initiatives in West Virginia, please visit www.qualityinsights-qin.org or contact Pam Meador at pmeador@wvmi.org or (304) 346-9864 ext. 4216 or Sherry Foltz at sfoltz@wvmi.org or (304) 346-9864 ext. 3231.