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Long-Term Care Survey Alert

Best Practices:

Select The Best CPGs For Your Facility

Published on Wed Sep 24, 2003

These tips will put you on the right track.

You don't want to fix what isn't broken, right? So if you're in the market for implementing clinical practice guidelines - or re-evaluating your existing ones - first identify clinical areas that need improving in your facility.
 
There are a number of ways to do that, according to Jacqueline Vance, director of clinical affairs for the American Medical Directors Association, including:
 

  • Analyze your quality indicators (QIs). "Look at any QIs where the facility is over the 70th percentile or that have flagged in any area," Vance advises. Then figure out the potential reasons for the data.    "Remember that a particularly high percentage does not necessarily mean that a problem exists. It may just reflect the characteristics of your population, a potential problem or errors in data entry," Vance says. "So look for the reasons behind the numbers, not just the percentages."
     
  • Generate customized MDS reports. Look for residents with certain clinical conditions, such as pressure ulcers, infections or weight loss, on specific units, Vance suggests.
     
  • Ask your pharmacy consultant to provide reports on areas of clinical concern (e.g., how many residents are on multiple medications with anticholinergic or hypotensive properties) and attempt to relate these to falls, anorexia, changes in mental status, and functional decline.
     
  • Review your existing policies and practices related to prevention and clinical management. "For example, determine how well your staff addresses the key issues related to preventing and managing pressure ulcers," Vance advises.
     
    By analyzing your current outcomes and clinical practices, you'll have a good idea where to target CPGs.  "For example, if the facility shows a high number of patients with unplanned weight loss, staff may wish to review or implement a protocol such as the AMDA's Altered Nutritional Status Guideline," Vance suggests. Or if you have a high number of patients with nosocomial pressure ulcers, you may want to implement a pressure ulcer guideline (see the list of CPGs in "Guidelines Galore").
     
    The public National Guideline Clearing House (    www.guideline.gov) also has a number of CPGs developed by different organizations that speak to care in long-term care facilities, advises Jean Slutsky, acting director for the Agency for Healthcare Research & Quality's Center for Outcomes and Evidence. "For example, the Infectious Disease Society of America has a set on evaluation of fever and infection in such facilities," Slutsky reports.
     
    Tip: Identify guidelines on the NGC web site by using key search words or use the browse function for disease/condition, organizations or treatment/interventions. The Web site also provides instructions to help users compile their own collection of guidelines and perform a guideline comparison. 

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