Improving the Quality of Care in Nursing Homes (1986) / Chapter Skim
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Appendix E: Key Indicators of Quality of Care
Appendix E: Key Indicators of Quality of Care
Pages 378-388
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From page 378... ...
Key indicators of inadequate care are prima facie evidence of a problem, but further investigation is required to determine whether the problem stems from bad care or from factors that are not within the facility's control. Key indicators can be used to distinguish between adequate and poor-quality care and between adequate and good or excellent care.
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From page 379... ...
Urinary Tract Infections. The development of infections among nursing home residents with indwelling urinary catheters may also be a sign of poor care.~6~20 One measure of quality, for purposes of comparing facility performance, would be the incidence of urinary tract infections among the residents in the facility who are catheterized.
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From page 380... ...
Examples of items include whether residents' hair and nails are clean and neat, whether they are dressed in their own clothing, whether the clothing is clean, and whether residents receive daily oral hygiene. In addition, the surveyors might observe whether call lights and other resident requests for assistance are promptly acknowledged, whether indwelling catheter tubes are clean, and whether catheter tubes and bags touch the floor.
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From page 381... ...
, the two most frequent diagnoses among nursing home residents are depression and intellectual impairment (organic brain syndrome, confusional states, dementia) .27 In the case of depression, the elderly are just as responsive to psychiatric treatment as younger people.28 Depression, demoralization, and social isolation have been measured and associated with social functioning,26 physical health status, premature mortality,29~32 and activity levels.33 Thus, greater attention should be paid to mental health aspects of care, including appropriate assessment and management techniques for mental and behavioral problems, and specialized activities programs.27 One possible indicator of quality in this domain is appropriate use of medications for this population, particularly for residents with depression.
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From page 382... ...
Activities and Social Participation. A variety of activities and choices among activities have been shown to be significant elements of residents' concepts of quality.38 Environmental circumstances, the availability of individualized activities, opportunities for social interaction and participation in activities inside and outside the nursing home that reduce social isolation are associated with improved mental and physical status 34-37.40 Quality of Life.
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From page 383... ...
, observing meal presentation (temperature and taste of food) , observing and interviewing residents regarding eating habits, need for assistive devices or staff assistance, food preferences, and investigating nursing staff levels and policies regarding food supplementation and nursing assistance in eating.
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From page 384... ...
. The extended survey would entail review of medical records and care planning procedures to determine whether medications are reconsidered monthly; review of drug interactions; investigation of the adequacy of pharmacy review: investigation of the extent of Medical Director involvement in the drug prescription process; investigation of nursing procedures regarding physician contacts; investigation of nursing oversight of medication complications; and investigation of the adequacy of care planning.
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From page 385... ...
1980. A Study of Anti-Psychotic Drug Use in Nursing Homes: Epidemiological Evidence Suggesting Misuse.
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From page 386... ...
1979. Medical Care Evaluation Studies in Long-Term Care Facilities.
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From page 387... ...
American Journal of Public Health 74(December)
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From page 388... ...
Medical Care 19(March)
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