The traditional approach to monitoring care quality is informal and the primary tools employed are non-specific and subjective care observations or satisfaction surveys completed by family members. Often, the satisfaction surveys lack specificity, yielding little or no detail that may be translated for quality improvement purposes.
The Abe’s Garden approach implements standardized observation forms and schedules used by supervisors, to monitor care quality. A minimum of two independent observations per year are conducted by internal staff and Vanderbilt researchers to assure data accuracy.
An example of these quality monitoring observations is the amount of time each resident spends in bed each day versus participating in meaningful social or physical activities. These observations also allow supervisors to monitor the quality of the interaction between various types of staff and the residents.
Other quality monitoring observations are whether or not staff members are interacting with residents in a dignified manner, and providing adequate stimulation to prevent cognitive and emotional decline, and providing residents choices during daily care provision.
Levels of engagement and affect (looking for extremes in both positive and negative affect) during activities are used as a program evaluation. Engagement therapists systematically record assessments of resident participation during engagement groups.
Vision and Objectives of Program Evaluation and CQI
Abe’s Garden is implementing the program evaluation and CQI model developed by the Vanderbilt Center for Quality Aging. This evaluation process is necessary to achieve the following goals:
- Generate quality outcome data
- Compare Abe’s Garden outcome measures to outcome measures from other dementia residential and respite communities
- Identify Abe’s Garden features that are successful
- Identify Abe’s Garden features that need improvement
- Identify systematic problems at Abe’s Garden that need to be addressed through a CQI process
- Develop interventions for individual Abe’s Garden residents
- Generate a transparent and objective methodology that can be shared with consumers and resident members
Outcome data is generated in the following ways:
- Direct observations of residents’ and staff behaviors
- Direct observations on the staff training topic of the week
- Direct observations during ADL care
- Direct observations of specific Abe’s Garden residents with behavioral or ADL problems requiring intervention
- Use of standardized tests to assess physical, cognitive and emotional status
- Implementation of interviews and satisfaction surveys that use open-ended questions as well as some traditional satisfaction survey questions that provide global satisfaction data.
- Implementation of interviews and satisfaction surveys that use open-ended questions, as well as some traditional satisfaction survey questions that provide global satisfaction data.
Outcomes That Are Measured:
- Resident engagement and resident affect during activities (observational data including enjoyment and stress)
- Staff/resident interactions during ADL care (observational data)
- Empathic staff behaviors while interacting with residents (observational data)
- Employee turnover
- Average number of medications used by residents
- Average number of psychotropics used by residents
- Average number of psychotropic PRNs (prescribed)
- Cognitive functioning
- Average number of residents who fall per month
- Number of fractures per month
- Number of residents per month with significant weight loss
- Numbers of residents per month with skin breakdowns
- Number of residents per month with infections
- Number of residents on hospice
- Number of residents who are discharged to a higher level of care
- Unanticipated declines in ADLs
- Number of ADLs that resident can perform independently
- Number of residents with improvements in ambulation
- Number of residents with incontinence
- Number of residents with decreased incontinence
- Family satisfaction surveys (written and verbal open-ended questions)
- Resident satisfaction surveys (written and verbal open-ended questions)
- Average number of life engagement activities per day
Structured observations foster accuracy and illumination of aspects of care in need of improvement and additional research.
Vanderbilt Center for Quality Aging staff utilizes this information for related research endeavors.
To monitor satisfaction, small groups of residents and families engage in direct interviews with care partners each month. Interviews focus on identifying care preferences and whether or not these preferences are being met, as well as specific aspects of care the resident or family would like to see addressed in an alternate manner.
Interview questions are open-ended and designed to elicit suggestions for improvement, i.e., “If you could change something about the meal service, what would it be?