Excellence in Action: Playing an Active Role in Improving Quality Measures!

Providing quality patient care in skilled nursing facilities has proven to be a daunting task in the midst of COVID-19 protocols. Restrictions on resident activities have meant limited interaction with peers, thus increasing depression and responsive behaviors. Additionally, patients’ inability to leave their rooms has contributed to significant declines in mobility and ADL performance. Limited staffing and the lack of communal dining has negatively affected the implementation of feeding interventions, resulting in increased weight loss, dehydration, and malnutrition in patients.  There’s no question that COVID-19 restrictions have impacted patients physically, cognitively, and psychosocially. Quality Measures (QMs) are reflecting this nationwide. In TMC facilities, however, we are seeing just the opposite.

While QM-related deficits are on the rise nationally, they are steadily decreasing in TMC facilities.  This is due to the diligence, creativity, and outside-the-box interventions provided by TMC therapists. It hasn’t been easy, but we have remained positive and encouraging during this unprecedented time. Our Thibodaux team, for instance – including Lajuana, Melanie, Gabby, Maci, and Lauren – joined forces with the staff at their facility to overcome the challenges of COVID-19, and doing so is making a positive difference in the lives of their residents.

To address weight loss, our Thibodaux, LA team collaborated with their facility’s Dietary Manager, who gave them a variety of snacks, dietary supplements, and beverages such as Gatorade and water to keep readily available in the therapy office.  Any time a resident receives therapy, the team offers the patient a snack and something to drink.  In doing this simple but thoughtful task, they found that just about every resident would accept the offer. This small action has helped decrease their facility’s unexpected weight loss and has also helped maintain residents’ hydration. The team continues to confer with the Dietary Manager regularly to make sure their snack/drink supply remains stocked.  Allison, their Area Manager, also purchased some popsicles and a variety of frozen snacks for them to offer, as well. 

As an additional strategy to address weight loss, they, and many of our Louisiana teams, implemented “doorway dining” – an intervention that encourages residents to eat their meals while sitting up in their wheelchairs in the doorway of their rooms.  This has allowed for residents to maintain interpersonal interaction, while maintaining 6 feet of social distancing. This also allows for staff and therapists to monitor intake, swallow function, and self-feeding abilities for residents who require supervision at meals. 

In addition, our Thibodaux team collaborated with the facility’s CNA supervisor to develop a communication system between therapy and the CNA staff. This system helps our therapists and the nursing staff communicate the residents’ needs based on their cognitive level.  To address the resident’s communication of cognitive leveling and self-feeding needs, the team implemented what they called a  “Peek-a-boo Chart,” in which the therapy team laminated color-coded cardstock according to Cognitive level: Red for End- and Late-Stages (Total Assistance needed at meals) – yellow for middle stage (requiring some assistance/encouragement and cueing), and green for early stage (independent to supervision level).  On the colored cardstock, the team made a list of residents who were functioning on each level, and placed required adaptive devices behind each color to protect patient privacy.  

For a combined intervention to address falls and urinary incontinence (UI), the TMC team implemented an intervention using bright colored duct tape to assist low-vision residents in locating the restroom. One particular resident was having trouble remembering where the restroom was after numerous room changes. He would often relieve himself in different places throughout his room thinking he had found the restroom.  Eventually, our team realized that he was able to see bright colors after slowly scanning his surroundings. To assist the resident in finding the restroom, they placed brightly colored duct tape on the floor, starting from the side of his bed where he typically sits, and ending in the restroom.

Since incorporating this method, the resident has not had any falls, nor has he had any incontinence episodes or confusion. All of these interventions are working together to improve the quality of care provided to the residents we serve, truly making a difference in their lives.

The Thibodaux, LA team actively demonstrates the TMC Experience by providing next-level service to our customers.  We are so proud of them, and all our teams who focus on the active role they play in their facility. They are making a difference every day.  ALL IN!