"Quality is never an accident it's always the result of high intention, sincere effort, intelligent direction, skillful execution, and it represents the wise choice of many alternatives," Wila Foster, Philosopher.
The Quality Indicator Survey (QIS) has been 15 years in the planning and is being developed by Centers for Medicare/Medicaid Services (CMS). California is scheduled to start the QIS process between June 2013-2014. The QIS process was developed to provide greater consistency and objectivity to the survey process. It is based on resident-centered care and determines what the resident's expectations are and if they are being met by the care being given.
There are two stages to the QIS process. Stage 1 is the preliminary stage where 40 residents/family members will be interviewed. 37% of all triggers will come from the interview process. The response to the interview questions will trigger further investigation and stage 2 will be started with the critical element pathway investigation implemented on 3 residents. When the critical elements are not met, citations are written under the specific F-tags.
The goal of the QIS process is for the community staff to build a relationship with the residents so that staff are like their family. The regulations aren't changing; what is changing is the way the regulations are enforced. Two new tags that will come with the QIS process will be F-242 which focuses on self determination and the resident's right to make choices. For example: Is the resident involved in choosing foods? How does the staff respond to meals being refused? Are residents offered fluids of choice between meals? F-252 focuses on the facility providing a home like environment and is all about the integration of culture change with resident choice and dignity.
Observation, interviews, kitchen tour, chart review will all be forms of data-gathering in a QIS survey. It's all about the relationship with the resident and if the community meets their needs and expectations by the care that is provided.
Nutrition care practices will be reviewed such as documentation by nursing of supplement intake and consistent weight documentation systems.
For the dietary department, this is the kind of focus we can be very successful with. But we will need to evaluate our service and bring it to the "home-like" environment we would like to provide for our parents and grandparents.
