1. QIS COMPLAINT PROCESS 101 Debora Barth, RN QIS/QR Supervisor September 13, 2012 dbarth@isdh.IN.gov

2. Complaints investigated over 2011: 1852 Complaints investigated in first six months of 2012: 1045 Old process – copies, paper, more paper, more paper!! New process – copies

3. Sample selection OLD PROCESSQIS PROCESS Tour Paper notes Compare notes to complaint – choose 3 residents for each area of complaint investigation ◦ Roster sample matrix Get side-tracked Initial tour Request lists Initiate care areas/F tags ▫Corresponding to complaint ▫Sample selection of 3 residents for each area STAY FOCUSED

4. CARE AREAS Abuse Abuse Prohibition Review Accidents Activities Activities of Daily Living, Cleanliness and Grooming Admission, Transfer, and Discharge Behavioral and Emotional Status Bowel Incontinence Choices Colostomy Communication and Sensory Problems Community Discharge Death Dental Status and Services Dialysis Dignity Dining Observation Environmental Observations Extended Survey Fecal Impaction Food Quality Foot Care General Critical Element Pathway Hearing Hospice and/or Palliative Care Hospitalization Hydration Illeostomy Infection Control and Immunization Review

5. CARE AREAS Infections (Non-UTI Related) Kitchen/Food Service Observation Liability Notices & Beneficiary Appeal Rights Review Medication Administration Observation Medication Storage Notification of Change Nutrition Pain Recognition and Management Parenteral Fluids Participation in Care Planning Personal Funds Review Personal Property Physical Restraints Positioning Preadmission Screening and Resident Review Pressure Ulcers Privacy Prosthesis Quality Assessment and Assurance Review Rehabilitation Resident Council President/Representative Interview Resident Room Respiratory Care Skin Conditions (non- pressure related) Social Services Sufficient Nursing Staff Review Tracheal Suctioning Tracheostomy Tube Feeding

6. CARE AREAS Unnecessary Medication Use Ureterostomy Urinary Catheter Use Urinary Incontinence Urinary Tract Infections Ventilator Vision Urinary Tract Infections Ventilator Vision

7. INVESTIGATION Conducted in Investigative Documentation screen Then copied on to the Clipboard and pasted into Citation Manager Corrected for Quality Review Pathways are provided for consistency Guidelines provide guidance for areas without pathways

8. CONCLUSION New process for complaint investigation Not CMS developed/approved Intended to provide more consistency in the investigative process Intended to promote more focused investigations.

9. Questions??? dbarth@isdh.IN.gov