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QAPI Resources

Guidance for nursing home providers regarding access to resources (materials or websites) to support QAPI implementation.


Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: February 11, 2020

CMS strives to provide nursing home providers with access to resources (materials or websites) to support QAPI implementation. Use of these resources is not mandated by CMS for regulatory compliance nor will their use ensure regulatory compliance.

Guides to Quality

Implementing Change in Long-Term Care: A Practical Guide to Transformation
This resource was prepared by the Pioneer Network with a grant from the Commonwealth Fund. Although it deals with implementing culture change (not QAPI), it is a good resource on the change process. Click here to access Implementing Change in Long Term Care - Opens in a new window .

National Nursing Home Quality Care Collaborative Change Package
The National Nursing Home Quality Care Collaborative (NNHQCC) Change Package provides strategies, change concepts, and specific actionable items that nursing homes can choose for ideas to improve residents’ quality of life and care. The Change Package is intended for nursing homes participating in the National Nursing Home Quality Care Collaborative led by CMS and the Medicare Quality Improvement Organizations (QIOs), to improve care for the millions of nursing home residents across the country. The Change Package was developed from a series of ten site visits to nursing homes across the country, and the themes that emerged regarding how they approached quality and carried out their work. It focuses on the successful practices of high performing nursing homes. Click here to access The NNHQCC Change Package (PDF).

QAPI at a Glance
QAPI will take many nursing homes into a new realm in quality - a systematic, comprehensive, data-driven, proactive approach to performance management and improvement. This guide provides detailed information about the “nuts and bolts” of QAPI. We hope that QAPI at a Glance conveys a true sense of QAPI’s exciting possibilities. Your QAPI results are generated from your own experiences, priority-setting, and team spirit. Click here to access QAPI at a Glance (PDF).

QAPI Written Plan How-To Guide
Beginning on November 28, 2017, nursing homes will be required to present their written QAPI plans to State and/or Federal Surveyors.  The QAPI plan is the written plan containing the process that will guide the nursing home's efforts in assuring care and services are maintained at acceptable levels of performance, and continually improved.  This guide was developed by Lake Superior Quality Innovation Network to assist nursing homes in creating their QAPI plan.  Click here to access the QAPI Written Plan How-To Guide. (PDF)

Useful Websites

Agency for Healthcare Research and Quality (AHRQ)
TeamSTEPPS for Long-Term Care - The Department of Defense and the Agency for Healthcare Research and Quality developed the TeamSTEPPS program to optimize performance among teams of healthcare professionals and improve collaboration and communication. The Long-Term Care version addresses issues specific to nursing homes. Click here to access TeamSTEPPS Tools - Opens in a new window .

Department of Veterans Affairs
The National Center for Patient Safety supports and leads the patient safety activities for all VA medical centers and has developed tools including Root Cause Analysis investigations. Click here to access Patient Safety Tools.

Donna’s Diary
Donna’s Diary is an interactive website for nursing homes to support learning about quality improvement and to enhance the quality of life for nursing home residents and staff. The entries in this fictitious diary of a director of nursing (DON) represent realistic case studies about the challenges nursing homes face. The solutions posed are based on best practices using QAPI principles. The website was created and is operated by Stratis Health. Click here to access Donna’s Diary.

Lean Goddess Video Series
This series of videos teaches quality improvement by applying quality strategies to everyday situations. This material was prepared by The Colorado Foundation for Medical Care (CFMC), the Learning and Action Network National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services (CMS). Click here to access the Lean Goddess Video Series (PDF).

Model for Improvement
The Institute for Health Care Improvement uses the Model for Improvement as the framework to guide improvement work. This model, developed by Associates in Process Improvement, is a simple, yet powerful tool for accelerating improvement. Learn about the fundamentals of the Model for Improvement and testing changes on a small scale using Plan-Do-Study-Act (PDSA). Click here for to access the IHI website.

National Nursing Home Quality Improvement Campaign
The NNHQI Campaign provides long term care providers and quality improvement professionals with free, easy access to evidence-based and model-practice resources. Tracking tools, customizable graphic displays, and live help desk are available to support your data-driven quality improvement project. Click here to access the National Nursing Home Quality Improvement Campaign.

Quality Improvement Organizations
Each state is served by a Quality Improvement Organization that offers resources and tools for nursing homes. Click here to find your Quality Improvement Organization.

Topic-Specific Resources

Adverse Events

CMS has compiled a listing of resources that may be helpful to nursing homes in identifying and preventing adverse events.

Click here to access Adverse Events Resources.

Change in Condition

Interact II
An example of a more extensive set of tools, INTERACT II is a system of tools to improve how nursing home caregivers communicate around change in resident condition. This comprehensive set of tools could be considered a QAPI process toolkit as well. Click here to access INTERACT II.

Infection Control

Agency for Healthcare Research and Quality (AHRQ)
AHRQ’s Nursing Home Antimicrobial Stewardship Guide is a field-tested and research-based resource that can help nursing homes improve antibiotic use and decrease the harms caused by inappropriate prescribing. This web-based guide provides facilities with tools to start, monitor and maintain an antibiotic stewardship program to include determining whether a potential infection should be treated and how to choose and appropriate antibiotic. Click here to access the Nursing Home Antimicrobial Stewardship Guide.

The Centers for Disease Control and Prevention (CDC)

The Core Elements of Antibiotic Stewardship for Nursing Homes
The Core Elements of Antibiotic Stewardship for Nursing Homes contains practical ways to initiate or expand antibiotic stewardship activities in nursing homes. Nursing homes are encouraged to work in a step-wise fashion, implementing one or two activities to start and gradually adding new strategies from each element over time. Any action taken to improve antibiotic use is expected to reduce adverse events, prevent emergence of resistance, and lead to better outcomes for residents in this setting. Click here to access the CDC’s Core Elements of Antibiotic Stewardship for Nursing Homes.

Infection Control Assessment Tool for Long-term Care Facilities (LTCFs):

The CDC has developed a tool that is intended to assist in the assessment of infection control programs and practices in nursing homes and other long-term care facilities.

Click here to access the CDC’s Infection Control Assessment Tool for LTCFs.

National Healthcare Safety Network:
The CDC’s National Healthcare Safety Network (NHSN) provides nursing homes and other long term care facilities with a customized system to track infections and infection and control practices such as hand hygiene in a streamlined and standardized way. When facilities track infections, they can identify opportunities for prevention and monitor progress toward stopping infections. On the national level, data entered into NHSN by long term care facilities will help define the burden of infections in this setting and gauge progress toward national infection prevention goals. Click here for more information on tracking infections using NHSN.

Nursing Homes and Assisted Living-Infection Control Resources
This CDC webpage includes guidance documents and web links to resources on the common infections that occur in long-term care facilities (e.g., Clostridium difficile and urinary tract infections) and how to prevent them for clinical staff and residents. Click here for more information.

Quality Improvement Organizations' (QIO) Nursing Home Training Sessions
This CMS sponsored website provides training tools and resources to implement antibiotic stewardship and prevent Clostridium difficile infections in residents.  This resource provides nursing contact hours for continuing education. Click here to access the QIO training sessions.

Person Centered Care

Picker Institute Publications
These publications include a Long-Term Care Improvement Guide, commissioned in 2010 and a Patient-Centered Care Improvement Guide, commissioned in 2008, both by Susan Frampton and others. The website also carries information on current books related to person centered care that the Picker Institute recommends. Click here to access Picker Institute Publications.

Pressure Ulcers

Agency for Healthcare Research and Quality (AHRQ)
AHRQ developed On-Time Pressure Ulcer Prevention (OTPP) to be an evidence-based program for nursing homes who currently use electronic medical records (EMRs). This program shows how to use reports generated from a nursing home’s own EMR to help identify residents who are at risk for pressure ulcers. Nursing homes can choose the reports they want to implement into day-to-day practice. The program provides a self-assessment of current practices, a menu of implementation strategies, and facilitator training materials. The program’s tools encourage multi-disciplinary communication to assess a resident’s changing risk factors, modify care plan interventions, and engage in root cause analysis when a pressure ulcer occurs or worsens. OTPP is a data-driven, proactive approach to improving the quality of life, care, and services in nursing homes. Click here to access the On-Time Pressure Ulcer Prevention program.

Note: References to non-CMS sources or sites on the Internet are provided as a service and do not constitute or imply endorsement of these organizations or their programs by CMS or the U.S. Department of Health and Human Services. CMS is not responsible for the content or accessibility of pages found at these sites. URL addresses were current as of the date of this publication.

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.