State Nursing Home Quality Improvement Programs: Site Visit and Synthesis Report. Overview of the QAN Program


As noted above, QAN staff are responsible for a number of activities such as conducting surveys in addition to their role providing information exchange (technical assistance). The latter activity is referred to as "QANing" and is the heart of the state's unique program.

Each of the state's 31 QAN nurses is assigned a particular territory for the purpose of QANing; caseloads range from approximately 8-12 facilities, with variations dependent on the amount of travel involved. There is a formal expectation that QAN visits to each facility will occur approximately once each quarter, although, as discussed below, this frequency does not appear to have been met consistently in recent times. In most cases, QAN nurses do not perform surveys in their own territories (i.e., in the facilities for which they are responsible for QANing). However, QAN nurses may cite a facility for deficiencies during a QAN visit, although this would be rare and would be based on an egregious violation which resulted in significant resident harm that was observed or discovered as part of the QAN visit. Other duties such as casemix accuracy review are generally performed in a QAN nurses' own territory.

QAN nurses are survey-trained, and participate as survey team members a minimum of four times per year. According to information prepared by the state's Aging and Adult Services Administration, these are the expectations of the state's QANs:

  • All QANs are survey trained and participate as a survey team member at least four times each year.

  • QANs review clinically targeted resident samples with the goal of determining systems that have or are at risk of deficient failed practice.

  • QANs trend data, make assessments of potential outcomes/harm, and develop follow-up plans for identified issues.

  • QANs provide quality assurance data for facilities to use in facility quality improvement processes.

  • QAN data are shared with the survey team as part of the preparation for a survey, as well as with complaint investigators when appropriate.

  • QAN case-mix accuracy review processes establish the expectation that accurate rates reflecting resident needs are validated, and that facilities must establish sound clinical practices in relationship to assessment.

  • QAN visits serve both as an "early warning system," and as an opportunity to provide technical assistance to facilities throughout the year. The early warning process occurs as QANs share information with surveyors.

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