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Improve Quality? Watch What Staff Is Doing

June 1, 2006
by root
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Direct observations of staff, conducted regularly, can be eye-opening by Anna Rahman, MSW; Sandra Simmons, PhD; John F. Schnelle, PhD
Improve Quality?
what staff
is doing

How standardized direct observations can make a difference by Anna Rahman, MSW;
Sandra Simmons, PhD;
John F. Schnelle, PhD
It's a mundane exercise but sometimes an eye-opening experience: The nursing supervisor stands in the facility's dining room, clipboard in hand. Her instructions are straightforward: Focus attention on five to ten residents who have been deemed at risk for weight loss. Throughout the meal, observe and record whether each of these residents receives from the staff:

  • physical assistance with feeding;
  • at least one verbal prompt to eat (e.g., "Wouldn't you like more peas, Mrs. Smith?"); and
  • some social interaction (e.g., "Hello, Mrs. Smith. It's good to see you today.").

Finally, record how much of the meal each resident consumed, then compare this with the nurses' aide's or feeding assistant's estimate of the resident's consumption. The point of the exercise? Its overarching objective is to improve feeding assistance for residents at risk of weight loss and thereby increase their mealtime food and fluid intake. The supervisor is on the lookout for staff behaviors-physical assistance, verbal prompts, and social stimulation-that have been shown to increase mealtime consumption.

But that's just the beginning. Direct observations of nursing home care accomplish several goals simultaneously, which is why this strategy is such a powerful tool for not only evaluating care but also improving it. Indeed, we at the Borun Center for Gerontological Research recommend direct observation as one of the most effective strategies for improving nursing home care. And heads up: The Centers for Medicare & Medicaid Services (CMS) is evaluating the benefits of using standardized observations in the nursing home survey process.

What is it about the act of directly observing care that makes it such a compelling component of nursing home quality improvement efforts? Table. The G-Z Building's expanded list of staff behaviors that characterize quality feeding assistance