What Is a QAPI Nurse?

Kathy Quan RN BSN PHN - 05/25/19

In almost any given situation someone is likely to comment that they could do that more efficiently, or have better results, or find a better way to do it. In health care we are always on the prowl for better and more efficient ways to do things. We strive for best practices and to have the best quality outcomes possible. We benchmark our facilities against others on a statewide basis and a national basis. In some instances, the results are published online for consumers to read and compare when making choices for the best possible healthcare for themselves and loved ones.

QAPI stands for Quality Assurance Performance Improvement. The QAPI process is mandated and, in many instances, it’s tied directly to reimbursement for medical providers such as hospitals, clinics, laboratories, home health care and hospice agencies. According to the Centers for Medicare and Medicaid (CMS), QAPI is defined as “a process of meeting quality standards and assuring that care reaches an acceptable level.”It’s a comprehensive on-going process and CMS lists 12 steps as a guideline to accomplishing the goals.

The auditing of patient charts, aggregation of the data, and oversight of the performance improvement process is accomplished by quality and compliance nurses. The quality team may should be comprised of other health care professionals including physicians, nurse managers, administrators, and even lay people from the community.

There are some aspects of QAPI that are dictated by reimbursement sources such as Medicare and Medicaid and if the provider is a Medicare certified provider must be met on an annual basis with quarterly reporting. For instance, a hospice agency is required to monitor data on QAPI issues such as pain management and may choose from a host of other issues like constipation or dyspnea. Agencies are also mandated to participate in experience of care surveys and the results are posted online for consumers to compare when choosing a hospice or home health care agency.

Data-Driven and Evidence-Based Process

QAPI is a data-driven program. The QAPI nurses audit a set sample of patient charts with a focus on selected quality issues to ensure patients are concurrently receiving quality best practice care and that their outcomes meet or exceed set goals. If necessary, they may audit all of the charts or those with a certain set of parameters to determine if a pattern of issues is present. QAPI examines the documentation to assure that the skilled assessments, individualized care, interventions, actions and outcomes are the best possible from all providers involved.

When improvement is needed, the QAPI nurses along with the Quality team set performance improvement goals and monitor the progress and adjust procedures and policies as needed to achieve goals. They will work closely with the staff education department to see that staff are made aware of the problems and changes being implemented to improve the care. Sometimes the QAPI nurse and staff educator are one in the same. Once the new standard is achieved, the QAPI department will continue to monitor to assure the standard is maintained.

QAPI Meets the Standards and Reflects the Complexity of the Organization

The governing body of the facility or agency has to ensure that the QAPI program meets the best standards to reflect the complexity of the organization and the services it provides; strives to reduce and prevent errors and improve patient safety; has a focus on specified indicators to show improved outcomes across the spectrum of care the organization provides; and involves all services including any contracted out in the QAPI process.

QAPI is a very important part of the healthcare process. It’s part of the checks and balances that helps to keep everyone safe and working within their scope of practice and always striving to do better. Patients deserve the highest quality of care possible and the QAPI department helps to keep the process rolling in the right direction.

The QAPI nurse can be the good cop or the bad cop but is usually not the most well appreciated nurse on the staff. Hopefully s/he is well respected and acknowledged for his/her role in improving patient care and outcomes. Nurses are often overheard saying it’s not a job they could ever do for a variety of reasons. It’s a “desk job.” It’s confrontational. They have to deal with accrediting agencies and surveyors. It doesn’t involve hands-on patient care, and many feel it can be boring or that it’s far from “real nursing.” However, keep in mind that in order to audit and evaluate something, the QAPI nurse must be an experienced nurse. The QAPI nurse has to be able to research and understand procedures s/he may have never seen or done before. For QAPI nurses, continuing education is an ongoing process and a wide variety of continuing education courses for nurses is a welcome opportunity.

The role of the QAPI nurse is to enforce the philosophy that things should be done right the first time.It starts with hiring the right clinicians and giving them the best possible onboarding and training. Then focusing on making sure they provide the right interventions to the right patient at the right time and provide evidence through the right documentation.

Success Comes from Walking the Walk and Talking the Talk

Improving quality of care’s success comes from being able to walk the walk and talk the talk without fears and confrontations. In order to improve, it is necessary to be willing to look at failures as well as success and see what worked and what didn’t, and how we can do better. We have to be able to ask hard questions and not fear the answers; but rather learn from them. QAPI should be viewed as a learning process and not as a threat, or a competition. Strong TEAMWORK is essential remembering that there is no I in TEAM. The QAPI process is evidence-based and perfecting documentation is a huge part of the QAPI nurse’s responsibility side by side with the education department.

The philosophy and goals for the QAPI department should be focused on patient care and outcomes that help the patient become educated and independent in self-care. Even when the patient won’t be cured, he should be taught to manage his diseases and symptoms and achieve comfort and an improved quality of life. The goals should include ways to reduce re-hospitalizations, prevent complications, and improve the experience of care.