More than 1.2 million U.S. nursing home residents and staff have been diagnosed with COVID-19 since the start of the pandemic.1 As of press time, a combined 134,671 had died,1 representing 23% of all reported COVID-19 deaths in the United States.2
In an ongoing effort to protect both groups from COVID-19, the Agency for Healthcare Research and Quality (AHRQ) has released two tools, Competency Check vs. Observational Audit: Validate Nursing Home Staff Performance to Improve Infection Prevention Processes for COVID-19 and Observational Audits: A Pathway to Improving Infection Prevention and Preventing the Spread of COVID-19.3 These tools aim to support the use of observational audits, which enable facilities to evaluate staff compliance with infection prevention practices.3 Observational audits are a necessary part of the Quality Assurance Performance Improvement (QAPI) program-a "systematic, comprehensive, and data-driven approach to maintaining and improving safety and quality in nursing homes"4 that long-term care facilities are required to implement.5 (See QAPI Implementation Framework4, 6 for more on the QAPI program.)
THE AHRQ TOOLS
To follow is a brief overview of both new tools.
Competency Check vs. Observational Audit: Validate Nursing Home Staff Performance to Improve Infection Prevention Processes for COVID-19
http://www.ahrq.gov/sites/default/files/wysiwyg/nursing-home/materials/competenc
This comparison tool outlines the differences between performing competency checks to meet education and regulatory compliance and conducting observational audits to inform quality improvement (QI). As indicated by the tool, a competency check is used to demonstrate staff knowledge of proper task performance. It is performed annually with the employee's knowledge and preceded by education and training; results are placed in an employee file. An observational audit, in comparison, is used to obtain data about actual task performance and identify process gaps or failures for QI purposes. It is performed unannounced and on a regular basis; education is not provided prior to the observation. The results are aggregated, tracked, and reviewed as part of the facility's QAPI program.
Observational Audits: A Pathway to Improving Infection Prevention and Preventing the Spread of COVID-19
http://www.ahrq.gov/sites/default/files/wysiwyg/nursing-home/materials/observati
This step-by-step guide describes how to conduct an observational audit to determine if staff are complying with infection prevention guidelines. It outlines specific actions for each step in the observational auditing process (selecting a tool and planning the audit; training the auditors and conducting the audit; and analyzing, reviewing, and acting on audit data). Another benefit of this tool is that it can help facilitate the collection of data to be used in designing and implementing an effective QAPI program.
The tool also offers tips for achieving success in the observational auditing process, including the following:
* Make auditing a group effort by training staff from diverse areas to observe and audit.
* Integrate auditing into daily tasks, such as rounding, to maximize time management.
* Keep the auditing process positive, emphasizing that auditing is intended to be constructive.
ADDITIONAL RESOURCES
Both tools are available as part of the AHRQ ECHO National Nursing Home COVID-19 Action Network-a partnership between the AHRQ, the University of New Mexico's ECHO Institute, and the Institute for Healthcare Improvement.7 The network also offers free training, mentorship, and a catalogue of resources to help nursing homes protect residents and staff by implementing evidence-based infection precaution and safety practices. To explore these resources, visit http://www.ahrq.gov/nursing-home/index.html.
REFERENCES