December 13, 2016
By Mountain-Pacific
The Douglas Care Center of Wyoming opened a 24-hour café that improved the quality of life for its residents while reducing weight loss and dehydration. Using Quality Assurance Performance Improvement (QAPI) methods, the facility conducted a root-cause analysis and tested various interventions that lead to the implementation of its café.
Giving residents the power to choose what and when they want to eat 24 hours a day is curbing weight loss and dehydration at the Douglas Care Center. Finding that remedy, though, was not any easy process. It took a dedicated committee nearly a year to implement, test, change and retest strategies before a solution was found.
Located in central Wyoming, the Douglas Care Center is a 60-bed, long-term care nursing home that specializes in rehabilitation and skilled nursing services. In 2015, the facility noticed a trend of weight loss in its residents after conducting routine monthly weight checks, prompting Douglas’ administration team to take action.
Creating a committee, finding a solution
The first step the administration team took was to educate stakeholders about the problem, while planting the idea that a committee could work on the issue. Once people understood the problem, leadership, staff and the center’s resident council supported the project and the formation of a committee.
Next, Douglas’ administration team formed a committee including representatives from the dietary, housekeeping, activities and nursing departments. The committee met regularly to evaluate root causes of the problem, while trying different interventions, documenting everything in a performance improvement plan (PIP). A PIP is a commonly used quality improvement tool that details end/start dates and the outcomes of processes.
The committee implemented interventions and then weighed residents to test outcomes. After numerous unsuccessful interventions, Mountain-Pacific Quality Health suggested a 24-hour café, a data-proven success in other facilities.
The committee presented the café option and the data from other nursing homes to the administration team, which approved the idea. One year later, the café has an assortment of beverages and snacks, a refrigerator and soda machine.
“All residents have the right to choose what they want to eat, regardless of dietary suggestions,” said Michelle Jensen, social services director for Douglas. “Our café honors that right by including both healthy snacks and unhealthy snacks and drink choices.”
Challenges
Staff admit the process to evaluate interventions, implement and then measure outcomes was time- consuming, but it was an important part of vetting possible solutions. Once the facility indentified the café as the solution, new challenges presented themselves:
- Where to build the café
- How to pay for it
- How to make up for the lost space, since the café was built in a meeting room
The committee opted to build the café next to the dining room area in a spare meeting room and worked with contractors to bid and build it. Funding the café was another challenge. The facility wanted to build it without incurring additional costs over its existing budget. Leadership asked department heads to evaluate their budgets to reduce costs, so directors from different departments worked together to be fiscally conservative. To sustain operations of the café, the center assigned staff members to maintain inventory and clean it. And to mitigate the lost meeting room where the café was built, the center moved meetings to other rooms in the facility.
Positive outcomes
The café empowers residents. Residents now have more independence and choices for what and when they want to eat and drink. These options are reducing weight loss and dehydration. The café also helps those with diabetes. Now residents can get food or drinks any time to help boost blood sugars. The space also serves as a home-like environment where families can visit their loved ones and have a meal together.
“We have gotten really good feedback from both the families and residents,” Jensen said. “Residents are very happy to go into the café and help themselves. It gives them that control over their lives.”
Staff have also seen decreased negative behaviors, more positive moods and increased mobility in residents. They get out of their rooms more often to check out the café and to socialize.
Advice for others interested in a 24-hour café
To replicate this success, Jensen recommends the following:
- Get residents on board to help with decisions, provide support and make food and drink choices.
- Allow for adjustments in parameters and decisions as the project evolves.
- Do not get discouraged by change.
- Allow for modifications during and after implementing a café.
- Remember: It is a learning process, and things may work differently for each facility.
About Mountain-Pacific—Mountain-Pacific is a 501(c)(3) nonprofit corporation and holds federal and state contracts that allow them to oversee the quality of care for Medicare and Medicaid members. Mountain-Pacific works within its region (Montana, Wyoming, Alaska, Hawaii and the U.S. Pacific Territories of Guam and American Samoa and the Commonwealth of the Northern Mariana Islands) to help improve the delivery of health care and the systems that provide it. Mountain-Pacific’s goal is to increase access to high-quality health care that is affordable, safe and of value to the patients they serve.
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