Reduce risk, boost compliance, and improve outcomes in your SNF with 4 key strategies from Polaris consultants.
Long-term care is no stranger to regulations, ranking second only to nuclear weapons in terms of required elements and government oversight. When it comes to risk management in our facilities, leadership may focus on clinically related risks, such as medication errors or the development of pressure ulcers, but there is a broad spectrum of opportunities that can minimize risks and improve outcomes. Throughout the first quarter of 2025, Polaris Group Nurse Consultants identified four major areas with facility-wide impacts to achieve regulatory compliance.
Comprehensive Staff Training Program
Is your comprehensive staff training program robust and effective? Be truthful in your assessment.
Staff may attend in-service training or participate in online training but does the information make the facility better? For example, does one in-service training session ensure that staff will remember all the required steps in safely administering medications?
One of the most effective ways to reduce risks in your nursing home is to ensure that your staff is well-trained and equipped to manage the unique challenges that come with providing care to elderly residents.
Comprehensive staff training should include topics such as:
- Safe resident handling and mobility
- Fall prevention and management
- Medication administration and management
- Infection control and prevention
- Emergency preparedness and response
- Abuse and neglect prevention
Suggestions
- Give post-tests, but give them 30 days after the in-service. The idea of the in-service is not to meet regulatory requirements; it is to improve job performance. Most employees can answer a post-test following the training, but few will get a 100 percent score 30 days later.
- For the in-person training, provide the post-test from the prior month's in-service at the beginning of the next in-service.
- For online training, offer pop quizzes to confirm mastery of the concepts. These may be provided individually by asking the employee to stop by the Staff Development office to take a short quiz. Answering 10 to 15 questions will provide the educator with a good idea of who needs additional training or whether the training material needs to be adjusted. And the added bonus is continued relationship-building opportunities with all staff.
- Celebrate the success stories and create excitement when employees complete learning modules. Make it a big deal – because it is! Often facilities create teams and award prizes in the spirit of friendly competition.
Outdated Policies and Procedures
Are you working with outdated policies and procedures? Is Health Equity part of your QAPI policy? Effective April 28, it should be.
Having current, clear, and well-documented policies and procedures in place is crucial for ensuring consistent care and minimizing risks of negative outcomes. Administration often identifies that annually updating policies is their goal -someday. Polaris Consultants have identified that 25% of deficiencies related to care plan and medication/treatment issues are simply because what is done in practice is not what is reflected in written policy.
Every facility should have comprehensive policies that cover areas such as:
- Admissions and discharge planning
- Care planning and documentation
- Incident reporting and investigation
- Medication administration and management
- Infection control and prevention
- Resident rights and grievance procedures
Suggestions
- Create a team that regularly reviews and updates your policies and procedures to ensure they remain current and compliant with industry standards and regulations.
- Ask for input from employees across all sectors of the organization to increase knowledge awareness and buy-in.
- Enforce these policies consistently and hold staff accountable for adhering to them, realizing that inconsistency in enforcement leads to inconsistency in compliance.
Culture of Accountability
Ask yourself if fostering a culture of accountability is a priority for you, a top priority.
A culture of open communication and accountability can help to identify potential issues and address them proactively, reducing the likelihood of citations. Encourage staff to report incidents, near-misses, and concerns without fear of retribution or being labeled a snitch. Establish a clear chain of command for reporting and investigating incidents and involve staff in the development of corrective action plans.
“We’re always working short” is a phrase used by staff that often echoes throughout the hallways. Allowing staff to utter the phrase to residents/families is asking for trouble.
It is not uncommon to hear nurses in the hall yelling to find their teammate. You might also see a family member at the nurse’s station stating they can’t find anyone to help their mother to the bathroom. Finding staff when needed is a problem for residents, families, and fellow staff members. During orientation, annual performance evaluations, and at every in-service, remind staff that telling customers that they are at risk of abuse because someone did not show up for work is unethical and will not be tolerated. Celebrate the success stories surrounding team productivity, awareness, and resident satisfaction. By fostering a culture of accountability, you can promote continuous improvement in your nursing home and demonstrate your commitment to providing the highest quality of care to your residents.
Suggestions
- Invest in some type of software that supports a paging system. It can be as simple and economical as walkie-talkies or as complex and proficient as targeted alert notifications.
- Explore which paging system best meets your needs. Should it be web-based, one or two-way paging, SMS text messages, text-to-speech voice functions, or group messaging?
- Consider the popular system that uses refrigerator magnets as a means of communication. Every clinical team member is given a magnet and, upon entering the resident's room, the caregiver places their magnet on the door jamb (much like an oxygen sign). When they leave the room, they remove their magnet and go to the next room. That way, when a nurse needs a nursing assistant, they merely look for a magnet on the door. When families need help, they will learn to search for a magnet and wait outside of the room. The perception that “I can never find staff” will change to “My staff is always working with residents.”
- Ensure there is a system where all employees are aware of residents’ needs and priorities.
- How does the housekeeper know that Mrs. Smith was placed in contact precautions last night?
- How does the cook know that Mr. Johnson’s diet was changed from regular to a modified one?
- How does the second shift CNA know that Mrs. Brown is now a Hoyer lift and not a two-person stand to pivot transfer?
- Make sure your shift change information occurs without exception and within the confines of a private space. Employees can’t do it if they do not know about it.
Effective Fall Prevention Strategies
If you were to describe your current falls program, ask yourself if words such as, solid, effective, consistent, or understood describe your falls program. If not, it is time for a full-on review of your program.
Falls are a leading cause of injury and liability claims in nursing homes, with up to 75% of residents experiencing a fall each year (Source: CDC). Implementing effective fall prevention strategies can help reduce the risk of falls and minimize potential liabilities.
Fall prevention strategies may include:
- Conducting regular fall risk assessments for each resident
- Developing individualized care plans to address fall risk factors
- Ensuring the physical environment is safe and free from hazards
- Providing appropriate assistive devices and equipment
- Educating staff and residents on fall prevention techniques
Suggestions
- Be sure your fall program is identified as a “Fall Prevention Program” with the emphasis on prevention.
- Since 50-75% of first-time fallers are not identified as a risk upon admission, implement fall prevention methods for every resident upon admission, with a review after the first 30 days.
- Fall prevention strategies tie directly with the rounding program and look at physical impairments and environmental hazards such as poor lighting, uneven surfaces, or slippery floors. Management by walking around should be the foundation for every fall program.
- According to NCBI, exercise programs that are scheduled, structured, and consistent decrease falls up to 55%. Consider Tai chi, wheelchair exercises, balance-focused exercises, and fun ‘games’ that have hidden benefits that support resident movement and mobility.
- 85% of falls occur within the first 30 days of admission. Have you asked the resident or family how their bedroom was arranged at home? Where was the bathroom located at home in relation to the bed – to their left or their right? Do they have a stronger side that needs to ‘lead’ their ambulation and transfer activities? Is the bed placed in a manner that encourages safe movement?
Facility “Grand Rounds” Program
Do you currently have a “facility rounding” program? Does this program sound like a lot of work?
Implementing a facility-wide rounding program is an impactful way to guarantee reductions in complaints and incidents. With the premise that purposeful rounding is purposeful work, “every day, every resident, every issue” helps us understand the value of what our eyes see, our ears hear, and our noses smell. As a Polaris Consultant, I recall asking a resident about dried and smashed peas that were on her floor near her bed, knowing that peas were on the menu four days earlier. She told me the peas had been there for days, and no one bothered to clean them up. Employees stepped around them, through them, and ignored them. Wow. Just wow. The mindset of “it’s not my job” is a dangerous one when it impacts resident safety and happiness.
Successful facility rounding programs have a two-fold benefit:
- Improve resident safety and mitigate risks.
- Improve staff engagement and, as a result, improve staff retention.
Proactive rounding solves problems before reaching the level of explosiveness. Making visual assessments of the resident and their surroundings daily reflects the care and concern you have for your residents, and it has an immeasurable reflection of you as a role model and problem solver. Polaris Group has a library of tools, including “Grand Rounds” templates, and can help customize one based on your facility priorities and opportunities for improvement.
Suggestions
Be honest and ask yourself what is getting in the way of developing a purposeful rounding program.
- Create a user-friendly rounding program that involves the senses and completion of scheduled tasks.
- Implement a facility-wide expectation of acknowledging call lights. Although call lights often require a clinical team member’s assistance, at times the call light is on for reasons any employee can address, i.e., turn on my fan, close the blinds, hand me the remote, refill my water pitcher, etc.
- Teach all staff that when they enter a resident’s room, they should take a glance around to identify potential accidents and report anything concerning to the charge nurse immediately.
- Include staff when addressing grievances or issues. Leadership’s circle should be welcoming and open to all. Encouraging input from employees exemplifies that you appreciate their ideas and creates a culture of open communication.
Conclusion
By prioritizing risk management and implementing these four strategies, you can create a safer environment for your residents and staff, improve the overall quality of care, and minimize the potential for survey citations.
Polaris Group has an arsenal of tools, forms, and templates to help you get started. For further information, reach out to our team!
