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The long-term care industry has seen vast changes the past several years.  From sweeping overhauls to regulatory requirements to changing the payment structure from Medicare.  In fact, the only thing that has remained constant is change.  With change, comes a newfound focus on policies, procedures and resident satisfaction.  On November 28th, 2019 nursing homes will be expected to implement phase 3 of Requirements of Participation set forth by CMS.  While the interpretive guidelines have yet to be released, the main focus will be on Quality Improvement practices and implementation.

QA (quality assurance) is a process of meeting quality standards and assuring that care reaches an acceptable level.  PI (also called Quality Improvement—QI) is a proactive and continuous study of processes with the intent to prevent or decrease the likelihood of problems by identifying areas of opportunity and testing new approaches to fix underlying causes of persistent/systemic problems.  QAPI is the merger of these 2 approaches to quality, Quality Assurance (QA) and Performance Improvement (PI).  QAPI is not a new idea for nursing homes.  Quality assurance plans have been in place and reviewed on at least a quarterly basis for quite some time.  However, with new regulatory requirements, these QAPI plans will be placed under increased scrutiny.

Food and Nutrition Services QAPI programs may include but are not limited to:

  • Sanitation
  • Person Centered Dining
  • Meal Preparation and Service
  • Food Quality
  • Steam Table and Tray line Accuracy
  • Food Costs
  • Dining Services
  • Unintended Weight loss/Pressure Injury
  • Customer Satisfaction
  • Menus/Recipes
  • Medical Records/Documentation
  • Policies and Procedures
  • Nourishments
  • Foodservice or Nursing staff Education


When an area is identified ask yourself these key questions:

  1. What is it we are trying to accomplish?
    • State your aim
  1. How will we know that change is an improvement?
    • Describe the measurable outcomes you want to achieve
  1. What change can we make that will result in an improvement?
    • Define the current process
    • Identify area problem areas that exist or where potential breakdown may occur
    • Decide what you will change in the process…remember that solution doesn’t have to be perfect the first time

Many tools are available to assess care processes and outcomes and to allow you to follow progress in areas you want to track and/or improve.  These tools may include checklists, flowsheets or templates or a resident satisfaction questionnaire.  QAPI process tools help to organize multiple tasks, enhance communication across different disciplines, help generate ideas and reach decisions, and to help track ideas and assess progress toward goals.

QAPI is a team effort.  The certified dietary manager, in collaboration with the registered dietitian nutritionist, plays a key role in achieving Quality Assurance and Performance Improvement in dietary/nutrition services.  Using QAPI can improve diverse aspects of care and services as well as resident, family, caregiver, and staff experience and satisfaction.