QSource Culture Crosswalk Toolkit



Home Change Model Restraint Tools Falls Patient Safety QI/Other Tools MDS 3.0/Audio Culture Survey Contacts


A Collaborative is a systematic approach to quality improvement using teams for best practice sharing within and between participating facilities.

Quotes About Culture Change
Teamwork

Restraint Collaborative Change Model

The 9th Scope of Work Tennessee Patient Safety Restraint Collaborative is sponsored by QSource, the Medicare Quality Improvement Organization (QIO) for Tennessee and runs from September 2008 to June 2011.

Modeled after the Institute for Healthcare Improvement's (IHI) Breakthrough Series Collaborative Framework, this resource toolkit provides the change package that 33 nursing homes across Tennessee utilized in coming together to test system changes aimed at making improvements in the reduction and/or elimination of physical restraint usage in their facilities.


A brief overview of the change model is linked here.

For an overview of the entire collaborative model click here to view.



The participants came together during quarterly regional learning sessions together to learn and share best practice ideas for restraint reduction and falls management. The following links provide materials covered during these sessions.


  • Learning Session One Documents | October 2008
  • Learning Session Two Documents | April 2009
  • Learning Session Three Documents | October 2009
  • Learning Session Four Documents | April 2010

See additional resources which are located within the above tabs


Educational Restraint Tools


  • Behavior Management in Long Term Care
    • Behavior Challenges in Long Term Care Presentation
    • Behavior Challenges Handouts
    • Behavior Event Response Form
  • Educational Tools
  • CMS Restraint Memos and Clarifications
  • CMS Restraint Reduction Video Series
  • Physical Restraint Reduction Presentation




  • Restraint Alternatives
  • System Change Tools
  • Seating/Positioning Resources
  • Side Rails, Bed Safety
  • Sunshine Room Job Description
  • Sunshine Room Guidelines
  • Try This Articles

Falling Leaf

Here is a list of action plan templates you may use to document and track your improvement actions.


  • Falling Leaf Resources
  • Fall Resources
  • Falls Management Presentation

Post Fall Investigational Tools


  • CDC Diagnosis and Treatment: Falls in the Nursing Home
  • Falls: Fall Investigation Report 2
  • Falls: Root Cause Analysis
  • Fall Action Lesson Learned Huddle Form: Mini Root Cause Analysis
  • Neurological Checklist
  • NUMC - Post Fall Review
  • Post Fall 72-Hour Monitoring Report
  • Post Fall Event Nursing Assessment/ Progress Note
  • Post Fall Interview
  • Post Fall Report
  • QA: Post Fall Investigation Report
  • Falls: Tips for Investigating a Fall

NH Patient Safety Resources

These are Patient Safety Resources that can be used in Nursing Homes.


  • Avoid these Drugs in the Elderly: ADE Medication List
  • Improving Patient Safety in Hospitals: AHRQ Resource List
  • ISMP's Guidelines for Standard Order Sets
  • FDA and ISMP Lists of Look-Alike Drug Name Sets With Recommended Tall Man Letters

Patient Safety QIOSC MedQIC Updates


  • July 2009
  • September 2009
  • October 2009
  • November 2009
  • December 2009
  • March 2010
  • July 2010
  • August 2010

Quality Improvement and Other Resources


  • Quality Improvement Resources
  • Website Resource List

Organizational Resources


  • Organizational Change Resources
  • Staff Stability Toolkit
    • Worksheet One
    • Worksheet Two
    • Worksheet Three
    • Worksheet Four | PDF Version
    • Worksheet Five
    • Worksheet Six | PDF Version
    • Worksheet Seven
    • Worksheet Eight
    • Worksheet Nine
    • Worksheet Training Analysis

MDS 3.0 Information

These documents represent MDS 3.0


  • RAI Section P Restraints
  • RAI CAA Chapter 4 Restraints
  • MDS 3.0 ADL Decision Flow Sheet
  • CMS Restraints Care Plan
  • Ten Ways to Improve Your Restraint Quality Measure Score

Audio Resources

Please allow for some time to download audio files due to the large file sizes.

NH Depression Audio Files

  • Depression Assessment (PHQ9) - Dr. Ira Katz
  • Depression: What are We Doing for Our Residents - Dr. Kort Nygard

Diana Waugh NH Restraint Audio Files
There are no hand outs available for this series

  • Diana Waugh Part One | Diana Waugh Part Two | Diana Waugh Part Three | Diana Waugh Part Four | Diana Waugh Part Five | Diana Waugh Part Six

Diana Waugh: Restraining Restraints? Right!

  • November 14, 2006 Teleconference: | Description card

Jo Taylor Falls Management Teleconferences

  • Audio: Falls Call, May 9 2007 | No Handout Available
  • Improving Quality through a Systematic Approach to Falls Management - January 21, 2009 | Audio File | Handout

Purpose of (AHRQ) Nursing Home Survey

The Nursing Home Survey on Patient Safety Culture was developed by the Agency for Healthcare Research and Quality to help nursing homes assess safety culture, track changes in resident safety over time, and evaluate the impact of safety interventions.

Like the previously released Hospital Survey on Patient Safety Culture, the nursing home survey is designed to capture the opinions of all nursing home staff from administrators and clinicians to housekeeping and maintenance workers. It is psychometrically sound and has been pilot-tested in 40 nursing homes across the country.


Nursing Home Survey Tools/User's Guide


  • Survey User's Guide Nursing Home Survey on Patient Safety Culture
  • Tips on Conducting The AHRQ Nursing Home Survey on Patient Safety
  • Nursing Home Survey on Patient Safety
  • NH Patient Safety Culture Survey (AHRQ) Presentation

Nursing Home Data Analysis Tools/User's Guide


  • Nursing Home Survey Data Entry and Analysis Tool User's Guide
  • Blank NHPS Data entry Analysis Tool | Instructions
  • Taking Action with Results from Safety Culture Surveys
  • Improving Patient Safety in Hospitals: AHRQ Resource List

Contact Us

Feel free send a message to any of us concerning this toolkit. If there are any technical issues or questions regarding the use of this toolkit please refer them to aculver@qsource.org

Contact information

Beth Hercher (QI Specialist)
email: bhercher@tnqio.sdps.org
phone: 901.273.2640


Tiresa Parker (QI Specialist)
email: tparker@qsource.org
phone: 1.615.574.7241

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