The On-Time program is based on a unique integration of research evidence and quality improvement principles with direct input from actual users, whose feedback and suggestions are incorporated to refine not only the clinical and health information technology (Health IT) tools, but also the approach to care. The On-Time process was not designed to be a magic bullet solution to the problem of pressure ulcers (PrUs). Rather, it is a flexible strategy that can be adjusted to each facility's particular context, carefully restructuring workflow processes and communication patterns to ensure a more attentive care procedure overall and prompt action on behalf of high risk residents.
On a broad scale, the On-Time project has improved clinical outcomes (PrU rates), increased certified
nurse assistant (CNA) satisfaction, helped improve communication about high-risk residents, and fostered collaboration across facilities. These nursing homes across the country have formed a network dedicated to solving common challenges and a community of innovators in long-term care quality improvement. Additional information about On-Time can be found on the AHRQ Web site (http://www.ahrq.gov/research/ontime.htm).
Factors that led to successful implementation were:
- A designated project lead committed to making On-Time implementation a priority, interested in building the skills of front-line staff (including CNAs), and willing to delegate responsibilities to multidisciplinary team members.
- Multidisciplinary team participation in On-Time activities.
- Various team members using the On-Time reports.
- Process redesign to integrate On-Time reports into existing meetings and implement new processes such as 5-minute stand-up meetings with dietary staff and CNAs.
Factors that led to a low level of implementation were:
- Lack of leadership or team time to implement On-Time.
- Noncompliance with project activities, such as: facility team conference calls and process redesign activities.
These factors for success and lack thereof will be incorporated into future implementation planning.
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