Ladies and gentlemen, thank you for joining the Quality Assessment Performance Improvement QAPI testing change in measuring improvement conference call. Your host for today is Tiffany Langham. Miss Langham, you may now begin.
Thank you, Katina. Good afternoon. We are so excited you all are joining us. You'll see we had questions posted. When was the last resident and employee party and what was the theme of the party? And if you'll notice, there is a chat box in the lower right-hand corner of your screen if you are not in full Crean mode. If you are in full screen mode, the chat box will be located at the top of the screen. You will click on the word chat and the box should open. The purpose of the chat box is to interact during the presentation. You can ask questions, answer questions others may have, or share your thoughts. My TFM colleagues and I will be monitoring the box, so please type freely.
In reviewing some of the answers, some of the input that people have, we are having luaus and a carriage, horse and carriage ride. Sounds like some of us are having a lot of fun and maybe some of us need to have a little more fun.
We are also going to have games, petting zoo and bounce houses and hot dogs. So I encourage you all to have fun when you are working, as well. Oops, it didn't advance. There we go. As a refresher, QAPI is quality assurance performance improvement. Each of you received the developed at a glance. Although it is still in draft form, we urge you to move forward as a team reviewing this a documentation to further develop your foundation. In addition, complete the self-assessment. This will jump start your efforts in establishing QAIP principles.
And this is me. I will be your moderator today. Tiffany Langham.
To make improvements, we have to continually observe, evaluate, and test our processes to be successful with quality assurance and performance improvement. Understanding how to use the worksheet for testing change will guide you to make measurable improvements using PDSA cycles. I would like to introduce to you our dedicated team members. Susan Purcell is the director of patient safety, Frank Barber is a Quality Improvement Consultant or QIC, located in the Austin area, Casey Brewster is our departmental assistant and our team would not be as successful in helping all of you on your journey without her. Debi may owe is a Quality Improvement Consultant also in the Austin area. Melody Malone is a QIC in the Dallas area. Minnie Malone is our project resources consultant who keeps us focused on our deliverable. And Carla Smith a Quality Improvement Consultant in lovely West, Texas.
Our first presenter will share her team's process in making improvement in their nursing leadership and communication. And she is Wendie Nevels, the Director of Nursing at rose haven retreat located in the pine any woods of East Texas. Melodi. He works for rose haven as the QIC, and she will be speaking along with Wendy.
Thanks a lot, Tiffany. Let me introduce lovely Wendy to you guys. WeEDI has been the director at Rose Haven for almost one full year. What I think is really interesting about Wendi is for a while she would drive across the Arkansas State line to go to work every day. That's a serious commitment when you drive across state lines. So it's been great to work withWendie over this last year. We'll proceed now. Wendie decided to jump on the worksheet for testing change which many of you have already seen as part of our model for improvement and work on nursing communication. So -- with leadership.
So what we're going to do is she actually gave me a worksheet for testing change and we are going to walk through it and actually go through the process that she did.
So, Wendy, when you decided to look at a aim or purpose for your cycle, explain to us what you were trying to do.
Hi, everybody. What I was trying to do is whenever it's particularly hard wherever a new [inaudible] comes that a building. Normally DONs are replaced. I was trying to reach out to the nurses and let them be a part of the solutions and the changes instead of me just telling them what to do. And so that's what we were trying to do. We were really trying to get that communication flowing between the administrative staff and floor staff, basically.
Okay. Great. And when you looked at how you would know a change would be an improvement, what were you trying to think about as your measurement strategy?
As far as measurement, I think whenever I put on here greater resident care outcomes, you can really tell that when someone is passionate about their job and they really feel as they are a part of the solutions, they really care. They really want our residents [inaudible]. And that's how I was meshing these improvements, system changes, to see how much, you know, our residents improved just in every day things as far as ADL care or things like that.
Okay. Thanks. And then what change did you decide you would take or test that might result in an improvement?
We started the nurse council meeting. We had our first meeting and we really just asked the nurses, what problems do you see? What things are not working for you? How would you improve something if you did have a problem with it? So we had listed three things that the nurses wanted to work on. And at the end of the meeting we decided that we would meet semi monthly. And in doing that, by meeting semi monthly, you can see, okay, what we talked about last time, those three things, how did those work? Did they help you out at all? Were there some kinks that we needed it work out? Or was it a great idea? We'll just adopt it right away. This is going great. Then we picked three mornings to focus on. Each time we come back, we bring different things to the table.
Awesome. Could you give us some ideas of the three things you guys would work on?
Yes, ma'am. On our first meet we go discussed our 24-hour port system. What they had in the beginning was everybody added what happened on their shift on one piece of paper. That was very confusing. Each shift was adding different things on there that didn't work. You know, you could tell which was the newest order. So the nurses come up with the idea for each shift to write their own report to carry things over from the previous shift that were still pertinent but also add what happened on their shift. By doing that, you can follow from day shift to evening shift to night shift. And night shift would be, obviously, the newest, most current one when you come back the next morning. And so that worked really well.
They also had a charting book, meaning anybody that needed charting on, they had it in this binder away from the charts. They found it to be very ineffective. For one, if they had to call the doctor about something that we were charting on, they didn't have the chart right there with them. They had to go find the chart and then get it. They also noticed that some shifts would chart and some wouldn't. So we developed a different system. They have a sticker that's on the outside of the chart and it's just a green sticker that says chart needs documentation. And it may say antibiotics or fall or anything like that. Whenever that nurse gets that chart, they have everything that they need right there. The chart on them or to answer questions from the doctor.
Okay. Sounds great.
Yeah.
So then did you work through your worksheet for testing change for this very first cycle, cited in your plan that you would do these meetings semi-monthly. Explain how you selected your test population, your nurses to be in the meeting.
Well, we are fortunate that we are small. So I don't have a large nursing staff. But what we did do is we took two nurses from each shift. Two from days, two from evenings, and two from nights because every shift is different. You will sometimes have days, something about evenings. I wanted to bring them together. I thought by getting nurses from each shift, they would become one team.
Okay. Sounds great. And then when you worked -- continued to work through it, these are the tasks that you determined you needed to do just to even get the first meeting going?
It was. A lot of them I had to sit down and think, okay, and then we scheduled it and I was really surprised that they all showed up, you know. They were kind of like what is this and we're not sure. But they were really open to it. So that helped out a lot.
Okay. Great. And then your prediction and your meshes were kind of interesting. Do you want to talk with us about that?
Well, whenever you introduce something Ike this and you always hope that you are on the same page as your floor staff. I know that I have not been in an office position that long, so I do kind of sympathize sometimes with the people on the floor. Sometimes you run into, if you are a DON or an office person, you kind of run into that, oh, they just need to do it. You always want to know that you have that communication. That they will come and tell you when things are wrong or how to fix things. So I predicted that if we all did communicate together, that that's what would happen. That I would know what was going on in my nursing home, even though I can't be here 24/7, but I have the staff behind me to let me know things are happening.
Okay.
And on the issues, you know, regarding system improvement, it just helps out so much when they see an issue and they are part of the solution. Something that they actually suggested was put into place.
I can't agree with you more. I think that's wonderful.
Thank you.
Now, when you actually went in and you did it. So this is your do he section on your wok sheet for testing change. So you actually held the meeting.
Um-hmm.
Right?
Yes, ma'am.
And then you actually have several issues to discuss. So were they asked to bring some issues to the meeting?
I didn't ask them prior to. We kind of did it on a spur of the moment for the first time. We actually got it scheduled and we were trying to get it all organized. But I was really surprised that they had several things to talk about. I thought that they would just kind of like, oh, I don't know, it's going fine. But they weren't. They had lots of issues that were real issues to me as well, but they recognized them. And I thought that was really important that they -- they already knew it. Now how do we fix it.
That's perfect. So then when you ran the study, did you do that as a group where you all felt it was effective, or was that something you just decided?
Whenever we ran the study phase -- like I said, we did semi monthly. By the time we come back, it's two weeks later. Now, during the two weeks the systems that we did implement my aDon and I would monitor them to make sure that things are still being charted on and such. I kind of asked the nurses, hey, how is this going for you? What do you think about it? And they said it was going really well, that they thought it was great. They felt empowered. They felt that they were helping out their co-workers. They were helping me. They were helping the residents. So that's how I kind of knew that it was a success. They didn't -- you know, sometimes you put new things in and they fight you. I don't want to do this. I don't think this is right, or I don't see the point. But they really responded positively to it.
Wonderful. And so then when you got into your ACT phase, you decided to full steam ahead?
Yes, ma'am. I did. When we ended the first meeting I did ask them, you know, when would you all like to meet? They said that Mondays were good. You know, usually in the afternoon. That's when everything kind of settled down after the weekend. And when we talked about how often to meet, semi-monthly seemed to fit us really well. Every week was just a little too much. However, once a month was not enough because you have too much of a gap to know if something is working or not or kind of lose track. So we really thought semi-monthly. And they came up with that, and I agreed to it. And I think the thing that made them believers the most that we were actually listening to them is that whenever we left the meeting and what we decided on, supply and my DDON went directly out on to the floor and implemented the system.
Okay. So as you guys make these changes on these three topics every time, you are doing this worksheet for testing change concept ACT every time with each one of those three items?
Yes, ma'am. We also keep minutes. Meeting minutes, you know. Just like with any other conference meeting.
Great. Okay. Sounds wonderful. And then we had something come up in the chat I kind of want to go back. Paul asks, do you use the exception method on your 24-hour report, or is every resident mentioned?
We do use the expectation method. We have lots of different places. We have admissions, discharges, people that are in the hospital, people that are on acute charting, whether it be a fall or a skin tear. We have, you know, incidents and accidents. We have antibiotics. We have a section that has your skills residents, whether they are part A or part B. Then we have a lab section. Any skin issues. And you also have a notes section. You may want to say a certain resident didn't eat as much today as she normally does or had a different behavior. We also have a section down there at the bottom, if you had to notify any family members or physicians. There is a section down there for them to fill out. It's a lot, but it covers all the basic areas.
Great. I hope that answered Paul's question.We are pretty much ready now for questions Wendie if the operator would like to give the instructions on the phone line.
Ladies and gentlemen, if you have any questions at this time press the number 1 key. Again, ladies and gentlemen, if you have any questions at this time please press the number one key. Our first question is going to come from Vanessa. Vanessa, please go ahead.
Did I push the number 1 key?
I guess it was an accident. Sorry.
There are no questions in queue.
Okay.
Also remember you can ask questions in the chat. Paul says thank you, Wendie. I have nurses that report on every resident, even though -- even when there's nothing that's changed over the last 24 hours.
Could I add something to his?
Sure.
What I've also done with my nurses, we do bedside reporting. And so what that means is we go room to room and they lay their eyes on the patient with each other. You know, by doing that you may actually catch, oh, this did happen last night and I forgot to put it on the report because you're actually looking at the patient. Like I say, I'm a small facility so we are able do that. But even if nothing happened they can say he slept well all not or sig like that. I think that -- or something like that. I think that helps, too.
Thank you, Wendie. I agree with you. It's just another way of reviewing residents and refreshing your mind. So thank you so much for sharing your team's journey, your challenges and successes and building that team and getting the team to have ownership of the process is -- sounds like you are well on your way in QAPI.
Thank you.
Okay. So we have a polling question. Are you actively using the worksheet for testing change? As Wendy spoke of, the worksheet for test change, and we should have a box pop up and you should have the option of choosing yes or no.
Well, some people are answering in the chat box that, yes, they are, please share your barriers and your successes on using the worksheet for testing change and working through that PDFA process. And you can share that in the forums that are on the QIO website. We will review that later in the webinar. And for those not using it, hopefully you are getting ideas with how to use that worksheet as the tool is instrumental to the QAPI process.
Okay. Our next presenter will share her team's journey beginning with how overwhelming the data can be. And she will keep sharing her quality improvement and successes. I would like to introduce Alicia Burrell, the Director of Nursing at Winterhaven. Frank Barber works for them as their Quality Improvement Consultant. So, Alicia.
Yes. Hi there.
Are you there?
Yes, ma'am.
Grab the floor.
My name is Alicia Burrell and I am the DON with fundamental healthcare at Winterhaven in Houston, Texas. We are about a 135-bed facility that's in transition. We are transitioning over to a secured unit, so we have reduced beds available at this time. I first became acquainted with Frank backer and TMS initiative right after I started at Winterhaven in late 2011. That time we were having problems with pressure ulcers. Rookie sources were provided and the focus of our staff and our very good treatment nurse, it appears that over the almost a year that we seemed to have that problem under control. As you all know, just when you think you have it under control, you don't. With that said, it continues to be an issue that we work on daily.
But what I really want to talk about is our process with Frank and our staff with --anti-psychotic drug reduction. When we look at our report, we identified several areas that needed work on. The one we checked immediately was the drug reduction. And more specifically, I would like to talk about the procedures that we used because I was having trouble with the procedural process. Every Thursday we have a quality review meeting where we go through quarterly care plans as well as any new admissions, falls, pressure ulcers, behaviors, et cetera.
And so our interdisciplinary chain decided this would be the best time to incorporate our anti-psychotic drug QAPI. So, as instructed when we first started, we very innocently checked the worksheet for testing change, PDFA format, and started answering the question. And so the first question was, what was the aim or the pumps? -- the purpose, and specifically what are we trying to accomplish? We knew that we wanted to appropriately discontinue our psychotropic medication usage. That's what we entered. And then on the second, how will we know when a change is an improvement? Again fairly simple. We thought, you know, we will see less psychotropics with greater resident care outcomes. And then again, number three, what change can we make that will result, again fairly simple. So we were feeling really confident about how we were progressing in that first meeting. But then we got to plan.
So under the section plan is when we had our first hiccup. So the first question, what is your next test of change? And we weren't really sure what that meant. So I'm being honest with you. We skipped to the tasks that are needed to set up this test of change and that's when we really hit the brick wall because for us to reduce anti-psychotics, and we're talking antidepressants, hypnotics, and the anti-psychotics, those scheduled, we must have come up with at least 50 tasks that needed to be accomplished. And so, you know, we were sitting around the conference room looking at each other like, how in the world are we going to get this done in a timely manner because it would require, at the minimum, massive facility-wide training, physician training, patient family education, focused review on well over half of our resident population when you included all the medications and reviewing months of behavior monitoring sheets as well as social worker notes. And we were all committed to this objective, but it was like, okay, we need to rethink this.
So what we did, we stepped back, picked up a clean sheet of the worksheet for testing change and revisited what our priorities would be.
So under the question, what are we trying to accomplish? We decided is we want to reduce all PRN and eye psychotic medication -- anti-psychotic medication. And are the first round for exempting the antidepressants, anti-hypnotic and the and eye ALYTICS. With that, we were off. Our pharmacy provides us with a monthly reduction tracking report, which provides us with a list of all the residents who are on all classifications.
So for this portion of QAPI we were easily able to identify a total of ten residents by physical and psychological as well as a review who had not taken the medication or medications in some instances in question for well over amonth -- amont.
So we were with our sky tryst, Dr. Lester. We were able to look at ten residents PRN medications. There were two residents the psychiatrists wanted to leave the medication on board for two weeks for further monitoring because of his as well as previous history with these residents.
So what we've done now is we are continuing our QAPI. But since we meet on a weekly basis, we are doing it with a different class of anti-psychotic medications each meeting. We've done PRN antidepressants. We are going to PRN hypnotics, PRN anti-alytics. I guess for our chain, you know, I mean, when you look at numbers it doesn't appear that it's a lot. I mean, we've only reduced our usage by 2%. But it's a success and it's a success mainly for our residents, but also for our team because they see the improvement that they have made in the residents life knowing these medications are no longer needing to be given to our residents.
You know, I think one of the most trying issues that we've had on our journey is trying to get our physicians onboard with our initiative. Not that they're reluctant to -- or not that they don't agree with the concept. But they do not want to adjust any anti-psychotic medications. Their preference is only that a psychiatrist make those adjustments, which is not always a problem if that particular resident is on the psychiatrist's caseload. But, you know, as you can imagine, not all of our residents are being seen by a psychiatrist. So what we have resorted to is requesting psychiatric consults for anti-psychotic medication management review from those physicians who are not willing to adjust medications or those medications. And I guess my question, you know, has anyone else had the same issues with their physicians? And how are you handling it?
Is that a question, Alicia?
Yes, sir.
Feel free to type answers in the chat box for her. Or when we get into her -- Alicia's presentation, we can open the line and anybody can share their ideas.
Yeah. To finish up under the do section, you know. When we -- on our first go-around under, you know, what was actually done, what we decided that we had discontinued medications on this go-around for eight of our residents. And actually had reduced medications for two more. And under observations, as the residents had not been taking these medications, it was -- it was kind of a wash because, I mean, there was nothing really to compare it to as-they on them? Had they been taking them? No. Are they taking them now? No. Under the study section, you know, we felt successful knowing that there were less meds available to be given inappropriately to our residents. And I guess under -- along with that, because of the focus and with both the nursing staff, the residents, and the families, it has opened up the door because they're asking a lot of questions. The families are wanting to know, well, why do you want -- why do you not want mom to have, you know, PRNhalidol? So we are able do an education piece at that time. At the same time, we are also educating the staff so they understand that there is other options. And us doing it this way, doing the small portion first before we go into the big portion of our discontinuation and reduction of our anti-psychotic medications is that we're laying groundwork. And so when the end services are given, the staff has an idea of what we're talking about. The families are aware and actually onboard with our initiatives. And so, Frank, I think that's all I have to say.
Excellent. We have got a lot of responses as far as in the chat box on some of the -- that particular issue. They are just flying in there. We will be able to hopefully record those and get those to you as well, Alicia. That will be great great. I do have one particular question and kind of looming around. It's one barrier is that encountering in Texas is significantly high prevalence of halidal being described routinely to residents in hospice. Is this a problem in your facility?
Yes, actually, halidal comes in the hospice comfort kit. As soon as a resident -- at least in the Houston area. I am not sure about the other areas. As soon as a resident is placed on hospice, you receive a comfort kit. Ativan, Haly . dol. Then they will add other narcotics as necessary. But, basically, it's opening the door for inappropriate use. Yes, sir, that is correct.
Have you approached any of your hospice people to see what they could possibly do in that particular area? They are coming in with those medications. You still have to count them as, you know, --
well, interesting that you ask that question. We actually had two nurse practitioners who came in with a particular hospice company yesterday and we did discuss that. This particular company is starting to use -- increase the use of nurse practitioners in their practice. And that was discussed with them. And they were not aware of it. And so, you know, unfortunately, that's the only one we have talked to at this point. But that is an excellent point that you bring up and one that we will be talking to the other companies about. Thank you.
Very good. Thank you.
I guess we can open it up for further questioning, if you want to.
Thank you. Ladies and gentlemen, if you have any questions at this time please press the number 1 key. If you have any questions at this time, please press the number 1 key. I am showing that we have one from Marie. Marie, please go ahead. Marie from Meridian care, your line is open.
Oh, that was an accident.
Oh, okay. I didn't even touch the phone.
There are no other questions in queue.
Okay. Well, we do have quite a bit of comments and sharing of what folks are doing working with their physicians on anti-psychotics and psychiatrists. Sorry. So Alicia can review that chat box and we will get some good ideas. I want to remind you all again that we are forums that you all can utilize as a chat, it's similar to a chat. You will be running threads. You will be able to converse there, as well.
Okay. There we go. Another question I would like to ask you all, and you all can type in the cha, is are you actively using the PDFA process?
I'm sorry. Was that question to me?
No. No. That was for the participants.
Sorry. Okay. We don't have any comments in the chat about the CDSA cycle. So we'll move on. I would like to introduce -- Lori Brown-Duncan. Frank Barber also works with their team. Lori.
Hi everyone. The two areas ways asked to speak about was the anti-psychotics as well and urinary tract infections. And Alicia really did a great job touching on the anti-psychotic meds. I am not nearly as brave as her. I didn't start with ten people. I started with my winners. I wanted to show the team there were some immediate results because we all like instant gratification. So we started with our PRN's as well. I did one resident per hall. And I have four halls. So we had four people at a time and we really concentrated on monitoring their behaviors. We would look at their behavior every day in their morning meeting to see if they were having any additional behaviors. I personally look at all of the records before we admit someone to the facility and try to do some education with the hospitals. We have a lot of residents that might admit with sepsis from home. They have some type of acute deLeariam and they are in the hospital and they are immediately put on an anti-psychotic and they just forget to DC it before they come here. I try to get them do that before it hits my numbers. A lot of times they don't know, so it will still hit my numbers and then we just have to work from there.
Really, the big thing is just the education. We used our medical director a lot to talk to the other physicians. Really there was only one that was a bit hesitant and the medical director kind of pled our case there. So that worked out. But the urinary tract infections, as far as how we got that number down, because that was a significant problem for us, I admit. But we chose a lead TNA from each shift. We gave them just a tiny little raise and a lot more authority and asked them to do one-on-one education with every CNA. So they went in and they D D a reverse demonstration. They checked everyone off. If anyone had any issues, then they immediately jumped in, stopped the peri care, pulled them out of the room at the end of it and showed, you know, showed them how to do it on the next resident that it became available. Those were all signed off.
Then we do small in-services everymont. So we just touch on our progress. And then everyone stays motivated. It's hard to tell everyone about the same thing all the time. So instead of being too repetitive, then we are sharing our small victories, even though it's baby steps. We are still eating elephant just one bite at a time. I think that helps to get their buy-in.
We also, on all new-hires, pull all of the nurses in and explain the accountability to them and we discuss -- we use our catheter reports at the end of the month and break it down with our tracking and trending how many infections per hall. Are they self-toiletters? If they are, we do one-on-one education with that resident about proper peri care. If it's dependent, we say is it your home? I need you to take accountability for this. We have them watch one-on-one by that CNA. And then ifes this an issue that continues, I talk to the crew on that myself. But so far it really hasn't come to that level just because they do -- they have the buy-in now. They know what the potential is. What could happen. And not in a negative way. But, you know, positively, is that they have no more infections on their hall. At least facility-acquired infections.
The performance improvement project, we try to follow good format with that. We discussed it with our monthly quality assurance meetings and we keep it in our minutes. So if there is any question with survey or anything.
Really that's kind of it as far as the UTIs. Nothing too special. Just spending that extra time and education and doing your check-offs and keep that off. Be diligent. A lot of diligence.
Lori, you monitor all of the interventions that the team puts into place on a regular basis?
I do.
You do? Okay.
Um-hmm.
And how large is your facility?
We have an in-service disciplinary team that helps me with that. We have two ABLMs. Both of them help me. A social worker gets involved and also activities, because the people aren't sick, there are more activities. So she likes helping us.
How large is your facility, Lori?
120. We are a pretty new building. Only been here two years. So our census is still around 100.
Okay. Definitely a large or medium sized nursing home.
Yeah. We are 91, I think, today.
Thank you so much for sharing your progress. Sounds like you guys are on the right track. Always good to get started. Especially being in a new facility and changing that culture into the QAPI process. It really helps reeducate and keep that education going with all of your staff. Thanks again for sharing.
Absolutely. Well, thanks for your help and your leadership.
You're welcome. I guess, Tina, we can open up the floor for further questions. I know we have had a lot of chat going on in the chat box.
Ladies and gentlemen, if you have any questions please press the number 1 key. If you have any questions at this time, please press the number 1 key. Our first question is going to come from Christie. Christie, please go ahead. Christie from Santa Fe health rehab?
No, ma'am. That must have been an accident. I'm sorry.
Okay. No problem.
I apologize.
It's okay. We do have one question in the chat for Lori. Have you included rehab in your toy lighting training?
Occupational therapy really helps us a lot. And kind of on the same side of that, we also work in the showering. Not just in the peri sections of the ABL care, but also in the showering, and try to get the residents to relearn them that selves with OT.
Excellent.
Well, thank you. If there is not any other questions, we'll move on. Thank you, Lori, for sharing your team's journey. Sounds like you all are having some great successes and overcoming some challenges.
At KIC we have one question from charl. At Santa Fe we have -- Charlotte, please go ahead.
That must have been an accident also.
Okay. Sorry.
Sorry.
There are no more questions.
Okay. For some reason I keep having issues continued with the slides advancing. There it goes. Well, do you want to know more about QAPI? So BOTLO or BOTLO. That may sound familiar to some. It's actually Be On The Look Out for our QAPI webinar series. This series is going to help build upon your foundation leading you to success. This is our website address. This is the place to keep updated on the latest news, resources, and learning opportunities. We have many print materials and recorded webinars that will assist you in your improvement efforts. On a side note, this site will open after the webinar ends and you close the webinar browser.
In addition, this is the forms I was speaking of. This is a wonderful resource for learning and sharing from your peers. Unfortunately, this is an underutilized area in our resources at the time. It can be an invaluable place to learn from your peers, as we've seen in the chat today. One of our presenters mentioned offline that she has the QIO website as her home page, so she has quick access to the forms, the resources and their emerging updates.
Are there any other questions or comments? Anything anyone would like to share?
Ladies and gentlemen, at this time if you have any any questions please press the number one 1. Again, if you have any questions at this time please press the number 1 key. There are no questions in queue.
Okay. Well, today you have taken your time to learn from peers and the long-term care industry. We hope you will take the lessons you learned today and begin or continue your journey with QAPI so you are not left behind and staying ahead and working through those challenges and successes. We would like to thank Wendie, Alicia, with their successes with their team meeting and decreasing anti-psychotics and UTIs. Also with improving the communication. You will see on the slide here a pop up box. We would love your feedback on today's presentation. So just take a quick minute to complete that. And the next couple of slides about TMS. TMF is focused on improving life by improving the quality of healthcare. And the QIO program. This is contact information. Our website, e-mail address, and our phone number. I appreciate everyone taking their time today to participate. Thank you, and I hope to see everyone again on the next webinar. Have a good day.
Ladies and gentlemen, this now concludes your call. You may all disconnect. Thank you.