QAPI Templates

QAPI PLAN — [FACILITY NAME]
Effective date: [DATE]   Approved by governing body: [DATE]

1. DESIGN AND SCOPE
   Our QAPI program is facility-wide and addresses clinical care, quality of life,
   resident choice, and care transitions. It uses the best available evidence to
   define and measure indicators of quality.
   Services in scope: [NURSING, DIETARY, THERAPY, SOCIAL SERVICES, ENVIRONMENTAL,
   ACTIVITIES, BUSINESS OFFICE, CONTRACTED SERVICES]

2. GOVERNANCE AND LEADERSHIP
   Executive responsibility: [ADMINISTRATOR NAME]
   QAA committee members: Director of Nursing, Medical Director (or designee),
   Infection Preventionist, Administrator, and at least three additional staff:
   [NAMES/TITLES]
   Meeting frequency: at least quarterly, and more often as indicated.
   Resources committed: [STAFF TIME, DATA SYSTEMS, TRAINING BUDGET]

3. FEEDBACK, DATA SYSTEMS AND MONITORING
   Data sources: MDS/CASPER quality measures, incident and fall reports,
   infection surveillance log, grievance log, resident and family council minutes,
   satisfaction surveys, staffing (PBJ) data, pharmacy drug regimen reviews.
   Review cadence: monthly dashboard, quarterly QAA review.
   Adverse event definition and tracking method: [DESCRIBE]

4. PERFORMANCE IMPROVEMENT PROJECTS (PIPs)
   Selection criteria: high risk, high volume, problem prone, or resident-identified.
   Number of concurrent PIPs: [NUMBER]
   Each PIP uses a written charter (see PIP Charter template).

5. SYSTEMATIC ANALYSIS AND SYSTEMIC ACTION
   Root cause analysis method: [5 WHYS / FISHBONE / FLOWCHART]
   Actions target systems and processes, not individual blame.
   Sustainability check: re-measure at 30, 60 and 90 days after implementation.

PROGRAM EVALUATION
   The QAPI plan is reviewed at least annually and revised based on results.
   Last review: [DATE]   Next review: [DATE]