Revision 16-1; Effective February 3, 2016
40 Texas Administrative Code §19.911, Rapid Response Teams (RRT), permits the Texas Department of Aging and Disability Services (DADS) quality monitors (QMs) to conduct RRT visits, based on early warning system (EWS) scores; those facilities identified as high risk through the EWS receive RRT visits. In addition, a facility will receive an RRT visit if it has received three deficiency citations in a 24-month period and those citations were determined to constitute an immediate threat to health and safety, related to the abuse or neglect of a resident.
RRT visits are a comprehensive form of a QM visit. The main difference between RRT and QM visits is that there is usually more than one clinical discipline involved, which could be any combination of nursing, dietary or pharmacy monitors. This allows for flexibility so the RRT may address nursing issues, as well as pharmacy or nutrition issues, to provide a broader view of the resident care systems. The regional regulatory liaison may be part of the team, with Ombudsman staff and other professionals assisting the team, as needed.
Facilities are required, by statute, to cooperate with the RRT, in an effort to improve the quality of care provided to residents.
The purpose of the visit is to help nursing facilities improve services and supports. This includes:
- Disseminating evidenced-based best practice (EBBP) information for specific focus areas through a streamlined, dynamic and interactive teaching model;
- Helping providers achieve optimal resident outcomes through the consistent application of EBBP;
- Engaging the nursing facility staff in a two- to four-day collaborative visit process that will provide an in-depth evaluation of their systems through observations, record reviews (including electronic medical records), interviews and analysis;
- Providing interactive technical assistance sessions to assist staff in identifying systems that need improvement;
- Providing a follow-up process, including phone calls, visits and in-services to assist providers in continuing to implement systems improvements; and
- Encouraging policy changes by including corporate level staff in the visit process whenever possible.
The RRT visit includes a comprehensive review of nursing facility systems and is conducted in an atmosphere that encourages learning and team building, while promoting positive partnerships with providers.
The RRT visit process begins with a letter from the QM to the facility's administrator announcing the purpose of the visit. The visit process is similar to a standard QM visit involving the same steps. The goal is to provide comprehensive technical assistance in an effective way to address underlying issues that impact quality in multiple focus areas. The discussion of the systems issues that are identified during the visit is coordinated between the disciplines who are participating in the visit to avoid duplication.
A nursing facility may request a technical assistance visit at any time. QM staff make every effort to accommodate such requests when providers ask for help with any of the issues that the Quality Monitoring Program (QMP) addresses.
Through an invited RRT visit, the facility can request a nurse, pharmacist or dietitian monitor, or any combination of these. In an invited RRT visit, the facility can choose the focus areas from among those in which the monitors have technical assistance resources.
By law, some restrictions are placed on invited visits. They cannot be scheduled earlier than 60 days after the date of an exit interview following an annual or follow-up survey or inspection, and they cannot be used to prepare for a regular inspection or survey.
If a facility is interested in scheduling an RRT visit, a facility representative should contact a QMP staff member assigned to their facility for assistance.