2023 Quality Report

Hospital Quality Improvement Projects - Clement J. Zablocki VA Medical Center, Milwaukee

Age-Friendly Journey

In early 2022, the Zablocki VA Medical Center Community Living Center (ZVAMC CLC) embarked on the Age-Friendly journey. The care in our CLC was already meeting most of the required elements so all that was needed was to tweak some of the assessment frequencies and submit the required 4Ms care description worksheet. By September, the CLC was recognized as an Age-Friendly Health System Participant.  

The next challenge was to earn the Level-2 Age-Friendly designation as: Committed to Care Excellence. All that was needed was to use the 4Ms framework to identify an opportunity for change and adapt. The first Age-Friendly (AF) project was focused on the community homes. Three houses each with 10 veterans are considered to be one neighborhood (unit) of the VA Community Living Center. The resident council voiced the need for all Veteran appointments to be noted on the white board located inside each resident room. The project was rolled out with a brief education on Age-Friendly and the 4Ms framework. The RN and nursing assistant staff were to ensure the Veteran’s upcoming appointments were listed on the white board unless the Veteran opted out. Subsequent audits showed intermittent improvement. Given this, our QAPI group was underwhelmed and decided we should attempt another project to submit for our Level 2 designation.

The QAPI group loved the adoption of use of the VIONE tool. VIONE stands for: Vital, Important, Optional, Not needed, Every medication has an indication. Basically, a mechanism to reduce pill burden and track successes and cost savings. The initial goal is to start small by introducing this one Veteran at a time; currently we have an N=1. VIONE is currently used only for outpatient populations at ZVAMC, however, it has been used successfully at other VA CLCs. 

Nationally, the VA is invested in promoting Age-Friendly practices. In early 2022 there were about 10 VAs in the nation which had obtained Institute for Healthcare Improvement Level-2 designation – Committed to Care Excellence; and by the end of the year there are about 40. The VA’s Office of Geriatrics and Extended Care linked with IHI Age-Friendly to adopt a Veteran Friendly model for Age-Friendly Health Systems. The project started the nine-month series in the fall of 2022 and will be completing the series in 2023. We anticipate that AF recognition will be an expectation for all VA CLCs.