Waveney R LaGrone, UT Health Houston Cizik School of Nursing
Purpose: This quality improvement (QI) project aimed to improve adherence to health and safety regulatory requirements by implementing an evidence-based nursing policy framework to strengthen documentation consistency and clinical practice in a Medicaid-funded Home and Community-Based Services (HCS) program serving adults with intellectual and developmental disabilities. Background: A baseline review (January–June 2025) identified documentation and regulatory compliance gaps, including three falls, eight psychotropic medication changes requiring follow-up, two emergency department visits or hospitalizations, and five late or incomplete Comprehensive Nursing Assessments (CNAs), highlighting the need for standardized nursing policies. Methodology: Guided by the Model for Improvement using Plan-Do-Study-Act (PDSA) cycles, 11 nursing policies were revised to align with Texas Administrative Code and Texas Board of Nursing standards. Registered nurses completed education before implementation. Outcomes were evaluated by reviewing nine group-home charts using documentation and regulatory compliance indicators. Results: All 11 nursing policies were successfully implemented. Compared with baseline, post-implementation results showed fewer documented falls (3 to 1), fewer psychotropic medication changes requiring follow-up (8 to 1), elimination of late or incomplete CNAs (5 to 0), and no emergency department visits or hospitalizations. Three non-serious clinical incidents were documented as balancing measures. Implications: The evidence-based nursing policy framework improved documentation consistency, regulatory compliance, and standardized clinical practice. This sustainable approach may serve as a model for strengthening regulatory adherence and improving care quality in Medicaid-funded HCS programs serving adults with intellectual and developmental disabilities.