Archive for 'Surveys & Compliance'

2 Syndromes That Will Derail Your Best Long-Term Care Survey Management Plans

Posted on 05. Mar, 2010 by .


If you aren’t holding these meetings, you’re missing a key opportunity.

When survey day disasters and complaint surveys appear to strike out of the blue, take another look. Two common phenomena could be behind what seems like bad luck, which means you can take steps to prevent both of them.

The first one involves staff who become overwhelmed and zombie-likeduring the survey, says Joy Jordan, RN, MSN, RAC-CT, who refers to this behavior as the “Paralytic Syndrome.” When the syndrome sets in, the next thing you know, “meds aren’t going out on time, call bells aren’t being answered,” and so on, says Jordan, a consultant in Brookfield, Wis.

Real-world practice: To keep care systems flowing during the survey, assign department heads to cover a certain range of residents’ rooms and be responsible for those residents wherever they might be in the facility, suggests nurse attorney Kathy Hurst, director of healthcare operations for TSW Management Group, which owns and manages nursing facilities in California. That’s the strategy that TSW finds works well. “The administrator may get rooms one through five, for example,” Hurst explains. “The department head makes sure the resident is getting turned and repositioned, including in a chair if the resident’s out of the room.” The assigned person also sees to it that the water pitchers get filled and the trash emptied, she adds.

Next: Don’t make this common mistake with mock surveys … (more…)

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Jazz Up In-Service Training at Your Nursing Facility

Posted on 21. Feb, 2010 by .

One sign you've got a kinesthetic learner on your hands. Image: Redbull student, Wikimedia Commons

One sign you’ve got a kinesthetic learner. Image: Redbull student, Wikimedia Commons

Is staff training an engaging event at your nursing facility or one that people muddle through?

Wake-up call: People dozing off in the back of the room may pay attention if the instructor crafts the educational sessions in a way that appeals, at least in part, to the way they learn best.

As trainers, however, “we often tend to design training that appeals to our strengths,” cautioned Maureen Sheahan, with PHI in Bronx, N.Y., during an Advancing Excellence in America’s Nursing Homes’Webinar on staff training. But adults learn best when trainers vary teaching activities.

For example, “some of us have to be in motion to learn,” she noted. These are the “kinesthetic learners.” Auditory learners love to listen, she noted. Some people are visual learners. To identify your predominant learning style, Sheahan suggested considering these key principles and information:

Kinesthetic Learners Like Hands-On Learning. Kinesthetic learners may find themselves doodling when listening. And they may be “easily distracted” during lectures. They like to be “active in the learning” process, Sheahan noted. They tend to skip the package instructions when trying to assemble something on their own. (more…)

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Looking to Prevent Rehospitalizations and Sidestep F Tags?

Posted on 15. Feb, 2010 by .


This 3-Prong Plan Can Expedite Care for Emergent Conditions

Ensuring nursing residents receive timely care can be difficult when you have to wait for busy attending physicians to return your calls or deal with on-call doctors who don’t know the residents. A few key strategies can, however, keep the treatment ball rolling and residents out of the emergency department and hospital.

Strategy No. 1: Develop symptom assessment protocols for nurses to gather data before calling the doctor about a resident. Nurse practitioner Clare Hendrick has developed 22 such protocols to help a nurse at the LPN level collect the right information to guide the doctor’s decision-making. The nurse uses the forms to gather information before calling the doctor, says Hendrick, principal of ProTime in San Clemente, Calif. The nurse then puts the completed form on the resident’s chart to remind the physician that something had happened in between visits. The protocols address issues ranging from falls to pressure ulcers, delirium/change in mental status to behavioral symptoms, UTI, and more.

Facilities can work with medical directors who get input from attendings to develop assessments for various conditions where the nurse gathers certain data before calling the physician, advises Steven Levenson, MD, CMD, in Baltimore, Md.

Don’t miss: Read about the other 2 key strategies and check out an assessment protocol for aggressive and combative behavior in Long-Term Care Survey Alert, Vol. 12, No. 2, available online immediately when you subscribe.

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F Tags: Nervous When Surveyors Watch You Do Med Pass?

Posted on 15. Feb, 2010 by .


Your skilled nursing facility staff will thank you for these goof-proof tips.

You’re getting ready to pour the morning meds when a surveyor appears over your shoulder to watch. And you know one wrong move could saddle the facility with an F tag, not to mention jeopardizing your performance record.

Never fear: A couple of strategies can help you avoid making common mistakes or getting sidetracked by a non-cooperative resident, reassures Kristi Kemper, RN, a quality assurance nurse with TSW Management Group Inc., which manages and owns nursing facilities in California.

Example: “During a med pass when the nurse has a lot of meds to give, the nurse can open up the med sheet and put a little dot by each medication on the med sheet so the nurse knows she poured that medication,” suggests Kemper. That approach can help the nurse avoid skipping a medication.

Also: Sometimes nurses get nervous knowing that a certain resident typically requires a lot of time to take his medications, adds Kemper. In that scenario, she tells the nurse to go ahead and a put a little clip by that resident’s name and go on to the next resident. Then come back to that resident marked by the clip after you’ve hit your stride in giving meds and feel more comfortable with surveyors observing.

Another way to combat survey jitters: Kemper finds that the more she observes nurses doing med pass to make sure they are following protocol, “the less nervous they get because they know what to expect. They get in the right habits and do fine during the survey.”

© Long-Term Care Survey Alert

Available on CD: Infection control compliance in skilled nursing facilities.

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CMS to Medicare Contractors: Home in on These Potential Problem Areas Identified by the OIG

Posted on 07. Feb, 2010 by .


We’ve got the links that tell you exactly what problems auditors are looking for.

If you tend to think of OIG reports as a lot of barking without much of a bite, think again. CMS has already directed its Medicare contractors to put providers on a shorter leash related to overpayments identified by four OIG reports last year.

Specifically, CMS Transmittal 620, issued on Jan. 15 with an effective and implementation date of Feb. 16, directs MACs and FIs to “strengthen program safeguards” related to issues identified by OIG reports looking at SNF consolidated billing for ambulances, and Medicare hospice care for nursing home beneficiaries. Also on the list: Medicare payments for pressure-reducing support services, and pricing for negative pressure wound therapy pumps.

Faster on the draw … (more…)

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Guard Against These Survey Snafus

Posted on 01. Feb, 2010 by .


Simple tips stop smokers from setting off fire alarms and staff from going rogue.

Anyone who has been on the survey front lines for long has war stories about unexpected events that can put a facility on the fast track to decertification. You can, however, head off serious citations by thinking through how to avoid these and other worst-case scenarios that can befall the best of facilities.

Real-world examples: One facility netted an immediate jeopardy citation when a nursing assistant told surveyors she’d come to work sick with a GI virus during an outbreak of the virus at the facility. In another case, a resident who’d been found at one point eating her denture-cleanser tablets, requiring a trip to the emergency department, still had the tablets in her room — even though the care plan clearly directed otherwise.

Read the full article in the latest edition of Long-Term Care Survey Alert, (Vol. 12, No. 2), available immediately online when you subscribe.

Available on CD: Long-Term Care Survey Prep 101.

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Nursing Home Compliance: Address These 2 Physician-Order Related Issues

Posted on 24. Jan, 2010 by .


Sidestep nursing board actions, immediate jeopardy citations, and payment recoupments.

With RACs on the loose and surveyors eager to hand out F tags, your facility might be wise to see how it’s handling these two areas:

1. A physician order that seems out of line. “Nursing home staff need to question physician orders that don’t seem to be advisable to follow,” says attorney Neville Bilimoria, partner, Duane Morris LLP in Chicago. He handled a situation where a nurse recognized that a medication order was 10 times greater than the usual dose — “but still an acceptable dose for some conditions.” But “rather than question the order, the nurse gave the medication dosage, which was actually the wrong dose,” he says. (more…)

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Ways to Crank Up Your IRF’s Physician Documentation

Posted on 24. Jan, 2010 by .


Use these tips to stay one step ahead of the new IRF coverage criteria.

As you charge full-force into 2010 tackling the new inpatient rehab facility coverage criteria, keep your physician documentation radar alert.

Putting emphasis on physician education and documentation will be critical, says Fran Fowler, FAAHC, managing director of Health Dimensions Group in Atlanta. And it’s not just the time constraints to complete the documentation that’ll prove challenging but also the documentation content. “I think all the physician documentation requirements is CMS’ attempt to differentiate what happensin [inpatient] rehab versus skilled care, because skilled care doesn’t really have a physician [involved in rehab],” she says.

The problem: Many IRFs will be starting one step back because “physician documentation has always been problematic,” notes Ann Lambert Kremer, OTR/L, MHSA, CPC, with Beacon Rehab Solutions in Portland, Maine. But you can stay one step ahead with these tips. (more…)

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3 SNFs Fined For Flushing Pharmaceutical Waste

Posted on 18. Jan, 2010 by .


We’ve got the links to medication disposal options to help you keep your facility out of regulatory cross-hairs.

New York Attorney General Andrew Cuomo has reached settlement agreements with two upstate hospitals and three nursing homes — the first-ever settlements requiring health care facilities to end their practice of disposing of pharmaceutical waste into the watershed, according to this release from AG Cuomo’s office.

The five health care facilities are located in Delaware and Putnam Counties and within the New York City Watershed — an almost 2000 square mile area that drains into reservoirs and lakes providing drinking water to eight million residents of New York City and one million people living in Westchester, Putnam, Ulster, and Orange Counties.

As we previously reported in Long-Term Care News, New York is just one of several states concerned about medication dumping. Unused medications flushed down toilets or sinks end up at sewage treatment plants or septic systems that are not designed to treat such wastes and do not remove some pharmaceuticals. Moreover, drinking water treatment plants, including those that chlorinate drinking water, do not consistently remove pharmaceuticals such as painkillers, antibiotics, anti-depressants, hormones and other waste drugs.

Next: Drug take-back plans can be a solution … (more…)

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Does Your SNF Have EHRs? Brush Up on Medical Privacy Basics Before Your Next Survey

Posted on 10. Jan, 2010 by .


CMS directs surveyors to look for these 2 common privacy missteps.

Electronic health records may be the wave of the future, but you have to make sure they don’t end up littering your CMS 2567 with F tags for privacy violations. And a recent survey & cert memo provides a heads up about what nursing home surveyors may target related to medical privacy.

Good and bad news: CMS doesn’t expect surveyors to assess whether EHRs comply with HIPAA privacy and security rules, the memo states. But the agency does direct surveyors to focus “on how the EHR system is being used in the facility.” Examples include whether facility staff members leave computer screens that display clinical record information “unattended and readily observable and accessible by other patients/residents or visitors.”

Also on surveyors’ hit list: Watch out for “documents publicly posting computer passwords.” This would be “evidence,” the memo says, “of noncompliance with both confidentiality and medical record authentication requirements.” The memo also directs surveyors to ask themselves:

“Is there evidence to support a complaint allegation that facility staff shared information obtained from an EHR with unauthorized individuals?”

Follow This Expert Advice to Shore Up Privacy … (more…)

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