Archive for 'Surveys & Compliance'

SNF Workplace Safety: Tap These Links to Prevent Ergonomic Injuries

Posted on 10. Jan, 2010 by .

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Photos: CDC

Photos: CDC

The OSHA web site is more helpful than you think.

Many nursing facilities are implementing patient handling programs that focus on ensuring resident and staff safety.

Key point: To rollout a program, you don’t have to reinvent the wheel, according to Kathleen Rockefeller, PT, ScD, MPH, with the School of Physical Therapy & Rehabilitation Sciences at the University of South Florida in Tampa. Facilities can seek help from the Occupational Safety & Health Administration (OSHA) or other agencies, tap safety specialists — or do some Web searching to see what’s out there, “which is quite a bit,” Rockefeller adds.

For example, check out the OSHA “Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders,” which the agency revised in 2009. The guidelines include various decision trees for repositioning and transferring residents (see pages 13, 15, and 16).

The CDC’s National Institute for Occupational Safety and Health has a publication on its Web site on how to set up a patient handling program in nursing homes.

© Long-Term Care Survey Alert.

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3 Ways to Safely Rein in Physical Restraint Use at Your SNF

Posted on 04. Jan, 2010 by .

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Focusing on these specific clinical issues targets the cause of most restraints.

Physical restraints pave the way for numerous negative resident outcomes, including functional decline, pressure ulcers, depression, falls, and loss of dignity. On the other hand, trying to do restraint reduction on the fly has been known to tie up facilities in IJ citations.

The way out: A three-pronged framework can help you reduce restraint use in a way that wins kudos from residents, families, and surveyors.

Step # 1: Identify whether you’re an outlier. One-fourth of the nation’s nursing homes are at zero percent restraint use — and another quarter are under three percent, noted Carol Benner, ScM, in a webinar on Advancing Excellence in America’s Nursing Homes campaign. So if your facility is above three percent, it has some work it can do to eliminate some of those restraints, said Brenner, field director for the campaign. (more…)

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To Dispose of Controlled Meds, Your SNF Needs a Well-Thought-Out Plan

Posted on 04. Jan, 2010 by .

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Environmental concerns up the compliance ante for managing this common task.

A patient dies or goes to another care facility, leaving his controlled medications behind. What you do next could cause a compliance headache on a couple of fronts.

The bottom line: You have to follow state law requirements for disposing of the medication, and these may differ from state to state. “Some states require two nurses to destroy the medication,” says Al Barber, a director of pharmacy services for Golden Living Pharmacy Services at Golden Living. “Other states require a nurse and a pharmacist to do so. In the latter case, the facility has to store the medications until the pharmacist comes in, which may be only once a month. The drugs have to be secured with a double lock,” adds Barber. (He doesn’t count the director of nursing’s office door as a lock because her door is often open.)

Disposing of the drugs isn’t just a matter of whom — but also how.

“Nursing home staff used to flush the medications,” says Barber. “But a lot of states and local Environmental Protection Agencies are advising against that or don’t allow it.” (more…)

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Ramp Up Your Wheelchair Program Into Best Practice Territory

Posted on 14. Dec, 2009 by .

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Photo: Agência Brasil, Wikipedia

Photo: Agência Brasil, Wikipedia

Find out how to prevent skin breakdown and positioning problems, and enhance quality of life.

The right care plan can help ensure that a wheelchair serves as an enabler rather than a device that can lead to pressure ulcers, dependence, depression — even dysphagia due to poor positioning.

Start by asking if the resident really needs a wheelchair as much as he’s using it, advises Deborah Gavin-Dreschnack, PhD, a health science researcher at the James A. Haley VA Patient Safety Research Center in Tampa, Fla. Setting a goal of getting the person to ambulate at least some of the time can help sidestep the many potential negative effects of chronic wheelchair use, she points out.

If the resident does require a wheelchair, make sure it’s a good fit. That’s the most important thing, emphasizes Kate Brewer, PT, MBA, GCS, VP of Greenfield Rehabilitation Agency Inc. in Milwaukee. (more…)

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5 Ways SNFs Must Prepare for the MICs

Posted on 29. Nov, 2009 by .

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Don’t let the Medicaid Integrity Contractors pack a knock-out punch to your long-term care facility

If you think the RACs sound bad, you may not yet have heard about the MICs (Medicaid Integrity Contractors). These payment watchdogs are already auditing nursing homes and other providers in some states.

Beware: “Long-term care facilities will be much more likely to get medical record requests from MICs than from the Recovery Audit Contractors (RACs),” says Steve Lokensgard, special counsel with the Minneapolis office of the law firm of Faegre & Benson LLP. Forty-four percent of MIC audits are occurring in hospitals, 29 percent in longterm care facilities, 21 percent in pharmacies, and the remaining 6 percent in other settings, according to the ODF.

5 Ways to Prepare Now

To stay a step ahead of the MICs, consider these key strategies.

1. Nail down the basics. In a nutshell, the MICs include three types of contractors: review, audit, and education. “The review contractors will do data mining to find issues indicative of an erroneous claim,” explains Lokensgard. The audit contractors will then conduct the audits either onsite or as a desk audit, according to Barbara Rufo, director of the Medicaid Integrity Contracting Division, who spoke during the special ODF on the MICs. Education MICs will pick up on concerns uncovered by the othertwo MICs to educate providers and others about Medicaid payment integrity and quality of care, according to CMS. (more…)

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SNF Compliance: Mismatch Between MDS & Therapy Eval

Posted on 23. Nov, 2009 by .

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4 mismatch hotspots auditors are looking for — plus 3 questions you need to ask to fix them.

With the RACs and other auditors on the loose, the last thing you want to do is miss a case where a Part A resident’s MDSs, therapy, and nursing documentation show major inconsistencies. That very scenario, which cost one SNF its payment, offers some key take-away points for all facilities trying to keep their payment and compliance on track.

What happened: A resident went on Part A following a three-day hospitalization for pneumonia and an exacerbation of chronic obstructive pulmonary disease. Based on the therapy evaluation, the resident was receiving occupational therapy primarily due to hand contractures — and speech therapy for dysphagia, reports Marilyn Mines, RN, RACCT, BC, manager of clinical services for FR&R Healthcare Consulting in Deerfield, Ill, who reviewed the case for the facility.

The fiscal intermediary’s medical reviewer requested the admission assessment, which the team completed with an assessment reference date during the same timeline as the therapy evaluations. Thus, “one would have expected” the MDS and evaluations to be consistent, says Mines. But they proved to be anything but.

The MDS appeared at odds with therapy in the following 4 key areas: (more…)

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Got Surveyors? Know Your EHRs Inside-Out

Posted on 15. Nov, 2009 by .

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These 3 simple EHR moves will make your survey smoother.

If you manage a rehab setting that sees surveyors in any setting, including SNFs, your electronic health records shouldn’t pose a stumbling block for them.

Surveyors must be able to conduct the survey process consistently across facilities — whether those facilities use paper-based records or electronic ones, said CMS in a letter to state survey agency directors.

To ensure consistency, surveyors should discuss their process with each facility in the beginning so that surveyors are allowed unrestricted access to medical records.

Teamwork: Rehab providers and other staff must help surveyors access the records they need regardless of how those records are stored. CMS’ letter outlines the steps you must take to help surveyors, including:

  • Provide the surveyor with a tutorial on how to use your particular EHR system;
  • Designate an individual who will, when requested by the surveyor, access the system, respond to any questions, or assist the surveyor as needed in accessing electronic information in a timely fashion; and,
  • Provide direct print capability to the surveyor or make available a printout of any record or part of a record upon request in a timeframe that does not impede the survey process.

Remember, CMS reminds surveyors to print or request paper copies only for the parts of records they need to support noncompliance findings, unless protocol requires otherwise.

Attention ALL rehab settings: CMS’ letter also reiterated that it supports and encourages the use of EHRs and is “committed to a goal that by 2014, most Americans will have access to health care providers who use EHRs,” a goal first established by President George Bush in 2004. You can access the full text of the letter here.

© Rehab Report

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SNF Infection Control Alert: New MRSA Strain

Posted on 09. Nov, 2009 by .

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Batten down the infection control practices. A souped-up MRSA strain may be on the loose. The superbug appears more lethal than other MRSA strains and also shows some resistance to vancomycin, the antibiotic that usually vanquishes the superbug, report researchers at Henry Ford Hospital.

Alarming stats: The study found that 50 percent of patients suffering from the new strain, USA 600, succumbed within 30 days compared to 11 percent infected with other forms of MRSA.

“The average 30-day mortality rate for MRSA bloodstream infections ranges from 10 percent to 30 percent,” states a Henry Ford release on the study.

“While many MRSA strains are associated with poor outcomes, the USA600 strain has shown to be more lethal and cause high mortality rates,” said Carol Moore, PharmD, a research investigator in Henry Ford’s Division of Infectious Diseases and lead author of the study, in the release. “In light of the potential for the spread of this virulent and resistant strain and its associated mortality, it is essential that more effort be directed to better understanding this strain to develop measures for managing it.”

The researchers report that the USA 600 strain possesses “unique characteristics” that could be tied to the higher death rate seen in the study. But “it’s unclear whether other factors like the patients’ older age, diseases or the spread of infection contributed to the poor outcomes collectively or with other factors,” the release reports. The average age of patients infected with the new strain was 64 versus 52 for patients infected with other types of MRSA.

Researchers presented the studying findings at the annual Infectious Diseases Society of America meeting held Oct. 29-Nov.1 in Philadelphia. Henry Ford funded the study.

A must-listen audio: F441 — Infection Control in SNFs.

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SNF Survey Savvy: Be Strategic About Revealing QA Efforts

Posted on 06. Nov, 2009 by .

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Find out how to assuage surveyors’ concerns, not create them.

Surveyors are on the scene for a standard annual inspection, and you know the facility has done its QA to address a couple of clinical problems that cropped up during the year. Should you cry mea culpa and fork over the QA action plan forthwith, or would it be better to use a more measured approach?

Some experts suggest holding your QA cards close to your chest while also being prepared to present a winning hand, if demanded.

The bottom line: When a surveyor starts asking questions and expressing concerns about an area that the facility has been working on in a QA plan, “that’s the appropriate time to share what the facility has been doing,” advises Patricia Boyer, MSM, RN, NHA, president of Boyer & Associates LLC in Brookfield, Wisc.

(more…)

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What SNFs Need to Know About OIG’s 2010 Work Plan

Posted on 02. Nov, 2009 by .

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Hint: Pay close attention to hospital never events and Medicaid patients’ outcomes and MDSs.

The 2010 OIG work plan includes a new focus on key resident care and MDS-related issues that can come back to haunt your nursing facility if you don’t focus on them now.

The OIG says it “will review Medicaid data to identify nursing facilities that may have provided substandard care resulting in or contributing to beneficiaries’ subsequent hospital admissions, including those for diagnoses of pressure sores, infections, or both.”

The OIG also plans to review CMS’ processes for ensuring nursing homes submit accurate and complete MDS data. The plan notes that approximately half of states use the MDS as a basis for Medicaid reimbursement for nursing homes.

Also new on the OIG’s hit list:

A plan to examine hospital admissions for “present on admission” (POA) conditions. “For certain diagnoses specified by CMS, hospitals receive a lower payment amount if the specified diagnoses were acquired in the hospital,” states the OIG plan. (These so-called “never events” include stage 3 or 4 pressure ulcers and fall-related injuries, although the work plan doesn’t identify the POA conditions.) (more…)

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