Archive for 'Surveys & Compliance'

SNF Infection Control Challenge: Test Your F411 Know-How

Posted on 24. Oct, 2009 by .


How does the Revised Nursing Home Survey Guidance for Infection Prevention/Control (F441) define an outbreak?

Question #1: Surveyors will be looking to see if your facility knows how to identify and contain an outbreak of infectious illness. How does the revised survey guidance define “outbreak?”

a. One case of a highly communicable infection.

b. Trends that are 10 percent higher than the historical rate of infection for the facility that may reflect an outbreak or seasonal variation.

c. Occurrence of three or more cases of the same infection over a specified length of time on the same unit or other defined areas.

d. All of the above.

Question #2: Which of the following represent true statements about coding wound infections on the MDS? Circle all that apply.

a. Code only skin ulcer infections (pressure ulcers, arterial, venous or diabetic ulcers).

b. Code infection of any type of wound (e.g., postoperative; traumatic; pressure) on any part of the body.

c. Code wound infection at I2l.

d. Code wound infection in Section I2 and Section M1.

Did you get the answers that will keep the F-tags away? Check out next Tuesday’s edition of Long Term Care News.

Available on CD or MP3: Steer Clear of F-Tags. With attorney Joseph Bianculli.

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Keep Your Post-Acute Delirium QM on Track as a QA Tool

Posted on 19. Oct, 2009 by .

Photo: Alexander Rahm

Photo: Alexander Rahm

If SNFs monitor this measure, they can help prevent rehospitalizations.

The delirium post-acute quality measure provides a warning that all may not be well with your assessment, care — or MDS coding. If the facility scores higher on the delirium QM than the national average, analyze what’s going on, suggests Sue LaBelle, MSN, RN, senior healthcare specialist with PointRight Inc. in Lexington, Mass.

If your facility is high on the measure (and inaccurate MDS coding isn’t the culprit), consider asking these questions, included in a fact sheet on delirium published by the American Medical Directors Association:

How many of the residents who have delirium were admitted into the facility with delirium?

Tip: “Identify that someone was admitted with signs and symptoms of delirium,” advises Nathan Lake, RN, BSN, MHSA, a long-term care expert in Seattle. “That way, if surveyors ask you about it later, you can show documentation that the delirium was assessed to be present at admission,” he points out.

How does the facility identify and assess delirium in a timely fashion, especially in those residents coming from the hospital?

How does the facility ensure that a doctor or other healthcare professional such as a nurse practitioner is involved in diagnosing and managing delirium?

How does the facility investigate factors that may contribute to delirium in its residents?

For example, how does the nursing facility monitor fluid balance and side effects of medications?

Editor’s note: For a suite of articles in MDS Alert on assessing and preventing delirium, including medication- induced delirium, e-mail the editor at

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What Your SNF Should Know About the New HIPAA Breach Notification Rules

Posted on 12. Oct, 2009 by .


Proactive documentation management has taken on new urgency for paper records.

New HIPAA breach notification rules now require your facility to report impermissible disclosures of unsecured protected health information that pose a significant risk of harm to the affected individual(s). Not only do you have to notify the individuals whose privacy has been breached, but also the Department of Health & Human Services (HHS) and the media, in some cases.

Action: Your facility might want to shore up its paper documentation management, especially if nurses doing preadmission assessments transport any written patient-related information to the facility.

Beware: The consequences of allowing your paper records to get out of hand can land your facility a spot on the local news. “If the breach of unsecured PHI involves more than 500 individuals in any jurisdiction, then the facility has to notify HHS and the media,” says Jim Sheldon-Dean, principal and director of compliance services for Lewis Creek Systems LLC in Charlotte, Vt. And the facility will end up on the HHS Web site. “If there are more than 10 affected individuals for whom you have no contact information, you may need to post a notice on your Web site or notify the media, providing a toll-free telephone number.”

Follow These Key Steps to Keep Documents Safe

As a first step, identify where all your paper documentation containing PHI is “and where it’s going,” advises Sheldon-Dean. “Who has it, how does it move around, and what information is contained in the documentation? Once you understand that, you can identify what you need to lock up at night, for example, or restrict from moving around.” It’s extra important to control specially regulated health record information,such as mental health issues, HIV, or substance a buse, he points out. (more…)

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Outpatient Rehab: Don’t Get Too Discount-Happy With Patients

Posted on 05. Oct, 2009 by .


Times are tough, yes, but SNFs that waive outpatient rehab therapy copays or discount their rates may be waving goodbye to precious revenue — and their compliance records.

“The biggest way to save money is to not purposefully lose money,” says Michael Weinper, MPH, PT, president & CEO of PTPN in Calabasas, Calif. And that’s precisely what waiving copays does — you’re in essence subsidizing the patient’s care.

Not to mention: Waiving copays is illegal, Weinper points out.

Important: Make sure patients understand the reason behind why you can’t waive copays, as opposed to just saying, “This is just our policy,” Weinper says. Therapists are business owners, and business owners should charge for everything they do.

Sometimes therapists or front desk staff may feel the practice is charging patients too much because the therapists don’t realize what it really costs to run a business. This might cause them to not bill for every service or to waive copays.

Solution: “Let your employees see the reality of the financial situation you face,” Weinper says. Show them your budget at a team meeting. “Most of them don’t realize how close you are to break-even. Some owners pay everyone first and then take their money last,” he says.

© Rehab Report.

AUDIO TRAINING EVENT: What SNFs need to know about the 2010 OIG Work Plan.

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SNFs: How To Ramp Up Your Swine Flu Infection Detection Program

Posted on 03. Sep, 2009 by .


4 ways to give your surveillance efforts more ooomph.

The World Health Organization has declared a swine flu pandemic, and that that means your facility needs to be ready to identify and report what could turn out to be the tip of an outbreak in your community.

“Experts do predict that the novel H1N1 will be a predominant flu this coming flu season,” says James Marx, RN, MS, CIC, an infection control expert and principal of Broad Street Solutions in San Diego. And even if the swine flu doesn’t end up being a major problem, your ramped-up surveillance will pay off by preventing the spread of other seasonal flu viruses and communicable illnesses, such as the norovirus. Here’s what experts suggest you should do now.

1. Look for a Cluster of Sx

“Identifying potential cases of swine flu (novel H1N1) can be tricky,” says Deborah Burdsall, RN, MSN, CIC, infection preventionist at Lutheran Home in Arlington Heights,Ill., and a spokesperson for the Association for Professionals in Infection Control. That’s because some of the symptoms for novel H1N1 — sudden onset of fever with headache, sore throat, and the usual flu aches and pains — may not stand out as something unusual. But the novel H1N1 virus also has “a component of diarrhea and nausea, which isn’t always true of influenza. In addition, the Centers for Disease Control & Prevention has noted that some people with H1N1 were complaining of sudden dizziness,” Burdsall notes.

AUDIO: Frances Fowler teaches you what you what your SNF needs to do to thrive in the new era of post-acute care.

Good idea: Evaluate staff members’ symptoms, too — and weed out false alarms. For example, if a staff person reports that she had 24 to 48 hours of nausea and vomiting without a respiratory component or fever — that’s most likely a GI virus, says Burdsall. “That is not influenza.” (more…)

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Does Your SNF Have an H1N1 Disaster Plan?

Posted on 27. Aug, 2009 by .


If not, here’s a cool tool that’ll give you a leg up.

The swine flu virus isn’t more deadly than other flu strains, but it’s got some other scary characteristics that make a pandemic/epidemic disaster plan more crucial than ever for your long-term care facility.

H1N1 is “likely to infect more people than usual because it is a new strain against which few people have immunity. This could mean that doctors’ offices and hospitals may get filled to capacity,” states a startling new wake-up call from White House.

Top recommendations from the President’s Council of Advisors on Science & Technology report on the 2009 novel H1N1 flu include:

  • Accelerating preparation of flu vaccine for high-risk individuals
  • Clarifying guidelines for antiviral medication use;
  • Upgrading the system to track the pandemic and guide resource allocation
  • Accelerate development of communication strategies, “including “Web-based social networking tools” to disseminate information
  • Identify a point-person at the White House with primary authority to coordinate key decisions government-wide as the pandemic evolves.

What LTC facilities can do now: Have a good disaster plan in place in case of a community outbreak of flu [or other infectious disease],” says Kristin Lueschow, RN, RRT, WCC, a consultant with Boyer & Associates in Brookfield, Wis.

Resource: Check out “Planning for a Pandemic/Epidemic or Disaster: Caring for Persons With Cognitive Impairment,” for tips on managing residents during a crisis. Numerous long-term care professional and trade groups developed the resource, including the American Health Care Association, the American Association of Homes & Services for the Aging, and the American Medical Directors Association.

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

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SNF Survey Savvy: Can You Spot Drug Diversion Warning Signs?

Posted on 19. Aug, 2009 by .


SNF risk management experts tell you how to spot & stop this all-too-common problem.

Drug diversion can land your nursing facility a spot on the nightly news — or worse.

Beware: In nursing homes, drug diversion is a form of abuse, “since it deprives the patient of proper medication,” warns the Texas Medicaid Fraud Control Unit in materials posted on the Texas Attorney General’s Web site.

Diversion can also defraud the Medicaid system, if it pays for medications the patient doesn’t receive, the MFCU points out.

Not only that: Federal agencies, including the Food & Drug Administration and Drug Enforcement Administration, are hot on the trail of a growing epidemic of prescription drug diversion in the community involving mostly opioids. Thus, nursing facilities are wise to double their efforts to prevent scheduled narcotics from getting in the wrong hands.

Focus on Compliance With the Basics

Audit on a regular basis to make sure nursing staff are complying with narcotic counts, and documenting pain assessments and evaluation of interventions for patients on opioids and other pain medications. When nurses don’t do the narcotic count routinely, and a problem with suspected diversion arises, it becomes evident that the count hasn’t been done, cautions Albert Barber, PharmD, who oversees pharmacy services at four nursing facilities for Golden Living, which is based in Ft. Smith, Ark.

AUDIO TRAINING EVENT: Conquer Pain & F309 Survey Deficiencies.

Two nurses should not only do the narcotic count each shift, but also witness each other wasting medication when a patient doesn’t require a full dose of a narcotic. “If only one licensed nurse is on a shift, the nurse could lock up the medication and waste it when a second nurse comes on duty on the following shift,” advises Barber. (more…)

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