As we enter this new decade skilled nursing facilities continue to adjust to regulatory changes, increased emphasis on star ratings and work to understand the ever-changing adjustment to the MDS system. Regulatory compliance remains at the forefront of operational issues, and there appear to be repeat opportunities for improvement.
As of February 5, 2020, the Centers for Medicare & Medicaid Services (CMS) has issued over 10,000 citations at a “G” level or higher across the United States.
In a closer observation the top five issues are as follows:
|689||Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. This was cited 2,538 times at a “G” level or higher.|
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. This was cited 1052 times at “G” or higher.
|686||Provide appropriate pressure ulcer care and prevent new ulcers from developing. This was cited 1046 times at “G” or higher.|
|684||Provide appropriate treatment and care according to orders, resident’s preferences and goals. This was cited 880 times at “G” or higher.|
|697||Provide safe and appropriate pain management for a resident who requires such services. This was cited 350 times at “G” or higher.|
Each of these deficiencies most certainly can be reduced or eliminated with focused effort on the following corrective actions:
- Log, report and review resident (and employee) incidents appropriately. Look for patterns of either incident type, location of the incident, time of incident (by shift), etc. Zero in on the root cause of incident issues and assemble a plan to correct. Bring this information forward in the Quality Assurance and Performance Improvement (QAPI) meetings and act on the data that is revealed.
- Does your staff know what constitutes abuse? Review your on-boarding and annual training for all levels of staff. Are your policies clear about zero tolerance? Does your staff know how to spot, and act on, a potential abusive action? If not, work to change your education. Also, look at your hiring process. Are you hiring individuals who align with your zero-tolerance policy? When interviewing potential new team members, if they do not align with your abuse policy, do not hire them.
- Pressure areas are preventable in almost every case. The wound care approach in your facility should always be “all hands-on deck,” and knowledge of pressure relieving techniques should be second nature to every care giver in the facility. This includes nurses, care aides, medication technicians, and any other staff members that provide hands on care. Additionally, education for staff such as housekeepers and maintenance should raise awareness to identify if a resident has been in the same position for an extended period of time. Ancillary staff members can be an extra set of eyes acting as an advocate for the residents.
- Residents have the choice of directing their own care. Include each resident in assembly of their care plan and educate them, if necessary, on appropriate avenues that will coincide with the physician’s orders.
- Pain management control resides in the hands of every care giver providing care for the residents— not just the licensed nurses. Nurses should assess pain levels from a clinical perspective, but other staff can assess pain in many other ways. For example, if there is a resident who has stopped going to his/her favorite activity because it’s painful to get in and out of a chair, the activities team could be the first line of access to notice this decline. Adjustments to the care plan and other potential interventions can be implemented with helpful information provided by the activities staff.
If your facility is struggling with the regulations and need assistance in formulating a solution, contact LW Consulting Inc. We provide many avenues for assistance available to long term care providers.
If you need help with education on these regulations, LW Consulting, Inc. is ready to assist you.