persons动易论坛
动易论坛 时间:2021-05-03 阅读:()
NursingHomeFacilityAssessmentToolandStateOperationsManualRevisionsSeptember7,20172AcronymsinthisPresentationLTC-Long-termCareRUG-ResourceUtilizationGroupsMOU-MemorandumofUnderstandingQAA-QualityAssessmentandAssuranceQAPI-QualityAssuranceandPerformanceImprovementBCP-BaselineCarePlanPRN-As-NeededIP-InfectionPreventionist3AgendaFacilityAssessmentToolJayWeinstein,CMSAngelDavis,CMSMarilynReierson,StratisHealthKellyO'Neill,StratisHealthFrequentlyAskedQuestions–StateCMSSubjectMatterExpertsOperationsManualAppendixPPRevisions4NursingHomeFacilityAssessmentToolJayWeinstein,CMSAngelDavis,CMSMarilynReierson,StratisHealth,NationalCoordinatingCenterKellyO'Neill,StratisHealth,NationalCoordinatingCenter5FacilityAssessmentTool–IntroductionJayWeinstein,NHA,HealthInsuranceSpecialist,DivisionofNursingHomes,SurveyandCertificationGroup,CMSAngelDavis,MBA,MS,BSN,RN,CenterforClinicalStandardsandQuality,QualityImprovementandInnovationGroup,DivisionofBeneficiaryHealthcareImprovementandSafety,CMSToolrequirementandintentTooloverview,developmentprocess,andpilotCloserlookatthetool–walkthrougheachsection6OptionalFacilityAssessmentToolDesignReflectFacilityAssessmentrequirementsdescribedintheregulationBesimplifiedasmuchaspossibleHelpnursingfacilityteamsinplanningfortheirassessmentModifiable–AllowateamtoconsiderandadditemsappropriatefortheirownfacilityandtoindividualizetheirassessmenttomeettheintentoftheregulationSupporttranslationofassessmentfindingsintoaplanUseofthistoolisnotmandatedbyCMS,nordoesitscompletionensureregulatorycompliance7FacilityAssessmentToolPurposeandIntentPurpose:todeterminewhatresourcesarenecessarytocareforresidentscompetentlyduringday-to-dayoperationsandemergenciesMaybeusedtomakedecisionsaboutdirectcarestaffneedsaswellascapabilitiestoprovideservicestotheresidentsinyourfacilityIntent:Forthefacilitytoevaluatetheirresidentpopulationandidentifyresourcesneededtoprovidenecessaryperson-centeredcareandservicesrequiredbyresidents8ToolDevelopmentProcessIterativeprocesswithCMSDrafttoolsharedduringapilottest(July2017)Nationalpartnerandstakeholderorganizations–representingnursinghomes,administrators,directorsofnursing,medicaldirectors,consumers,andsurveyorsNursinghomes,17homesrepresenting7states,mixofrural/urban,large/medium/small,forprofit/nonprofit,ownershipCommentsandfeedbackusedtorevisethetool9FacilityAssessmentToolOverviewIntroductionRequirement,purpose,overviewofthetool,guidelinesforconductingtheassessment,tabletocapturewhentheassessmentwascompleted/updatedandthoseinvolvedThreepartsResidentprofileandfactorsthatimpactcareandsupportneedsServicesandcareofferedbasedonresidentneedsFacilityresourcesneededtoprovidecompetentcareforresidentsTwoattachmentsReferencestothefacilityassessmentintheOctober2016ReformofrequirementsforLong-TermCare(LTC)facilitiesSampleprocessforconductingtheassessment(intendedforinternalnursinghomeuseonly)PlanfortheassessmentCompletetheassessmentSynthesizeandusetheassessmentfindingsEvaluateyourprocessandplanforfutureassessments10PilotTestCommentsandFeedbackAgreementthatitwashelpfulinprovidingdirectionfortheassessmentNearlyallagreedthetoolwasalignedwiththeregulationsandinterpretiveguidance,includedcleardescriptionsofwhatwasbeingasked,providedhelpfulexamples,andcouldbeusedtodeterminewhatresourcesarenecessarytocareforresidentsAgreementthatlistsandexamplesinthetoolwerehelpful,tohelpteamsthinkmorein-depthandnotoverlookkeyareas"Makesusanalyzewhatourresourcesareandlackofresourcestomeettheneedsandrequestsofourclientele.
""Ittriggersapauseforleadershiptocomprehensivelylookatthefacility'soperationsandcomparethattoitsstatedgoals(ifany),identifiedchallenges,etc.
"11PilotTestCommentsandFeedbackAgreementthatAttachment2"Suggestedprocessfortheassessment,"including"synthesisanduseoffindings"washelpfulMentionthatdescribingacuitycanbechallengingSomecommentersaskedformoreinformationinthestaffingsection,othersaskedforlessSomerequestsforalgorithmsorresidentclassificationsystemstodeterminestaffingneeds,patterns,etc.
Somecommentsthatthefirstassessmentmaytakesometime,butafterthat,updatesshouldbequickerManyhelpfulcommentstostrengthenthetool12Let'sLookattheToolLinkforthetool:FacilityAssessmentTool13FacilityAssessmentTool:GuidelinesforConductingtheAssessmentUsedatafromavarietyofsourcesPlanforaninclusiveprocesstoincludepersonsthatcareaboutthisConductatthefacilitylevelReviewandupdateannuallyorwhentherearesignificantchangesUseasarecordtounderstandreasonforstaffingandresourcedecisionsUnderstandhowtheassessmentmaybeusedinthesurveyprocessSeeAttachment2forasuggestedprocessforconductingtheassessment14Part1:ResidentProfileNumbers:licensedbeds,averagedailycensus,#personsadmitted/dischargedCommondiseases/conditions,physicalandcognitivedisabilities(tohelpidentifytypesofresourcesneededtomeettheneedsofresidentslivingwiththeseconditionsorcombinationsofconditions)DecisionsregardingcaringforresidentswithconditionsthatyoudonotcommonlyseeAcuity–toidentifypotentialimplicationsregardingtheintensityofcareandservicesneededThreeexamplesprovided:MajorResourceUtilizationGroups(RUG)-IVcategoriesSpecialtreatmentandconditionsAssistancewithactivitiesofdailylivingOtherEthnic,culture,religiousorotherfactorsthatmayaffectthecareprovided15Part2:ServicesandCareResidentsupportandcareneedsbasedonwhatyourresidentpopulationrequires–toidentifyandreflectonresourcesneededtoprovidethesetypesofcareSamplelistprovided–tobemodifiedbasedonyourpopulation16Part3:FacilityResourcesNeededtoProvideCompetentCareStafftypeSamplelistprovidedfortypeofstaffandotherprofessionals/practitionersStaffingplan–generalapproachtostaffingFordiscussiononhowtodeterminesufficientstaffing,seeAttachment2,7.
bTwoexamplesprovidedOverallnumberofstaffneededGeneralstaffingplanIndividualstaffassignmentStafftraining/educationandcompetenciesSamplelistsprovided(notinclusive)Policiesandproceduresforprovisionofcare17Part3:FacilityResourcesNeededtoProvideCompetentCareWorkingwithmedicalpractitionersPhysicalenvironmentandbuilding/plantneedsOtherContracts,MemorandumofUnderstanding(MOU)orotheragreementswiththirdpartiesHealthinformationtechnologyresourcesInfectionpreventionandcontrolprogramFacility-basedandcommunity-basedriskassessment18Attachment1:RegulatoryMentionsofFacilityAssessmentForyourreferenceNotinclusive19Attachment2:SampleProcessforConductingtheAssessmentPlanfortheassessmentDesignatealeaderLeaderpreparesTeamformedandincludedindiscussionsabouttheintentoftheassessmentandtheprocessandtimelinetobeusedInclusiveprocess–haveallvoicesrepresentedintheassessmentLeadershipsupportstheworkoftheteam–checkinfrequentlyCompletetheassessment20Attachment2:SampleProcessforConductingtheAssessmentSynthesizeandusethefindingsReviewthefindingsRememberthepurposeandintent–makedecisionaboutneededresources,includingdirectcarestaffneedsaswellastheircapabilitiestoprovideservicesandsupporttoresidents;identifyopportunitiesforimprovementWorkthroughthesuggestedquestionsWhathaschangedwithourpopulationDoweneedtomakeanychangestostaffingHowdoweknowifwehavesufficientstaffingWhattraining,educationcompetencyneedsdowehaveHowcanwebettercollaboratewithmedicalpractitionersAnyinfectioncontrolissuesAnyQualityAssessmentandAssurance(QAA)/QualityAssuranceandPerformanceImprovement(QAPI)opportunitiesDoesourbudgetincludetheresourcesweneed21Attachment2:SampleProcessforConductingtheAssessmentEvaluateyourprocessandplanforfutureassessmentsBepreparedtorespondtosurveyorquestionslistedintheinterpretiveguidanceDebriefwithyourteam:whatwentwell,whatcanwedodifferentlynexttimeEstablishaprocessforupdatingtheassessment22What'sNextNursinghomescanuseoradaptthisoptionaltoolCMS:"DuetothesignificantvariationsinthetypesofLTCfacilities,residentpopulations,andresourcesamongtheLTCfacilityfacilities,webelievethatthefacilitiesneedtheflexibilitytodeterminethebestwayforeachfacilitytocomplywiththisrequirement…andconductthatassessment,aslongasitaddressesorincludesthefactorsoritemssetforthin§483.
70(e).
"Wehavenotrequiredanyspecificmethodologyforfacilitiestouseforthefacilityassessment.
"Experienceandfeedback:Asnursinghomesconducttheirassessments,weexpecttolearnmoreaboutwhathasworkedbestforthem,andhopethisinformationwillbesharedamonghomes,andlongtermcarestakeholdergroups23FrequentlyAskedQuestions-StateOperationsManualAppendixPPRevisionsCMSSubjectMatterExperts24§483.
12FreedomfromAbuse,Neglect,andExploitationWhataretheDifferentRequirementsforReportingofSuspectedCrimesv.
AllegedViolations25§483.
12FreedomfromAbuse,Neglect,andExploitationWhatistheDefinitionofSeriousBodilyInjury"Seriousbodilyinjury"meansaninjuryinvolvingextremephysicalpain;involvingsubstantialriskofdeath;involvingprotractedlossorimpairmentofthefunctionofabodilymember,organ,ormentalfaculty;requiringmedicalinterventionsuchassurgery,hospitalization,orphysicalrehabilitation;oraninjuryresultingfromcriminalsexualabuse(Seesection2011(19)(A)oftheAct)26§483.
15Admission,Transfer,andDischargeFacility-initiatedandresident-initiatedtransfersanddischarges:"Facility-initiatedtransferordischarge":Atransferordischargewhichtheresidentobjectsto,didnotoriginatethrougharesident'sverbalorwrittenrequest,and/orisnotinalignmentwiththeresident'sstatedgoalsforcareandpreferences"Resident-initiatedtransferordischarge":Meanstheresidentor,ifappropriate,theresidentrepresentativehasprovidedverbalorwrittennoticeofintenttoleavethefacility(leavingthefacilitydoesnotincludethegeneralexpressionofadesiretoreturnhomeortheelopementofresidentswithcognitiveimpairment)27§483.
15Admission,Transfer,andDischargeSendingcopyoftransfer/dischargenoticetoombudsman:Appliestofacility-initiateddischargesForemergencyroomtransfers,maysendnoticetoombudsmanwhenpracticablesuchasinalistofresidentsonamonthlybasisNoticeoftransferordischargenotrequiredforresident-initiateddischarges28§483.
15Admission,Transfer,andDischargeIsaresident'stransferordischargefacility-orresident-initiatedForatransferordischargetobeconsideredresident-initiated:"Themedicalrecordshouldcontaindocumentationorevidenceoftheresident'sorresidentrepresentative'sverbalorwrittennoticeofintenttoleavethefacility,adischargecareplan,anddocumenteddiscussionswiththeresidentor,ifappropriate,his/herrepresentative,containingdetailsofdischargeplanningandarrangementsforpost-dischargecare.
"(F623guidance)29§483.
21ComprehensiveResidentCenteredCarePlansHowcanprovidersmeetthe48hourrequirementifadmissionoccursontheweekendTheregulationsdonotspecifyhowtocreatetheBaselineCarePlan(BCP);FacilitieswillhavetodeviseaprocessthatensuresnewadmissionshavetheirBCPdonewithintherequired48hours.
ItmaybenecessaryforBCPtobedevelopedoverthecourseofseveralshiftsE.
G.
,Newadmissionat11:40pmonFriday–BCPcompleteby11:40pmonSunday.
30§483.
21ComprehensiveResidentCenteredCarePlansWhatmustbeincludedintheBCP483.
21(a)states,"…TheBCPmust—(ii)Includetheminimumhealthcareinformationnecessarytoproperlycareforaresidentincluding,butnotlimitedto–(A)Initialgoalsbasedonadmissionorders(B)Physicianorders(C)Dietaryorders(D)Therapyservices(E)Socialservices(F)PASARRrecommendation,ifapplicable"Itisexpectedthattheadmissionorderswillbeused,alongwithinformationgatheredbytheadmittingnurse,whichwillincludeinputfromtheresidentorrepresentative.
31§483.
21ComprehensiveResidentCenteredCarePlansCantheBCPbewrittenbeforeadmission,orbeforetalkingtotheresidentItmaybepossibletobegindevelopmentofpartsoftheBCPbeforetheactualadmissionbasedoninformationreceivedfromthetransferringprovider,however,theinformationmustbeverifiedbytheadmissionordersandadmittingnurse'sobservationandinterviewoftheresident32§483.
21ComprehensiveResidentCenteredCarePlansIsaverbalsummaryoftheBCPacceptableTheguidanceatF655states,"Thefacilitymustprovidetheresidentandtherepresentative,ifapplicable,withawrittensummaryofthebaselinecareplan…"33§483.
45PharmacyServicesTwoseparaterequirementsforAs-Needed(PRN)ordersfor:PsychotropicmedicationsAnti-psychoticmedicationsPsychotropicmedicationsinclude,butarenotlimitedto,medicationsinthefollowingcategories:AntipsychoticAnti-depressantAnti-anxietyHypnotic34§483.
45PharmacyServicesFrominterpretiveguidanceatF757/F758:TypeofPRNOrderTimeLimitationExceptionRequiredActionsPRNordersforpsychotropicmedications,excludingantipsychotics14daysOrdermaybeextendedbeyond14daysiftheattendingphysicianorprescribingpractitionerbelievesitisappropriatetoextendtheorder.
Attendingphysicianorprescribingpractitionershoulddocumenttherationalefortheextendedtimeperiodinthemedicalrecordandindicateaspecificduration.
PRNordersforantipsychoticmedicationsonly14daysNoneIftheattendingphysicianorprescribingpractitionerwishestowriteaneworderforthePRNantipsychotic,theattendingphysicianorprescribingpractitionermustfirstevaluatetheresidenttodetermineiftheneworderforthePRNantipsychoticisappropriate.
35§483.
45PharmacyServicesEvaluationofresidentbeforewritinganewPRNorderforantipsychoticmedication:Theattendingphysicianorprescribingpractitionermustdirectlyexaminetheresidentandassesstheresident'scurrentconditionandprogresstodetermineifthePRNantipsychoticmedicationisstillneededTheattendingphysicianorprescribingpractitionershould,ataminimum,determineanddocumentthefollowingintheresident'smedicalrecord:IstheantipsychoticmedicationstillneededonaPRNbasisWhatisthebenefitofthemedicationtotheresidentHavetheresident'sexpressionsorindicationsofdistressimprovedasaresultofthePRNmedication36§483.
60FoodandNutritionServicesQualifiedDieticianAqualifieddietitianorotherclinicallyqualifiednutritionprofessionalisonewho—Holdsabachelor'sorhigherdegree;Completedatleast900hoursofsuperviseddieteticspractice;IslicensedorcertifiedasadietitianornutritionprofessionalbytheState;andMeetstherequirementsofeducationandexperienceof§483.
60(a)(1)(i)and(ii).
Note:IfyouwerehiredbeforeNov28,2016,youhave5yearstomeettheserequirements.
37§483.
60FoodandNutritionServices483.
60(a)(2)Ifaqualifieddietitianorotherclinicallyqualifiednutritionprofessionalisnotemployedfull-time,thefacilitymustdesignateapersontoserveasthedirectoroffoodandnutritionservicesDesignatedpersonsinclude:Acertifieddietarymanager(or)Acertifiedfoodservicemanager(or)Someonewhohassimilarnationalcertificationforfoodservicemanagementandsafetyfromanationalcertifyingbody(or)Someonewhohasanassociate'sorhigherdegreeinfoodservicemanagementorinhospitality,ifthecoursestudyincludesfoodservicesorrestaurantmanagement,fromanaccreditedinstitutionofhigherlearning.
Note:Thesedesigneesmustreceivefrequentscheduledconsultationsfromaqualifieddietitianorotherqualifiednutritionalprofessional.
38§483.
75QAPIWhatneedstobeinplacenowAQAAcommitteewhich–Iscomposedof:DirectorofNurses;MedicalDirector(ordesignee);and3otherstaff,oneofwhichmustbeAdministrator,owner,boardmemberorotherindividualinleadershiprole.
InfectionControl&PreventionOfficer-effective11/28/19Meetsatleastquarterlyandasneededto:IdentifywhichQAAactivitiesarenecessary,andDevelop&implementappropriateplansofactiontocorrectidentifiedqualitydeficiencies.
39§483.
75QAPIWhatchangeswillgointoeffectonNovember28,2017PresentQAPIplantostateorfederalsurveyors-AQAPIPlandescribestheprocessforconductingQAPI/QAAactivitiessuchasidentifyingandcorrectingqualitydeficienciesandopportunitiesforimprovementTheQAPIplanshouldbetailoredtoreflectthespecificunits,programs,departments,anduniquepopulationeachfacilityservices40§483.
75QAPIWillCMSprovideatemplatefortheQAPIPlanQAPIWrittenPlanHow-toGuide,developedbyLakeSuperiorQualityInnovationNetworkforparticipantsintheNationalNursingHomeQualityCareCollaborativeVisittheNursingHomeQAPIWebsiteforadditionaltoolsandresources41§483.
80InfectionControlIsdocumentationoftheinformationwehaveprovidedandcorrespondenceregardingourantibioticstewardshippoliciesandthepractitioner'scontinueduseofantibioticswithoutavalidcauseenoughforustoproveduediligenceonthepartofthefacilityF881,AntibioticStewardshipProgramF757,UnnecessaryDrugs42§483.
80InfectionControlDoestheantibioticstewardshipprogramapplyonlytotheuseofantibioticsorwouldsuchaprogramalsoapplytotheuseofantifungalsandantivirals,whichwouldbeincludedunderthebroadertitleofan"antimicrobialstewardshipprogram"Doestheprogramapplytoallformulationsofantibiotics(e.
g.
,ophthalmicantibiotics,topicalantibiotics)AntibioticsAllformulations43§483.
80InfectionControlDoesanInfectionPreventionist(IP)havetobecertifiedandbywhatdateisthisrequiredTheroleandqualificationsoftheIPareeffectiveNovember28,2019TheIPmustbequalifiedbyeducation,training,experienceorcertification44Question&AnswerSession45ResourcesVisittheCMSSurveyandCertification–NursingHomeswebpageContactusatNHSurveyDevelopment@cms.
hhs.
gov46ThankYou–PleaseEvaluateYourExperienceShareyourthoughtstohelpusimprove–Evaluatetoday'seventVisit:MLNEventswebpageformoreinformationonourconferencecallandwebcastpresentationsMedicareLearningNetworkhomepageforotherfreeeducationalmaterialsforhealthcareprofessionalsTheMedicareLearningNetworkandMLNConnectsareregisteredtrademarksoftheU.
S.
DepartmentofHealthandHumanServices(HHS).
47DisclaimerThispresentationwascurrentatthetimeitwaspublishedoruploadedontotheweb.
Medicarepolicychangesfrequentlysolinkstothesourcedocumentshavebeenprovidedwithinthedocumentforyourreference.
Thispresentationwaspreparedasaservicetothepublicandisnotintendedtograntrightsorimposeobligations.
Thispresentationmaycontainreferencesorlinkstostatutes,regulations,orotherpolicymaterials.
Theinformationprovidedisonlyintendedtobeageneralsummary.
Itisnotintendedtotaketheplaceofeitherthewrittenlaworregulations.
Weencouragereaderstoreviewthespecificstatutes,regulations,andotherinterpretivematerialsforafullandaccuratestatementoftheircontents.
""Ittriggersapauseforleadershiptocomprehensivelylookatthefacility'soperationsandcomparethattoitsstatedgoals(ifany),identifiedchallenges,etc.
"11PilotTestCommentsandFeedbackAgreementthatAttachment2"Suggestedprocessfortheassessment,"including"synthesisanduseoffindings"washelpfulMentionthatdescribingacuitycanbechallengingSomecommentersaskedformoreinformationinthestaffingsection,othersaskedforlessSomerequestsforalgorithmsorresidentclassificationsystemstodeterminestaffingneeds,patterns,etc.
Somecommentsthatthefirstassessmentmaytakesometime,butafterthat,updatesshouldbequickerManyhelpfulcommentstostrengthenthetool12Let'sLookattheToolLinkforthetool:FacilityAssessmentTool13FacilityAssessmentTool:GuidelinesforConductingtheAssessmentUsedatafromavarietyofsourcesPlanforaninclusiveprocesstoincludepersonsthatcareaboutthisConductatthefacilitylevelReviewandupdateannuallyorwhentherearesignificantchangesUseasarecordtounderstandreasonforstaffingandresourcedecisionsUnderstandhowtheassessmentmaybeusedinthesurveyprocessSeeAttachment2forasuggestedprocessforconductingtheassessment14Part1:ResidentProfileNumbers:licensedbeds,averagedailycensus,#personsadmitted/dischargedCommondiseases/conditions,physicalandcognitivedisabilities(tohelpidentifytypesofresourcesneededtomeettheneedsofresidentslivingwiththeseconditionsorcombinationsofconditions)DecisionsregardingcaringforresidentswithconditionsthatyoudonotcommonlyseeAcuity–toidentifypotentialimplicationsregardingtheintensityofcareandservicesneededThreeexamplesprovided:MajorResourceUtilizationGroups(RUG)-IVcategoriesSpecialtreatmentandconditionsAssistancewithactivitiesofdailylivingOtherEthnic,culture,religiousorotherfactorsthatmayaffectthecareprovided15Part2:ServicesandCareResidentsupportandcareneedsbasedonwhatyourresidentpopulationrequires–toidentifyandreflectonresourcesneededtoprovidethesetypesofcareSamplelistprovided–tobemodifiedbasedonyourpopulation16Part3:FacilityResourcesNeededtoProvideCompetentCareStafftypeSamplelistprovidedfortypeofstaffandotherprofessionals/practitionersStaffingplan–generalapproachtostaffingFordiscussiononhowtodeterminesufficientstaffing,seeAttachment2,7.
bTwoexamplesprovidedOverallnumberofstaffneededGeneralstaffingplanIndividualstaffassignmentStafftraining/educationandcompetenciesSamplelistsprovided(notinclusive)Policiesandproceduresforprovisionofcare17Part3:FacilityResourcesNeededtoProvideCompetentCareWorkingwithmedicalpractitionersPhysicalenvironmentandbuilding/plantneedsOtherContracts,MemorandumofUnderstanding(MOU)orotheragreementswiththirdpartiesHealthinformationtechnologyresourcesInfectionpreventionandcontrolprogramFacility-basedandcommunity-basedriskassessment18Attachment1:RegulatoryMentionsofFacilityAssessmentForyourreferenceNotinclusive19Attachment2:SampleProcessforConductingtheAssessmentPlanfortheassessmentDesignatealeaderLeaderpreparesTeamformedandincludedindiscussionsabouttheintentoftheassessmentandtheprocessandtimelinetobeusedInclusiveprocess–haveallvoicesrepresentedintheassessmentLeadershipsupportstheworkoftheteam–checkinfrequentlyCompletetheassessment20Attachment2:SampleProcessforConductingtheAssessmentSynthesizeandusethefindingsReviewthefindingsRememberthepurposeandintent–makedecisionaboutneededresources,includingdirectcarestaffneedsaswellastheircapabilitiestoprovideservicesandsupporttoresidents;identifyopportunitiesforimprovementWorkthroughthesuggestedquestionsWhathaschangedwithourpopulationDoweneedtomakeanychangestostaffingHowdoweknowifwehavesufficientstaffingWhattraining,educationcompetencyneedsdowehaveHowcanwebettercollaboratewithmedicalpractitionersAnyinfectioncontrolissuesAnyQualityAssessmentandAssurance(QAA)/QualityAssuranceandPerformanceImprovement(QAPI)opportunitiesDoesourbudgetincludetheresourcesweneed21Attachment2:SampleProcessforConductingtheAssessmentEvaluateyourprocessandplanforfutureassessmentsBepreparedtorespondtosurveyorquestionslistedintheinterpretiveguidanceDebriefwithyourteam:whatwentwell,whatcanwedodifferentlynexttimeEstablishaprocessforupdatingtheassessment22What'sNextNursinghomescanuseoradaptthisoptionaltoolCMS:"DuetothesignificantvariationsinthetypesofLTCfacilities,residentpopulations,andresourcesamongtheLTCfacilityfacilities,webelievethatthefacilitiesneedtheflexibilitytodeterminethebestwayforeachfacilitytocomplywiththisrequirement…andconductthatassessment,aslongasitaddressesorincludesthefactorsoritemssetforthin§483.
70(e).
"Wehavenotrequiredanyspecificmethodologyforfacilitiestouseforthefacilityassessment.
"Experienceandfeedback:Asnursinghomesconducttheirassessments,weexpecttolearnmoreaboutwhathasworkedbestforthem,andhopethisinformationwillbesharedamonghomes,andlongtermcarestakeholdergroups23FrequentlyAskedQuestions-StateOperationsManualAppendixPPRevisionsCMSSubjectMatterExperts24§483.
12FreedomfromAbuse,Neglect,andExploitationWhataretheDifferentRequirementsforReportingofSuspectedCrimesv.
AllegedViolations25§483.
12FreedomfromAbuse,Neglect,andExploitationWhatistheDefinitionofSeriousBodilyInjury"Seriousbodilyinjury"meansaninjuryinvolvingextremephysicalpain;involvingsubstantialriskofdeath;involvingprotractedlossorimpairmentofthefunctionofabodilymember,organ,ormentalfaculty;requiringmedicalinterventionsuchassurgery,hospitalization,orphysicalrehabilitation;oraninjuryresultingfromcriminalsexualabuse(Seesection2011(19)(A)oftheAct)26§483.
15Admission,Transfer,andDischargeFacility-initiatedandresident-initiatedtransfersanddischarges:"Facility-initiatedtransferordischarge":Atransferordischargewhichtheresidentobjectsto,didnotoriginatethrougharesident'sverbalorwrittenrequest,and/orisnotinalignmentwiththeresident'sstatedgoalsforcareandpreferences"Resident-initiatedtransferordischarge":Meanstheresidentor,ifappropriate,theresidentrepresentativehasprovidedverbalorwrittennoticeofintenttoleavethefacility(leavingthefacilitydoesnotincludethegeneralexpressionofadesiretoreturnhomeortheelopementofresidentswithcognitiveimpairment)27§483.
15Admission,Transfer,andDischargeSendingcopyoftransfer/dischargenoticetoombudsman:Appliestofacility-initiateddischargesForemergencyroomtransfers,maysendnoticetoombudsmanwhenpracticablesuchasinalistofresidentsonamonthlybasisNoticeoftransferordischargenotrequiredforresident-initiateddischarges28§483.
15Admission,Transfer,andDischargeIsaresident'stransferordischargefacility-orresident-initiatedForatransferordischargetobeconsideredresident-initiated:"Themedicalrecordshouldcontaindocumentationorevidenceoftheresident'sorresidentrepresentative'sverbalorwrittennoticeofintenttoleavethefacility,adischargecareplan,anddocumenteddiscussionswiththeresidentor,ifappropriate,his/herrepresentative,containingdetailsofdischargeplanningandarrangementsforpost-dischargecare.
"(F623guidance)29§483.
21ComprehensiveResidentCenteredCarePlansHowcanprovidersmeetthe48hourrequirementifadmissionoccursontheweekendTheregulationsdonotspecifyhowtocreatetheBaselineCarePlan(BCP);FacilitieswillhavetodeviseaprocessthatensuresnewadmissionshavetheirBCPdonewithintherequired48hours.
ItmaybenecessaryforBCPtobedevelopedoverthecourseofseveralshiftsE.
G.
,Newadmissionat11:40pmonFriday–BCPcompleteby11:40pmonSunday.
30§483.
21ComprehensiveResidentCenteredCarePlansWhatmustbeincludedintheBCP483.
21(a)states,"…TheBCPmust—(ii)Includetheminimumhealthcareinformationnecessarytoproperlycareforaresidentincluding,butnotlimitedto–(A)Initialgoalsbasedonadmissionorders(B)Physicianorders(C)Dietaryorders(D)Therapyservices(E)Socialservices(F)PASARRrecommendation,ifapplicable"Itisexpectedthattheadmissionorderswillbeused,alongwithinformationgatheredbytheadmittingnurse,whichwillincludeinputfromtheresidentorrepresentative.
31§483.
21ComprehensiveResidentCenteredCarePlansCantheBCPbewrittenbeforeadmission,orbeforetalkingtotheresidentItmaybepossibletobegindevelopmentofpartsoftheBCPbeforetheactualadmissionbasedoninformationreceivedfromthetransferringprovider,however,theinformationmustbeverifiedbytheadmissionordersandadmittingnurse'sobservationandinterviewoftheresident32§483.
21ComprehensiveResidentCenteredCarePlansIsaverbalsummaryoftheBCPacceptableTheguidanceatF655states,"Thefacilitymustprovidetheresidentandtherepresentative,ifapplicable,withawrittensummaryofthebaselinecareplan…"33§483.
45PharmacyServicesTwoseparaterequirementsforAs-Needed(PRN)ordersfor:PsychotropicmedicationsAnti-psychoticmedicationsPsychotropicmedicationsinclude,butarenotlimitedto,medicationsinthefollowingcategories:AntipsychoticAnti-depressantAnti-anxietyHypnotic34§483.
45PharmacyServicesFrominterpretiveguidanceatF757/F758:TypeofPRNOrderTimeLimitationExceptionRequiredActionsPRNordersforpsychotropicmedications,excludingantipsychotics14daysOrdermaybeextendedbeyond14daysiftheattendingphysicianorprescribingpractitionerbelievesitisappropriatetoextendtheorder.
Attendingphysicianorprescribingpractitionershoulddocumenttherationalefortheextendedtimeperiodinthemedicalrecordandindicateaspecificduration.
PRNordersforantipsychoticmedicationsonly14daysNoneIftheattendingphysicianorprescribingpractitionerwishestowriteaneworderforthePRNantipsychotic,theattendingphysicianorprescribingpractitionermustfirstevaluatetheresidenttodetermineiftheneworderforthePRNantipsychoticisappropriate.
35§483.
45PharmacyServicesEvaluationofresidentbeforewritinganewPRNorderforantipsychoticmedication:Theattendingphysicianorprescribingpractitionermustdirectlyexaminetheresidentandassesstheresident'scurrentconditionandprogresstodetermineifthePRNantipsychoticmedicationisstillneededTheattendingphysicianorprescribingpractitionershould,ataminimum,determineanddocumentthefollowingintheresident'smedicalrecord:IstheantipsychoticmedicationstillneededonaPRNbasisWhatisthebenefitofthemedicationtotheresidentHavetheresident'sexpressionsorindicationsofdistressimprovedasaresultofthePRNmedication36§483.
60FoodandNutritionServicesQualifiedDieticianAqualifieddietitianorotherclinicallyqualifiednutritionprofessionalisonewho—Holdsabachelor'sorhigherdegree;Completedatleast900hoursofsuperviseddieteticspractice;IslicensedorcertifiedasadietitianornutritionprofessionalbytheState;andMeetstherequirementsofeducationandexperienceof§483.
60(a)(1)(i)and(ii).
Note:IfyouwerehiredbeforeNov28,2016,youhave5yearstomeettheserequirements.
37§483.
60FoodandNutritionServices483.
60(a)(2)Ifaqualifieddietitianorotherclinicallyqualifiednutritionprofessionalisnotemployedfull-time,thefacilitymustdesignateapersontoserveasthedirectoroffoodandnutritionservicesDesignatedpersonsinclude:Acertifieddietarymanager(or)Acertifiedfoodservicemanager(or)Someonewhohassimilarnationalcertificationforfoodservicemanagementandsafetyfromanationalcertifyingbody(or)Someonewhohasanassociate'sorhigherdegreeinfoodservicemanagementorinhospitality,ifthecoursestudyincludesfoodservicesorrestaurantmanagement,fromanaccreditedinstitutionofhigherlearning.
Note:Thesedesigneesmustreceivefrequentscheduledconsultationsfromaqualifieddietitianorotherqualifiednutritionalprofessional.
38§483.
75QAPIWhatneedstobeinplacenowAQAAcommitteewhich–Iscomposedof:DirectorofNurses;MedicalDirector(ordesignee);and3otherstaff,oneofwhichmustbeAdministrator,owner,boardmemberorotherindividualinleadershiprole.
InfectionControl&PreventionOfficer-effective11/28/19Meetsatleastquarterlyandasneededto:IdentifywhichQAAactivitiesarenecessary,andDevelop&implementappropriateplansofactiontocorrectidentifiedqualitydeficiencies.
39§483.
75QAPIWhatchangeswillgointoeffectonNovember28,2017PresentQAPIplantostateorfederalsurveyors-AQAPIPlandescribestheprocessforconductingQAPI/QAAactivitiessuchasidentifyingandcorrectingqualitydeficienciesandopportunitiesforimprovementTheQAPIplanshouldbetailoredtoreflectthespecificunits,programs,departments,anduniquepopulationeachfacilityservices40§483.
75QAPIWillCMSprovideatemplatefortheQAPIPlanQAPIWrittenPlanHow-toGuide,developedbyLakeSuperiorQualityInnovationNetworkforparticipantsintheNationalNursingHomeQualityCareCollaborativeVisittheNursingHomeQAPIWebsiteforadditionaltoolsandresources41§483.
80InfectionControlIsdocumentationoftheinformationwehaveprovidedandcorrespondenceregardingourantibioticstewardshippoliciesandthepractitioner'scontinueduseofantibioticswithoutavalidcauseenoughforustoproveduediligenceonthepartofthefacilityF881,AntibioticStewardshipProgramF757,UnnecessaryDrugs42§483.
80InfectionControlDoestheantibioticstewardshipprogramapplyonlytotheuseofantibioticsorwouldsuchaprogramalsoapplytotheuseofantifungalsandantivirals,whichwouldbeincludedunderthebroadertitleofan"antimicrobialstewardshipprogram"Doestheprogramapplytoallformulationsofantibiotics(e.
g.
,ophthalmicantibiotics,topicalantibiotics)AntibioticsAllformulations43§483.
80InfectionControlDoesanInfectionPreventionist(IP)havetobecertifiedandbywhatdateisthisrequiredTheroleandqualificationsoftheIPareeffectiveNovember28,2019TheIPmustbequalifiedbyeducation,training,experienceorcertification44Question&AnswerSession45ResourcesVisittheCMSSurveyandCertification–NursingHomeswebpageContactusatNHSurveyDevelopment@cms.
hhs.
gov46ThankYou–PleaseEvaluateYourExperienceShareyourthoughtstohelpusimprove–Evaluatetoday'seventVisit:MLNEventswebpageformoreinformationonourconferencecallandwebcastpresentationsMedicareLearningNetworkhomepageforotherfreeeducationalmaterialsforhealthcareprofessionalsTheMedicareLearningNetworkandMLNConnectsareregisteredtrademarksoftheU.
S.
DepartmentofHealthandHumanServices(HHS).
47DisclaimerThispresentationwascurrentatthetimeitwaspublishedoruploadedontotheweb.
Medicarepolicychangesfrequentlysolinkstothesourcedocumentshavebeenprovidedwithinthedocumentforyourreference.
Thispresentationwaspreparedasaservicetothepublicandisnotintendedtograntrightsorimposeobligations.
Thispresentationmaycontainreferencesorlinkstostatutes,regulations,orotherpolicymaterials.
Theinformationprovidedisonlyintendedtobeageneralsummary.
Itisnotintendedtotaketheplaceofeitherthewrittenlaworregulations.
Weencouragereaderstoreviewthespecificstatutes,regulations,andotherinterpretivematerialsforafullandaccuratestatementoftheircontents.
NameCheap新注册.COM域名$5.98
随着自媒体和短视频的发展，确实对于传统的PC独立网站影响比较大的。我们可以看到云服务器商家的各种促销折扣活动，我们也看到传统域名商的轮番新注册和转入的促销，到现在这个状态已经不能说这些商家的为用户考虑，而是在不断的抢夺同行的客户。我们看到Namecheap商家新注册域名和转入活动一个接一个。如果我们有需要新注册.COM域名的，只需要5.98美元。优惠码：NEWCOM598。同时有赠送2个月免费域名...
Dynadot COM特价新注册48元
想必我们有一些朋友应该陆续收到国内和国外的域名注册商关于域名即将涨价的信息。大概的意思是说从9月1日开始，.COM域名会涨价一点点，大约需要单个9.99美元左右一个。其实对于大部分用户来说也没多大的影响，毕竟如今什么都涨价，域名涨一点点也不要紧。如果是域名较多的话，确实增加续费成本和注册成本。今天整理看到Dynadot有发布新的八月份域名优惠活动，.COM首年注册依然是仅需48元，本次优惠活动截止...
青云互联：香港安畅CN2弹性云限时首月五折,15元/月起,可选Windows/可自定义配置
青云互联怎么样?青云互联是一家成立于2020年的主机服务商，致力于为用户提供高性价比稳定快速的主机托管服务，目前提供有美国免费主机、香港主机、韩国服务器、香港服务器、美国云服务器，香港安畅cn2弹性云限时首月五折，15元/月起；可选Windows/可自定义配置，让您的网站高速、稳定运行。点击进入：青云互联官方网站地址青云互联优惠码：八折优惠码：ltY8sHMh (续费同价)青云互联香港云服务器活动...
动易论坛为你推荐
-
三星支付宝新闻联播网易yeahwordpress模板我在wordpress模板下载了一套模板，做了www.xuanqianbao.com这个站,模板的原站是www.rrzdm.com.一样的模板，我在文件在插入图片，却不能在首页显示，他的网站却可以.直支付宝蜻蜓发布蜻蜓支付可以代理么piaonimai这位主播叫什么宜人贷官网宜人财富怎么样？徐州商标徐州松木家具前十名香盛圆排第几可信网站可信网站认证一定要办吗网站后台密码破解如何破解网站后台密码zencart模板zencart里那些目录分别对应MVC设计模式的模型 视图 和控制器呢？