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.
PhotonVPS：美国Linux VPS半价促销2.5美元/月起,可选美国洛杉矶/达拉斯/芝加哥/阿什本等四机房
photonvps怎么样?photonvps现在针对旗下美国vps推出半价促销优惠活动，2.5美元/月起，免费10Gbps DDoS防御，Linux系统，机房可选美国洛杉矶、达拉斯、芝加哥、阿什本。以前觉得老牌商家PhotonVPS贵的朋友可以先入手一个月PhotonVPS美国Linux VPS试试了。PhotonVPS允许合法大人内容，支持支付宝、paypal和信用卡，30天退款保证。Photo...
恒创科技SonderCloud，美国VPS综合性能测评报告，美国洛杉矶机房，CN2+BGP优质线路，2核4G内存10Mbps带宽，适用于稳定建站业务需求
最近主机参考拿到了一台恒创科技的美国VPS云服务器测试机器，那具体恒创科技美国云服务器性能到底怎么样呢？主机参考进行了一番VPS测评，大家可以参考一下，总体来说还是非常不错的，是值得购买的。非常适用于稳定建站业务需求。恒创科技服务器怎么样？恒创科技服务器好不好？henghost怎么样？henghost值不值得购买？SonderCloud服务器好不好？恒创科技henghost值不值得购买？恒创科技是...
SugarHosts新增Windows云服务器sugarhosts六折无限流量云服务器六折优惠
SugarHosts糖果主机商我们较早的站长们肯定是熟悉的，早年是提供虚拟主机起家的，如今一直还在提供虚拟主机，后来也有增加云服务器、独立服务器等。数据中心涵盖美国、德国、香港等。我们要知道大部分的海外主机商都只提供Linux系统云服务器。今天，糖果主机有新增SugarHosts夏季六折的优惠，以及新品Windows云服务器/云VPS上线。SugarHosts Windows系统云服务器有区分限制...
动易论坛为你推荐
-
手机iphonephpadmin下载求张艺兴《莲》mp3下载360退出北京时间在国外如何把手机时间调回到中国北京时间？波音737起飞爆胎为什么客机每次起飞都要先跑一段距离什么是支付宝支付宝是什么意思？腾讯官方电话腾讯公司电话多少网站方案设计求一篇校园网络设计的方案什么是通配符DOS命令具体讲的是什么？免费代理加盟哪有免费的代理可以做的？qq挂件如何使QQ气泡和挂件成为永久的？