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Since the new Long-Term Care Survey Process (LTCSP) launched on November 28, 2017, 702 citations have been given for F686 (Skin Integrity). 22% of those tags are a G scope or above. Many of the citations are for:
· Failure to provide care to treat and/or prevent worsening pressure ulcers
· Failure to prevent facility-acquired pressure ulcers
· Failure to develop and/or follow the care plan
· Failure to ensure accurate assessment, obtain treatment orders, or communicate with other professional staff
· Failure to prevent infection of wounds
Widespread pressure ulcer issues are no surprise when facilities don’t have proper protocols in place for prevention, early identification, and treatment, according to Wendy DeCarvalho, MS, BSN, RN, DNS-CT, Director of Nursing for Scotia Village in North Carolina. As a DNS and clinical nurse consultant in long-term care facilities nationwide, DeCarvalho has worked to improve Quality Measures, including those for pressure ulcer rates. “If the staff doesn’t have protocols in place, pressure ulcers often go unchecked, untracked, and untreated,” she says. She recommends the following best practices.
Payroll-Based Journal (PBJ) electronic staffing data has gone live, forming the basis for revised RN and total nursing staffing star rating, as well as the Five-Star Quality Rating System star ratings, on Nursing Home Compare. The updated Five -Star Technical Users’ Guide has all of the technical specifications, and while those specifications are critical to understanding the “how to” calculations, many providers still need to go back to the basics to ensure that the data going into PBJ is accurate—and that they are prepared for whatever additional measures come down the pike.
Often nurses think that the Payroll-Based Journal (PBJ) electronic staffing data submission system is an issue for payroll or the business office, notes Suzy Harvey, RN-BC, RAC-CT, managing consultant for BKD in Springfield, MO. “However, now that PBJ will impact ratings in the Five Star Quality Rating System, the director of nursing services (DNS) needs to be aware of PBJ and involved in the process.”
The Centers for Medicare & Medicaid Services (CMS) offers several reports that can help DNSs be sure their PBJ data is accurate, timely, and ready for prime-time viewing as staffing measures and Five-Star staffing star ratings on Nursing Home Compare. Industry experts suggest DNSs take the following steps:
F700 (Bedrails) is one of 17 discrete F-Tags now included under Section 483.25, Quality of Care, in Title 42 of the Code of Federal Regulations. These tags are among the indicators of substandard quality of care, meaning even a single deficiency with a scope/severity level of F, H, I, J, K, or L could potentially trigger an extended survey. Some recent standard surveys under the new Long-term Care Survey Process (LTCSP) indicate that providers may want to review their compliance in this area.
The new F700 tag has new corresponding interpretive guidance in Appendix PP of the State Operations Manual. The Key Elements for Noncompliance for F700 are as follows:
Clinical staff are incredibly busy completing the tasks that are expected of them every day. It seems there is never enough time to get everything done. As the demand for high-quality care continues to rise, nurse leaders will need to look to the research to identify evidence-based approaches to improving clinical outcomes, increasing customer satisfaction, and maximizing staff efficiency. These best practices are often generated in acute care settings but can be used in long-term care with great success.
One evidence-based approach that offers value for long-term care settings is hourly rounding. Hourly rounding is the process of ensuring that a resident is checked each hour by a member of staff to ensure he or she is safe, well positioned, and needs are met. Since the first study on hourly rounding was done, the practice has been implemented in numerous clinical settings, including long-term care, in the new-admission process and in programs for preventing falls, reducing call light use, and monitoring residents with changes in condition.
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