You Are Here:Home/Resources/DNS Navigator/DNS Navigator Details
Federal regulations require nursing homes to provide safe, individualized medication administration to residents. However, even before the COVID-19 public health emergency, many consultant pharmacists only went to nursing homes once a month for medication regimen reviews and did medication administration observation audits on a quarterly basis.
“Medication pass (aka med pass) is a team sport,” notes Lisa Morris, BPharm, RPh, BCGP, FASCP, chairman of the board at ASCP in Alexandria, VA. “Whether your consultant pharmacist does med pass audits once a month or once a quarter, you need to follow up on areas of concern because your staff need to be careful and follow your facility’s medication pass protocol every day, not once a month or once a quarter. None of the rules for medication pass have changed because of COVID-19 other than the location if you have a ‘hot’ COVID-19 unit. In fact, the med pass guidelines were designed for times like this, when you want to avoid potential cross-contamination.”
Directors of nursing services (DNSs) can take the following steps to optimize safe medication administration in between audits by the consultant pharmacist:
Use the facility’s incident reporting system
When interviewing for a new position, don’t forget that an interview is a two-sided exchange. “Not only is the facility interviewing you to determine if you’re a good fit for them, but as the interviewee, you should also interview them to do the same,” says Alexis Roam, MSN, RN-BC, DNS-CT, QCP, curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN).
Here’s what every director of nursing services (DNS) should consider before interviewing for their next position.
Know what you want from a position change.
There are many moments in life when it pays to be flexible, but choosing a new workplace merits thoughtful consideration. Simply learning about what another company has to offer and thinking “that could work for me” isn’t the same as proactively finding a great fit.
Some people flourish in structured, corporate environments with clear processes and procedures. Others prefer family-owned environments, where there is less structure and support, but more empowerment and decision-making responsibilities.
Inhalation treatment of respiratory conditions such as asthma and COPD is the predominant mode of therapy for the simple and logical reason that applying pharmacological agents to the target organ reduces the drug dose, maintains good efficacy, as well as reduces potential systemic adverse effects. To this end, there are now multiple systems for delivering therapeutic agents either as single or fixed dose combinations of two or three agents. The focus of this article is on the delivery devices and potential challenges with multiple device options rather than the therapeutic agents. It is important to recognize that even the best therapeutic agents cannot be effective unless they are delivered to the correct target organ or site.
Given the wealth of treatment and delivery options, it is surprising that treatment of COPD remains less than optimal and reported rates of device use errors remain high (Sanchis J et al. 2016, Molimard et al. 2017). This topic has been broadly discussed in the latest Global Initiative for Obstructive Lung Disease (GOLD 2021) report, with an emphasis on effective training and appropriate device selection for COPD patients. In a recent study, only 23% of patients discharged from the hospital demonstrated appropriate use of dry powder inhalers (Sulaiman et al. 2017). It is important to note that despite significant improvements in device design and a greater understanding of drug delivery issues, such as aerodynamics of particle flow as well as optimal particle size for pulmonary delivery, device error rates have remained high for decades (Sanchis et al. 2016). It is now well-recognized that education and training are key components of proper inhaler use, which requires regular assessment and the implementation of the “teach back” method (Dantic 2014). The importance of continued assessment is highlighted by the observation that the training effect does not persist (Press et al. 2016).
Nursing home staff members, like everyone in the United States and across the globe, want to go back to “normal.” However, directors of nursing services (DNSs) need to ensure that infection prevention and control remains a priority both in the short term as COVID-19 vaccinations occur and in the long-term as the public health emergency eventually ends. Steps that DNSs can take to further these objectives include the following:
In the near term
All providers are excited and grateful that COVID-19 vaccines are being rolled out to residents and staff, says Linda Behan, RN, BSN, CWCN, CIC, senior director of infection prevention and control at Genesis HealthCare in Kennett Square, PA. “However, the vaccine isn’t the be-all and end-all. Taking the vaccine doesn’t mean that everything is automatically all better.”
Nursing homes will have to remain vigilant and continue with the same infection prevention and control practices that they have had in place throughout the pandemic, says Behan. “Whether it’s surveillance, personal protective equipment (PPE) use, or testing protocols—all of that needs to continue for a while. The COVID-19 vaccine will not provide immediate protection, and we need to see how the prevalence goes down in each nursing home’s local community. So, there is still a ways to go.”
The phone rings early one Saturday morning; it’s the night shift nurse calling to tell you that Mrs. Jones has a large bruise on her chest and staff does not know how it occurred. What you do next affects not only Mrs. Jones’ and other residents’ safety—it also has potential survey implications.
A facility confronting such a scenario must conduct a thorough and effective investigation. Most long-term care leaders both know and dread the requirement for investigations. When one is necessary, something unintended has occurred. Staff must actively work to uncover the cause or causes so interventions can be put in place to prevent future or widespread occurrences.
The State Operations Manual (SOM), Appendix PP, provides guidance to surveyors determining compliance with regulations. Under the regulatory group 483.12, Freedom from Abuse, Neglect, and Exploitation, the SOM details 10 citations, or F-tags. F610, which deals with investigating, preventing, and correcting alleged violations, is one of the abuse citations. It also is one of the top 20 most cited F-tags. Regulations under F610 require facility staff to respond to allegations of abuse, neglect, exploitation, or mistreatment by conducting a thorough investigation. For full details of all the requirements under F610, refer to Appendix PP. In this article, we will discuss F610 citation findings and share some tips to help you avoid them.
As of 2017, 66 percent of nursing homes used an electronic health record (EHR) in some capacity, according to the Office of the National Coordinator for Health Information Technology. However, directors of nursing services (DNSs) are not always taking full advantage of the capabilities these tools offer. “Implementing or optimizing an EHR is hard work, but like anything with nursing leadership, if you put that time in to build a culture, it will save you and your staff so much time down the road,” says Becky Kaufmann, RN, vice president of quality assurance and education for Lutheran Life Communities in Arlington Heights, IL.
The following steps can help DNSs and other nurse leaders either implement a new EHR or optimize the use of an existing EHR to align with staff workflows:
Start with the data
An EHR should provide DNSs and other clinicians with access to data that will lead to a solution of an identified problem’s root cause, says Kevin Whitehurst, senior vice president for Skilled Nursing Solutions at MatrixCare in Bloomington, MN.
To access this resource, please login or sign up for a membership.