• F550, Resident Rights, and Five Ways to Avoid this Top Ten Citation

    Tuesday, September 22, 2020 | Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA

    Surveyors arrive onsite for the annual survey and tour the facility. They overhear a nurse aide refer to a resident as “honey.” In the next room, they see a nurse completing a dressing change with the door open, exposing the resident. Both of these instances, and many others, are resident rights issues which could lead to a citation under F550.


    Today, F550 is one of the top ten most cited survey deficiencies across the country. Despite being in the top ten, many of these citations result from minor issues that can be easily corrected within a facility.


    This article reviews F550 requirements, discusses the top reasons for citations, and provides five quick tips to avoid future F550 citations.


    F550 Requirements

    The Nursing Home Reform Law of 1987 requires that every nursing home promote and protect the rights of each resident. To participate in Medicare and Medicaid, nursing homes must meet these requirements, with adherence verified during nursing home surveys.


    F550 refers to resident rights, including the right to be treated with dignity and respect, in an environment that promotes quality of life. Appendix PP of the State Operations Manual says that:

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  • Emergency Preparedness Basics: Is Your Program Ready to Go?

    Tuesday, September 22, 2020 | Caralyn Davis, Staff Writer

    The Centers for Medicare & Medicaid Services (CMS) requires that all nursing homes have an emergency preparedness program. With disasters ranging from the COVID-19 pandemic to wildfires and hurricanes seemingly around every corner, taking the following steps can help providers have a program that can stand up to any emergency:


    Make sure your program is compliant

    “In 2016, CMS issued the emergency preparedness rules of participation (ROPs). Figuratively speaking, these ROPs took emergency preparedness requirements from zero to 60—they are extremely comprehensive,” says Stan Szpytek, an independent fire and life safety/disaster preparedness consultant.


    “You need to conduct a hazard vulnerability assessment for your specific facility, and then you must have policies and procedures and an emergency operations plan that address every specific emergency that can occur based on that hazard vulnerability assessment,” he explains. “So the first step is knowing the specific threats and perils your facility faces and making sure that you have a compliant emergency operations plan.”

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  • 10 Tips for Cultivating Resiliency in Facility Staff

    Tuesday, September 8, 2020 | Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP

    So far, 2020 has been a very trying year, to say the least. COVID-19 caught long-term care teams unaware and has not only affected staff physically, but emotionally as well. Illness and loss of life among both residents and employees, combined with lack of supplies, testing, staffing, and the fear of bringing the virus home to family has been very stressful and is affecting everyone. As part of the management team, the director of nursing services (DNS) needs to be able to measure their facility staff’s emotional health and aid them to adapt or “bounce back” from adversity. In other words, the DNS needs to cultivate resilience. This article will assist the DNS and other nurse leaders to have a better understanding of what resilience looks like and will provide tips on how to encourage staff to build resilience and find strength in this difficult time.


    What happens when the leadership team doesn’t build resilience?

    When staff lack resilience and that lack goes undetected, not only is it detrimental to the individual, but it also affects the facility in general. Staff who feel unappreciated or unsupported are more apt to experience burnout and become unable to function effectively, which compromises resident safety and care. These symptoms may also evolve into post-traumatic stress disorder or other chronic illness for the person later (Wu et al., 2020). If staff feel out of control or insufficiently trained, they are more likely to call off work, further straining a facility’s staffing issues. Individuals unable to bounce back may have an increase in mental health issues, such as anxiety, depression, and insomnia (Miller, 2020), which may affect their ability to work.


    What is resilience?

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  • USP <800>: What Is It, and Why Do DNSs Need to Know?

    Tuesday, September 8, 2020 | Caralyn Davis, Staff Writer

    Late last year, nursing homes gained additional time to deal with implementing United States Pharmacopeia (USP) general chapter <800>, “Hazardous Drugs—Handling in Healthcare Settings.” While COVID-19 has rightfully taken precedence through much of 2020, directors of nursing services (DNSs) still need to get up to speed on the USP <800> practice standards, which in the coming years could present a roadmap of liability for long-term care facilities if staff are adversely impacted by hazardous medications.


    The basics

    The independent, nonprofit scientific organization U.S. Pharmacopeia (also known as USP) writes compounding standards, says Dana Saffel, PharmD, CPh, BCGP, president/CEO of PharmaCare Strategies in Santa Rosa Beach, FL, and a member of the board of directors at the American Society of Consultant Pharmacists (ASCP). “As part of those compounding standards, the new USP <800> creates standards for managing hazardous drugs.”


    USP <800> was supposed to go into effect on Dec. 1, 2019, notes Saffel. “However, the only references to this new chapter come from revisions to existing chapters on sterile and nonsterile compounding. Those other two chapters were put back into revision at the end of last year due to the filing of appeals. Therefore, USP <800> will remain informational only and not be an official active chapter until the two preceding chapters that reference it become official. For now, you have a sanctioned bye that gives you more time until it is an official USP recommendation.”

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  • Crushing Meds: How to Keep Patients Safe and Be Survey-Ready

    Tuesday, August 25, 2020 | Caralyn Davis, Staff Writer

    Nursing home staff sometimes crush medications that should not be crushed, says Diane Crutchfield, PharmD, BCGP, an independent consultant pharmacist in Knoxville, TN. “Staff crush medications to make them easier—or in some cases even possible—to administer. For example, some residents will spit out tablets or capsules even if they are in a spoonful of applesauce; other residents may have trouble swallowing due to a history of stroke. As a result, staff try to crush medications as much as possible. Unfortunately, when staff are trying to give medications to, for example, 20 residents who may have seven or eight medications each, they may not take the time to stop and see whether each medication can be crushed.”


    Steps that directors of nursing services (DNSs) can implement to ensure staff are on the right track when it comes to crushing medications include the following:


    Provide reference materials

    “The most critical best practice is knowing which medications cannot be crushed based on the manufacturer’s instructions,” says Dana Kelleher, RPh, an independent consultant pharmacist based in Coopersburg, PA. “Most of the time, staff shouldn’t crush any medication that a manufacturer says ‘do not crush.’”


    Either the pharmacy labeling or the electronic medication administration record (MAR) should say, “Do not crush this medication,” if applicable, points out Crutchfield. The guidance for surveyors in F761 (Label/Store Drugs & Biologicals) in Appendix PP of the State Operations Manual addresses a nursing home’s responsibility to comply “with currently accepted labeling requirements, even though the pharmacies are responsible for the actual labeling”:

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  • 5 Tips to Better Communication with Families

    Tuesday, August 25, 2020 | Jessica Kunkler, MA

    Having a loved one in a nursing home often inspires intense emotions. For many, regular visits and calls to their loved ones helps alleviate some of those feelings and puts their minds at ease. However, after the official arrival of the coronavirus to the United States, these visits and calls all but stopped. Although these were necessary steps to protect residents, staff, and families, these changes compounded an already stressful situation by removing family members’ means of managing their emotions.


    Lamont Johnson, who lives just a few miles away from his mother’s nursing home, was recently featured in a CNBC story. After the COVID-19 pandemic became widespread, he wasn’t able to visit her for months. “The stress of the situation was amplified by a lack of communication,” according to Johnson. “Oftentimes, no one would answer when he called the nursing home.”

    When COVID-19 hit her facility, Kristie Bacher, RN, BS, RAC-CTA, RAC-CT, CPC, QCP, and her staff took action to ensure communication between the facility and residents’ families was in place. They instituted a weekly Zoom call open to all family members. In those calls, the medical director shared updates on COVID at the facility and explained the steps the facility was taking to battle the disease and reduce spread. On a more personal level, the facility had every staff member “buddy” with a resident and regularly report back to their family on how their loved one was doing. “It was all worth the effort,” says Bacher.


    Communicating with families during this stressful time is not only required, it can also help your residents and their families immensely. Here's how to better communicate with families during the COVID-19 pandemic, according to Denise Winzeler, RN, BSN, LNHA, AAPACN curriculum development specialist.

    1. Practice empathy for family members.

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  • The Documentation Toolkit: What It is and Why DNSs Need It Now

    Monday, August 10, 2020 | AADNS

    Nurses have often heard “if it wasn’t documented, it wasn’t done,” but they still struggle to consistently capture documentation that is timely, accurate, and comprehensive. This struggle sometimes emerges when underlying system failures go unaddressed by leadership. To fix this, the director of nursing services (DNS) and other nurse leaders need to improve the processes that are interfering with sound documentation practices and provide education that links a nurse’s skills to the documentation.

    To accomplish these goals, the American Association of Directors of Nursing Services (AADNS) recently published the Documentation Toolkit for the Nurse Leader, which contains several helpful tools and resources to make lasting improvements to nursing documentation. Alexis Roam, MSN, RN-BC, DNS-CT, QCP, curriculum development specialist for AADNS, shares some tips for how DNSs and other nurse leaders can use this tool to review their processes and overcome documentation pitfalls.


    Revisit the four pillars of documentation

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  • Now’s the Time to Review Medication Management: Here’s Why and How

    Monday, August 10, 2020 | Caralyn Davis, Staff Writer

    As the COVID-19 pandemic continues to pick up speed in many states without waiting for a fall/winter surge, nursing homes across the country are looking for ways to streamline and improve systems so that they can provide high-quality, patient-centered care that also prioritizes infection prevention and control. “One way to achieve this goal is to have open conversations about what is important to residents and families with regard to medications—and also be mindful of the time and infection control burdens that medication management can impose on overstretched, overstressed staff,” suggests Nicole Brandt, PharmD, MBA, BCGP, BCPP, FASCP, executive director of The Peter Lamy Center on Drug Therapy and Aging and professor of Pharmacy Practice and Science at the University of Maryland School of Pharmacy in Baltimore.


    Working with the U.S. Deprescribing Research Network, The Peter Lamy Center pulled together a multidisciplinary task force, co-chaired by Brandt, that developed Optimizing Medication Management During the COVID-19 Pandemic: Implementation Guide for Post-Acute and Long-Term Care to provide a framework of guiding principles for this conversation.


    “The goal of the guide is patient-centered—to improve outcomes for older adults living in post-acute and long-term care facilities,” says Michael Steinman, MD, professor of Medicine with a focus in geriatrics at the University of California – San Francisco and the San Francisco VA Medical Center, and co-principal investigator at the U.S. Deprescribing Research Network. Steinman also co-chaired the multidisciplinary task force that created the guide. “The task force wanted to make the guide as useful as possible in improving those outcomes while still recognizing that healthcare providers and staff are incredibly busy during this time of the pandemic.”


    Medication changes should be able to help nursing homes in three key ways:

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  • Scaled-Back FY 2021 SNF PPS Final Rule Holds Few Surprises

    Tuesday, August 4, 2020 | Caralyn Davis, Staff Writer

    The FY 2021 SNF PPS Proposed Rule was a shadow of what the Centers for Medicare & Medicaid Services (CMS) had planned due to the ongoing coronavirus 2019 (COVID-19) public health emergency. So it's no surprise that the final rule, Medicare Program: Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNFs); Updates to the Value-Based Purchasing Program for Federal Fiscal Year (FY) 2021 (CMS-1737-F), finalizes most, if not quite all, of the proposals without modification. And while COVID-19 caused some changes to the payment rate calculations, CMS cited commenters' requests for additional relief from COVID-19 as beyond the scope of this rulemaking. 

    Here are some of the key updates that directors of nursing services (DNSs) should pay attention to:


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  • Engaging Residents and Overcoming Loneliness during the COVID-19 Public Health Emergency

    Tuesday, July 28, 2020 | AADNS

    The COVID-19 pandemic is a strange and difficult time for long-term care residents. There is a lot happening in their environment that is unfamiliar, and nurse leaders have the difficult job of ensuring residents’ physical safety while also addressing the importance of combating resident loneliness. Leaders have to adapt, be strategic, and find clever ways to engage residents. Joan Devine, RN, director of education for Pioneer Network, offers some insights, resources, and ideas that nurse leaders can utilize to improve person-centered care and resident well-being during this time.

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