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Nurses are critical to the health and well-being of residents in long-term care, overseeing all aspects of care, including residents’ physical, mental, social, and spiritual wellness. Although members of the interdisciplinary team (IDT) assist with their respective disciplines, the nurse is ultimately the one with 24/7 oversight of resident care. Nurses are the eyes and ears of the physician in the long-term care setting and serve as advocates for the residents during the drug regimen review (DRR).
Since the most recently updated CMS guidelines regarding DRR which includes medication reconciliation in the skilled nursing facility were released, facilities have struggled to understand the rules. One of the significant drivers behind these new regulations is the increased rate of medication-related adverse drug events (ADEs). One critical item, however, is still missing from the updated requirements—the resident perspective on medications. The CMS guidelines address DRR and identify the medications that must be reviewed, the scheduling of reviews, clinically significant medication issues, the facility-designated person responsible for conducting the DRR, and communication between the physician and nurse. Little to no mention is made of resident preference and choice related to medications. Do residents want to take all those medications? Is their quality of life improving?
Payroll Based Journal (PBJ) Policy Manual Updates, Notification to States and New Minimum Data Set (MDS) Census Reports
• Notification to States –
The Centers for Medicare & Medicaid Services (CMS) will provide CMS Regional Offices (ROs) and State Survey Agencies with a list of facilities with potential staffing issues to support survey activities for evaluating sufficient staffing and improving resident health and safety.
• Updates in the PBJ Policy Manual and Frequently Asked Questions (FAQs) – We are expanding the guidance on the meal breaks policy to ensure consistency. In addition, we are adding guidance regarding reporting hours for “Universal Care Workers.”
• Additional Technical Support for Facilities – New MDS-based census reports in the Certification and Survey Provider Enhanced Reporting (CASPER) system.
Nursing homes can have the most beautiful policies and procedures for infection prevention and control in the world, but if staff aren’t following through on them, they are a waste of paper, notes Deb Patterson Burdsall, PhD, RN-BC, CIC, FAPIC, an infection prevention and control consultant and faculty member at the Association for Professionals in Infection Control and Epidemiology (APIC) in Arlington, VA.
“So monitoring and auditing infection prevention processes in the facility is a critical component of quality care,” says Burdsall. “Unfortunately, the focus on infection prevention has not always been well-supported because infection surveillance, monitoring whether proper supplies are available and used correctly, and watching whether staff are performing hand hygiene and correctly using personal protective equipment all take time, which means the effort costs money.”
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