Risk Management

In a SNF, there are a lot of moving pieces, a lot to manage, and a lot can go wrong. Mitigating the risk of adverse events is a daily task. From care systems review and root cause analysis to anticipatory management, the resources below are designed to help you do just that. Protect your staff and residents now before you have to pick up the pieces after the fact. 

  • New Dementia Care and Psychotropic Med Tracking Tool: NNHQIC Seeks Pilot Testers (9/18)

    By NNHQIC - September 06, 2018

    The National Nursing Home Quality Improvement Campaign (NNHQIC) seeks pilot testers for a new Dementia Care and Psychotropic Medication Tracking Tool. This Excel-based tool will track information for individuals living with dementia AND any resident for whom psychotropic medications are prescribed.  It will support and prompt individualized care, document key processes, and provide information to identify opportunities and drive improvement. Interested organizations please send a message to Help@nhQualityCampaign.org to request additional information on participating in the pilot test.

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  • Antibiotic Stewardship: Fluoroquinolones and Black Box Warning Update (9/18)

    By CDC - September 06, 2018

    The U.S. Food and Drug Administration (FDA) Recently Strengthened its Black Box Warning About Fluoroquinolone Use

    Appropriate fluoroquinolone prescribing is important for patient safety. A recent study published in Clinical Infectious Diseases reports that fluoroquinolones are commonly prescribed for conditions when antibiotics are not needed at all, or when fluoroquinolones are not the recommended first-line therapy.

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  • Nursing Home Compare Claims-based Measures Technical Specifications Updated (8/18)

    By CMS - August 02, 2018
    This update contains the specifications for the Number of Hospitalizations per 1,000 Long-Stay Resident Days measure, including details on the numerator and denominator for the measure, exclusions, and the measure calculation methodology. The technical specifications will be updated with details on the risk-adjustment model prior to this measure being posted on Nursing Home Compare in October 2018. This update adds MDS variables to the risk-adjustment models of the short-stay, claims-based quality measure and updates the coefficients for each variable, based on data from October 1, 2016 to September 30, 2017.
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  • Free AHRQ Antibiotic Stewardship Training: Is It Right for Your Facility?

    By AHRQ - June 27, 2018
    The AHRQ Safety Program for Improving Antibiotic Use: A National Program for Antibiotic Stewardship: 

    The Agency for Healthcare Research and Quality (AHRQ), in conjunction with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and NORC at The University of Chicago, created the AHRQ Safety Program for Improving Antibiotic Use to develop and implement a bundle of interventions designed to improve antibiotic stewardship and antibiotic prescribing practices across acute care, long-term care, and ambulatory care facilities across the United States.


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  • Nursing Home Compare & PBJ Updates: Long-stay Resident Hospitalization Rate to Be Added to NHC / Five Star; Non-Nursing Staff for PBJ to Be Posted; Health Inspection Freeze to End (6/18)

    By CMS - June 22, 2018
    • In October 2018, the long-stay hospitalization measure will be posted on the Nursing Home Compare website as a long-stay quality measure. In the spring of 2019, this quality measure will be included in the Five Star Quality Rating System.  Additionally, in July 2018 we will update the other claims-based quality measures reported on the Nursing Home Compare website.
    • To increase transparency, CMS will begin posting the number of hours worked by other staff (i.e., non-nursing) in July 2018. Facilities are required to submit hours for all other staff as listed in Table 1 of the PBJ Policy Manual. We will also distinguish between hours submitted for direct employees and contract staff. 
    • In October 2019, CMS will resume posting the average number of citations per inspection for each state and nationally. CMS is monitoring outcomes of the new inspection process and plans to resume health inspection rating calculations (i.e., end the freeze) in the spring of 2019. CMS will communicate more details about this prior to its implementation.



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  • 13 Best Practices to Prevent High-Scope Citations for F686 (Skin Integrity)

    By Jessica Kunkler, MA, Staff Writer - June 19, 2018

    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.

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  • Fall Prevention: It’s Easy to Miss What You’re Not Looking For

    By Linda Shell, DNP, MA, RN, DNS-CT - June 19, 2018
    Does this sound familiar? Mary, an 87-year-old memory care resident and recurrent faller, has another fall in her room. A housekeeper spots her lying on the floor. Staff members rush to help. Alarm, floor mat, low bed? What will it be this time? The nurse completes an incident report and an intervention is care planned. The same scenario with Mary repeats itself over and over. She falls, a new intervention fails, her family grows concerned, staff members become frustrated, and the resident and facility are at risk.
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  • Q&A: Does anyone have a procedure for destruction of unused and/or discontinued narcotics?

    By AADNS Network - June 19, 2018
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  • NIH HerbList App (6/18)

    By NIH - June 17, 2018
    App offers easy access to scientifically backed information on herbs and herbal products.
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  • NIOSH Training for Nurses on Shift Work and Long Work Hours (6/18)

    By CDC - June 07, 2018
    The purpose of this online training program is to educate nurses and their managers about the health and safety risks associated with shift work, long work hours, and related workplace fatigue issues,. The training program will also relay strategies in the workplace and in the nurse’s personal life to reduce these risks
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  • Resident Prioritization Tool

    By CMS and Telligen - April 10, 2018
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  • Step Up Your GDR Game Part 1: Team-Building is Critical

    By Caralyn Davis, Staff Writer - April 10, 2018
    In the second quarter of 2017, 15.5 percent of long-stay nursing home residents received an antipsychotic medication as measured by the publicly reported MDS-based quality measure (QM), Percent of Residents Who Received an Antipsychotic Medication (Long-Stay). That represents a 35 percent decrease in the national prevalence since the fourth quarter of 2011, according to the most recent data from the National Partnership to Improve Dementia Care in Nursing Homes.
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  • The Importance of a Thorough Investigation: What You Need to Know

    By Emily Royalty-Bachelor, Staff Writer - April 10, 2018
    As a director of nursing services or an administrator of a long-term care facility, you naturally hope that the day-to-day care, services, and activities that happen within the facility proceed without incident. However, despite precautions and oversight, reportable incidents do indeed occur. That’s why it is imperative that, when they do, you have policies and procedures in place to conduct a thorough investigation and that you implement processes to prevent similar incidents from occurring again.
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  • PBJ Data Used in 5 Star Effective April 2018; CMS-671 Collection Ends June 1 (4/18)

    By CMS - April 09, 2018

    • Transition to Payroll-Based Journal (PBJ) Data – Starting in April, 2018, CMS will use PBJ data to determine each facility’s staffing measure on the Nursing Home Compare tool on Medicare.gov website, and calculate the staffing rating used in the Nursing Home Five Star Quality Rating System.

    • Staffing data audits - We are providing lessons-learned from audits conducted, and guidance to facilities for improving their accuracy. Nursing homes whose audit identifies significant inaccuracies between the hours reported and the hours verified, or facilities who fail to submit any data by the required deadline will be presumed to have low levels of staff. This will result in a one-star rating in the staffing domain, which will drop their overall (composite) star rating by one star for a quarter.

    • Requirement for registered nurse (RN) staffing – We are reminding nursing homes of the importance of RN staffing and the requirement to have an RN onsite 8 hours a day, 7 days a week. Nursing homes reporting 7 or more days in a quarter with no RN hours will receive a one-star rating in the staffing domain, which will drop their overall (composite) star rating by one star for a quarter. This action will be implemented in July 2018, after the May 15, 2018 submission deadline for data for 2018 Calendar Quarter 1, 2018 (January – March, 2018) data.

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  • Massachusetts Pilot Uses Supervisory Training to Improve the Quality of LTC Jobs (3/18)

    By National Fund for Workforce Solutions - March 26, 2018
    According to the National Fund for Workforce Solutions’ new report, Improving Supervision for Frontline Jobs: A Massachusetts Case Study of Skilled Nursing Facilities, efforts to improve frontline supervision can improve the quality of entry-level jobs in long-term care resulting in higher retention of Certified Nursing Assistants (CNA) and better care for patients.   Working with the Massachusetts Senior Care Association and SkillWorks, the report examined findings from five skilled nursing facilities that implemented the PHI Coaching Approach to supervision.
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