Most-Cited F-tags Nationwide: F880 And F689 Are The Top Concerns

By Caralyn Davis, Staff Writer - September 11, 2018

The top five most commonly cited F-tags in the new Long-term Care Survey Process (LTCSP) haven’t changed much since Feb. 26, when AADNS first took a look at the data available in QCOR, the Quality, Certification, and Oversight Reports site of the Centers for Medicare & Medicaid Services (CMS). F880 (Infection Prevention and Control) maintains its position as the most frequently cited new survey tag across the country. In addition. F880 is the third most-cited new F-tag with a severity level of F or above, as well as the 10th most-cited tag with a severity level of J, K, or L (immediate jeopardy).

 

“Historically, infection prevention and control has been a huge issue, and it is continuing to grow,” says Angie Szumlinski, LNHA, RN-BC, RAC-CT, BS, director of risk management for HealthCap/QA Reader in Ann Arbor, MI. “Many providers don’t have staff who know how to run a strong infection prevention and control program. They don’t understand surveillance and how to track the different types of organisms. That’s worrisome, especially since CMS is focusing on infection control and recently came out with new guidelines for reducing Legionella risk in water systems.” Note: Access the QSO and S&C memos here.

 

Successful infection prevention and control programs hinge on education and the facility assessment, says Szumlinski. “If you are in an area where you commonly see outbreaks or have a high incidence of COPDs or other issues where residents come in compromised, you have to (1) know that from your all-hazards risk assessment, and (2) educate staff so that they know when to throw up the flag and not wait until residents are septic or have other severe problems. Staff understanding how to identify and report changes in condition is a critical piece of the infection control process.”

 

In addition, some infection prevention and control citations seem to focus on systems issues, notes Szumlinski. “For example, many providers understand when to put a resident in isolation as a transmission-based precaution. However, they often run into trouble understanding when to pull that resident out of isolation so that they are using the least restrictive transmission-based precaution possible and avoiding unnecessary involuntary seclusion once the resident is no longer a risk for transmitting the infection.”

 

While F880 remains a top concern, there has been a slight reshuffling in the second through fourth most-cited tags nationwide. F689 (Free of Accident Hazards/Supervision/Devices) has climbed to the second most-common tag, up from the fourth most-cited tag in February. That is consistent with F689’s ranking as the second most-cited new F-tag with a severity level of F or above, as well as the No. 1 cited tag with a severity level of J, K, or L (immediate jeopardy).

 

“Under F689, providers need to step back, look at their facility assessment using an all-hazards approach, and determine who they are as a facility,” suggests Szumlinski. “For example, if you are admitting residents who are an elopement risk, who have behaviors that affect others, or who are known to fall frequently, are you prepared to proactively address those risks upon admission, or are you assuming that your staff can handle things they can’t?”

 

Sometimes facilities won’t deny an admission because they are afraid the referral source will cut them off, adds Szumlinski. “However, if you take residents you aren’t prepared for, you may pay the price. When you take an admission you can’t manage, it can be extremely difficult to get that resident out—you can’t discharge them unless you can find another placement.

 

“So you must have a strong facility assessment working through who you are, what you do, why you do it, and how you do it. Then you need to re-evaluate and adjust your program to meet the needs of those high-risk residents,” she continues. “The minute surveyors see that you haven’t done that, you are looking at a high-level citation, not necessarily because you had a negative outcome but because you are at high risk for one.”

 

F656 (Develop/Implement Comprehensive Care Plan) has dropped to the third most-common tag, down from No. 2 in February. However, while it’s still a common tag, F656 often has less severe consequences: It is only the 12th most-cited new F-tag with a severity level of F or above and the 17th most-cited tag with a severity level of J, K, or L (immediate jeopardy).

 

Like F656, F812 (Food Procurement, Store/Prepare/Serve - Sanitary) has dropped down a spot in the overall rankings, to No. 4 from No. 3 in February. F812 also is the No. 1 most-cited new F-tag with a severity level of F or above, but it doesn’t make the list of the top 20 F-tags with a severity level of J, K, or L (immediate jeopardy).

 

F684 citations on the rise

The fifth most-common tag is now F684 (Quality of Care), up from eighth place in February. It is also the sixth most-cited F-tag with a severity level of F or above and the fourth most-common with a severity level of J, K, or L (immediate jeopardy).

 

F657 (Care Plan Timing and Revision), the No. 5 tag in February, has slipped to sixth place, and F641 (Accuracy of Assessments) similarly slipped to the 12th most-cited tag, down from 10th. That still means three tags related to the Resident Assessment Instrument (RAI) remain among the top 20 most-common tags. However, like F656, the consequences for F657 and F641 tend to be less severe. Neither ranks in the top 20 F-tags with a severity level of F or above or with a severity level of J, K, or L (immediate jeopardy).

 

F686 citations jumped

F686 (Treatment/Services to Prevent/Heal Pressure Ulcers) was a big mover, jumping up to the eighth most-cited F-tag from No. 12 in February. It is also the fourth most-cited F-tag with a severity level of F or above and the ninth most-common with a severity level of J, K, or L (immediate jeopardy).

 

F677 (ADL Care Provided for Dependent Residents) also moved into the top 10 (No. 9) in the overall rankings, up from No. 13. However, it didn’t rank in the top 20 for either F-tags with a severity level of F or above or F-tags with a severity level of J, K, or L (immediate jeopardy).

 

F550 (Resident Rights/Exercise of Rights) dropped to No. 10 overall from No. 7 in February. Like F677, the consequences of this citation are less severe. It didn’t rank in the top 20 for either F-tags with a severity level of F or above or F-tags with a severity level of J, K, or L (immediate jeopardy).

 

Below the following QCOR-derived charts will provide additional insights into how the various F-tags stack up against each other:

  • Top 20 new F-tags cited nationwide during FY 2018 standard and complaint surveys as of 7/02/18 (ranked in descending order);

  • Top 20 new F-tags with a severity level of F or above cited nationwide during FY 2018 standard and complaint surveys as of 7/02/18 (ranked in descending order);

  • Top 20 new F-tags with a severity level of J, K, or L (immediate jeopardy) cited nationwide during FY 2018 standard and complaint surveys as of 7/02/18 (ranked in descending order); and

  • Top 10 new E-tags cited nationwide during FY 2018 standard and complaint surveys as of 7/02/2018.

 

Note: Look for more in-depth reviews of common F-tags and preventive measures that directors of nursing services (DNSs) can implement in upcoming issues.

 

 

Top 20 new F-tags cited nationwide during FY 2018 standard and complaint surveys as of 7/02/18 (ranked in descending order)

Tag Number

Tag Description

F880

Infection Prevention & Control

F689

Free of Accident Hazards/Supervision/Devices

F656

Develop/Implement Comprehensive Care Plan

F812

Food Procurement, Store/Prepare/Serve Sanitary

F684

Quality of Care

F657

Care Plan Timing and Revision

F761

Label/Store Drugs and Biologicals

F686

Treatment/Services to Prevent/Heal Pressure Ulcer

F677

ADL Care Provided for Dependent Residents

F550

Resident Rights/Exercise of Rights

F842

Resident Records - Identifiable Information

F641

Accuracy of Assessments

F758

Free from Unnecessary Psychotropic Meds/PRN Use

F755

Pharmacy Services/ Procedures/ Pharmacist/ Records

F690

Bowel/Bladder Incontinence, Catheter, UTI

F658

Services Provided Meet Professional Standards

F609

Reporting of Alleged Violations

F580

Notify of Changes (Injury/Decline/Room, etc.)

F584

Safe/Clean/Comfortable/Homelike Environment

F610

Investigate/Prevent/Correct Alleged Violation

 

Source: QCOR results based on CASPER data as of 07/02/2018.

 

 

 

Top 20 new F-tags with a severity level of F or above cited nationwide during FY 2018 standard and complaint surveys as of 7/02/18 (ranked in descending order)

Tag Number

Tag Description

F812

Food Procurement, Store/Prepare/Serve Sanitary

F689*

Free of Accident Hazards/Supervision/Devices

F880

Infection Prevention & Control

F686*

Treatment/Services to Prevent/Heal Pressure Ulcer

F600*

Free from Abuse and Neglect

F684*

Quality of Care

F725

Sufficient Nursing Staff

F835

Administration

F867

QAPI/QAA Improvement Activities

F921

Safe/Functional/Sanitary/
Comfortable Environment

F881

Antibiotic Stewardship Program

F656

Develop/Implement Comprehensive Care Plan

F697*

Pain Management

F692*

Nutrition/Hydration Status Maintenance

F760*

Residents are Free of Significant Med Errors

F580

Notify of Changes (Injury/Decline/Room, etc.)

F607*

Develop/Implement Abuse/Neglect Policies

F804

Nutritive Value/Appear, Palatable/Prefer Temp

F838

Facility Assessment

F755

Pharmacy Services/ Procedures/ Pharmacist/Records

* An asterisk at the end of the tag number indicates that this is a substandard quality-of-care tag, which could result in an extended survey where there are one or more deficiencies with a scope/severity level of F, H, I, J, K, or L.

 

Source: QCOR results based on CASPER data as of 07/02/2018.

 

 

 

Top 20 new F-tags with a severity level of J, K, or L (immediate jeopardy) cited nationwide during FY 2018 standard and complaint surveys as of 7/02/18 (ranked in descending order)

Tag Number

Tag Description

F689

Free of Accident Hazards/Supervision/Devices

F600

Free from Abuse and Neglect

F835

Administration

F684

Quality of Care

F678

Cardio-Pulmonary Resuscitation (CPR)

F610

Investigate/Prevent/Correct Alleged Violation

F580

Notify of Changes (Injury/Decline/Room, etc.)

F607

Develop/Implement Abuse/Neglect Policies

F686

Treatment/Services to Prevent/Heal Pressure Ulcer

F880

Infection Prevention & Control

F726

Competent Nursing Staff

F760

Residents are Free of Significant Med Errors

F867

QAPI/QAA Improvement Activities

F658

Services Provided Meet Professional Standards

F609

Reporting of Alleged Violations

F695

Respiratory/Tracheostomy Care and Suctioning

F656

Develop/Implement Comprehensive Care Plan

F725

Sufficient Nursing Staff

F700

Bedrails

F837

Governing Body

 

Source: QCOR results based on CASPER data as of 07/02/2018.

 

 

 

Top 10 new E-tags cited nationwide during FY 2018 standard and complaint surveys as of 7/02/2018

Tag Number

Tag Description

E0035

LTC and ICF/IID sharing plan with patients

E0039

Emergency Prep Testing Requirements

E0026

Roles under a Waiver Declared by Secretary

E0024

Policies/Procedures-Volunteers and staffing

E0037

Emergency Prep Training Program

E0018

Procedures for Tracking of Staff and Patients

E0001

Establishment of the Emergency Program (EP)

E0015

Subsistence needs for staff and patients

E0031

Emergency Officials Contact Information

E0032

Primary/Alternate Means for Communication

 

Source: QCOR results based on CASPER data as of 07/02/2018.

 


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