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Solutions: A Blog for Health Care Professionals

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

 

Regulations Update – February 11, 2014

Instead of focusing on one regulation in this update, I have decided to share some tips to help facilitate improvement in resident/patient care and a more successful Health Facility Survey.  During the past several months I have found opportunities for learning continue to be present.  There seems to be a cycle occurring as observed during the past 15 years.  I have seen facilities improve quality in resident/patient care. 

Then a year or two later staff are no longer doing what is needed to ensure quality of care.  What happened?  Health care facilities are not static.  They are in a state of constant change.  One month a nurse retires, and the next month a new nursing graduate is hired. Certified nurse aides vary in their longevity.  Some will work at the same facility for several years and others may stay at one facility a year or two and then move on.  Every time a facility staff moves on and a new person joins the team the continuity of care is challenged.  It is imperative for nursing leadership in a health facility to schedule rounds on a regular basis.  When rounds are done, opportunities for improvement are generally discovered. 

The following examples are based on my observations at different health care facilities during the past year:

MEDICATION ADMINISTRATION:

EYE DROPS:

  • Eye drops need to be administered according to manufacturer’s recommendations.  When a resident/patient is prescribed more than one eye drop, the medication administration staff needs to review the drug insert which comes in the box containing the bottle of eye drops.  Usually when I am observing eye drop administration, I will ask how long the staff should wait after administering one drop before administering the next eye drop.  If the staff does not know, I ask about information on the drug insert, and usually it is not present on the medication cart.  Recently a resident/patient was prescribed four different eye drops by the ophthalmologist.  The nurse said she usually administered the drops without a pause in between the drops.  The pharmacist was consulted, and it was found three of the eye drops needed to have a space of 5 minutes time in between and the fourth eye drop needed 10 minutes pause before the next eye drop.  This pause is needed to ensure the best absorption of the medication is achieved.  The above information was added by the pharmacist to the Medication Administration Record to ensure consistency by the medication administration staff when they administer the eye drops.  It was decided the eye drop needing 10 minutes in between drops would be administered last.

 

 

GLUCOMETERS:

  • If your facility is using the same glucometer for several residents/patients, a change needs to be initiated.  The CDC and the APIC recommend one glucometer per one resident/patient.  By following this recommendation, potential for cross-contamination is reduced. 
  • When doing a finger stick blood sugar or administering insulin, the medication administration staff should do these procedures in a private area for the privacy and dignity of the residents.  I have frequently observed this process occurring in the dining room or in the hallway by the dining room in the presence of other residents/patients.
  • The glucometers need to be sanitized before and after each use.  Read the label of the product your facility provides for this.  Recently I checked the label of bleach wipes used for this purpose and discovered the wet contact times varied according to the micro-organism – bacteria, viruses, fungi, Clostridium difficile, Methicillin Resistent Staphlococcus Aureus.  If the label is followed, the glucometer’s outside surface could deteriorate because one of the wet contact times was 10-15 minutes.  I encourage you to read the label of the product you are using to sanitize the glucometer and if needed, explore other options.
  • Quality control testing must be completed according to the glucometer manufacturer’s recommendations.  During the past year I found this is not consistently being done.  If the glucometers in use are not accurate and this is not discovered, the treatment provided to residents/patients with diabetes will not be effective.  When diabetes is not managed effectively the long term effects on the diabetic person’s kidneys, eyes, peripheral nerves, and circulatory system are negative thus reducing quality of life and increasing the cost of health care for this person.   

Regularly scheduled observational rounds to determine if your facility is following quality standards and policy and procedures is a priority.  If your nursing leadership staff is not conducting regular rounds, begin as soon as possible.

 

For help with complying with the professional standards regulation, contact Avera Education & Staffing Solutions at 665-668-8475 today.

 

Marci Pederson, RN, BSN

As a former health facilities senior surveyor, Marci served a variety of health care facilities. Her experience includes nursing education, medical/surgical nursing, psychiatric nursing, infection control, utilization review and quality assurance.

 

Have a question for Marci? A topic idea for her next column? Need more information on having a mock survey at your facility? Send her an email at mapederson@avera.org.


F281—Federal Regulations

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F373—Accidents

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F371—"Sanitary Conditions"

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F441—"Facility Establishes Infection Control Program"

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F371—Food Procurement

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F281—Professional Standards

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F441—Facility Establishes Infection Control Program

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Federal Regulation – F164, “Personal Privacy/Confidentiality of Medical Records”

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Federal Regulation F309 - "Quality of Care: Provide Necessary Care for Highest Practicable Well-Being"

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Federal Regulation F323 - "Facility is Free of Accident Hazards"

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Federal Regulation F514 - "Clinical Records"

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Bottom Line vs. Patient Care

How Staffing Impacts Profitability

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Federal Regulation - F431 "Pharmacy Service Consultation (for controlled drugs); Labeling of Drugs and Biologicals; Storage of Drugs and Biologicals."

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Federal Regulation - F279 "Develop Comprehensive Care Plans"


Federal Regulation – F253 “Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior”

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F425 Pharmacy Services

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Federal Regulation - F371 Sanitary Conditions

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NIOSH Assessment of Risks for 16- and 17-Year Old Workers Using Power-Driven Patient Lift Devices

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F281 Professional Standards of Quality

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Federal Regulation - F441 Infection Control

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2010 Blogs

November 23, 2010

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

F431 Pharmacy Services

F280 - Comprehensive Care Plans was the 9th most cited regulation as a deficiency during 2009 in long term care facilities in South Dakota. There were 18 deficiencies written for F280. This regulation says,
483.10(d)(3) The resident has the right to -- unless adjudged incompetent or otherwise found to be incapacitated under the laws of the State – participate in planning care and treatment or changes in care and treatment.

483.20(k)(2) A comprehensive care plan must be---(i) Developed within 7 days after the completion of the comprehensive assessment; (ii) Prepared by an interdisciplinary team, that includes the attending physician, a registered nurse with responsibility for the resident, and other appropriate staff in disciplines as determined by the resident’s needs, and, to the extent practicable, the participation of the resident, the resident’s family or the resident’s legal representative; and (iii) Periodically reviewed and revised by a team of qualified persons after each assessment.”

When becoming familiar with this regulation we need to keep in mind the whole picture and how the resident’s comprehensive care plan fits in this picture.

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November 1, 2010

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

Reader Questions

Dear Ms. Pederson:

I write to you regarding the proper way to empty a male urinal. It may sound trivial but there is nothing I can find on the proper way to empty the urinal in a semi-private room and the toilet has no mechanism to facilitate their rinsing. I'd appreciate a moment of your time and will give credence to your opinion or policy.

Thank you,
RN, BSN
Clinical Resource Manager

Dear RN, BSN:

Thank you for your email and question. Before answering your question, I confirm that it is difficult to find something specific regarding what to do with emptying and cleaning a male urinal when the patient/resident is in a semi-private room. I did some searching on the CDC website and reviewed the federal regulations’ Guidance to Surveyors. Based on your description of the environment, I would make the following comments to answer your question.

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October 1, 2010

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

F431 Pharmacy Services

F431 Pharmacy Services was the 8th most cited regulation as a deficiency during 2009 in long term care facilities in South Dakota. There were 19 deficiencies written for F431.

This regulation says,

“483.60(b) Service Consultation. The facility must employ or obtain the services of a licensed pharmacist who—

(2) Establishes a system of records of receipt and disposition of all controlled drugs in sufficient detail to enable an accurate reconciliation; and

(3) Determines that drug records are in order and that an account of all controlled drugs is maintained and periodically reconciled.

483.60(d) Labeling of Drugs and Biologicals. Drugs and biologicals used in the facility must be labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable.

483.60(e) Storage of Drugs and Biologicals.

(1) In accordance with State and Federal laws, the facility must store all drugs and biologicals in locked compartments under proper temperature controls, and permit only authorized personnel to have access to the keys.

(2) The facility must provide separately locked, permanently affixed compartments for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976 and other drugs subject to abuse, except when the facility uses single unit package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected.”

This regulation covers three main areas of interest:

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September 10, 2010

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

F309 Quality of Care

F309 Quality of Care was the 7th most cited regulation as a deficiency during 2009 in long term care facilities in South Dakota. There were 21 deficiencies written for F309.

F309 states, ““Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.”

There are a couple of points in the Guidance to Surveyors to be aware of, and they are:

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July 21, 2010

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

F514 Clinical Records

F514 titled Clinical Records was the 6th most cited regulation as a deficiency during 2009 in long term care facilities in South Dakota. There were 24 deficiencies written.

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July 2, 2010

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

F253 Housekeeping and Maintenance

South Dakota long term care facilities had 28 deficiencies cited for F253 in 2009. It ranks number five in the top ten deficiencies for long-term care facilities in South Dakota.

F253 states, “Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior”

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June 3, 2010

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

Celebrating Success

I am grateful to be a part of Avera Education & Staffing Solutions. Today I returned to my office from a nursing home feeling joyful! I have worked with this facility the past three years by providing mock surveys, updating policies and procedures, and assisting with their post-survey plans of correction. This week I had the privilege of being present during their survey to lend support.

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May 1, 2010

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

Federal Regulation - F371 Sanitary Conditions

F371 had 36 deficiencies cited in South Dakota long-term care facilities in 2009. It ranks number four in the tiop ten deficiencies for long-term care facilities in South Dakota.

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March 31, 2010

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

Federal Regulation - F323 Accidents and Supervision

F323 states, “The facility must ensure that – The resident environment remains as free of accident hazards as is possible; and each resident receives adequate supervision and assistance devices to prevent accidents.”

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February 25, 2010

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

Regulations Update

Let’s look at this regulation and the Guidance to Surveyors. F281 states, “(3) The services provided or arranged by the facility must—(i) Meet professional standards of quality”. Professional standards of quality mean accepted standards of clinical practice and can apply to any professional discipline. Because many of us reading this newsletter are in nursing, we may refer more to that clinical area of expertise.

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Janaury 22, 2010

Marci Pederson, RN, BSN, Nurse Educator/Consultant, Avera Education & Staffing Solutions

Regulations Update

Starting this month I will have a regulations update every month in the new Solutions Blog. Check in regularly for other blog entries from our consultants.

My topic this month is regulation F441—Infection Control. This regulation has tremendous importance for our long-term care residents. According to the Guidance for Surveyors, “Infections are a significant source of morbidity and mortality for nursing home residents and account for up to half of all nursing home resident transfers to hospitals.

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