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Regulations Update

Federal Regulation

F281 Comprehensive Care Plan In 2009 this was the most cited F-tag in South Dakotas long-term care facilities with a total of 44 deficiencies.

Marci Pederson, RN, BSN, Nurse Educator/Consultant

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. Professional standards cover a broad area, which is probably why it is cited more times than other regulations. Where do we find professional standards? What resources are available to us when we have questions about professional standards?

These days we are fortunate to have access to so much information even though there are times when we feel we have information overload. Where do we look for evidence-based professional standards guidance? Here is a list of resources:

  • Centers for Disease Prevention and Control (CDC) – to find infection prevention and control professional standards, check this user-friendly website www.cdc.gov. I used this website when preparing “The Next Level of the New Infection Prevention and Control Guidance for Surveyors” webinar. I was amazed at how easy it was to access information. If you didn’t see my webinar, you can still access the archived presentation >>
  • Current manuals or textbooks on nursing, social work, physical therapy, etc. One of the textbooks many South Dakota surveyors use is “Fundamentals of Nursing”, 7th Edition, by Patricia A. Tyler and Ann Griffin Perry. This book is helpful if you have a professional standards concern pertaining to clinical procedures.
  • Standards published by professional organizations such as American Nurses Association, American Dietetic Association, American Medical Association, American Medical Directors Association, National Association of Social Work, etc.
  • Practice guidelines published by the Agency of Health Care Policy and Research.
  • Professional journals such as the American Journal of Nursing, Journal of Infectious Diseases, etc.
  • Reference handbooks such as Lexi-Comp’s “Drug Information Handbook.”

How do we know when to look for professional standards information? Whenever someone asks why something is done the way it is and the answer is “that is the way we have always done it”, it is time to check on professional standards references/resources. The SD Board of Nursing or the Department of Health Office of Licensure and Certification can also provide guidance.

What kinds of deficiencies could be written under F281? Here are two examples:

  • When metered dose inhalers are not administered according to the manufacturers’ recommendations. If the inhaler contains a steroid, it is a professional standard for the person administering the medication to assist the person receiving the inhaler with rinsing his/her mouth out with water after the metered dose inhaler is administered. Without doing this, the person receiving the inhaler is at risk for an oral yeast infection, which can progress to an inflammation of the esophagus possibly affecting the person’s intake of food, leading to weight loss.
  • Physician’s orders not clarified by the nurse. “One Tylenol as needed for pain,” would be a professional standard concern because the dose and time of administration are not clear.

How can our health care teams become more tuned in to professional standards? There are always options. Here are a few ideas:

  • Have a team brainstorming session.
  • Assign a team member who is good at finding information on the internet to be the professional standards guru when a professional standards question occurs.
  • Have a contest in your facility to see who can make the most interesting professional standards communication board.
  • Visit with me to discuss Survey Preparedness Consulting options. We can schedule a mock survey, discuss plan of action or staff training.

Wouldn’t it be amazing if deficiencies written under the Professional Standards F281 tag are reduced by 50% in 2010? Our Survey Preparedness Consulting service has a proven track record of reducing and eliminating deficiencies. Call 605-668-8475 today—we’ll discuss your needs, your timetable and your budget.


Marcik Pederson, RN, BSN

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.