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Solutions: A blog for Health Care Professionals 

July 13, 2012

F281—Professional Standards

South Dakota long term care facilities had 66 deficiencies cited for F281 in 2011.  It ranked number 2 in the top twenty deficiencies for long-term care facilities in South Dakota. The regulation F281 states,

"§483.20(k)(3)

(3) The services provided or arranged by the facility must—

Meet professional standards of quality " 

There was an increase in the number of deficiencies written for F281 in the past three years.  They are as follows: 2009 – 44 deficiencies; 2010 – 42 deficiencies; and 2011 – 66 deficiencies. 

Professional standards of quality means the services provided are provided in accordance with accepted standards of clinical practice.  Standards regarding quality care practices usually are evidence-based practices, and reference sources for standards of practice include but are not limited to:

  • Current manuals or textbooks on nursing, social work, physical therapy, etc.
  • Standards published by professional organizations such as the American Dietetic Association, American Medical Association, American Medical Directors Association, American Nurses Association, National Association of Activity Professionals, National Association of Social Work, etc.
  • Clinical practice guidelines published by the Agency of Health Care Policy and Research
  • Current professional journal articles
  • Center for Disease Control and Prevention

If the surveyors determine there has been a negative outcome or there is a great potential for a negative outcome as a result of a facility's practice, they will ask your facility for references upon which the practice is based.  The facility staff needs to be familiar with facility policy, and facility policies and procedures must be evidence-based.   Because professional standards are interdisciplinary, it is easy to see why there are more deficiencies written for this regulation.   I have listed below some reasons for F281 deficiencies.

  • If there is a negative outcome such as deterioration of a pressure sore in a hospice resident because the responsibilities and lines of communication were not clearly stated for both nursing facility staff and hospice staff, F281 may be cited.
  • If inaccurate transcriptions of physician orders or transcriptions of physician orders are being missed with no action taken to determine and correct these problems, F281 may be cited.
  • Lack of notification of the physician of acute medical conditions may result in the citation of F281.
  • Inappropriate techniques used when administering prescribed treatments may result in the citation of F281. 

Staff should not hesitate to look for answers about standards of practice by using references available for this purpose.  Most facilities now have access to internet services and can access information from accrediting and regulatory bodies.  The Agency of Health Care Policy and Research, the CDC, and CMS are excellent resources that are available on the internet.  Utilizing these resources as well as making sure facility staff's continuing education needs are met will help to ensure the residents' care meets professional standards.

Another thing to keep in mind in relation to F281 is the services arranged by the facility.  Perhaps a resident receives health services from outside of the facility.  The practitioner may see the resident on a regular basis, but may not be meeting the resident's needs by not working closely enough with the facility.  The nursing home facility could be held responsible and cited for F281.

If your facility would like to improve regulatory compliance and quality of care pertaining to professional standards, contact us at (605) 668-8475 for solutions. 

Marci 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.