Transcript F-309 Revised Guidance to Surveyors How does this impact

F-309 Revised Guidance to
Surveyors
How does this impact your
Documentation
Joan Redden
VP Regulatory Affairs
Skilled Healthcare, LLC
F-309
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Although the regulation does not
specifically mention a particular condition,
it does require that the necessary care
and services to provide for each resident
to attain or maintain his or her highest
practicable level of well-being, the
facility is expected to provide the
necessary care and services necessary to
improve, maintain or prevent decline, to
the extent possible.
New Guidance F-309
Effective March 31, 2009
The F-309 guidance is utilized for the
review of quality of care including,
but not limited to, such areas as
end of life, diabetes, renal failure,
fractures, congestive heart failure,
non-pressure related skin ulcers,
pain or fecal impactions.
Additional Changes to the F-309
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The guidance now removed hospice and
dialysis survey protocol language from
Appendix P and placed it into F 309
Additional revisions that were published
along with the changes to F 309 included:
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Guidance to the storage of MDS F286
Removed demand billing process to task 5C
Removed weight loss investigations protocol to
F 325 from Appendix P
Interpretive Guidelines 483.25
In any instance in which there has
been a lack of improvement or a
decline, the survey team must
determine if the occurrence was
unavoidable or avoidable. This
determination requires that 3
areas in documentation are not
present!
Determination of Avoidable Decline
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An accurate and complete
assessment is not found
A care plan is not implemented
consistently or based on information
form the assessment
Evaluation of the results of the
interventions and revising
interventions are not present
Determination of Quality of Care
“Determine if the facility is providing
the necessary care and services
based on the findings of the
comprehensive assessment and
plan of care!”
Review of The Non-pressure Ulcer
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At the time of assessment and
diagnosis of a skin ulcer/wound, the
clinician is expected to document the
clinical basis e.g. underlying
conditions contributing to the
ulcerations, ulcer edges, wound bed,
locations, surrounding tissues, which
permit differentiating the ulcer type,
especially if the ulcer characteristics
are consistent with pressure ulcers,
but it is determined not to be one.
Investigative Protocols, IP
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Observe whether the staff implemented the
care consistently across the various shifts.
Interview C.N.A’s, residents, and /or
responsible party as to their awareness of the
care plan
Review the MAR, IDT, RAI, MDS and CP to
determine the accuracy of the assessment
Determine if the staff have monitored the
effectiveness of the care plan interventions,
reviewing and revising with the directions of
the resident or responsible party.
IP of the Dialysis Resident
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Review the MAR to assure that medications
are administered before and after dialysis as
ordered by the physician. This should account
for optimal timing to maximize effectiveness
and avoid adverse effects of medication
Interview staff as to their knowledge of how
to mange emergencies and complications of
bleeding, septic shock, and other infection
control concerns
Are the staff aware of the emotional and
psycho-social needs of the resident. Are
these areas documented
Hospice
If the resident is receiving hospice services, it is
important that the care of the resident is
appropriately coordinated among all the
providers. The nursing staff remain the
resident’s primary care giver under the
regulatory requirements. Hospice assumes
the full responsibility for the professional
management of the resident.
There must be evidence of collaborative
documentation between the providers
for the care of the resident.
Pain Management
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recognize, identify, manage, and
prevent are all actions words!
Unrelieved pain is not an inevitable
consequence of aging, but leads to
decreased function and diminished quality
of life.
Misconceptions can negatively affect the
ability to adequately recognize, assess,
prevent , or manage a resident’s pain.
Acceptable Documentation
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Identifies the pain indicators and
characteristics, causes and contributing
factors
identities a history of pain and related
interventions
identifies the impact of the pain of the
resident's function and quality of life
Identifies the resident response to
interventions including the efficacy and
adverse consequences and modifies
according to standards of good clinical
practice.