5/6/2015. Mia Sadler, RN

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1 Mia Sadler, RN Enrollment-and- Certification/SurveyCertificationGenInfo/Policyand-Memos-to-States-and-Regions.html 1

2 Arlinda (Veda) Cejas Long Term Care Supervisor Charlyne White Team Coordinator Updated Organizational Chart New Deputy Director Mr. Dennis Blair Two new Team Coordinators: Ms. Chenelle Beachan and Ms. Evelyn Scott Ms. Queen Whitfield retired. Ms. Pat Lair retired. As of April 21, 2015 we have 39 surveyors in long term care plus 5 in training. Montgomery office Birmingham office Mobile office 2

3 Sandra Faulkner Long Term Care Supervisor Felicia Williams-Smith Long Term Care Supervisor Angela Parker Team Coordinator Sylvia Foreman Team Coordinator Krista Dyess-Lyons Team Coordinator Chenelle Beacham Team Coordinator Evelyn Scott Team Coordinator Vacant Team Coordinator Wykeshia Horne Long Term Care Supervisor Vacant Team Coordinator Grants given out to 24 states to design comprehensive national background check programs for direct patient access employees in long term care facilities. ADPH attendance at the CMS National Background Check Program in May

4 EPOC first used by only four states. Currently there are 13 states using EPOC. CMS allowing additional states to use EPOC. As of April 22, 2015 there were twenty-six facilities that did not have an EPOC user. Thirteen of the twenty-six facilities had previously been activated to use EPOC. Thirteen of the twenty-six have never been activated to use EPOC. April 13-15, 2015 Mandatory Attendance for all State Agency Directors to attend. Townsend, Maryland 4

Reform will result in better care, smarter spending and

centered Incentive for outcome Sustainable Coordinated Care

5 Reform will result in better care, smarter spending and healthier people. Historical State Producer centered Incentive for volume Unsustainable Fragmented Care Evolving Future State Patient centered Incentive for outcome Sustainable Coordinated Care Fee for service payment systems Value based purchasing ACOs Episode based payments Medical Homes Quality Cost Transparency 5

Infection Control Presenters Dr. Bruce Lee, MD, MBA and Sarah M. Bartsch, MPH Dr.

Slow the Development of Resistant Bacteria and Prevent the Spread of Resistant Infections 2.

Advance Development and Use of Rapid and Innovative Diagnostic Tests for Identification and Characterization of Resistant

6 Infection Control Presenters Dr. Bruce Lee, MD, MBA and Sarah M. Bartsch, MPH Dr. Daniel Schwartz, MD, MPH Karen Hoffman, RN, MS, CIC, SHEA Shari M. Ling, MD 1. Slow the Development of Resistant Bacteria and Prevent the Spread of Resistant Infections 2. Strengthen National One-Health Surveillance Efforts to Combat Resistance 3. Advance Development and Use of Rapid and Innovative Diagnostic Tests for Identification and Characterization of Resistant Bacteria 4. Accelerate Basic and Applied Research and Development for New Antibiotics, Other Therapeutics, and Vaccines 5. Improve International Collaboration and Capacities for Antibiotic Resistance plan_for_combating_antibotic-resistant_bacteria.pdf 6

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8 In 2013 CDC published a report outlining the top 18 drug resistant threats to the United States. These threats were categorized based on level of concern: Urgent, Serious, and Concerning pdf Urgent Threats- These are high-consequence antibiotic-resistant threats because of significant risks identified across several criteria. These threats may not be currently widespread but have the potential to become so and require urgent public health attention to identify infections and to limit transmission. Clostridium Difficile (CDIFF) Carbapenem-Resistant Enterobacteriaceae(CRE) Neisseria gonorrhea Know what types of drug-resistant infections are present in your facility and patients. Request immediate alerts when the lab identifies drugresistant infections in your patients. Alert receiving facility when you transfer a patient with a drug-resistant infection. Protect patients from drug-resistant infections. Follow relevant guidelines and precautions at every patient encounter. Prescribe antibiotics wisely. Remove temporary medical devices such as catheters and ventilators as soon as they are no longer needed. 8

9 Require and strictly enforce CDC guidance for infection detection, prevention, tracking, and reporting. Reporting: Alabama Department of Public Health Bureau of Communicable Diseases DETECT, TEST, and REPORT Make sure your lab can accurately identify infections and alert clinical and infection prevention staff when these bacteria are present Know infection and resistance trends in your facility and in the facilities around you. When transferring a patient, require staff to notify the other facility about all infections. Join or start regional infection prevention efforts. Promote wise antibiotic use Family of germs that are difficult to treat because they have a high resistance to antibiotics. High mortality rate among invasive infections Up to 40-50% Potential to spread beyond hospitals Infections in community and long term care facilities 9

Important to wear gloves and to remove and dispose of the

10 Important to wear gloves and to remove and dispose of the gloves properly. l Klebsiella species and Escherichia coli (E. coli) are examples of Enterobacteriaceae, a normal part of the human gut bacteria, that can become carbapenem-resistant. KPC (Klebsiella pneumoniae carbapenemaseresistant) and NDM (New Delhi Metallo-betalactamase) are types of CRE 10

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12 CDC ff_clinicians.html Advancing Excellence _Factsheet_for_Leadership_Infections.pdf 12

Webinars and surveyor training in response to infection

transition between acute care and long term care.

13 Webinars and surveyor training in response to infection control issues. Refinement and/or development of Infection Control tools to be used by surveyors to assess compliance and improve transition between acute care and long term care. Incorporation of infection control elements based on recommendations of infection control experts into CMS guidance 13

14 First Management of Multi-drug resistant organisms in Nursing Home Setting Second Urinary Tract Infections and Respiratory Tract Infection in the nursing home population. Third Environmental issues and C Diff Highlight the issue MDS Targeted Surveys Add Quality Measures Anti-Psychotics in 2015 Hospital Readmission plus others in 2016 National Nursing Home Complaint Deficiencies 2013 F323 Accidents F309 Highest Practicable F225 Investigate and report allegations F157 Notify of Changes F226 Develop and implement abuse policies F441 Infection Control F514 Complete and Accurate Records F281 Services meet professional standards F279 Develop comprehensive care plans. 14

Quality of Care/Treatment Physical Environment Dietary Services

Transfer & Discharge Rights Identify opportunities to increase accuracy of

Continued focus on training for providers and State RAI Coordinators Enhance

15 Quality of Care/Treatment Physical Environment Dietary Services Resident/Patient/Client Rights Quality of Life Infection Control Admission, Transfer & Discharge Rights Identify opportunities to increase accuracy of assessing residents. Continued focus on training for providers and State RAI Coordinators Enhance Question and Answer process Changes related to requirements of the IMPACT Act of 2014 Harmonization of quality measures and assessment items Targeted surveys 15

16 In 2014, Centers for Medicare & Medicaid Services (CMS) and five States piloted a focused survey to assess MDS coding practices and its relationship to resident care in nursing homes. MD,PA, VA, IL, MN A report** on the findings from the pilot was published: 25% of MDS 3.0 assessments for falls showed disagreement between the MDS and the record. 18% of MDS assessments reviewed for pressure ulcers showed disagreement between the MDS 3.0 and the record 17% of MDS assessments reviewed for restraints other than side rails showed disagreement between the MDS and the record **Results should be interpreted with caution. 15% of MDS assessments reviewed for late loss ADLs (include bed mobility, toileting, transfer, and eating) showed disagreement between the MDS and the record. 16

17 Survey and Certification Letter 15-25NH dated February 13, 2015: Two surveyors over approximately two days. Three surveyors (two primary and one alternate) One surveyor must be an RN A supervisor must also be trained Rolled out in two phases Surveys must start by May 13, 2015 and be completed by September 30, Intent: Further identify MDS 3.0 coding practices and inaccuracies. Identify fluctuations in staffing levels through the year Identify any staffing trends that are insufficient to meet the needs of the resident, Webinar training for State Agencies and Regional Offices Referring nursing homes to MDS RAI Manual and Appendix PP. No new regulations involved in these surveys. Deficiencies identified during the surveys will result in relevant citations and enforcement actions in accordance with CMS policy and regulations. 17

18 Point of contact in Alabama for CMS is Lisa Pezent. Supervisor is Felicia Williams. Background: Section 6106 of the Affordable Care Act Funding provided by the IMPACT Act of 2014 Report staffing levels, turnover, and tenure Auditable back to payroll data Collected more frequently than 671/672 forms CMS data submission system: Payroll based Journal (PBJ) Patient-Assessment- Instruments/NursingHomeQualityInits/Staffing- Data-Submission-PBJ.html 18

19 How is staffing data going to be audited? Enforcement? How reported on nursing home compare? CMS working on guidance. General principle for residents with law enforcement jurisdiction. Depends on terms of release Have to meet the needs of the resident while still providing the safety of the other residents and meet all safety requirements. Must meet all regulatory requirements. Not going away. Not currently opening QIS to other states. Thinking about combining best parts of traditional and QIS survey process to form one survey process for all states. 19

20 Dementia with behaviors or Dementia with psychosis are no longer an appropriate clinical indication without other documentation. Comprehensive Assessment Care Plan Attending Physician Interdisciplinary team Medical Director Drug Regimen Review Unnecessary Medications Gradual Dose Reductions Chemical Restraints 20

21 Expanding to four other states Looking at Chapter 7 of the State Operations Manual Six Facilities F Tags: F223, F224, F225, F226 Resident Behavior and Facility Practices F309, F314, F323 Quality of Care F490, F493 - Administration 21

22 Failed to follow their policy and procedure related to the assessment, management and monitoring of pressure sores. Failed to ensure wounds were identified and assessed, treatments were correctly transcribed and implemented, and care plans were developed to meet individualized needs. Facility failed to prevent sexual abuse to a cognitively impaired resident. Facility failed to report an allegation of physical abuse to the State Agency. Facility failed protect resident(s) from any further potential abuse pending the completion of the investigation. 22

23 A resident was pushed outside to the smoking area by a dietary staff member. When the staff let go of the wheelchair, it continued to roll uncontrollably from the smoking area to a parking area where he fell face forward out of the wheelchair. Staff watched the resident in the wheelchair roll uncontrollably and did not respond. Facility's nursing staff failed to provide immediate emergency medical services to a resident identified as having Full Code status. Code of Alabama 1975 Section Determination of death. An individual who, in the opinion of a medical doctor licensed in Alabama, has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards. (Acts 1979, No , p. 276, 1; Act , p. 1506, 1.) 23

1) The registered nurse or licensed practical nurse may receive a pronouncement of a patient s death from a physician via

2) A facility policy shall specify the permissible patient conditions for which the registered nurse or licensed practical nurse

Continue to find errors with the completion of this form.

greater than or equal to subset numbers i.e. F94 - # of residents with catheters F95 How many present on admission Include in

24 1) The registered nurse or licensed practical nurse may receive a pronouncement of a patient s death from a physician via telecommunication without a physical examination of the patient by that physician. 2) A facility policy shall specify the permissible patient conditions for which the registered nurse or licensed practical nurse in a specific health care facility or agency may receive the pronouncement of a patient s death by telecommunications. Continue to find errors with the completion of this form. On ADPH s list of common errors in completing the CMS672 we have added: For specific resident conditions, total numbers must be greater than or equal to subset numbers i.e. F94 - # of residents with catheters F95 How many present on admission Include in report if alleged resident victim has a roommate and if roommate was credible and a witness. Include in report investigation into specific allegation. Example: family alleged neglect due to resident not being bathed in over a week and observations of being dirty. 24

25 Not including vital information about alleged suspect and key witnesses (full name, address, phone number, social security number, driver s license number etc.) 25

6/29/2015. Focused Survey for MDS Assessment. Objectives: Review the results of the MDS pilot study.

6/29/2015. Focused Survey for MDS Assessment. Objectives: Review the results of the MDS pilot study. Focused Survey for MDS Assessment Idaho Health Care Association July 21, 1015 1:45 P.M. 3:15 P.M. Louann Lawson, BA, RN, RAC-CT AHIMA Approved ICD-10-CM/PCS Trainer Nurse Consultant, Clinical Reimbursement