The Minnesota Department of Health held their first 2012 nursing facility conference call on January 17, 2012. Highlights of the call include:

• Overview of survey data from 2011 and 2012.
• F-329 Unnecessary Drugs remains a very common deficiency in Minnesota (issued in approximately 36% of Minnesota surveys and 19% of surveys in the nation). MDH representatives suggested that providers utilize the Quality Indicator Survey (QIS) unnecessary medication review form and Tables 1 and 2 contained in the F-329 guidance. Providers should also continue to pay particular attention to psychoactive medication, dose reductions, physician documentation for ongoing medication use, clinical rationale for duplicative medications, and pro re nata (prn) parameters. MDH representatives also stressed that F-428 is being issued when the pharmacist consultant is making recommendations that are not addressed by the attending physician. When this occurs, the facility should get their medical director involved and provide documentation of the results.
• Mechanical lifts — MDH and the Office of Health Facility Complaints (OHFC) continue to see an increase in deficiencies, and individual as well as facility findings of neglect, regarding the incorrect use of mechanical lifts. Suggestions:
• Follow the manufacturer’s directions for use
• Use only slings approved for use by the lift manufacturer (avoid “generic” brands of slings)
• Make sure you orient staff on each lift system (lift, all types of slings, proper use, etc.) according to the manufacturer’s directions for use
• Staff using lifts should have proof of a competency test or proficiency test on file
• If the lift requires two staff to operate, made sure staff never take shortcuts and use it alone
• There have also been deficiencies for staff failing to use transfer belts when the use of a transfer belt is indicated in the plan of care
• Paid feeding assistants — Deficiencies issued at F-373 are frequently issued at a fairly high scope and severity level. Facilities were reminded to ensure that residents fed by paid feeding assistants do not have any complicated feeding problems (difficulty swallowing, recurrent lung aspirations, history of stroke, etc.) and to make sure such assessments are current, as resident conditions can change.
• Abuse prevention policies and reporting (F-225/F-226). This portion of the call generated a lot of discussion and questions. MDH representatives stressed the following compliance issues:
• F-225 states the administrator and state agency must be notified “immediately” of suspected maltreatment. While the guidance to surveyors defines “immediately” as: “as soon as possible, but ought not exceed 24 hours after discovery of the incident,” that does not mean that facilities have up to 24 hours to notify the administrator or state agency. The reports should be made immediately once a facility determines a report is required. Given that these two deficiencies are now being issued in Minnesota more than any other state in the nation, I (Doug Beardsley) would suggest providers begin to err on the side of over-reporting to avoid these deficiencies. In a review of recent deficiencies, of particular concern are incidents regarding alleged theft, verbal abuse, resident-to-resident altercations, alleged “rough handing” by staff, and bruising.
• Another concern that was raised by MDH staff is that they are seeing a lack of documented facility investigations to determine if suspected abuse or neglect occurred.
• Elder Justice Act reporting — Information shared by MDH was consistent with information available on the Elder Justice Act Reporting Requirements Resources section of the Care Providers of Minnesota website (go to the Just for Members section under Regulatory Resources). Want to understand this Act’s facility and staff obligations better? Register for our webinar scheduled for January 24, 2012!

The next MDH nursing facility provider conference call is scheduled for Monday, March 19, 2012, from 1:00 p.m. to 2:00 p.m.

Doug Beardsley
952.851.2489
dbeardsl@careproviders.org